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:5.3.1
Reaction
Root concept of the Reaction information model. This root concept contains all data elements of the Reaction information model.
NL-CM:5.3.7
ReactionPhenomenon
0..*
The substantive specification of the reaction (symptoms) that occurs when the patient is exposed to the substance.
Container of the SpecificationExposure concept.This container contains all data elements of the SpecificationExposure concept.
NL-CM:5.3.12
ReactionPeriod
0..1
Start Date: Date and time the response started. This may also only be a date or a partial date, if not known more precisely. TimeDuration: Duration of the reaction. End date: Date and time when the response stopped occurring. This may also only be a date or a partial date, if this is not known more precisely.
NL-CM:5.3.3
DateTimeCommit
1
The date the reaction was recorded.
NL-CM:5.3.2
Author::HealthProfessional
1
Person who records the reaction, this can be a healthcare professional, patient or contact person.
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
Voorbeeld file fout: Unable to find the specified file. : nl.zorg.Reactie-v1.0(NL)_Voorbeeld.docx
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.
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
Reaction
ReactionPhenomenon
or as spreadsheet 