The tendency to develop an adverse physical reaction when exposed to a specific substance, group of substances or type of radiation.
Purpose
Information regarding a patient's propensity to een adverse reaction indicates that an undesirable reaction may occur upon exposure to the specified substance, group of substances or radiation. This may be a reason for the healthcare provider to monitor the specified substance, group of substances or radiation.
Evidence Base
Note on zib HypersensitivityIntolerance
Not everyone gives the same meaning to the terms Hypersensitivity and Intolerance. There is more consensus about the term Allergy. The term Hypersensitivity generally serves as broader than Allergy. The name HypersensitivityIntolerance for the root concept of the zib indicates that this zib broadly covers all diagnoses that boil down to the patient's tendency to develop an undesirable reaction when exposed to a specific substance, group of substances or type of radiation.
This tendency may have been demonstrated by additional diagnostic tests, but can also be assumed based on the nature of the reaction(s) and/or the number of reactions that occurred when exposed to the substance(s) or radiation. HypersensitivityIntolerance covers, among other things, medicines, food ingredients, inhalation allergens (e.g. pollen), insect venom and contact allergens (e.g. nickel and latex).
The Hypersensitivity Intolerance zib is based on the zib DiagnosticInsight, because it concerns a diagnosis. The main difference is the container 'Agent' instead of 'Reason'. In addition, only 1 diagnosis can be recorded and no differential diagnosis, because a different hypersensitivity also implies a different agent. For this reason, Agens also has cardinality 1.
Just like DiagnosticInsight, HypersensitivityIntolerance has a reference to Condition, because it concerns the diagnostic interpretation of the condition.
The cardinality of the reference to Condition is 0..1, because in the case of a denial of a hypersensitivity or intolerance there is no condition to which that diagnosis relates. To represent that a patient is not aware of, for example, an allergy to penicillin or that an allergy to penicillin has been excluded, one should use the zib Exclusion with a reference to HypersensitivityIntolerance. In this case, the instance of HypersensitivityIntolerance does not refer to a Condition.
Functionality (informative)
EHRs already offer the option to distinguish between recording a new diagnosis or changing a diagnosis. Similar functionality is also necessary when it concerns a hypersensitivity or intolerance. When recording a new hypersensitivity or intolerance, the EHR must create a new Condition and have the new instance of HypersensitivityIntolerance refer to it.
Because hypersensitivity or intolerance is a diagnosis, the EHR must also make it possible to change a 'normal' diagnosis to a hypersensitivity or intolerance and vice versa. In the event of such a change, the EHR must have the new instance of HypersensitivityIntolerance or DiagnosticInsight refer to the same Condition as the previous instance of HypersensitivityIntolerance or DiagnosticInsight.
In order to be able to distinguish between a 'normal' diagnosis and a hypersensitivity or intolerance, the EHR should preferably have meta-knowledge of whether or not a diagnosis concerns a hypersensitivity or intolerance and, on that basis, offer the correct subset of the diagnosis list. If not, there is no validation as to whether the diagnosis chosen by the user is a 'normal' diagnosis or a hypersensitivity or intolerance.
Information Model
Type
Id
Concept
Card.
Definition
DefinitionCode
Reference
NL-CM:8.6.1
HypersensitivityIntolerance
This is a reference to the rootconcept of information model HypersensitivityIntolerance.
The care professional that acquired the diagnostic insight regarding the hypersensitivity or intolerance. This can be a different individual than the person who recorded the diagnostic insight.
The healthcare professional's assessment of the expected severity of the reaction upon future exposure to the substance, group of substances or environmental factor to which the patient is hypersensitive or intolerant.
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
OvergevoeligheidIntolerantie
DiagnostischInzichtDatum
07-10-2023
12-12-2023
ZekerheidsStatus
In Overweging
Bevestigd
WijzeVanVaststellen
Vastgesteld op basis van anamnese.
Vastgesteld op basis van het klinisch beeld en aanvullend onderzoek
Categorie
Voedingsmiddelen
VerwachtRisicoBijBlootstelling
Licht
Licht
Diagnose
DiagnoseNaam
Lactose-intolerantie
Lactose-intolerantie
NadereSpecificatieDiagnoseNaam
Agens
Stof
Lactose
Lactose
Toelichting
Diagnosesteller::Zorgverlener
Naam
Drs. L.J. Verhagen
Drs. L.J. Verhagen
Specialisme
Huisarts
Huisarts
AandoeningOfGesteldheid
PeriodeAanwezig
StartDatumTijd
19-08-2023
19-08-2023
StatusDatum
07-10-2023
12-12-2023
Ernst
Matig
Matig
OvergevoeligheidIntolerantie
DiagnostischInzichtDatum
08-08-2023
ZekerheidsStatus
Waarschijnlijk
WijzeVanVaststellen
Vastgesteld op basis van het klinisch beeld en aanvullend onderzoek.
Categorie
Geneesmiddelen, Voedingsmiddelen.
VerwachtRisicoBijBlootstelling
Ernstig
Diagnose
DiagnoseNaam
Neiging tot nadelige reactie op stof
NadereSpecificatieDiagnoseNaam
Agens
Stof
Carmine
Toelichting
Vastgesteld middels provocatietest.
Diagnosesteller::Zorgverlener
Naam
Mevr. E. Süshel
Specialisme
Allergologie
AandoeningOfGesteldheid
PeriodeAanwezig
StartDatumTijd
05-2023
StatusDatum
07-10-2023
Ernst
Matig
OvergevoeligheidIntolerantie
DiagnostischInzichtDatum
02-05-2023
ZekerheidsStatus
Bevestigd
WijzeVanVaststellen
Vastgesteld op basis van het klinisch beeld en aanvullend onderzoek.
Categorie
Geneesmiddelen
VerwachtRisicoBijBlootstelling
Mild
Diagnose
DiagnoseNaam
Geneesmiddelovergevoeligheid
NadereSpecificatieDiagnoseNaam
Agens
Stof
Rituximab
Toelichting
Anafylactoïde reacties bij een hogere pompstand dan 5-6. Meerdere positieve challenges en negatieve dechallenges, passend bij rituximab geïnduceerde cellysis.
Diagnosesteller::Zorgverlener
Naam
Mevr. C. van Aa
Specialisme
Neurologie
AandoeningOfGesteldheid
PeriodeAanwezig
StartDatumTijd
15-02-2023
StatusDatum
02-05-2023
Ernst
Matig
Instructions
A hypersensitivity or intolerance always refers to the condition of which it is the interpretation. If > 1 instance of hypersensitivity or intolerance, reaction or diagnostic insight refers to the same condition, then the instantiation with the most recent diagnosis date represents the current diagnostic insight.
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
HypersensitivityIntolerance
Condition
or as spreadsheet 