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An allergy or intolerance describes a patient’s tendency towards hypersensitivity to a certain substance, so that an unwanted physiological reaction is expected after exposure to the substance, while most people would not exhibit such a reaction to that amount. The observed physiological changes are usually the result of an immunological reaction.
The substances can be categorized as follows:
Medicine
Medicine category
Ingredient/addition
Nutrition
Environmental factor
Animal
Plants
Chemicals
Inhaled allergenic
Purpose
Documenting and communicating allergies and intolerances is an important part of medical registration. It concerns the core of patient safety in general and medication safety in particular. In the execution of research, treatment and care, these patient characteristics constantly have to be taken into account.
In principle, allergies and intolerances are also disorders and also could be entered as a problem. Nevertheless, these are usually entered separately.
Allergies/Intolerances have a lot in common with warnings (Alert). An important difference is that with allergies and intolerances, a lot of detailed information is recorded on things such as the reactions to the causative substance. Furthermore, not every warning is a problem or medical condition. Every allergy/intolerance is, however, while not every allergy or intolerance implies a warning.
Evidence Base
For all allergies in the Netherlands, the codes available in the G standard are used to register and complete medicinal allergies in the work process of prescribers and pharmacists (in medication monitoring). This is outlined in the document “Allergies and unwanted substances IR V-2-3-1”.
This code is insufficient when it comes to reactions to exposure to food products, items (such as bandages and band-aids), plants and animals. For these items, the standard allows the use of free text or the use of SNOMED CT code. However, no validated value set is currently available for this purpose for SNOMED CT.
Information Model
Type
Id
Concept
Card.
Definition
DefinitionCode
Reference
NL-CM:8.2.1
AllergyIntolerance
Root concept of the AllergyIntolerance information model. This root concept contains all data elements of the AllergyIntolerance information model.
NL-CM:8.2.2
CausativeAgent
1
Substance, group of substances or environmental factor to which the patient is allergic or hypersensitive.
The date and time at which the allergy or undesired reaction was determined.
This can be an exact date and time, or a rough indication of the date (such as only the year, or the month and the year).
NL-CM:8.2.7
Criticality
0..1
Critical extent is defined as “the potential severity of future reactions.”
This represents a clinical evaluation of the worst case scenario for a future reaction. It can be based on the severity of past reactions, the dose and manner of exposure which caused reactions in the past, and the life-threatening potential of the type of reaction. Critical extent is a property of the allergy, and not of the reaction itself.
More specific indication of the substance that caused the reaction. This can be a specific substance from a group of substances to which the patient is allergic or hypersensitive.
Date and time at which the reaction took place. This may also be just the date or a partial date, in the event that the exact date is unknown.
Columns Concept and DefinitionCode: hover over the values for more information
For explanation of the symbols, please see the legend page
Example Instances
Only available in Dutch
AllergieIntolerantie
VeroorzakendeStof
Bijengif
Penicilline
AllergieCategorie
Stof of product
Medicijn
AllergieStatus
Actief
Actief
MateVanKritiekZijn
Ernstig
Ernstig
BeginDatumTijd
08-11-2008
1995
LaatsteReactieDatumTijd
15-11-2009
02-06-1998
Toelichting
-
-
Reactie
Symptoom
Misselijk en braken
Exantheem
ReactieBeschrijving
-
-
Ernst
Ernstig
Matig ernstig
ReactieTijdstip
-
02-06-1998
ReactieDuur
-
-
WijzeVanBlootstelling
-
Oraal
SpecifiekeStof
-
Amoxicilline
Issues
No known allergies
The question is whether to offer a code for "No known allergies (SNOMED CT 160244002)" and subdirectories in this information model that fall under this code, or to determine that, where applicable, the document should outline when the information model is to be applied. Value set for the ‘Causative substance’ concept
Currently, no defined code list is yet available for allergenic substances other than medication. Entering SNOMED CT must therefore suffice to code allergenic substances for the time-being. The G standard is used to code medical products.
Valueset OID 2.16.840.1.113883.2.4.3.11.60.40.2.8.2.11
Conceptname
Codesystem name
Codesystem OID
Alle waarden
G-standaard Ongewenste medicatiegroepen
2.16.840.1.113883.2.4.4.1.902.122
SymptomCodelist
Valueset OID 2.16.840.1.113883.2.4.3.11.60.40.2.8.2.5
Conceptname
Conceptcode
Codesystem name
Codesystem OID
Description
Anaphylaxis
39579001
SNOMED CT
2.16.840.1.113883.6.96
Anafylaxie
Angioedema
41291007
SNOMED CT
2.16.840.1.113883.6.96
Angio-oedeem
Upper respiratory tract hypersensitivity reaction
490008
SNOMED CT
2.16.840.1.113883.6.96
Overgevoeligheidsreactie van de bovenste luchtwegen
Dyspnea
267036007
SNOMED CT
2.16.840.1.113883.6.96
Kortademigheid
Bronchospasm
4386001
SNOMED CT
2.16.840.1.113883.6.96
Bronchospasme
Urticaria (hives)
126485001
SNOMED CT
2.16.840.1.113883.6.96
Urticaria
Contact dermatitis
40275004
SNOMED CT
2.16.840.1.113883.6.96
Contactdermatitis
Itching of skin
418363000
SNOMED CT
2.16.840.1.113883.6.96
Jeuk
Eruption of skin
271807003
SNOMED CT
2.16.840.1.113883.6.96
Exantheem
Allergic conjunctivitis
473460002
SNOMED CT
2.16.840.1.113883.6.96
Allergische conjunctivitis
TEN - Toxic epidermal necrolysis
23067006
SNOMED CT
2.16.840.1.113883.6.96
Toxische epidermale necrolyse
Nausea and vomiting
16932000
SNOMED CT
2.16.840.1.113883.6.96
Misselijk en braken
Diarrhoea
62315008
SNOMED CT
2.16.840.1.113883.6.96
Diarree
Drug-induced erythema multiforme
297942002
SNOMED CT
2.16.840.1.113883.6.96
Door medicatie veroorzaakte erythema multiforme
Fever
386661006
SNOMED CT
2.16.840.1.113883.6.96
Koorts
Overig
OTH
NullFlavor
2.16.840.1.113883.5.1008
Overig
More on this information model
More technical information and HL7/XML documentation you can find on the Nictiz Art-Decor page about this information model[1]
This information model is also available as pdf file or as spreadsheet
About this information
The information in this wikipage is based on Prerelease 2017 #1
Conditions for use are located on the mainpage
This page is generated on 21/09/2017 17:54:17
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AllergyIntolerance
CausativeAgent
or as spreadsheet 