Content Managers Advisory Group

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Summary

There are several concepts in SNOMED of the type Allergy to animal x dander (finding) but none of just Allergy to animal x (finding). Animal dander is not an allergen but rather a structure on which allergenic proteins may adhere. Allergy to animal x dander concepts are not clinically useful as avoidance would be focused on the animal itself rather than a part of the animal and most would not recognize a specific source from which the actual allergen is derived. In addition, the same allergenic protein may be found in several different sources. The group would like the CMAG to consider a request to inactivate Allergy to animal x dander (finding) concepts and replace with new Animal protein x (substance) and Allergy to animal x (finding concepts) with the following model:

FSN=Allergy to animal x protein (finding)

PT=Allergy to animal x

=== 420134006 |Propensity to adverse reaction (finding)|: { 719722006 |Has realization (attribute)| = 472964009 |Allergic process (qualifier value)|, 246075003 |Causative agent (attribute)| = |Animal protein x (substance)| }


Please review this request and provide your responses below by Tuesday 17th November. 


Actions: 

DateRequested actionRequester(s)Response required by:Comments

 

Response on the plan for inactivation of animal dander allergy concepts. 

Bruce Goldberg

  • Camilla Wiberg Danielsen  Please provide a response on the plan to inactivate animal dander allergy concepts by 
  • Daniel Karlsson Please provide a response on the plan to inactivate animal dander allergy concepts by 
  • Sheree Hemingway Please provide a response on the plan to inactivate animal dander allergy concepts by 
  • Elze de Groot Please provide a response on the plan to inactivate animal dander allergy concepts by 
  • Linda Parisien Please provide a response on the plan to inactivate animal dander allergy concepts by 
  • Matt Cordell Please provide a response on the plan to inactivate animal dander allergy concepts by 
  • Olivier Bodenreider Please provide a response on the plan to inactivate animal dander allergy concepts by 
  • Jostein Ven Please provide a response on the plan to inactivate animal dander allergy concepts by 
  • Theresa Barry Please provide a response on the plan to inactivate animal dander allergy concepts by 
  • Elizabeth Tanya Antoun Please provide a response on the plan to inactivate animal dander allergy concepts by 
  • Katrien Scheerlinck Please provide a response on the plan to inactivate animal dander allergy concepts by 
Please post your final responses in the Country response table below. Discussion comments can be made as comments.


Relevant documents

  File Modified
PDF File Briefing Note - Replacement of concepts representing allergy to animal parts- March 2022.pdf 2022-Mar-10 by Cathy Richardson

Country response 

CountryDateResponse
USA27OCT2020

The proposal seems generally reasonable.

A few value sets in NLM's Value Set Authority Center refer to Allergy to animal x dander (finding) concepts and will be directly affected if we do inactivation/creation rather than modification (which I can understand for editorial reasons).

I am wondering whether procedure concepts also referring to "animal x dander" remain appropriate or would need to be refactored similarly to the corresponding Allergy concepts – they could be similarly genericized (e.g., Cat allergen  specific immunoglobulin E antibody measurement). Just a thought.

NL27OCT2020Agreed!
IRL27/10/2020OK here, as these terms at not currently in use here.
AUS

 

Just checking the evaluation procedures/observables will remain as these seem to be pretty standard across the industry.

There are also tests for urine, serum, epithelium individually and combinations of

Otherwise, I think the change is reasonable for Clinical Findings. It's consistent to how 232350006|House dust mite allergy| is modelled.

Presumably, this doesn't just apply to dander but all the 'animal materials', ie. feathers.
Will this logic/pattern apply to reactions also? i.e. <<418448002|Allergic reaction caused by animal (disorder)| (although there's limited content here at the moment).

Will this pattern also be extended to plants? pollens/seed

Could just use even general substances like 'dog material substance' (Subtsance from dog)

DK

 

Are the FSN and PT in the example correct?

In the example if the PT is | Allergy to horse | the FSN would be | Allergy to horse protein |, but can you talk about at ‘horse protein’? This sounds especially strange if this statement in the Summary is true: “In addition, the same allergenic protein may be found in several different sources”. I suppose this means that the same allergenic protein can be found in e.g. a zebra and so it would not be a ‘horse protein’ only.

I am thinking that maybe the FSN should have been | Allergy to Animal protein x |, but this would not match the PT | Allergy to horse | either.

I am not an allergist, but a terminologist, so perhaps I just do not understand this subject. Perhaps an example with an actual case would be helpful? /Camilla

CANovember 16, 2020

I agree with Camilla's second paragraph there and was not sure how to replicate a simple example that would make sense for the FSN: Allergy to cat dander (finding) would become: Allergy to cat protein (finding). 

I'm updating my comment, since I have received one from a key implementer in Canada: 

It is likely that the “allergy to x dander” concepts have been interpreted as “allergy to x” and captured in various patient information systems.  To have these “allergy to x dander” concepts inactivated may pose a problem for these systems.  Data remediation is most often not done, it is just too expensive and time consuming.  The new concepts could be used on a go-forward basis, but then any queries would need to be modified to search for the new concept OR “allergy to x dander” (and new queries would need to remember to do that).  I know it is bad practice to redefine concepts (e.g. keep the same concept code, but change the description to “allergy to x”), but given the widespread capture of allergy information in patient information systems, it may be the lesser of two evils in this case.

NZ23 Nov 2020

Sorry late- have nothing to add but agree with the discussion re use of concepts from Denmark and Canada in testing for allergies. Also agree with Australi regarding the modellig of these concepts requiring re alignment if change to specific protein is made.





Member countries without a CMAG rep


CMAG response

DateCMAG ResponseNext steps










Final outcome: 

Date: 


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3 Comments

  1. Cathy Richardson

    Bruce Goldberg - please see the question from  Denmark (DK) above. 

    1. Bruce Goldberg

      I will attempt to answer the questions raised above:

      1. USA: I am wondering whether procedure concepts also referring to "animal x dander" remain appropriate: See examples of use in other hierarchies below:
        1. 392402007 |Cat dander specific immunoglobulin E antibody measurement (procedure)|: No such thing. The IgE is directed to a protein derived from or residing on cat dander.
        2. 388296008 |Cat dander specific immunoglobulin E (substance)|: Same as above
        3. 411572004 |Cat dander diagnostic allergen extract (product)|: Yes. The product is an extract of cat dander
        4. If a concept such as Allergy skin test to cat dander (procedure) existed in SNOMED, this would be appropriate because the test uses a product derived specifically from cat dander.
      2. AUS: 
        1. Just checking the evaluation procedures/observables will remain as these seem to be pretty standard across the industry.
          1. The in vitro procedures as illustrated above are not directed against the dander itself but rather a protein derived from or residing on the dander.
          2. For skin testing procedures, the test uses a product derived specifically from an animal source such as dander.
        2. Could just use even general substances like 'dog material substance' (Subtsance from dog): The type of allergies we are talking about are always due to proteins found on different animal materials.
      3. DK: In the example if the PT is | Allergy to horse | the FSN would be | Allergy to horse protein |, but can you talk about at ‘horse protein’? This sounds especially strange if this statement in the Summary is true: “In addition, the same allergenic protein may be found in several different sources”. I suppose this means that the same allergenic protein can be found in e.g. a zebra and so it would not be a ‘horse protein’ only.
        1. To clarify, I am referring to "source" as a part of a some animal such as cat dander, serum, urine, saliva as opposed to a protein derived from different animals. The same allergenic proteins may be present in different parts of the same animal as shown in the attachment (sorry it looks like I don't have permission to add files to this page). The allergenic proteins of different animals are distinct but may be cross reactive among different species.
      4. CA: I know it is bad practice to redefine concepts (e.g. keep the same concept code, but change the description to “allergy to x”), but given the widespread capture of allergy information in patient information systems, it may be the lesser of two evils in this case.
        1. The question of renaming. vs. inactivation with creation of new concepts will be discussed within the Allergy CRG

      Thank you all for your valuable comments.

      Bruce

  2. Bruce Goldberg

    AUS: Dear all. I have reconsidered some of my responses to the above and will paste here for further consideration:1. Just checking the evaluation procedures/observables will remain as these seem to be pretty standard across the industry.

    • Yes, the evaluation procedures would remain the same (see below)
    • These principles should apply to all animal material

    USA: I am wondering whether procedure concepts also referring to "animal x dander" remain appropriate: 

    • As the products used for diagnostic and therapeutic allergy procedures are distinct, even though they are directed against allergenic proteins rather than the source of these proteins, would remain the same