Food allergy level chart

Currently, the degree of food allergy that is commonly used in the global allergy community and takes into account the feasibility of clinical treatment and home care is divided into five levels, from the mildest level 1 (transient local reaction) to the most severe level 5 (anaphylactic shock). Level 3 and above are high-risk categories, and emergency drugs need to be carried with you. There is no fixed rule for the severity of allergic reactions. Past mild symptoms do not mean that severe attacks will not occur in the future.

I have worked as a nurse in the allergology department of a tertiary hospital for 7 years. In the past two years, I just remember that the grading standards of different societies were very confusing - the classification of the European Academy of Allergy and Clinical Immunology (EAACI) is more biased towards clinical medication decision-making, and the classification of the American Academy of Allergy, Asthma and Immunology (AAAAI) Focusing more on risk warnings at home, the two groups argued for almost two years a few years ago over whether "redness around the mouth alone counts as a clear allergic reaction." Finally, they unified the situation of "local symptoms only appearing at the contact area, completely subsided within 24 hours without medication, and no other discomfort" as Level 1 mild illness.

Last time I met a mother who brought her 3-year-old baby to the doctor. She said that the baby had a red mouth after taking a bite of mango. After washing her face for two hours, it all disappeared. The baby was running around and playing without being affected at all. This is the most typical grade 1 reaction. Many parents will rush to do a full set of allergen tests when encountering this situation. In fact, it is completely unnecessary. The current academic circles are also divided on how to deal with this situation: one group believes that as long as clear allergy-related symptoms appear, early screening should be done to avoid risks. ； The other school of thought believes that the immune function of infants and young children is still developing, and occasional transient mild symptoms do not require excessive intervention, just observation. Ordinary families don’t have to worry about who to listen to. As long as similar symptoms don’t appear in the future, there is no need to rush to the hospital.

Level 2 is more troublesome than level 1, which means the symptoms have spread beyond the contact area. For example, after eating a hairy peach, not only the mouth is red, but also a few scattered urticaria appear on the body, which is very itchy. However, taking an antihistamine will completely subside in an hour or two, and there will be no discomfort in breathing or digestion. I am allergic to peach hairs to level 2. In the summer, my arms will itch for a long time when I touch freshly picked peaches. I just take a tablet of loratadine and it has not gotten worse after so many years. I just need to be careful not to chew the skinned peaches directly, so I don’t need to be overly nervous.

But if the allergic reaction has crossed the threshold of "only itchy but not uncomfortable" and reaches level 3, then the priority of prevention and control must be fully maximized. Two months ago, a high school student was transferred to the emergency department. After eating half a piece of peanut-filled mooncake, not only did he get wheezes all over his body, but he also complained that his throat was tight, his voice was hoarse, and he had trouble breathing. When he came, his blood oxygen had dropped to 92%, and he was given glucocorticoids to relieve the symptoms. In the current general classification, as long as mild respiratory symptoms or gastrointestinal symptoms such as mild abdominal pain and vomiting occur, it is classified as level 3, which is also the high-risk threshold. The EAACI guidelines clearly require patients with level 3 and above to carry an epinephrine auto-injection pen (also commonly referred to as a "life-saving pen" by allergy patients). However, many domestic patients and family members feel that this is too exaggerated and think that antihistamines are enough. This is currently a controversial point. My personal practical advice is that if your throat has become tight or your voice has become hoarse, don’t save money. It’s better to have one than to be too late if something goes wrong.

The higher level 4 is a clear precursor to severe allergies, such as obvious difficulty breathing, persistent severe abdominal pain, frequent vomiting, and even confusion and unsteadiness. At this time, don’t hesitate to call 120 immediately. If you have a life-saving pen, Immediately prick the outer thigh muscle, do not pull it out after pricking, hold it for 10 seconds and then pull it out. I repeat this step three times every time I educate the patients. There are really too many people who are in a hurry when they have an accident. They don’t know where to prick with the pen. They really need to practice the movements several times when they have nothing to do.

The most dangerous level 5 is anaphylactic shock, in which blood pressure plummets and consciousness is lost. Without timely treatment, death may occur within half an hour. Last year, there was a young man in his early 20s who was known to be allergic to crayfish, but he still ate half of one. He thought that the allergy was just a rash, so he refused to go to the hospital. He fainted halfway, and his heart stopped when he was sent to the emergency room. It took two hours to save him, but he still couldn't be saved. It was a pity. Oh, by the way, I must mention a misunderstanding that many people have here: the level of allergies is not fixed. Many people only have level 1 localized redness at first. After repeated exposure to allergens, the level suddenly jumps to level 3 or even level 5. Don’t take it lightly because you think, “My allergies were fine before.”

There is another question that has been asked eight hundred times: does drinking milk and getting diarrhea or eating hot pot to cause acne count as a food allergy? This is still being debated in the academic community. One school of thought believes that only IgE-mediated immune reactions are considered allergies, and non-immune-mediated reactions such as lactose intolerance and food intolerance are not. ； The other group believes that as long as there are clear adverse reactions after eating, they should be included in allergy-related prevention and control. In fact, ordinary people don't have to worry about classification at all. As long as they feel uncomfortable after eating something, just don't touch it. Classification is a headache for us in academics.

When I educate patients, I never ask them to memorize the five levels by heart. I just remember one sentence: As long as any of the three symptoms of allergies include labored breathing, tight throat, dizziness, and inability to stand, don’t hesitate to seek emergency help immediately. For the rest, just adjust based on your own feelings. After all, levels are dead, people are alive, and your own body knows best.