ArticleThe Journal of allergy and clinical immunology2023
United States Drug Allergy Registry (USDAR) grading scale for immediate drug reactions.
Article in The Journal of allergy and clinical immunology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Standards for practical management of drug hypersensitivity reactions to intravenous drugs and proactive early allergy involvement before referral: A WAO Statement.The World Allergy Organization journal · 2026Review
- A Two-Year Pharmacovigilance Analysis of Adverse Drug Reactions Reported from a University Allergy Setting.Journal of clinical medicine · 2026Article
- Knowledgeable Language Models as Black-Box Optimizers for Personalized Medicine.... International Conference on Learning Representations · 2026Article
- Gender Equity Education in Oncology: A Survey Study of Hematology-Oncology Fellowship Program Directors.Journal of cancer education : the official journal of the American Association for Cancer Education · 2025Article
- Role of anti-IgE in immediate drug allergy.The Journal of allergy and clinical immunology · 2025Article
- A Skin Testing Strategy for Non-IgE-Mediated Reactions Associated With Vancomycin.The journal of allergy and clinical immunology. In practice · 2024Article
- First-Line Antituberculosis Drug Challenge Reactions in Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome in an HIV Endemic Setting.The journal of allergy and clinical immunology. In practice · 2024Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
backgroundThere is no accepted grading system classifying the severity of immediate reactions to drugs.
objectiveThe purpose of this article is to present a proposed grading system developed through the consensus of drug allergy experts from the United States Drug Allergy Registry (USDAR) Consortium.
methodsThe USDAR investigators sought to develop a consensus severity grading system for immediate drug reactions that is applicable to clinical care and research.
resultsThe USDAR grading scale scores severity levels on a scale of 0 to 4. A grade of no reaction (NR) is used for patients who undergo challenge without any symptoms or signs, and it would confirm a negative challenge result. A grade 0 reaction is indicative of primarily subjective complaints that are commonly seen with both historical drug reactions and during drug challenges, and it would suggest a low likelihood of a true drug allergic reaction. Grades 1 to 4 meet the criteria for a positive challenge result and may be considered indicative of a drug allergy. Grade 1 reactions are suggestive of a potential immediate drug reaction with mild symptoms. Grade 2 reactions are more likely to be immediate drug reactions of moderate severity. Grade 3 reactions have features suggestive of a severe allergic reaction, whereas grade 4 reactions are life-threatening reactions such as anaphylactic shock and fatal anaphylaxis.
conclusionThis proposed grading schema for immediate drug reactions improves on prior schemata by being developed specifically for immediate drug reactions and being easy to implement in clinical and research practice.
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