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Summary

The Allergies/Hypersensitivity and Intolerance Clinical Reference Group is seeking information on which countries are using the allergy to substance concepts e.g. 417532002 |Allergy to fish (finding)| rather than just documenting allergies using substance and product concepts. 

Action item

DateRequested actionRequester(s)Response required by:Comments
6 December 2019Advice on allergy concepts used in your country

Cathy Richardson

Bruce Goldberg

  • Camilla Wiberg Danielsen  Please advise if your country is using the allergy to substance concepts rather than just documenting allergies using substance and product concepts.
  • Daniel Karlsson  Please advise if your country is using the allergy to substance concepts rather than just documenting allergies using substance and product concepts.
  • Sheree Hemingway  Please advise if your country is using the allergy to substance concepts rather than just documenting allergies using substance and product concepts.
  • Elze de Groot  Please advise if your country is using the allergy to substance concepts rather than just documenting allergies using substance and product concepts.
  • Linda Parisien  Please advise if your country is using the allergy to substance concepts rather than just documenting allergies using substance and product concepts.
  • Matt Cordell  Please advise if your country is using the allergy to substance concepts rather than just documenting allergies using substance and product concepts.
  • Olivier Bodenreider  Please advise if your country is using the allergy to substance concepts rather than just documenting allergies using substance and product concepts.
  • Jostein Ven  Please advise if your country is using the allergy to substance concepts rather than just documenting allergies using substance and product concepts.
  • Theresa Barry  Please advise if your country is using the allergy to substance concepts rather than just documenting allergies using substance and product concepts.
Please post your responses in the Country response table below.




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Country response 

CountryDateResponse
 Norway06.12.2019 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.
 Denmark06.12.2019 Denmark is presently not using the allergy concepts.
 The Netherlands 09.12.2019 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 10.12.2019

 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 2019-12-12There 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 2019/12/23Evidence 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).
 UK24/12/19 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 2020-01-06Canada 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).
Member countries without a CMAG rep  

 

CMAG response

DateCMAG ResponseNext steps
   
   
   

 

Final outcome: 

Date: 

 

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5 Comments

  1. Andrew S. Kanter

    Do you wish to be specific about where the documentation is occurring? For example, it is appropriate to have an allergy/sensitivity section with Penicillin or Latex documented, but an allergy can be elevated to the problem/condition list where "Allergy to Penicillin(s)" would appear and be associated with an ICD code.

    1. Bruce Goldberg

       In our EPIC configuration, we document allergies and adverse reactions in a separate module populated by FDB so that cross reactivities and previous reactions can trigger alerts. We also make use of a limited number of Allergy to X substances to use as problem list entries and to associate with certain orders such as for desensitizations.


      Bruce

  2. Jostein Ven

     As you probably know, Epic is about to be implemented in hospitals in Mid-Norway. Anyone here who knows how this area is implemented in Epic?

  3. Katrien Scheerlinck

    In the context of the implementation of FHIR, Belgium is working on the creation of valuesets for the profile "BeAllergyIntolerance"

    1. Daniel Karlsson

      Katrien Scheerlinck , this has also been the topic of the SNOMED on FHIR PG. Please have a look at AllergyIntolerance Binding and comment as needed!

      Thanks,
      Daniel