Anaphylactic Shock: Classification

Severity scale for classification of anaphylactic reactions according to Ring and Messmer.

Grade Skin Gastrointestinal tract(gastrointestinal tract) Respiratory tract(respiratory organs) Cardiovascular system
I
  • Pruritus (itching)
  • Flush (redness occurring in fits and starts).
  • Urticaria (hives)
  • Angioedema (bulging elastic swellings (eg, in the facial area: lip, cheeks, forehead) that appear suddenly and disfigure the appearance).
 – – –
II
  • Pruritus
  • Flush
  • Urticaria
  • Angioedema
  • Nausea (sickness)
  • Abdominal cramps
  • Vomiting
  • Rhinorrhea (runny nose)
  • Hoarseness
  • Dyspnea (shortness of breath)
  • Tachycardia(heartbeat too fast: > 100 beats per minute):increase ≥ 20/min.
  • Hypotension(low blood pressure):fall ≥ 20 mmHg systolic.
  • Cardiac arrhythmias
III
  • Pruritus
  • Flush
  • Urticaria
  • Angioedema
  • Vomit
  • Defecation (bowel movement)
  • Laryngeal edema(Swelling of the larynx).
  • Bronchospasm(Cramping of the bronchi).
  • Cyanosis(blue discoloration of the skin)
  • Shock
IV
  • Pruritus
  • Flush
  • Urticaria
  • Angioedema
  • Vomit
  • Defecation (bowel movement)
  • Respiratory arrest
  • Circulatory arrest