Arasi et al.World Allergy Organization Joumal (2023)16:100753WORLD ALLERGYhttp://doi.org/10.1016/j.waojou.2023.100753ORGANIZATIONJOURNALOpen AccessWAO consensus on DEfinition of FoodAllergy SEverity (DEFASE)Stefania Arasi,MD,PhD,MSc1*,Ulugbek Nurmatov,MD1,Audrey Dunn-Galvin,PhDGraham Roberts,DM.Paul J.Tumner,FRCPCH,PhD9,Sayantani B.Shinder,MD,PhDhRuchi Gupta,MD,MPhik,Philippe Eigenmann,MD',Anna Nowak-Wegrzyn,MD,PhD".",Ignacio J.Ansotegui,MD,PhD,Montserrat Femandez Rivas,MDP,Stavros Petrou,PhD9.r.sLuciana K.Tanno,MD,PhD4,Marta Vazquez-Ortiz,MD,PhDW,Brian Vickery,MD,PhD*,Gary Wong,MD,FRCPCY,Montserrat Alvaro-Lozano,MD,PhDb,Migdad Asaria,PhDa,Philippe Begin,MD,MScda,Martin Bozzola,MD,Robert Boyle,MD9Helen Brough,MD,PhD Victoria Cardona,MD,PhDR.Sharon Chinthrajah,MD,PhDAntonella Cianferoni,MDam,Antoine Deschildre,MDan,,David Fleischer,MDP,Flavio Gazzani,PhD29,Jennifer Gerdtsa,Marilena Giannetti,PhDag,Matthew Greenhawt,MD,MBA,MSca,Maria Antonieta Guzman,MDatElham Hossny,MD,PhD,FAAAA4,Paula Kauppi,MD,Carla JonesM,Francesco Lucidi,PhDaxOlga Patricia Monge Ortega,MD,PhD9,Daniei Munblit,MD,PhDAntonella Muraro,MDbGiovanni Pajno,MD,Marcia Podestabd,Pablo Rodriguez del Rio,MD,PhDb,Maria SaidfAlexandra Santos,MD,MSc,MRCPCH,PGCAP,FHEA,PhDb9,Marcus Shaker,MDbh.bi.bj.bk,Hania Szajewska,MD,PhD,Carina Venter,PhDbm,Cristopher Warren,PhDb,Tonya Winders5Motohiro Ebisawa,MD,PhDPP and Alessandro Fiocchi,MDbABSTRACTBackground:While several scoring systems for the severity of anaphylactic reactions have beendeveloped,there is a lack of consensus on definition and categorisation of severity of food allergydisease as a whole.Aim:To develop an international consensus on the severity of food allergy(DEfinition of FoodAllergy Severity,DEFASE)scoring system,to be used globally.Methods:Phase 1:We conducted a mixed-method systematic review(SR)of 11 databases forpublished and unpublished literature on severity of food allergy management and set up a panelof international experts.Phase 2:Based on our findings in Phase 1,we drafted statements for a two-round modifiedelectronic Delphi (e-Delphi)survey.A purposefully selected multidisciplinary international expertpanel on food allergy(n=60)was identified and sent a structured questionnaire,including a set ofstatements on different domains of food allergy severity related to symptoms,health-relatedquality of life,and economic impact.Participants were asked to score their agreement on eachstatement on a 5-point Likert scale ranging from "strongly agree"to "strongly disagree".Medianscores and percentage agreements were calculated.Consensus was defined a priori as being"Allergy Diseases Research Area,Pediatric Allergology Unit,Bambino Gesuhttp:/doi.org/10.1016/-waojou.2023.100753Children's Hospital IRCCS,Rome,ItalyReceived 15 September 2022;Received in revised from 20 January 2023;"Corresponding author.Pediatric Allergology Unit,Bambino Gesu HospitalAccepted 3 February 2023(IRCCS),Piazza S.Onofrio,00161 Rome,Italy.E-mail:stefania.arasi@o
