Allergy CRG meeting minutes from November 8, 2018 call

1

Welcome and role call

@Bruce Goldberg

2

New membership

@Bruce Goldberg, ALL

• @Former user (Deleted), Pharmacist, MIMS Australia

• @Former user (Deleted), Deputy Clinical Manager, Product, MIMS Australia

3

Allergy Content changes for January 2019 release

Bruce Goldberg

1. Hypersensitivity/Allergy/Non-allergic hypersensitivity condition classes defined using GCIs

2. Propensity to adverse reaction and Allergic disposition moved from disorders to findings

3. New Allergic disorder (disorder) hierarchy representing abnormal structures (associated morphology inflammation + finding site X e.g. Allergic rhinitis)

4. New Intolerance to substance (finding) hierarchy created under Propensity to adverse reaction (finding) as a sibling of Hypersensitivity disposition (finding)

5. Allergic disorder and Allergic reaction now subsumed by Disorder of immune function (disorder)

• The revision of about 2,000 hypersensitivity conditions have been remodelled following the new editorial guide (exclude hypersensitivity reaction):

  1. Hypersensitivity/Allergy/Non-allergic hypersensitivity condition classes defined using General Concept Inclusion (GCI) axioms in order to encompass disorders, dispositions and processes (reactions).

  2. Propensity to adverse reaction and Allergic disposition moved from disorders to findings. They are remodeled using the proximal primitive parents with a role group consisting of 719722006 |Has realization (attribute)| with value of allergic process or its subtype. The new convention for descriptions are Hypersensitivity/Allergy/Non-allergic hypersensitivity to X (finding).

  3. New Allergic disorder (disorder) hierarchy representing abnormal structures. The allergic disorders are modelled by associated inflammation morphology + allergic process or subtype + finding site X e.g. Allergic rhinitis)
  The contact hypersensitivity conditions have been remodeled by the new concepts of Immunoglobin E-mediated allergic contact hypersensitivity process (qualifier value) and Non-immunoglobin E-mediated allergic contact hypersensitivity process (qualifier value).

  4. New Intolerance to substance (finding) hierarchy created under Propensity to adverse reaction (finding) as a sibling of Hypersensitivity disposition (finding)

  5. 414029004 |Disorder of immune function (disorder)| is remodeled and defined by using a pathological process of 769247005 |Abnormal immune process (qualifier value). As a result, it subsumes allergic disorders and allergic reactions.

  6. Pseudoallergy condition and Pseudoallergy disposition renamed to Non-allergic hypersensitivity condition (finding) and Non-allergic hypersensitivity disposition (finding) and they have been remodelled following the new concept model.

  The following two points need to check with release notes for substance to avoid duplications.
  7. Inactivate “Allergy to X" concepts where X is a modification of a base substance and replace it with Allergy to the base substance.

  8. As the result of Allergy project requirements, the following top level groupers/Allergen classes in substance hierarchy are inactivated by assigning their children to appropriate structural and/or functional parents :
  • 414052000 | Drug allergen by structure |
  • 414057006 | Drug pseudoallergen|
  • 414053005 | Drug allergen or pseudoallergen|
  • 414058001 | Drug pseudoallergen by function|
  Note: Other top level groupers (as specified in Allergies-19) will be inactivated in the future releases.

  
  
  
  

4

Project proposal for group

@Bruce Goldberg

Allergy to substance (finding) hierarchy has a large number of descendants many of which likely do not represent allergy at all. These need to be identified and eventually moved under another hierarchy such as propensity to adverse reactions, intolerance to substance or non-allergic hypersensitivity to substance

• Volunteers needed

5

WHO ICD-11 definitions of Allergy and hypersensitivity

@Bruce Goldberg

Does the WHO ICD-11 definitions of Allergy and hypersensitivity make sense?

• @Jim Case to bring my concerns to Medical Scientific Advisory Committee (MSAC) (JTC Note: Submitted to the MSAC for consideration on the December conference call)
  
  

• General agreement that ICD-11 definitions require clarification

6

Allergy dispositions

@Bruce Goldberg

• Requirements for adding new content

• Potential add: allergy to alpha-gal (galactose-alpha-1,3-galactose) - red meat allergy

7

Allergen refset

@Bruce Goldberg

• ETA for top 300 allergen list

• Use cases

8

Adjourn

@Bruce Goldberg, All

• Next call will be held on Thursday December 13 at  20:00 UTC https://snomed.zoom.us/my/allergycrg