From the lack of skin symptoms to the shortening of the latency interval - An attempt to include warning signals for severe anaphylaxis in a severity assessment tool

Background: Anaphylaxis represents the most immediate severe allergic reaction, and the need for early symptom recognition has led to the compilation of different clinical classifications.The objective of review: We aimed to create a completed and easy-usable anaphylaxis severity assessment tool that includes some warning signs for disease severity and helps allergists and emergency caregivers in disease management.Discussion: The overall severity either is defined by the highest numerical value of clinical symptoms.This instrument considers severe hypotensive events lacking skin symptoms after exposure to culprit allergen(s) more severe cases than identical reactions with skin symptoms.The abrupt hypotension may lead to failure of fluid extravasation and lack of mediators' concentration outside the cardiovascular system.The instrument also considers neurological symptoms and cardio/ cerebrovascular disease risk factors for ineffective initial treatment, complications, and a warning signal to ask for intensive care unit personnel to assist the treatment team.Independently to cardiorespiratory symptoms, an evidenced short(er) time interval between allergen exposure and the successive reaction (compared to previous episodes) is considered an indicator for the subject's observation in the red area of the emergency unit because the clinical situation may worsen suddenly. Conclusions:The potential incorporation of this instrument in the future severity assessment systems may help specialized caregivers recognize supplemental warning signals that account for possible disease worsening or complications and, therefore, allow them to avoid unnecessary fatal outcomes.