First, are there additional items or alternative forms of scoring that would make the scale more sensitive to differences in severity, specifically in relation to mild forms of reaction? Or does the current scale reflect reality, namely that there is not enough difference between a state of 'no reaction' and a 'mild reaction' to be worth detecting with a severity scale? Conversely, is there duplication in the listed items that produces a bias towards severe reactions? Further analysis of our **data** failed to identify such items or weightings. The second point focuses on the relative importance of symptoms. While a value of 0.77 for Cronbach's alpha suggests good agreement between items, we noted that principal components analysis identified an additional independent factor (dimension) in the **data** that contrasted items describing skin signs with those describing sensory and motor function. This dimension accounted for 26% of the total variation and suggests that, while the combined items provide an adequate general measure of severity, there is a distinction between signs related to nerve function and other signs of reaction. This may be important in the light of the fact that some reactions manifest with skin and nerve involvement, while other reactions show only skin or only nerve involvement. Our coding system gave approximately equal weight to skin involvement and recent changes in nerve function. Does this reflect the relative clinical importance of these two groups of items? Given the longer-term implications of nerve impairment, is there a case for giving additional weight to items reflecting recent change in nerve function? Would this make the scale less sensitive to visible symptoms of reaction that may be the primary concern of the affected person?