Welcome and role call

• Welcome and roll call
  
  

• See actions

• Replacing allergy to substance concepts by allergy to products
  • use products as causative agent for combined substances (used as active ingredients for medicinal products) + concepts representing roles + Vaccines + where causative agent represent a product (other than medicinal product). Need general agreement on this guideline.
  • Question as to whether to just rename and remodel existing allergy to substance concepts with allergy to product concepts or retire the large number of existing concepts and create new allergy to product concepts
  • Decision to be decided in upcoming EAG meeting
• Allergy to role+structure to be replaced with allergy to structure
  • e.g. 419930008 |Allergy to sulfonamide diuretic (finding)|--->91939003 |Allergy to sulfonamide (finding)|
• Model for allergy to combination product in development
• We need to review an additional set of 419199007 |Allergy to substance (finding)| and 416098002 Allergy to drug (finding) concepts for possible retirement (See action)

• https://docs.google.com/spreadsheets/d/1zRsbP2FWIsO9dvRu2up0SV4viS0FUJAL/edit#gid=231836406

• Issues brought up during call:
  • Russell Leftwich expressed concerns about allergy to products.
    • EHRs at least in the U.S. use substances for allergy documentation (although not precoordinated expressions)
    • May interfere with decision support if one documents an allergy to a very specific product such as Amoxicillin 250 mg which then does not trigger a warning if Amoxicillin 500 mg is ordered.
  • Allergy to role+structure to be replaced with allergy to structure
    
    • For structures that may have > 1 therapeutic role, an allergy may be specific to only 1 role.
      • This would be problematic if allergy to structure A was documented for which structure A role B is not tolerated but structure A role C is tolerated so that administration of structure A role C would be deemed to be contraindicated.
      • Example: Allergy to sulfonamide antibiotic and Allergy to sulfonamide diuretic
        • Sulfonamide diuretics are usually tolerated in those with sulfonamide antibiotic allergy.
          • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1783707/
        • I was able to order furosemide in a patient with document sulfonamide allergy in our EPIC installation.

• AOB