Query regarding Allergy intolerance and adverse reaction - FHIR [closed]












1














We have a query about Patient’s allergies that are being recording in different clinical systems



Query: Few clinical systems manage allergies with three broad categories – Allergy, Intolerance and Adverse reaction. Can adverse reaction be a category on its own? If so can we understand with a real time example?



While going through FHIR standard’s definition of Allergy resource, they categorize allergies with two types - Allergy and intolerance.



As per FHIR references, as extracted from the below link



https://www.hl7.org/fhir/allergyintolerance.html




  1. A record of a clinical assessment of an allergy or intolerance; a
    propensity, or a potential risk to an individual, to have an adverse
    reaction on future exposure to the specified substance, or class of
    substance.


  2. Adverse reactions may be:



      An allergy (typically type I hypersensitivity, plus other "allergy- 
    like" reactions, including pseudoallergy).
    An intolerance (typically non-immune adverse reactions that are not
    determined or perceived to be allergic or "allergy-like", and are
    to some degree idiosyncratic and/or individually specific [i.e. are
    not a reaction that is expected to occur with most or all patients
    given similar circumstances])



From the above citations we can arrive as Allergy can only be categorized by two types – Allergy and Intolerance. Any reaction for an allergy/ intolerance is an adverse reaction.



Is it clinically valid to classify allergy with two categories? ‘Adverse reaction’ need not be a category on its own?










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closed as off-topic by n.m., Matthias, xmojmr, jeremycg, ChrisF Nov 28 at 13:59



  • This question does not appear to be about programming within the scope defined in the help center.

If this question can be reworded to fit the rules in the help center, please edit the question.









  • 4




    I'm voting to close this question as off-topic because it doesn't appear to be about programming.
    – n.m.
    Nov 23 at 6:19
















1














We have a query about Patient’s allergies that are being recording in different clinical systems



Query: Few clinical systems manage allergies with three broad categories – Allergy, Intolerance and Adverse reaction. Can adverse reaction be a category on its own? If so can we understand with a real time example?



While going through FHIR standard’s definition of Allergy resource, they categorize allergies with two types - Allergy and intolerance.



As per FHIR references, as extracted from the below link



https://www.hl7.org/fhir/allergyintolerance.html




  1. A record of a clinical assessment of an allergy or intolerance; a
    propensity, or a potential risk to an individual, to have an adverse
    reaction on future exposure to the specified substance, or class of
    substance.


  2. Adverse reactions may be:



      An allergy (typically type I hypersensitivity, plus other "allergy- 
    like" reactions, including pseudoallergy).
    An intolerance (typically non-immune adverse reactions that are not
    determined or perceived to be allergic or "allergy-like", and are
    to some degree idiosyncratic and/or individually specific [i.e. are
    not a reaction that is expected to occur with most or all patients
    given similar circumstances])



From the above citations we can arrive as Allergy can only be categorized by two types – Allergy and Intolerance. Any reaction for an allergy/ intolerance is an adverse reaction.



Is it clinically valid to classify allergy with two categories? ‘Adverse reaction’ need not be a category on its own?










share|improve this question













closed as off-topic by n.m., Matthias, xmojmr, jeremycg, ChrisF Nov 28 at 13:59



  • This question does not appear to be about programming within the scope defined in the help center.

If this question can be reworded to fit the rules in the help center, please edit the question.









  • 4




    I'm voting to close this question as off-topic because it doesn't appear to be about programming.
    – n.m.
    Nov 23 at 6:19














1












1








1







We have a query about Patient’s allergies that are being recording in different clinical systems



Query: Few clinical systems manage allergies with three broad categories – Allergy, Intolerance and Adverse reaction. Can adverse reaction be a category on its own? If so can we understand with a real time example?



While going through FHIR standard’s definition of Allergy resource, they categorize allergies with two types - Allergy and intolerance.



As per FHIR references, as extracted from the below link



https://www.hl7.org/fhir/allergyintolerance.html




  1. A record of a clinical assessment of an allergy or intolerance; a
    propensity, or a potential risk to an individual, to have an adverse
    reaction on future exposure to the specified substance, or class of
    substance.


  2. Adverse reactions may be:



      An allergy (typically type I hypersensitivity, plus other "allergy- 
    like" reactions, including pseudoallergy).
    An intolerance (typically non-immune adverse reactions that are not
    determined or perceived to be allergic or "allergy-like", and are
    to some degree idiosyncratic and/or individually specific [i.e. are
    not a reaction that is expected to occur with most or all patients
    given similar circumstances])



From the above citations we can arrive as Allergy can only be categorized by two types – Allergy and Intolerance. Any reaction for an allergy/ intolerance is an adverse reaction.



Is it clinically valid to classify allergy with two categories? ‘Adverse reaction’ need not be a category on its own?










share|improve this question













We have a query about Patient’s allergies that are being recording in different clinical systems



Query: Few clinical systems manage allergies with three broad categories – Allergy, Intolerance and Adverse reaction. Can adverse reaction be a category on its own? If so can we understand with a real time example?



While going through FHIR standard’s definition of Allergy resource, they categorize allergies with two types - Allergy and intolerance.



As per FHIR references, as extracted from the below link



https://www.hl7.org/fhir/allergyintolerance.html




  1. A record of a clinical assessment of an allergy or intolerance; a
    propensity, or a potential risk to an individual, to have an adverse
    reaction on future exposure to the specified substance, or class of
    substance.


  2. Adverse reactions may be:



      An allergy (typically type I hypersensitivity, plus other "allergy- 
    like" reactions, including pseudoallergy).
    An intolerance (typically non-immune adverse reactions that are not
    determined or perceived to be allergic or "allergy-like", and are
    to some degree idiosyncratic and/or individually specific [i.e. are
    not a reaction that is expected to occur with most or all patients
    given similar circumstances])



From the above citations we can arrive as Allergy can only be categorized by two types – Allergy and Intolerance. Any reaction for an allergy/ intolerance is an adverse reaction.



Is it clinically valid to classify allergy with two categories? ‘Adverse reaction’ need not be a category on its own?







hl7-fhir






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asked Nov 23 at 6:16









Karthikeyan Dharmalingam

61




61




closed as off-topic by n.m., Matthias, xmojmr, jeremycg, ChrisF Nov 28 at 13:59



  • This question does not appear to be about programming within the scope defined in the help center.

If this question can be reworded to fit the rules in the help center, please edit the question.




closed as off-topic by n.m., Matthias, xmojmr, jeremycg, ChrisF Nov 28 at 13:59



  • This question does not appear to be about programming within the scope defined in the help center.

If this question can be reworded to fit the rules in the help center, please edit the question.








  • 4




    I'm voting to close this question as off-topic because it doesn't appear to be about programming.
    – n.m.
    Nov 23 at 6:19














  • 4




    I'm voting to close this question as off-topic because it doesn't appear to be about programming.
    – n.m.
    Nov 23 at 6:19








4




4




I'm voting to close this question as off-topic because it doesn't appear to be about programming.
– n.m.
Nov 23 at 6:19




I'm voting to close this question as off-topic because it doesn't appear to be about programming.
– n.m.
Nov 23 at 6:19












2 Answers
2






active

oldest

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1














The notion of AllergyIntolerance is that there's an increased risk of something bad happening to the patient if they're exposed to a particular substance. Having had an adverse reaction in the past when exposed to a substance is a reason for asserting an increased risk. However, that prior adverse reaction will either have been an allergic reaction or it will be "something else" - and all "something else" reactions are considered to be intolerances. If, rather than capturing a situation of "increased risk" you want to instead track particular individual reactions to try to determine causality, suggest looking at the AdverseEvent resource which focuses on that. In practice, you might well have both - an AllergyIntolerance to ensure there's a flag noting the potential risk to the patient that will trigger decision support when prescribing, etc. plus an AdverseEvent resource to handle the reporting/analysis associated with a particular reaction.






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    0














    This is an important issue to understand because of the prominent place allergy and adverse reactions play in clinical care.



    The two categories "allergy" and "intolerance" are historical, longstanding. Most non-clinicians and even the majority of clinicians have little insight into the mechanisms that underly allergic reactions, and tend to classify all reactions to which a particular individual has a propensity to from a substance as "allergy". The advancement of knowledge over the past few decades has led to an understanding that there are a number of non-immunologic mechanisms for "allergic reactions" some of which appear much like an Type I hypersensitivity reaction (anaphylaxis or hay fever) and some of which do not. The historical existence of only two categories ensconced in legacy standards, leaves only the category=intolerance for everything known to be non-immunologic. The important thing overall is that an individual has been determined to have the attribute of sensitivity to a particular substance (or class).



    Many adverse reactions are neither allergy nor intolerance: drug-drug interactions that result in a physiologic reaction, overdose, surgical mishaps, radiation burns, transfusion reactions, etc. For that matter, if an individual has an allergic or intolerance reaction and has never had one before, they have an adverse reaction but they don't have "an allergy" until after that reaction and someone makes a judgement that they are likely to have future reactions if exposed to that substance.






    share|improve this answer




























      2 Answers
      2






      active

      oldest

      votes








      2 Answers
      2






      active

      oldest

      votes









      active

      oldest

      votes






      active

      oldest

      votes









      1














      The notion of AllergyIntolerance is that there's an increased risk of something bad happening to the patient if they're exposed to a particular substance. Having had an adverse reaction in the past when exposed to a substance is a reason for asserting an increased risk. However, that prior adverse reaction will either have been an allergic reaction or it will be "something else" - and all "something else" reactions are considered to be intolerances. If, rather than capturing a situation of "increased risk" you want to instead track particular individual reactions to try to determine causality, suggest looking at the AdverseEvent resource which focuses on that. In practice, you might well have both - an AllergyIntolerance to ensure there's a flag noting the potential risk to the patient that will trigger decision support when prescribing, etc. plus an AdverseEvent resource to handle the reporting/analysis associated with a particular reaction.






      share|improve this answer


























        1














        The notion of AllergyIntolerance is that there's an increased risk of something bad happening to the patient if they're exposed to a particular substance. Having had an adverse reaction in the past when exposed to a substance is a reason for asserting an increased risk. However, that prior adverse reaction will either have been an allergic reaction or it will be "something else" - and all "something else" reactions are considered to be intolerances. If, rather than capturing a situation of "increased risk" you want to instead track particular individual reactions to try to determine causality, suggest looking at the AdverseEvent resource which focuses on that. In practice, you might well have both - an AllergyIntolerance to ensure there's a flag noting the potential risk to the patient that will trigger decision support when prescribing, etc. plus an AdverseEvent resource to handle the reporting/analysis associated with a particular reaction.






        share|improve this answer
























          1












          1








          1






          The notion of AllergyIntolerance is that there's an increased risk of something bad happening to the patient if they're exposed to a particular substance. Having had an adverse reaction in the past when exposed to a substance is a reason for asserting an increased risk. However, that prior adverse reaction will either have been an allergic reaction or it will be "something else" - and all "something else" reactions are considered to be intolerances. If, rather than capturing a situation of "increased risk" you want to instead track particular individual reactions to try to determine causality, suggest looking at the AdverseEvent resource which focuses on that. In practice, you might well have both - an AllergyIntolerance to ensure there's a flag noting the potential risk to the patient that will trigger decision support when prescribing, etc. plus an AdverseEvent resource to handle the reporting/analysis associated with a particular reaction.






          share|improve this answer












          The notion of AllergyIntolerance is that there's an increased risk of something bad happening to the patient if they're exposed to a particular substance. Having had an adverse reaction in the past when exposed to a substance is a reason for asserting an increased risk. However, that prior adverse reaction will either have been an allergic reaction or it will be "something else" - and all "something else" reactions are considered to be intolerances. If, rather than capturing a situation of "increased risk" you want to instead track particular individual reactions to try to determine causality, suggest looking at the AdverseEvent resource which focuses on that. In practice, you might well have both - an AllergyIntolerance to ensure there's a flag noting the potential risk to the patient that will trigger decision support when prescribing, etc. plus an AdverseEvent resource to handle the reporting/analysis associated with a particular reaction.







          share|improve this answer












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          share|improve this answer










          answered Nov 23 at 15:56









          Lloyd McKenzie

          3,004168




          3,004168

























              0














              This is an important issue to understand because of the prominent place allergy and adverse reactions play in clinical care.



              The two categories "allergy" and "intolerance" are historical, longstanding. Most non-clinicians and even the majority of clinicians have little insight into the mechanisms that underly allergic reactions, and tend to classify all reactions to which a particular individual has a propensity to from a substance as "allergy". The advancement of knowledge over the past few decades has led to an understanding that there are a number of non-immunologic mechanisms for "allergic reactions" some of which appear much like an Type I hypersensitivity reaction (anaphylaxis or hay fever) and some of which do not. The historical existence of only two categories ensconced in legacy standards, leaves only the category=intolerance for everything known to be non-immunologic. The important thing overall is that an individual has been determined to have the attribute of sensitivity to a particular substance (or class).



              Many adverse reactions are neither allergy nor intolerance: drug-drug interactions that result in a physiologic reaction, overdose, surgical mishaps, radiation burns, transfusion reactions, etc. For that matter, if an individual has an allergic or intolerance reaction and has never had one before, they have an adverse reaction but they don't have "an allergy" until after that reaction and someone makes a judgement that they are likely to have future reactions if exposed to that substance.






              share|improve this answer


























                0














                This is an important issue to understand because of the prominent place allergy and adverse reactions play in clinical care.



                The two categories "allergy" and "intolerance" are historical, longstanding. Most non-clinicians and even the majority of clinicians have little insight into the mechanisms that underly allergic reactions, and tend to classify all reactions to which a particular individual has a propensity to from a substance as "allergy". The advancement of knowledge over the past few decades has led to an understanding that there are a number of non-immunologic mechanisms for "allergic reactions" some of which appear much like an Type I hypersensitivity reaction (anaphylaxis or hay fever) and some of which do not. The historical existence of only two categories ensconced in legacy standards, leaves only the category=intolerance for everything known to be non-immunologic. The important thing overall is that an individual has been determined to have the attribute of sensitivity to a particular substance (or class).



                Many adverse reactions are neither allergy nor intolerance: drug-drug interactions that result in a physiologic reaction, overdose, surgical mishaps, radiation burns, transfusion reactions, etc. For that matter, if an individual has an allergic or intolerance reaction and has never had one before, they have an adverse reaction but they don't have "an allergy" until after that reaction and someone makes a judgement that they are likely to have future reactions if exposed to that substance.






                share|improve this answer
























                  0












                  0








                  0






                  This is an important issue to understand because of the prominent place allergy and adverse reactions play in clinical care.



                  The two categories "allergy" and "intolerance" are historical, longstanding. Most non-clinicians and even the majority of clinicians have little insight into the mechanisms that underly allergic reactions, and tend to classify all reactions to which a particular individual has a propensity to from a substance as "allergy". The advancement of knowledge over the past few decades has led to an understanding that there are a number of non-immunologic mechanisms for "allergic reactions" some of which appear much like an Type I hypersensitivity reaction (anaphylaxis or hay fever) and some of which do not. The historical existence of only two categories ensconced in legacy standards, leaves only the category=intolerance for everything known to be non-immunologic. The important thing overall is that an individual has been determined to have the attribute of sensitivity to a particular substance (or class).



                  Many adverse reactions are neither allergy nor intolerance: drug-drug interactions that result in a physiologic reaction, overdose, surgical mishaps, radiation burns, transfusion reactions, etc. For that matter, if an individual has an allergic or intolerance reaction and has never had one before, they have an adverse reaction but they don't have "an allergy" until after that reaction and someone makes a judgement that they are likely to have future reactions if exposed to that substance.






                  share|improve this answer












                  This is an important issue to understand because of the prominent place allergy and adverse reactions play in clinical care.



                  The two categories "allergy" and "intolerance" are historical, longstanding. Most non-clinicians and even the majority of clinicians have little insight into the mechanisms that underly allergic reactions, and tend to classify all reactions to which a particular individual has a propensity to from a substance as "allergy". The advancement of knowledge over the past few decades has led to an understanding that there are a number of non-immunologic mechanisms for "allergic reactions" some of which appear much like an Type I hypersensitivity reaction (anaphylaxis or hay fever) and some of which do not. The historical existence of only two categories ensconced in legacy standards, leaves only the category=intolerance for everything known to be non-immunologic. The important thing overall is that an individual has been determined to have the attribute of sensitivity to a particular substance (or class).



                  Many adverse reactions are neither allergy nor intolerance: drug-drug interactions that result in a physiologic reaction, overdose, surgical mishaps, radiation burns, transfusion reactions, etc. For that matter, if an individual has an allergic or intolerance reaction and has never had one before, they have an adverse reaction but they don't have "an allergy" until after that reaction and someone makes a judgement that they are likely to have future reactions if exposed to that substance.







                  share|improve this answer












                  share|improve this answer



                  share|improve this answer










                  answered Nov 28 at 13:42









                  Russ Leftwich

                  1




                  1















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