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Table 4 Erlangen symptom score used to quantify unrestricted diet, hypoallergenic diet and reactions during blinded, placebo-controlled food challenges (BPCFC)

From: Excretion of urinary histamine and N-tele methylhistamine in patients with gastrointestinal food allergy compared to non-allergic controls during an unrestricted diet and a hypoallergenic diet

I. General symptoms
1. Reduction of general condition 2. Core temperature
Mild 1 Subfebrile; 37,5 to 38,0°C 1
Moderate 2 Low fever; 38,0 to 39,0°C 2
Severe 3 High fever; >39,0°C 3
Intolerable 4  
II. Organotropic symptoms
1. Eyes 2. CNS
- Itching/burning - Conjunctiva - Headache/vertigo - Sensitivity  
Mild 1 Erythema 1 Mild 1 Paresthesia 1
Moderate 2 Swelling unilateral 2 Severe 2 Prickling 1
Continuous 3 Swelling bilateral 3 Migraine 3 Heat (feeling) 1
3. Cardiovascular system
Decrease of blood pressure (systolic) Increase of heart rate  
>10 mm hg 3 >10/min 3
>20 mm hg 6 >20/min 6
>30 mm hg 10 >30/min 10
4. Respiratory systems
- Nasal congestion - Prickling/itching (nose & pharynx)
Unilateral 1 Occasional 1
Bilateral 2 With rubbing 2
Mouth breathing 3 Continuous 3
- Rhinorrhea - Sneezing
Occasional 1 Occasional 1
Frequently 2 Frequently 2
Continuous 3 Continuous 3
- Larynx   - Pulmonary function test
Hoarseness 2 FEV1 80–60% / PEF <75% (baseline) 2
Laryngeal edema 5 FEV1 < 60% / PEF < 50% (baseline) 5
- Bronchial obstruction (auscultatory) - Cough
Expiratory wheezing 2 Occasional 1
In- & expiratory wheezing 5 Frequently 2
Massive obstruction (silent lung) 10 Staccato cough 3
5. Gastrointestinal tract
- Buccal cavity - Abdomianl pain/cramps
Erythema/thumbness 1 Mild 1
Swelling 2 Moderate 2
Aphts 3 Severe 3
- Esophagus - Diarrhea
Pain 1 Loose Number of stools x 1
Dysphagia/pyrosis 2 Liquid Number of stools x 2
Bolus (feeling)   3 Bloody Number of stools x 3
- General
Meteorism 1     
Nausea 1     
Vomiting Episodes x 2     
6. Locomotor apparatus  
- Arthralgia (including spinal column) - Arthritis (with joint effusion)
1 joint 1 1 joint 1
2–4 joints 2 2–4 joints 2
>4 joints 3 >4 joints 3
7. Skin
- Pruritus -Erythema
Occasional 1 Mild 2
>2 minutes 2 Moderate, <50% body surface 5
Excoriations 3 Generalized, >50% body surface 10
- Urticaria/angioedema     
<3 hives 2     
3–10 hives 5     
Generalized, generalized flush 10     
  Result:
<3 points Negative result  
3–5 points Questionable result  
>6 points Positive result  
  1. Individual reactions and symptoms during the test days with unrestricted diet, potato-rice diet and during the food challenge tests were documented each for a 24 hours period and calculated for the corresponding diet and day, respectively.
  2. Food challenges were only performed when patients had a clear resolution of their symptoms under the hypoallergenic diet with symptom scores < 3 points. Symptom scores higher than 6 points were judged as positive reactions and compared with the score during potato-rice diet [11,12].