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Table 1 Grading of anaphylaxis according to severity of clinical symptoms. Sampson 2003

From: Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study

Grade Skin GI Tract Respiratory Tract Cardiovascular Neurological
1 Localized pruritus, flushing, urticaria, angioedema Oral pruritus, oral “tingling”, mild lip swelling    
2 Generalized pruritus, urticaria, angioedema Any of the above, nausea and/or emesis x’s 1 Nasal congestion and/or sneezing   Change in activity level
3 Any of the above Any of the above, plus repetitive vomiting Rhinorrhea, marked congestion, sensation of throat pruritus or tightness Tachycardia (increase >15 beats/min) Change in activity level plus anxiety
4 Any of the above Any of the above plus diarrhea Any of the above, hoarseness, “barky” cough, difficulty swallowing, dyspnea, wheezing, cyanosis Any of the above, dysrhythmia and/or mild hypotension “Light headedness” feeling of “pending doom
5 Any of the above Any of the above, loss of bowel control Any of the above, respiratory arrest Severe bradycardia and/or hypotension or cardiac arrest Loss of consciousness
  1. All symptoms are not mandatory. The severity score should be based on the organ system most affected, e.g., if grade 3 respiratory symptoms are present but only grade 1 GI symptoms, then the anaphylaxis severity score would be “grade 3”. Boldface letters are absolute indications for the use of epinephrine; use of epinephrine with other symptoms will depend on patient’s history