Norway

In our national summary record, we are using concepts like fish, milk, egg etc to document past reactions to etc, i.e. the allergen as a separate information element. Our plan is to map this to SNOMED CT (partially done already) or use SNOMED CT as the base terminology. In that context, we won't use the precoordinated concepts. The national work on archetypes do not use the precoordinated concept. It is not decided yet exactly how allergic reactions/allergies will be documented in the Epic implementation in Mid-Norway. So there is a chance that the precoordinated concepts will be used.

 Denmark

 Denmark is presently not using the allergy concepts.

 The Netherlands

 In the Netherlands we are using a few of the precoordinated allergies in our diagnosis list: allergy for insect venom, allergy to food, allergic contact dermatitis, occupational allergy, allergic inhalant dermatitis. Next to that we have 5 allergens reference sets where the allergy can be specified further.

 Australia

 Both sets of concepts are in use.

• We encourage vendors to implement the substance heirarchy for "recording allergens" which most already do. This ensures they get the best coverage / user experience available. Also any decision support is easier to trigger of this (not having to calculate the causative agent, though that's not a huge task)
• The Allergy concepts (clinical findings) are also used when populating a generic problem list. However most systems have a dedicated Allergy recording module, where the agents are recorded.
• We strongly discourage the use of anything but Clinical Findings/Situations in a problems field. As the intent is often ambiguous - is a record of "Amoxicillin" mean Allergy to, or Current medication ?

Sweden

There is a recently published national specification for hypersensitivities which might influence provision of care (e.g. drug allergies, latex allergy). We use substance hierarchy concepts for the substance allergens. Hypersensitivity findings concepts are used for generic categorization similar to FHIR's AllergyIntolerance.category.

 USA

Evidence of use of Allergy to X (finding) in several value sets (e.g., Allergy to Beta Blocker Therapy). Note: in other cases, value sets list the offending substances instead (e.g., Allergy/Intolerance Substance, Food).

Although the direction of travel is towards post-coordinated expressions, and we have a 'draft for trial use' refset to support the Care Connect Allergy Intolerance FHIR profile: https://nhsconnect.github.io/CareConnectAPI/api_clinical_allergyintolerance.html, currently the 'allergy to xxx (finding)' concepts are what are predominantly used here.

Canada Health Infoway publishes a Canadian subset of more than 700 SNOMED CT codes for representing the specific non-drug allergen or other agent/substance to which the client has an allergic reaction. All cocepts are from the Substance hierarchy. We also have at least one Jurisdiction that is seeking to align to FHIR concepts for allergy where applicable and is also looking to leverage the IPS AllergyIntolerance value set which uses concepts from: all descendants of 762766007 | Edible substance (substance); all descendants of 406455002 | Allergen class (substance); all descendants of 425620007 | Metal (substance); all descendants of 373873005 | Pharmaceutical / biologic product (product). Note that the FHIR example terminology bindings for the http://hl7.org/fhir/ValueSet/allergyintolerance-code include codes from http://snomed.info/sct : where concept is-a 418038007 (Propensity to adverse reactions to substance), where concept is-a 267425008 (Lactose intolerance), where concept is-a 29736007 (Syndrome of carbohydrate intolerance), where concept is-a 340519003 (Lysine intolerance), where concept is-a 190753003 (Sucrose intolerance), where concept is-a 413427002 (Acquired fructose intolerance), where concept is-a 716186003 (No known allergy).