World Allergy Organization Grading System for Systemic Allergic Reactions: it Is Time to Speak the Same Language When it Comes to Allergic Reactions

  • Mario Sánchez-BorgesEmail author
  • Ignacio Ansotegui
  • Linda Cox
Specific Immunotherapy (L Cox, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Specific Immunotherapy


Purpose of review

To discuss current methods for grading severe allergic reactions (SARs) in view of the new WAO modified classification system.

Recent findings

While there is not universally accepted system for classifying SAR severity, and due to the high degree of heterogeneity and difficulties for comparisons between the various methods, the new WAO proposal is simple, suitable for use in clinical practice and universally applicable for all allergic reactions, covering the full spectrum of possible grades of severity.


There is a requirement for a simple and comprehensive system to classify systemic allergic reaction severity. The modification to WAO’s classification of SARs to allergen immunotherapy recently proposed by Cox et al. constitutes an important contribution in the goal of obtaining useful and helpful information for all involved stakeholders.


Anaphylaxis Allergic reaction Severity Systemic allergic reaction 


Compliance with ethical standards

Conflict of interest

Ignacio Ansotegui reports personal fees from Mundipharma, Roxall, Sanofi, MSD, Faes Farma, Hikma, UCB, and Astra Zeneca outside the submitted work. Mario Sanchez-Borges and Linda Cox declare no conflicts of interest relevant to this manuscript.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Mario Sánchez-Borges
    • 1
    Email author
  • Ignacio Ansotegui
    • 2
  • Linda Cox
    • 3
  1. 1.Allergy and Clinical Immunology DepartmentCentro Médico Docente La Trinidad, and Clínica El AvilaCaracasVenezuela
  2. 2.Department of Allergy and ImmunologyHospital Quironsalud, BizkaiaBilbaoSpain
  3. 3.Nova Southeastern UniversityFort LauderdaleUSA

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