Oth toevoegen aan Waardenlijsten met een required binding
Concept
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 onset of the allergy or intolerance. In practice, this date is rarely if ever known because the allergy or intolerance is already present when the first reaction occurs. For practical reasons, we therefore use the moment of occurrence of the symptoms of the first reaction assigned to the allergy or intolerance as the start date and time. This can be an exact date and time but also a global indication of the date (e.g. only year or year and month).
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
Toelichting
-
-
Reactie
Symptoom
Misselijk en braken
Exantheem
ReactieBeschrijving
-
-
Ernst
Ernstig
Matig ernstig
ReactieTijdstip
-
02-06-1998
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.
Technical specifications in HL7v3 CDA and HL7 FHIR
To exchange information based on health and care information models, additional, more technical specifications are required.<BR>
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:
HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment
HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR
AllergyIntolerance
CausativeAgent
or as spreadsheet 