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Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review

Arasi, Stefania, Nurmatov, Ulugbek ORCID:, Dunn-Galvin, Audrey, Daher, Shahd, Roberts, Graham, Turner, Paul J., Shinder, Sayantani B., Gupta, Ruchi, Eigenmann, Philippe, Nowak-Wegrzyn, Anna, Sánchez Borges, Mario A., Ansotegui, Ignacio J., Fernandez-Rivas, Montserrat, Petrou, Stavros, Tanno, Luciana Kase, Vazquez-Ortiz, Marta, Vickery, Brian P., Wong, Gary Wing-Kin, Ebisawa, Motohiro and Fiocchi, Alessandro 2021. Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review. World Allergy Organization Journal 14 (3) , 100503. 10.1016/j.waojou.2020.100503

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Background and aims The term “Food Allergy” refers to a complex global health problem with a wide spectrum of severity. However, a uniform definition of severe food allergy is currently missing. This systematic review is the preliminary step towards a state-of-the-art synopsis of the current evidence relating to the severity of IgE-mediated food allergy; it will inform attempts to develop a consensus to define food allergy severity by clinicians and other stakeholders. Methods We undertook a mixed-methods systematic review, which involved searching 11 international biomedical databases for published studies from inception to 31 December 2019. Studies were independently screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses and, therefore, narrative synthesis of quantitative and qualitative data was performed. Results We found 23 studies providing eligible primary data on symptom-specific severity of food allergic reactions, and 31 previously published symptom-severity scoring systems referred to food allergic reactions. There were seven studies which assessed quality-of-life measures in patients (and family members) with different food allergy severity and two studies that investigated the economic burden of food allergy severity. Overall, the quality and the global rating of all included studies were judged as being moderate. Conclusions There is heterogeneity among severity scoring systems used and even outcomes considered in the context of severity of food allergy. No score has been validated. Our results will be used to inform the development of an international consensus to define the severity of food allergy. Systematic review registration A protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration number CRD42020183103 (

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This is an open access article under the CC BY license (
Publisher: Elsevier
ISSN: 1939-4551
Funders: World Allergy Organization (WAO), supported by a grant from Novartis, as well as Abbott Laboratories and Food Allergy Research & Education (FARE).
Date of First Compliant Deposit: 25 April 2022
Date of Acceptance: 17 December 2020
Last Modified: 16 May 2023 10:42

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