Allergy CRG meeting minutes from November 8, 2018 call

Bruce Goldberg

Bruce Goldberg, ALL

• Ying Hui (Nikki) Ng, Pharmacist, MIMS Australia
• Victoria Fitzgerald, Deputy Clinical Manager, Product, MIMS Australia

Bruce Goldberg

1. Hypersensitivity/Allergy/Non-allergic hypersensitivity condition classes defined using GCIs
2. Propensity to adverse reaction and Allergic disposition moved from disorders to findings
3. New Allergic disorder (disorder) hierarchy representing abnormal structures (associated morphology inflammation + finding site X e.g. Allergic rhinitis)
4. New Intolerance to substance (finding) hierarchy created under Propensity to adverse reaction (finding) as a sibling of Hypersensitivity disposition (finding)
5. Allergic disorder and Allergic reaction now subsumed by Disorder of immune function (disorder)

Release notes for Jan. 2019

• The revision of about 2,000 hypersensitivity conditions have been remodelled following the new editorial guide (exclude hypersensitivity reaction):

  1. Hypersensitivity/Allergy/Non-allergic hypersensitivity condition classes defined using General Concept Inclusion (GCI) axioms in order to encompass disorders, dispositions and processes (reactions).

  2. Propensity to adverse reaction and Allergic disposition moved from disorders to findings. They are remodeled using the proximal primitive parents with a role group consisting of 719722006 |Has realization (attribute)| with value of allergic process or its subtype. The new convention for descriptions are Hypersensitivity/Allergy/Non-allergic hypersensitivity to X (finding).

  3. New Allergic disorder (disorder) hierarchy representing abnormal structures. The allergic disorders are modelled by associated inflammation morphology + allergic process or subtype + finding site X e.g. Allergic rhinitis)
  The contact hypersensitivity conditions have been remodeled by the new concepts of Immunoglobin E-mediated allergic contact hypersensitivity process (qualifier value) and Non-immunoglobin E-mediated allergic contact hypersensitivity process (qualifier value).

  4. New Intolerance to substance (finding) hierarchy created under Propensity to adverse reaction (finding) as a sibling of Hypersensitivity disposition (finding)

  5. 414029004 |Disorder of immune function (disorder)| is remodeled and defined by using a pathological process of 769247005 |Abnormal immune process (qualifier value). As a result, it subsumes allergic disorders and allergic reactions.

  6. Pseudoallergy condition and Pseudoallergy disposition renamed to Non-allergic hypersensitivity condition (finding) and Non-allergic hypersensitivity disposition (finding) and they have been remodelled following the new concept model.

  The following two points need to check with release notes for substance to avoid duplications.
  7. Inactivate “Allergy to X" concepts where X is a modification of a base substance and replace it with Allergy to the base substance.

  8. As the result of Allergy project requirements, the following top level groupers/Allergen classes in substance hierarchy are inactivated by assigning their children to appropriate structural and/or functional parents :
  • 414052000 | Drug allergen by structure |
  • 414057006 | Drug pseudoallergen|
  • 414053005 | Drug allergen or pseudoallergen|
  • 414058001 | Drug pseudoallergen by function|
  Note: Other top level groupers (as specified in Allergies-19) will be inactivated in the future releases.

  
  
  

• Bruce Goldberg to create and upload a Google sheets document containing the descendants of 419199007 |Allergy to substance (finding)|
• David Woods to upload an e-book on mechanisms of adverse effects to substances to use as an additional resource
  

Does the WHO ICD-11 definitions of Allergy and hypersensitivity make sense?

• Jim Case to bring my concerns to Medical Scientific Advisory Committee (MSAC) (JTC Note: Submitted to the MSAC for consideration on the December conference call)
  

• General agreement that ICD-11 definitions require clarification

• Eric Macy to send Bruce Goldberg original work on drug allergy definitions

Bruce Goldberg

• Bruce Goldberg to create a draft proposal for requirements for adding new content under 419199007 |Allergy to substance (finding)|
• Bruce Goldberg to develop concept model for allergy to alpha-gal (galactose-alpha-1,3-galactose) - red meat allergy

Bruce Goldberg

• Bruce Goldberg to follow up with Russell Leftwich

Bruce Goldberg, All