Comparative evaluation of seven severity grading systems in pediatric oral food challenges: Distinctions between anaphylactic and non-anaphylactic reactions
In brief
One in six positive pediatric food challenges result in anaphylaxis
In 855 children undergoing 1901 oral food challenges, 344 (18%) were positive and 61 (17.7%) met anaphylaxis criteria. When judged against the new WAO 2024 standard, all seven scoring systems were highly sensitive, but only the EAACI system achieved the best mix of sensitivity and specificity, while others differed mainly on gastrointestinal signs. The authors call for a unified severity scale to improve diagnosis and treatment.
- Journal
- The World Allergy Organization journal (Q1)
- Published
- 30 July 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Taha Yasin Akın, Yusuf Ziya Varlı, Nagihan İskender, Nefise Nezihe Uluç, İsmail Özanlı, Mebrure Yazıcı, et al.
- PMID
- 42571228
- DOI
- 10.1016/j.waojou.2026.101433
Why clinicians should know about it
- Picked for Immunology and Allergy (paper of the day, 10 August 2026).
- Picked for Pediatrics and Child Health (paper of the day, 10 August 2026): Severity grading systems in pediatric oral food challenges
Abstract
BACKGROUND: Multiple severity scoring systems exist for classifying reactions during OFCs; however, the lack of uniformity among them results in inconsistent identification and management of anaphylaxis. OBJECTIVE: This study aimed to evaluate the clinical characteristics and severity of anaphylactic and non-anaphylactic reactions during oral food challenges (OFCs) in children and to compare the concordance and discrepancies among 7 different severity scoring systems. METHODS: In this single-center, retrospective, and observational study, positive OFCs were retrospectively graded using 7 different severity classification systems. The concordance and discrepancies among the classification systems, including the World Allergy Organization (WAO) 2024 criteria, the International Classification of Diseases 11th Revision (ICD-11), and the European Academy of Allergy and Clinical Immunology (EAACI) classifications, were evaluated. RESULTS: Of the 1901 OFCs performed on 855 patients, 344 (18.1%) were positive, and among these, 61 (17.7%) were classified as anaphylactic reactions. Patients with anaphylactic reactions were significantly older than those with non-anaphylactic reactions (median age: 27 months vs. 15 months; p < 0.001). Using the WAO2024 criteria as the reference standard, both ICD-11 and EAACI classifications showed 100% sensitivity, while specificity for all systems ranged from 86.2% to 99.3%. Discrepancies among severity scoring systems were primarily due to differences in the interpretation of gastrointestinal manifestations. EAACI showed the most favorable balance between sensitivity and specificity, whereas CoFAR and Dribin demonstrated the highest specificity. CONCLUSION: The findings emphasize the need for a harmonized severity classification system that is applicable in both clinical practice and research. Such standardization would enhance diagnostic accuracy and improve the management of food allergies in children.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.