ArticleThe Journal of allergy and clinical immunology2022
Updating the CoFAR Grading Scale for Systemic Allergic Reactions in Food Allergy.
Article in The Journal of allergy and clinical immunology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it, 86 citations in OpenAlex.
- Re-evaluating treatment success in trials of peanut oral-immunotherapy: impact of different definitions on efficacy outcomes.Current opinion in allergy and clinical immunology · 2025Pooled it
- Transepidermal Water Loss in Oral Food Challenges in Children With Peanut Allergy: A Randomized Clinical Trial.JAMA network open · 2025Trial
- Incidence of food allergic reactions among adolescents engaged in food allergy management.Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2025Trial
- Clinical and immunological outcomes after randomized trial of baked milk oral immunotherapy for milk allergy.JCI insight · 2025Trial
- A randomized double-blinded trial to assess recurrence of systemic allergic reactions following COVID-19 mRNA vaccination.The Journal of allergy and clinical immunology · 2024Trial
- Omalizumab for the Treatment of Multiple Food Allergies.The New England journal of medicine · 2024Trial
- Who fails the egg ladder? Predictors of reactions and clinical outcomes with individualized entry-step selection in 197 children with IgE-mediated egg allergy.European journal of pediatrics · 2026Article
- Comparative evaluation of seven severity grading systems in pediatric oral food challenges: Distinctions between anaphylactic and non-anaphylactic reactions.The World Allergy Organization journal · 2026Article
- Oral Food Challenges After Treatment With Omalizumab in the Clinical Setting.The journal of allergy and clinical immunology. In practice · 2026Article
- Anaphylaxis: Clinical Criteria, Severity, and Clinical Courses.Immunology and allergy clinics of North America · 2026Review
- Cetuximab Hypersensitivity in the Setting of Asymptomatic Alpha-Gal Sensitization.Head & neck · 2026Article
- COVID-19 mRNA revaccination is safe and well tolerated in individuals with previous adverse reactions to the vaccine and/or long COVID.The journal of allergy and clinical immunology. Global · 2026Article
- Homology Modeling of Sesame Allergenic Protein and Prediction of B-Cell Linear Antigenic Epitopes Using Immunoinformatic Tools.Foods (Basel, Switzerland) · 2025Article
- Food allergy clinical course in children and adolescents treated with dupilumab for atopic dermatitis.Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2025Article
- Objective sensitization algorithm validates parental report of food allergy in children.The journal of allergy and clinical immunology. Global · 2025Article
- Article
- Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients.The journal of allergy and clinical immunology. Global · 2025Article
- Advances in Mechanisms of Anaphylaxis in Wheat Allergy: Utility of Rodent Models.Foods (Basel, Switzerland) · 2025Review
- Anaphylaxis severity grade, during oral food challenges, assessed by five different classifications.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2025Observational
- A phase 2 randomized controlled trial using biologics to improve multi OIT outcomes (COMBINE): design, rationale, and methods.Frontiers in allergy · 2025Article
Corrections and comments
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Authors and funding
14 authors at 10 institutions in 1 country.
Funding
Abstract
backgroundImmunotherapy is promising as an efficacious treatment for food allergy. Other food allergy treatments are also under development. However, adverse allergic events during treatment, as well as during oral food challenges, are common and reporting is not standardized.
objectiveA more nuanced grading scale is needed to create a comprehensive and universal system to categorize adverse events and their severity for food allergy clinical trials.
methodsStarting with the 2012 Consortium for Food Allergy Research (CoFAR) Grading Scale and the World Allergy Organization Grading System, we developed the CoFAR Grading Scale for Systemic Allergic Reactions, Version 3.0, in collaboration with industry partners with expert opinion.
resultsThe revised CoFAR Grading Scale for Systemic Allergic Reactions has 5 levels of increasing severity, ranging from generalized urticaria, localized angioedema, rhinitis, and abdominal pain (grade 1) to death (grade 5). Systemic reactions are further categorized within each grade by relevant organ system. Mild, single-system reactions are differentiated from mild, multisystem reactions. Lower respiratory tract symptoms are graded on the basis of response to therapy; those that are refractory to standard treatment (eg, requiring >3 doses of intramuscular epinephrine, continuous intravenous epinephrine infusion, and continuous albuterol nebulization) and respiratory compromise requiring mechanical ventilation are classified as grade 4, life-threatening reactions.
conclusionsUniversal and consistent use of the revised CoFAR Grading Scale beyond the CoFAR centers would allow for better data aggregation and safety comparisons in clinical trials for food allergy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.