Allergies/Hypersensitivity and Intolerance Clinical Reference Group

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Date

Thursday, November 18, 2021

Schedule
2nd Thursday of every month 
Time: 18:30 UTC




Zoom Details

 https://snomed.zoom.us/j/934143312?pwd=REVPWFl2Zm56a3AvandGSGxiMXYzQT09

Meeting ID: 934-143-312

International numbers available: https://snomed.zoom.us/zoomconference?m=EochJjO8ozm1ZiDr_x9p-bFJCbIBwgqV


Attendees:

Apologies






Objectives

  • To begin review, revision and completion of the allergy implemntation guide

Discussion items

ItemDescriptionOwnerNotesAction
0Reminder to record call
1

Welcome and role call

Bruce Goldberg



2Allergy implementation guide

Kin-Wah Fung

  • Allergy implementation guide updates

3Protein contact dermatitis

Bruce Goldberg

  • The Dutch would like to create a concept for |Protein contact dermatitis| for their diagnosis thesaurus (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760939/) which they believe should be a child of 200847009 |Allergic contact dermatitis caused by food in contact with skin (disorder)|.  
  • abd-88-0611.pdf

  • Protein contact dermatitis is an allergic skin reaction induced principally by proteins of either animal or plant origin. The clinical presentation is that of a chronic dermatitis, and it is often difficult to differentiate between allergic contact dermatitis and other eczematous dermatoses. One distinguishing clinical feature is that acute flares of pruritus, urticaria, edema, or vesiculation are noted minutes after contact with the causative substances. Additionally, the patch-test result is typically negative, and the scratch- or prick-test result is positive. The pathogenesis of protein contact dermatitis is unclear but may involve a type I (immunoglobulin E [IgE], immediate) hypersensitivity reaction, type IV (cell-mediated delayed) hypersensitivity reaction, and/or a delayed reaction due to IgE-bearing Langerhans' cells. Management involves avoidance of the allergen.
4Question from the Netherlands

Natasha Krul

  • The idea is to use a thesaurus with ‘clean’ diagnoses that have no additional information (so severe asthma’ or ‘food allergy caused by peanut’ have been replaced by ‘asthma’ and ‘food allergy’) the metadata are references sets with allergens, and classifications of severity. For most diagnoses we can use the SNOMED-codes for mild, moderate and severe but there are a few exceptions tot his. The exceptions are asthma, allergic rhinoconjunctivitis and a few more. For those specific diagnoses allergy specialists use specific classifications of severity, for example GINA is used for asthma and ARIA  for allergic rhinoconjunctivitis.

  • To be able to exchange and register the information that the severity was registered using one of these classifications we need to create and OID, so that when the health care professionals registers ‘asthma’ for diagnosis, automatically a list of the GINA pops up. The receiver of that information also need to receive the info that the severity was coded by using GINA. The problem we are encountering now is that all these specific classifications do not have numeric codes, they just have display names like mild, moderate and severe, as opposed to SNOMED which uses numeric identifiers.

  •  I think most physicians in the U.S. document using ICD-10 CM. You can see the asthma and allergic rhinitis content by clicking on the links below

     

    https://icd10cmtool.cdc.gov/?fy=FY2021&q=asthma

    https://icd10cmtool.cdc.gov/?fy=FY2021&q=allergic%20rhinitis

     

    At my institution, we use an interface terminology which is created by physicians and which contains unique identifiers as well as maps to SNOMED and ICD-10 CM. If you download the Kaiser CMT donation files from NLM you can see what this looks like. I have attached a file with our asthma and allergic rhinitis diagnoses but it is old and contains ICD-9 rather than ICD-10 maps.


  • What I can see in your file is that you have created new SNOMED codes for entitites like ‘severe ashtma’ and ‘controlled asthma’ etc which is the exact opposite of the way the allergy specialists want to do it over here haha. So although you have definitely answered my question, thank you very much, unfortunately we can not use your solution as an example for our solution the allergy specialist here want to avoid additions like severe and controlled to a term. They want ‘asthma’ and then additional information can be added like severe or controlled….


  • SNOMED has severity qualifier values under 272141005 |Severities (qualifier value)|. One could create a dropdown with these severities and another dropdown with diagnoses such as asthma. Currently most severities of disorders are modeled as primitives and do not use the severity attribute with the severities qualifier values (except for 3 concepts) so even if your system supports postcoordination, SNOMED does not support that model.
5EU Allergy Intolerance Information model

  • There is a EU-funded initiative to create European health data models. Among them is an allergy model. 

  • The main critique of the current SNOMED allergy model in the hospital discharge report is that the concept of allergic condition to define the type of reaction should be replaced by the risk of reacting (propensity). 

  • This is augmented by the statement "that some patients will never have any manifestation of their allergy, as it will only have been detected by patch or prick test", which is of course correct. 

  • Allergy Intolerance Information Model - v1.2.docx
  • Allergic condition in SNOMED is a disjunctive grouper that means an allergic disease (i.e. something with a morphology and finding site such as allergic rhinitis.), an allergic disposition (propensity to develop symptoms on exposure to an allergen) and allergic reaction (the realization of an allergic disposition observed during a patient encounter upon allergen exposure).
  • Also, when you say "that some patients will never have any manifestation of their allergy, as it will only have been detected by patch or prick test", this is incorrect. What you are describing is known as sensitization i.e. the exposure to and development of an immune response to an allergen. This should not be documented as an allergy but rather just as a test finding. Unfortunately many physicians do confuse a positive test result with allergy.
4Adjourn

Bruce Goldberg

  • AOB
  • Announcement

Meeting Files

  File Modified
Microsoft Powerpoint Presentation Allergy_Intolerance to food substances.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Allergy Guide v20210512-rh.docx 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet Food allergergens in FDB.xlsx 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Allergy Guide v20210512.docx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy to animals follow-up.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy Adverse reaction to substances products v2.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Contrast media.docx 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document 373266007 Anesthetic (substance) identifiy.docx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy Adverse reaction to substances products .pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document AllergyIntolerance Binding-v15-20200409_233911.docx 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet Copy of CRS requests related to animal protein.xlsx 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet Pollens_allergyto_to create_SIG20190906.xlsx 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet Foods_allergyto_to create_SIG20190906.xlsx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy to animals alternate model (2).pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy to animals alternate model.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy to animal follow-up from CMAG.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet Drugs_allergyto_to create_SIG20190906.xlsx 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet Other_allergyto_to create_SIG20190906.xlsx 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet AnimalSubstances_SIG20190906.xlsx 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet allergens for SIG (partial)_20190802.xlsx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy to animals.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet DHD - Losse Allergenenlijst - Snomed.xlsx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy_Intolerance CRG bullet points.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy SNOMED on FHIR.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy to combination products, stereoisomers, bases.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy to living organisms.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Feedback from FDB re retiring of substance groupers.docx 2021-Aug-11 by Bruce Goldberg
PDF File EHR_Editorial Annals of Allergy 6-2016.pdf 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document SNOMED on FHIR.docx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Alpha-gal allergy.pptx 2021-Aug-11 by Bruce Goldberg
PDF File HL7_XPARADIGM_ALLERGY_VS_R1_INFORM_2018AUG.pdf 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet HL7_XPARADIGM_ALLERGY_VS_R1_I2_2018 May ALLERGY SUBSTANCES.xlsx 2021-Aug-11 by Bruce Goldberg
ZIP Archive HL7_XPARADIGM_ALLERGY_VS_R1_INFORM_2018AUG.zip 2021-Aug-11 by Bruce Goldberg
PDF File Drug+Allergy.pdf 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Registratie allergieen en bijwerkingen AIOS dag Utrecht 1-11-2019.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet Pirson_Not_In_CSCT.xlsx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergen components.pptx 2021-Aug-11 by Bruce Goldberg
Text File Re Recording allergies in prescribing system.txt 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Allergy project plan for 2019.docx 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Allergy definition query for MSAC.docx 2021-Aug-11 by Bruce Goldberg
PDF File Drug-Book-web.pdf 2021-Aug-11 by Bruce Goldberg
PDF File nihms371252.pdf 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Allergy Guide 20160112.docx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Anaphylaxis Mueller grades.pptx 2021-Aug-11 by Bruce Goldberg
PNG File image2019-12-10_16-5-31.png 2021-Aug-11 by Bruce Goldberg
PNG File image2019-12-10_16-4-12.png 2021-Aug-11 by Bruce Goldberg
PNG File image2019-12-10_15-29-28.png 2021-Aug-11 by Bruce Goldberg
PNG File image2019-12-10_15-28-40.png 2021-Aug-11 by Bruce Goldberg
Microsoft Excel Spreadsheet Allergy to substance verification.xlsx 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Briefing note - Changes to the modeling of hypersensitivity_allergy and pseudoallergy content_final.docx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Redesigning the allergy module of the electronic health 8-9-2018.pptx 2021-Aug-11 by Bruce Goldberg
Microsoft Powerpoint Presentation Allergy update.pptx 2021-Aug-11 by Bruce Goldberg
ZIP Archive Allergy to animals.zip 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Allergy Guide v20210407.docx 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Allergy Guide v20210806 clean.docx 2021-Aug-11 by Bruce Goldberg
PDF File abd-88-0611.pdf 2021-Aug-11 by Bruce Goldberg
JPEG File Protein contact dermatitis.jpg 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Allergy Intolerance Information Model - v1.2.docx 2021-Aug-11 by Bruce Goldberg
Microsoft Word Document Allergy Guide v20211021 combined.docx 2021-Dec-02 by Bruce Goldberg

Here is a link to the recording of today's call: https://snomed.zoom.us/rec/share/GZuVSjliMT-W0RG12rzowGh6fVNCw9TsBgNBKfjerYHP4jdvgFfRCVlAsADVBvCM.AmCIHZLHNoS4x86p Passcode: gX25x1.V

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