4.2 AllergyIntolerance リソース

logo fhir

Home ＞ Clinical ＞ AllergyIntolerance [allergyintolerance]

Resource AllergyIntolerance - Content4.2

Allergy/Intolerance.

The resource name as it appears in a RESTful URL is [root]/allergyintolerance/

Allergy/Intolerance resources are used to provide information about adverse sensitivities to substances that lead to physiologic changes that are clinically observable. An adverse sensitivity is defined as:

A condition expected to result in undesirable physiologic reaction to an amount of a substance that would not produce a reaction in most individuals. The substance is the trigger of an immunologic response that produces the observed physiologic changes, or in some instances nonimmunologic mechanisms that produce clinically identical physiologic changes. The immunologic response might be considered the actual cause of the reaction, but it is exposure to the trigger substance that is clinically observable.

This definition excludes clinically identical episodes that may be caused by physical agents, such as heat, cold, sunlight, or vibration, by exercise activity, or by infectious agents. Those conditions caused by physical agents or infectious would be captured on the problem list (List/Condition Resources). The allergy/intolerance list is a list of conditions that represent a propensity unique to this individual for a reaction upon future exposure to a specified substance.

Note that this specification draws a distinction between the patients condition/problem list and an allergy/intolerance list, even though allergies and intolerances are also conditions. This is because the distinction is a long established clinical workflow, even to patients. Asking an individual "if they have any problems" is not going to invoke an account of their past reactions to medications or foods. Instead, they are asked if they "have any allergies". An allergy/intolerance is also different in that a potential harm from exposure to an external substance that may be ordered by a provider in the course of their care but is not inherent to exposure to that substance for the general population.

Most of the details of the sensitivity can be found in the set of reactions that are associated with the resource, though these may not be present when the patient has not provided enough information. Adverse Reactions do not have to be always associated with an AllergyIntolerance which may appropriate when an single reaction has not provided enough evidence for a meaningful Allergy/Intolerance, or in specific views of events rather than in a general clinical record.

Resource Content4.2.1

<AllergyIntolerance xmlns="http://hl7.org/fhir"> <!-- from Resource: extension, narrative, and contained --> <identifier><!-- 0..1 Identifier An external identifier for the sensitivity --></identifier> <criticality value="[code]"/><!-- 0..1 Criticality of the sensitivity --> <sensitivityType value="[code]"/><!-- 1..1 Type of the sensitivity --> <recordedDate value="[dateTime]"/><!-- 0..1 Date when the sensitivity was recorded --> <status value="[code]"/><!-- 1..1 Status of the sensitivity --> <subject><!-- 1..1 Resource(Patient) Who the sensitivity is for --></subject> <recorder><!-- 0..1 Resource(Practitioner|Patient) Who recorded the sensitivity --></recorder> <substance><!-- 1..1 Resource(Substance) The substance that causes the sensitivity --></substance> <reaction><!-- 0..* Resource(AdverseReaction) Reactions associated with the sensitivity --></reaction> <sensitivityTest><!-- 0..* Resource(Observation) Observations that confirm or refute the sensitivity --></sensitivityTest> </AllergyIntolerance>

Alternate definitions: Schema/Schematron, Resource Profile

Terminology Bindings 4.2.1.1

Notes:4.2.2

  • Criticality vs Severity
    • Criticality is defined as "The potential seriousness of a future reaction." This represents a clinical judgment about the worst case scenario for a future reaction. It would be based on the severity of past reactions, the dose and route of exposure that produced past reactions, and the life-threatening or organ system threatening potential of the reaction type. Criticality is an attribute of the allergic condition, not the reaction(s).
    • High criticality does not equate to a future severe reaction, but rather the potential for a severe and life-threatening reaction. Most reaction types are dose dependent, including anaphylaxis. Therefore, although they have a sensitivity of high criticality, exposure to a small dose of the substance to which they are sensitive might result in only a mild reaction. Severity of the reaction is also dependent on the route of exposure, but criticality since it applies to the condition, is not.

Search Parameters 4.2.3

Search Parameters for RESTful searches. The standard parameters also apply. See Searching for more information.