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Tanno LK, Briand Y, Perie A, Castells M, Demoly P. Drug allergy awareness and perspectives with the implementation of the International Classification of Diseases-11. Curr Opin Allergy Clin Immunol 2024; 24:203-209. [PMID: 38873859 DOI: 10.1097/aci.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
PURPOSE OF REVIEW To understand the current global scale of drug hypersensitivity (DH) and drug allergy (DA), and to identify possible strategies to increase the accuracy of epidemiological data. RECENT FINDINGS Global patterns of DH/DA seem to be changing and increasing worldwide, but there are still great challenges in capturing quality DH/DA mortality and morbidity statistics (MMS). DH/DA MMS may gain new perspectives with the global implementation of the International Classification of Diseases (ICD)-11. Improving the quality of epidemiological data related to DH/DA should clarify areas of uncertainty, which would lead to better strategies to reduce the burden of these conditions. SUMMARY DH/DA remains a complex and unaddressed problem globally that often deprives patients of optimal medication choices and places them at risk for life-threatening reactions. DH/DA labels should contribute to people well being, by protecting true allergic individuals from being re-exposed to their allergic drugs and providing needed medications to individuals wrongly labeled as allergic or who have lost allergic sensitivity. The true rate of DH/DA is in fact unknown due to a number of factors, such as misdiagnosis, miscoding and under- and over-notification, among others. Moreover, there is lack of data about DH/DA epidemiology in many countries. Difficulties on collecting accurate and comparable data should be acknowledged, with great impact in the correct labeling DH/DA in electronic health records and official statistics. More accurate definitions, classification and coding may contribute to a better-quality MMS thanks to the ICD-11, under implementation worldwide. Improving the quality of epidemiological data related to DH/DA should clarify areas of uncertainty, which would lead to better strategies to reduce the burden of these conditions. As knowledge derived from populations is key information for more realistic decision-making, the construction of the new section addressed to DH/DA in the ICD-11 will allow the collection of more accurate epidemiological data to support quality management of patients, and facilitate healthcare planning to implement public health measures to prevent and reduce the morbidity and mortality attributable to these conditions.
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Affiliation(s)
- Luciana Kase Tanno
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier - INSERM - Inria (Premedical)
- WHO Collaborating Centre on Scientific Classification Support, Montpellier
| | - Yann Briand
- Agence Numerique de Santé
- French WHO Collaborating Centre, Paris, France
| | | | - Mariana Castells
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier
- Desbrest Institute of Epidemiology and Public Health, University of Montpellier - INSERM - Inria (Premedical)
- WHO Collaborating Centre on Scientific Classification Support, Montpellier
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Tanno LK, Caminati M, Pouessel G, Senna G, Demoly P. Epidemiology of anaphylaxis: is the trend still going up? Curr Opin Allergy Clin Immunol 2023; 23:349-356. [PMID: 37548324 DOI: 10.1097/aci.0000000000000933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
PURPOSE OF REVIEW To understand the current global scale of anaphylaxis and identify possible strategies to increase the accuracy of epidemiological data. RECENT FINDINGS Anaphylaxis mortality and morbidity statistics may gain new perspectives with the global implementation of the ICD-11. Improving the quality of epidemiological data related to anaphylaxis should clarify some areas of uncertainty about risk factors, leading to better targeting of strategies to protect those patients at risk, and support decision-making to facilitate health care planning and implementation of public health measures to prevent anaphylaxis. SUMMARY The true rate of anaphylaxis is unknown due to a number of factors, such as misdiagnosis, miscoding and undernotification. Moreover, there is lack of information about anaphylaxis epidemiology in many countries. Difficulties on collecting accurate and comparable data should be acknowledged and anaphylaxis data can vary widely. Currently, most robust data are derived from hospitalization datasets and national mortality databases. Anaphylaxis accounts for up to 0.26% of overall hospital admissions. It is suggested that the number of hospital admissions for anaphylaxis is increasing in many countries, both with respect to all-causes of anaphylaxis and by trigger, but the mortality rate remains low. However, there are still great challenges in capturing quality anaphylaxis mortality and morbidity statistics. Better understanding of anaphylaxis trends should clarify some areas of uncertainty about risk factors and prospect effective prevention strategies. As the knowledge derived from populations is key information for more realistic decision-making, the construction of the new section addressed to anaphylaxis in the ICD-11 will allow the collection of more accurate epidemiological data to support high quality management of patients, and to better facilitate health care planning to implement public health measures, reduce the morbidity and mortality attributable to anaphylaxis.
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Affiliation(s)
- Luciana Kase Tanno
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier
- Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier - INSERM
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Marco Caminati
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
| | - Guillaume Pouessel
- Department of Paediatrics, CH Roubaix
- Paediatric Pneumology and Allergology Unit, CHRU Lille, France
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
- Department of Medicine, University of Verona, Verona, Italy
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier
- Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier - INSERM
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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Clark E, Kase Tanno L, Vo T, Blanc B, Demoly P, Caimmi D. Anaphylaxis management in a French pediatric emergency department: Lessons from the ANA-PED study. Clin Transl Allergy 2023; 13:e12289. [PMID: 37632240 PMCID: PMC10392053 DOI: 10.1002/clt2.12289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Anaphylaxis is a serious systemic hypersensitivity reaction that requires immediate recognition and prompt administration of epinephrine/adrenaline. The present study aimed to assess the appropriateness of epinephrine/adrenaline use in children identified as allergic by physicians in the emergency department (ED) at the time of the reaction, and to identify factors that are possibly associated with epinephrine/adrenaline administration, auto-injector prescription, and further referral to an allergist. METHODS We performed a retrospective cross-sectional study at the pediatric ED of the University Hospital of Montpellier, France. We included all consecutive children who attended the ED between 2016 and 2020 with an allergy-related diagnosis at discharge. RESULTS We included 1056 allergy-related visits, including 224 (21.2%) with a diagnosis of anaphylaxis at discharge; only 17.0% of them received an epinephrine/adrenaline injection, and 57.1% consulted an allergist after the acute episode. An auto-injector was prescribed to 63 (28.1%) patients at discharge from the ED. Besides the severity of the clinical presentation, factors associated with a guidelines-based management of the anaphylactic reaction and with an increased administration rate of epinephrine/adrenaline included presence of asthma symptoms and presence of extended skin reactions. CONCLUSIONS Our study underlines persistent gaps in the management of pediatric anaphylaxis in ED, focusing on hereby identified levers. By disseminating current knowledge and guidelines on anaphylaxis and allergies, specialists could work together with emergency physicians to establish effective management algorithms and improve anaphylaxis management and care pathways for children experiencing allergic reactions, especially anaphylaxis. TRAIL REGISTRATION Clinical Trials, number NCT05112367.
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Affiliation(s)
- Evangéline Clark
- Allergy Unit of the PneumologyAllergy and Thoracic Oncology ServiceUniversity Hospital of MontpellierMontpellierFrance
- IDESPUMR UA11INSERMUniversity of MontpellierMontpellierFrance
| | - Luciana Kase Tanno
- Allergy Unit of the PneumologyAllergy and Thoracic Oncology ServiceUniversity Hospital of MontpellierMontpellierFrance
- IDESPUMR UA11INSERMUniversity of MontpellierMontpellierFrance
| | - Tram Vo
- IHU Méditerranée InfectionAP‐HMMEPHIMarseilleFrance
| | - Brigitte Blanc
- Pediatric Emergency DepartmentUniversity Hospital of MontpellierMontpellierFrance
| | - Pascal Demoly
- Allergy Unit of the PneumologyAllergy and Thoracic Oncology ServiceUniversity Hospital of MontpellierMontpellierFrance
- IDESPUMR UA11INSERMUniversity of MontpellierMontpellierFrance
| | - Davide Caimmi
- Allergy Unit of the PneumologyAllergy and Thoracic Oncology ServiceUniversity Hospital of MontpellierMontpellierFrance
- IDESPUMR UA11INSERMUniversity of MontpellierMontpellierFrance
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Tanno LK, Demoly P. Food allergy in the World Health Organization's International Classification of Diseases (ICD)-11. Pediatr Allergy Immunol 2022; 33:e13882. [PMID: 36433855 PMCID: PMC9828038 DOI: 10.1111/pai.13882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
There are increasing global data regarding the prevalence of food allergy and food-induced anaphylaxis. However, knowledge in morbidity and mortality epidemiological data is still not optimal, and international comparable standards remain poorly accessed. This information could in turn support better clinical practice and possibly prevent future severe reactions and avoidable fatalities. The International Classification of Diseases (ICD) is the standard diagnostic tool used for epidemiology, health management, and clinical purposes supported by the World Health Organization (WHO). It is also used to determine health care payment and reimbursement of providers and health care services in hospitals. Thanks to the academic and technical efforts under the ALLERGY in ICD-11 initiative the pioneer "Allergy and hypersensitivity conditions" section has been built under the "Disorders of the Immune System" chapter of the ICD-11. The "Food hypersensitivity" (FH) subsection is classified under the "Complex allergic or hypersensitivity conditions" section and "Food-induced anaphylaxis" is under the "Anaphylaxis" section. In order to inform the development of strategies to reduce preventable FHs/food allergies, the burden of disease in different healthcare settings and patient populations and their common etiologies need to be understood. Besides, greater specificity regarding clinical conditions and services delivered will provide payers, policy makers, and providers with better information to make major refinements to countries payment and reimbursement systems, including the design and implementation of pay-for-performance program.The new classification addressed to FHs will enable the collection of more accurate epidemiological data to support quality management of patients with FHs/food allergies, and better facilitate health care planning and decision-making and public health measures to prevent and reduce their morbidity and mortality. The improved logic and standardized definitions through the ICD-11 (and other WHO classifications) will also facilitate international comparisons of quality care and the sharing of best practice globally.
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Affiliation(s)
- Luciana Kase Tanno
- Division of Allergy, Department of Pneumology, Allergology and Oncology, University Hospital of Montpellier, Montpellier, France.,Institut Desbrest d'Epidémiologie et de Santé Publique, UMR UA-11, University of Montpellier - INSERM, Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Pascal Demoly
- Division of Allergy, Department of Pneumology, Allergology and Oncology, University Hospital of Montpellier, Montpellier, France.,Institut Desbrest d'Epidémiologie et de Santé Publique, UMR UA-11, University of Montpellier - INSERM, Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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5
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Tanno LK, Clark E, Mamodaly M, Cardona V, Ebisawa M, Asontegui I, Sanchez-Borges M, Santos AF, Fiocchi A, Worm M, Caimmi D, Latour Staffeld P, Muraro A, Pawankar R, Greenberger PA, Thong BYH, Martin B, Demoly P. Food-induced anaphylaxis morbidity: Emergency department and hospitalization data support preventive strategies. Pediatr Allergy Immunol 2021; 32:1730-1742. [PMID: 34142390 DOI: 10.1111/pai.13578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anaphylaxis is a recognized public health issue. There is no doubt that food-induced anaphylaxis (FIA) has tremendous impact on the quality of life of patients and their families and increases direct and indirect costs. FIA is associated with increasing rates of emergency department admissions and hospitalizations and implies the risk of death. Morbidity epidemiological data are a key to tailor public health actions to this non-communicable disease. The aim of this article was to review published morbidity epidemiological data relating to FIA and potential risk factors, in order to provide evidence-based recommendations to reduce the risk of severe adverse outcomes. METHODS We identified published studies available in PUBMED/MEDLINE (1966-2020), EMBASE (1980-2020) and CINAHL (1982-2020). The systematic review was carried out using MeSH terms related to FIA ED admissions and hospitalizations. RESULTS A total of 25 articles were selected, 80% published in the last 5 years. After critical analysis of methodological and clinical characteristics reported in the data selected, we were able to propose preventive strategies. CONCLUSION Anaphylaxis is a recognized public health issue. FIA is associated with increasing rates of ED admissions and hospitalizations and imply in risk of death. More than reviewing and critically interpreting the key patterns related to FIA morbidity published data, we proposed strategies in order to promote quality care of patients suffering from FIA. Our World Health Organization Collaborative Center is deeply involved in this process, and we believe that the proposed strategies will inform future healthcare policies on anaphylaxis. The long-term objective would be to improve clinical care and quality of life of patients and their families, and develop risk-stratified, cost-effective preventive measures.
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Affiliation(s)
- Luciana Kase Tanno
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France.,Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.,ARADyAL Research Network, Barcelona, Spain
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Ignacio Asontegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia Erandio, Bilbao, Spain
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Alexandra F Santos
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Alessandro Fiocchi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergy, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Davide Caimmi
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France
| | | | - Antonella Muraro
- Food Allergy Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | | | - Paul Allen Greenberger
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Bryan Martin
- Medicine and Pediatrics, The Ohio State University in Columbus, Columbus, OH, USA
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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Bu J, Lin Y, Qing LQ, Hu G, Jiang P, Hu HF, Shen EX. Prediction of skin disease using a new cytological taxonomy based on cytology and pathology with deep residual learning method. Sci Rep 2021; 11:13764. [PMID: 34215767 PMCID: PMC8253798 DOI: 10.1038/s41598-021-92848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
With the development of artificial intelligence, technique improvement of the classification of skin disease is addressed. However, few study concerned on the current classification system of International Classification of Diseases, Tenth Revision (ICD)-10 on Diseases of the skin and subcutaneous tissue, which is now globally used for classification of skin disease. This study was aimed to develop a new taxonomy of skin disease based on cytology and pathology, and test its predictive effect on skin disease compared to ICD-10. A new taxonomy (Taxonomy 2) containing 6 levels (Project 2–4) was developed based on skin cytology and pathology, and represents individual diseases arranged in a tree structure with three root nodes representing: (1) Keratinogenic diseases, (2) Melanogenic diseases, and (3) Diseases related to non-keratinocytes and non-melanocytes. The predictive effects of the new taxonomy including accuracy, precision, recall, F1, and Kappa were compared with those of ICD-10 on Diseases of the skin and subcutaneous tissue (Taxonomy 1, Project 1) by Deep Residual Learning method. For each project, 2/3 of the images were included as training group, and the rest 1/3 of the images acted as test group according to the category (class) as the stratification variable. Both train and test groups in the Projects (2 and 3) from Taxonomy 2 had higher F1 and Kappa scores without statistical significance on the prediction of skin disease than the corresponding groups in the Project 1 from Taxonomy 1, however both train and test groups in Project 4 had a statistically significantly higher F1-score than the corresponding groups in Project 1 (P = 0.025 and 0.005, respectively). The results showed that the new taxonomy developed based on cytology and pathology has an overall better performance on predictive effect of skin disease than the ICD-10 on Diseases of the skin and subcutaneous tissue. The level 5 (Project 4) of Taxonomy 2 is better on extension to unknown data of diagnosis system assisted by AI compared to current used classification system from ICD-10, and may have the potential application value in clinic of dermatology.
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Affiliation(s)
- Jin Bu
- Hospital for Skin Disease (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, Jiangsu, China.
| | - Yu Lin
- Guangzhou South China Biomedical Research Institute, Co., Ltd, Guangzhou, 510275, Guangdong, China
| | - Li-Qiong Qing
- Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541002, Guangxi, China
| | - Gang Hu
- School of Agriculture, Sun Yat-Sen University, Guangzhou, 510275, Guangdong, China
| | - Pei Jiang
- Xinhua College of Sun Yat-Sen University, Guangzhou, 510520, Guangdong, China
| | - Hai-Feng Hu
- School of Electronics and Information Technology (School of Microelectronics), Sun Yat-Sen University, Guangzhou, 510006, Guangdong, China.
| | - Er-Xia Shen
- Sino-French Hoffmann Institute, School of Basic Sciences, The Second Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, Guangzhou Medical University, Guangzhou, 511436, Guangdong, China. .,The State Key Laboratory of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510182, Guangdong, China.
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Tanno LK, Berard F, Beaudoin E, Didier A, Demoly P. SARS-CoV-2 Vaccination and Anaphylaxis: Recommendations of the French Allergy Community and the Montpellier World Health Organization Collaborating Center. Vaccines (Basel) 2021; 9:560. [PMID: 34072058 PMCID: PMC8228790 DOI: 10.3390/vaccines9060560] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/22/2022] Open
Abstract
Vaccines against COVID-19 (and its emerging variants) are an essential global intervention to control the current pandemic situation. Anaphylactic reactions have been reported after SARS-CoV2 RNA vaccines. Anaphylaxis is defined as a severe life-threatening generalized or systemic hypersensitivity reaction. This risk is estimated at 1/1,000,000 in the context of vaccine safety surveillance programs. The COVID-19 vaccination is rolling-out vastly in different courtiers and surveillance programs are key to monitor severe adverse reactions, such as anaphylaxis. Anaphylaxis due to vaccine is extremely rare and specific cases should receive individualized investigation and care. The here presented recommendations and follow-up from the French allergy community and the Montpellier WHO Collaborating Center in order to support the vaccination program and intends to support to healthcare professionals in their daily basis.
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Affiliation(s)
- Luciana Kase Tanno
- Division of Allergy, Département de Pneumologie et Addictologie, University Hospital of Montpellier, 34295 Montpellier, France;
- WHO Collaborating Center for Classification Scientific Support, University Hospital of Montpellier, 34295 Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, 34093 Montpellier, France
| | - Frédéric Berard
- Hospices Civils de Lyon, Universite Claude Bernard lyon I, Inserm U1111-CIRI, 69495 Lyon, France;
| | - Etienne Beaudoin
- Regional Institute for Allergic and Environmental Diseases-Clinical Immunology, Metz Regional Hospital, 57000 Metz, France;
| | - Alain Didier
- Pôle des Voies Respiratoires, Hôpital Larrey, CHU de Toulouse, CEDEX 9, 31059 Toulouse, France;
- Centre de Physiopathologie Toulouse Purpan, INSERM U1043, CNRS UMR 5282, Université Toulouse III, CEDEX 3, 31024 Toulouse, France
| | - Pascal Demoly
- Division of Allergy, Département de Pneumologie et Addictologie, University Hospital of Montpellier, 34295 Montpellier, France;
- WHO Collaborating Center for Classification Scientific Support, University Hospital of Montpellier, 34295 Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, 34093 Montpellier, France
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Abstract
PURPOSE OF REVIEW To understand the current global epidemiological data of anaphylaxis and identify potential strategies to improve patients' care and prevention. RECENT FINDINGS Anaphylaxis mortality and morbidity statistics (MMS) may gain new perspectives with the implementation of the International Classification of Diseases (ICD)-11 in the forthcoming years. Improving the quality of epidemiological data related to anaphylaxis should clarify some areas of uncertainty about risk factors, leading to better targeting of strategies to protect those patients at risk, and support decision-making to facilitate healthcare planning and implementation of public health measures to prevent anaphylaxis. SUMMARY Anaphylaxis is a complex noncommunicable diseases with adverse impact on health-related quality of life of patients and their carriers and a significant proportion of deaths may be preventable. It requires an integrated holistic plan to improve quality of healthcare and gathering accurate and comparable epidemiological data is key. Morbidity related to anaphylaxis seems to be increasing worldwide whereas mortality of anaphylaxis appears to be low and stable, but this still has great challenges in capturing quality anaphylaxis MMS. Improving the quality of epidemiological data related to anaphylaxis should clarify some areas of uncertainty about risk factors, leading to better targeting of strategies to protect those patients at risk. As knowledge derived from populations is key information for more realistic decision-making, the construction of the new section addressed to anaphylaxis in the ICD-11 will allow the collection of more accurate epidemiological data to support quality management of patients, and better facilitate healthcare planning to implement public health measures to prevent and reduce the morbidity and mortality attributable to these conditions.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- University Hospital of Montpellier, Montpellier, and Desbret Institute of Epidemiology and Public Health, University of Montpellier, Montpellier, France
- WHO Collaborating Center for Classification Scientific Support, Paris, France
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, and Desbret Institute of Epidemiology and Public Health, University of Montpellier, Montpellier, France
- WHO Collaborating Center for Classification Scientific Support, Paris, France
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The Challenge of Establishing the Burden of Anaphylaxis: Some Recent Trends. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00257-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tanno LK, Demoly P. Anaphylaxis in children. Pediatr Allergy Immunol 2020; 31 Suppl 26:8-10. [PMID: 33236416 DOI: 10.1111/pai.13336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 01/27/2023]
Abstract
Anaphylaxis in children is a potential acute life-threatening systemic hypersensitivity reaction. Anaphylaxis fatality rate is estimated to be 0.65% to 2%. Food is the main anaphylaxis trigger in children, notably cow's milk, peanuts, and tree nuts. Mucocutaneous manifestations are observed in more than 90% of cases, but it is not essential for diagnosis. Deaths are rather secondary to the laryngeal edema, observed in 40%-50% of cases. Personal history of asthma, allergy to particular foods such as peanuts and tree nuts, and adolescence are known risk factors for anaphylaxis and more severe reactions. Epinephrine (adrenaline) is the medication of choice for the first-aid treatment of anaphylaxis. However, adrenaline auto-injectors (AAIs) are commercially available in only 32% of world countries. There are still considerable unmet needs in the field of anaphylaxis in children. Therefore, the Montpellier WHO Collaborating Centre aims to start the global action plan applied to anaphylaxis.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio-Libanês, São Paulo, Brazil.,University Hospital of Montpellier, Montpellier, France.,Sorbonne Université, INSERM UMR-S 1136, IPLESP, Equipe EPAR, Paris, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Sorbonne Université, INSERM UMR-S 1136, IPLESP, Equipe EPAR, Paris, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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A Proposal from the Montpellier World Health Organization Collaborating Centre for Better Management and Prevention of Anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:676-683.e1. [PMID: 33059097 DOI: 10.1016/j.jaip.2020.09.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/23/2022]
Abstract
Since the first description of anaphylaxis in 1902, its clinical importance as an emergency condition has been recognized worldwide. Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction characterized by rapid onset and the potential to endanger life through respiratory or circulatory compromise. It is usually, although not always, associated with skin and mucosal changes. Although the academic/scientific communities have advocated to promote greater awareness and protocols for the management of anaphylaxis based on best evidence, there are few efforts documenting feedback as to the success of these efforts. In this article, we review the key unmet needs related to the diagnosis and management of anaphylaxis, and propose a public health initiative for prevention measures and a timetable action plan that intends to strengthen the collaboration among health professionals and especially primary care physicians dealing with anaphylaxis, which can encourage enhanced quality of care of patients with anaphylaxis. More than calling for a harmonized action for the best management of anaphylaxis to prevent undue morbidity and mortality, the Montpellier World Health Organization Collaborating Centre here proposes an action plan as a baseline for a global initiative against anaphylaxis. We strongly believe that these collaborative efforts are a strong public health and societal priority that is consistent with the overarching goals of providing optimal care of allergic patients and best practices of allergology.
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Bilò MB, Corsi A, Martini M, Penza E, Grippo F, Bignardi D. Fatal anaphylaxis in Italy: Analysis of cause-of-death national data, 2004-2016. Allergy 2020; 75:2644-2652. [PMID: 32364284 DOI: 10.1111/all.14352] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Epidemiological data on fatal anaphylaxis are underestimated worldwide. Few Italian data do exist. The aims of the study are to determine the anaphylaxis mortality rate in Italy and its associations with demographic characteristics (gender, age, and geographical distribution), and to investigate which are the most common triggers of fatal anaphylaxis. MATERIAL AND METHODS This is a descriptive study analyzing data reported to the National Register of Causes of Death database and managed by the Italian National Institute of Statistics for the years 2004-2016. An analytical method was developed to identify all the ICD-10 codes related to anaphylaxis deaths, which were divided into two classes: "Definite anaphylaxis deaths" and "Possible anaphylaxis deaths." RESULTS From 2004 through 2016, 392 definite anaphylaxis deaths and 220 possible anaphylaxis deaths were recorded. The average mortality rate for definite anaphylaxis, from 2004 to 2016, was 0.51 per million population per year. Definite fatal anaphylaxis was mostly due to the use of medications (73.7%), followed by unspecified causes (20.7%) and hymenoptera stings (5.6%). Concerning possible anaphylaxis deaths, the most common cause was venom-stinging insect (51.4%). We did not find any data on food fatal anaphylaxis. Unspecified anaphylaxis accounted for 21%-28% of all cases, underlining the difficulty in accurately ascertaining the causes of fatal anaphylaxis and therefore in assigning the proper ICD-10 code. CONCLUSION This is the first study of anaphylaxis-related mortality coming from an official database of the whole Italian population. However, the actual number of deaths by anaphylaxis, and their related triggers, is probably underreported, mostly due to limitations of the current recording system, and to a poor allergy education. Corrective actions should be undertaken for the benefit of the Health System.
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Affiliation(s)
- Maria Beatrice Bilò
- Allergy Unit Department of Clinical and Molecular Sciences Polytechnic University of Marche Ancona Italy
- Department of Internal Medicine University Hospital Ospedali Riuniti di Ancona Ancona Italy
| | - Alice Corsi
- Postgraduate School of Allergy and Clinical Immunology Università Politecnica delle Marche Ancona Italy
| | - Matteo Martini
- Postgraduate School of Allergy and Clinical Immunology Università Politecnica delle Marche Ancona Italy
| | - Elena Penza
- Allergy Unit IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Francesco Grippo
- Integrated System for Health, Social Assistance and Welfare Istituto Nazionale di Statistica Rome Italy
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Tanno LK, Chalmers R, Jacob R, Kostanjsek N, Bierrenbach AL, Martin B, Molinari N, Annesi‐Maesano I, Papadopoulos NG, Sanchez‐Borges M, Rosenwasser LJ, Ansontegui I, Ebisawa M, Sisul JC, Jares E, Gomez M, Agache I, Muraro A, Wong GWK, Thien F, Pawankar R, Mahr TA, Sublett JL, Lang DM, Casale T, Demoly P. Global implementation of the world health organization's International Classification of Diseases (ICD)-11: The allergic and hypersensitivity conditions model. Allergy 2020; 75:2206-2218. [PMID: 32578235 DOI: 10.1111/all.14468] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 12/21/2022]
Abstract
The International Classification of Diseases (ICD) provides a common language for use worldwide as a diagnostic and classification tool for epidemiology, clinical purposes and health management. Since its first edition, the ICD has maintained a framework distributing conditions according to topography, with the result that some complex conditions, such as allergies and hypersensitivity disorders (A/H) including anaphylaxis, have been poorly represented. The change in hierarchy in ICD-11 permitted the construction of the pioneer section addressed to A/H, which may result in more accurate mortality and morbidity statistics, including more accurate accounting for mortality due to anaphylaxis, strengthen classification, terminology and definitions. The ICD-11 was presented and adopted by the 72nd World Health Assembly in May 2019, and the implementation is ongoing worldwide. We here present the outcomes from an online survey undertaken to reach out the allergy community worldwide in order to peer review the terminology, classification and definitions of A/H introduced into ICD-11 and to support their global implementation. Data are presented here for 406 respondents from 74 countries. All of the subsections of the new A/H section of the ICD-11 had been considered with good accuracy by the majority of respondents. We believe that, in addition to help during the implementation phase, all the comments provided will help to improve the A/H classification and to increase awareness by different disciplines of what actions are needed to ensure more accurate epidemiological data and better clinical management of A/H patients.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio‐Libanês São Paulo Brazil
- University Hospital of Montpellier Montpellier France
- INSERM UMR‐S 1136 IPLESP Equipe EPAR Sorbonne Université Paris France
- WHO Collaborating Centre on Scientific Classification Support Montpellier France
- ICD‐11 Medical and Scientific Advisory Committee WHO Geneva Switzerland
| | - Robert Chalmers
- ICD‐11 Medical and Scientific Advisory Committee WHO Geneva Switzerland
- Centre for Dermatology University of Manchester Manchester UK
| | - Robert Jacob
- Classifications, Terminologies and Standards World Health Organization Geneva Switzerland
| | - Nenad Kostanjsek
- Classifications, Terminologies and Standards World Health Organization Geneva Switzerland
| | - Ana Luiza Bierrenbach
- Hospital Sírio‐Libanês São Paulo Brazil
- Sanas Epidemiology and Research São Paulo Brazil
- Teaching Research Institute (IEP) Hospital Sírio Libanês São Paulo Brazil
| | - Bryan Martin
- Medicine and Pediatrics The Ohio State University in Columbus Columbus OH USA
| | | | | | - Nikolaos G. Papadopoulos
- Centre for Paediatrics and Child Health Institute of Human Development University of Manchester Manchester UK
- Department of Allergy 2nd Pediatric Clinic University of Athens Athens Greece
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Medico Docente La Trinidad Caracas Venezuela
| | - Lanny J. Rosenwasser
- Division of Immunology Research Department of Pediatrics Children's Mercy Hospitals & Clinics Kansas City MO USA
| | - Ignacio Ansontegui
- Department of Allergy and Immunology Hospital Quirónsalud Bizkaia Erandio Bilbao Spain
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital Sagamihara Japan
| | - Juan Carlos Sisul
- Latinalerican Society of Allergy, Asthma and Immunology Villarica Paraguay
- American College of Allergy, Asthma and Immunology Arlington Heights IL USA
| | - Edgardo Jares
- LIBRA Foundation and CMP SA Buenos Aires Buenos Aires Argentina
| | - Maximiliano Gomez
- Research & Education Fundación Ayre Allergy & Asthma Unit Hospital San Bernardo Catholic University of Salta Salta Argentina
| | | | - Antonella Muraro
- Department of Women and Child Health Food Allergy Referral Centre Veneto Region Padua General University Hospital Padua Italy
| | - Gary W. K. Wong
- Department of Pediatrics Chinese University of Hong Kong Hong Kong China
| | - Francis Thien
- Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Vic Australia
- Department of Respiratory Medicine Eastern Health Box Hill Vic. Australia
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Todd A. Mahr
- Pediatric Allergy and Clinical Immunology Gundersen Health System in La Crosse La Crosse WI USA
| | - James L. Sublett
- Family Allergy & Asthma Louisville KY USA
- Department of Pediatrics Section of Allergy & Immunology University of Louisville School of Medicine Louisville KY USA
| | - David M. Lang
- Department of Allergy and Clinical Immunology Respiratory Institute Cleveland Clinic OH USA
| | - Thomas Casale
- Morsani College of Medicine University of South Florida Tampa FL USA
| | - Pascal Demoly
- University Hospital of Montpellier Montpellier France
- INSERM UMR‐S 1136 IPLESP Equipe EPAR Sorbonne Université Paris France
- WHO Collaborating Centre on Scientific Classification Support Montpellier France
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Coronavirus Disease (COVID)-19: World Health Organization Definitions and Coding to Support the Allergy Community and Health Professionals. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2144-2148. [PMID: 32418622 PMCID: PMC7211746 DOI: 10.1016/j.jaip.2020.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 12/30/2022]
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Abstract
In addition to medical innovations, the International Classification of Diseases (ICD-11) addresses the changing needs of digitized healthcare systems. This article describes the concept and developmental structure of the ICD-11.The new technical structure of the ICD-11 allows for a considerably simplified use of the classification and at the same time significantly improves the ability to record individual health conditions at the desired level of detail. The integration of the entire contents and structural information of the ICD-11 in an ontologically organized all-encompassing structure, the so called "foundation", in combination with the connected online platforms is a step into the future. It simplifies translation and maintenance of the classification and considerably improves consistency, especially between language versions. The foundation also permits the production of use-specific versions, so called linearisations, that facilitate the application of ICD by the relevant user groups.The ICD-11 allows versioning-safe documentation using a unique character string, the unique reference identifier. The ICD-11 has been designed for the current de facto use cases. The content of ICD-11 has been updated and linked to other classifications and terminologies. These innovations enable up-to-date documentation of relevant health information in all areas, aggregation of data and the analysis of examination of interrelationships in health.
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Tanno LK, Simons FER, Sanchez-Borges M, Cardona V, Moon HB, Calderon MA, Sisul JC, Muraro A, Casale T, Demoly P. Applying prevention concepts to anaphylaxis: A call for worldwide availability of adrenaline auto-injectors. Clin Exp Allergy 2019; 47:1108-1114. [PMID: 28856836 DOI: 10.1111/cea.12973] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- L K Tanno
- Hospital Sírio Libanês, São Paulo, Brazil.,University Hospital of Montpellier, Montpellier, France.,Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Paris, France
| | - F E R Simons
- Section of Allergy & Clinical Immunology, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
| | - M Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - V Cardona
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - H-B Moon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - M A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - J C Sisul
- Latinalerican Society of Allergy, Asthma and Immunology, Villarica, Paraguay.,American College of Allergy, Asthma and Immunology, Villarica, Paraguay
| | - A Muraro
- European Academy of Allergy and Clinical Immunology, Padua, Italy.,Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy
| | - T Casale
- American Academy of Allergy Asthma and Immunology, Tampa, FL, USA.,Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - P Demoly
- University Hospital of Montpellier, Montpellier, France.,Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Paris, France
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Tanno LK, Chalmers R, Bierrenbach AL, Simons FER, Martin B, Molinari N, Annesi-Maesano I, Worm M, Cardona V, Papadopoulos NG, Sanchez-Borges M, Rosenwasser LJ, Ansontegui I, Ebisawa M, Sisul JC, Jares E, Gomez M, Agache I, Hellings P, Muraro A, Thien F, Pawankar R, Sublett JL, Casale T, Demoly P. Changing the history of anaphylaxis mortality statistics through the World Health Organization's International Classification of Diseases-11. J Allergy Clin Immunol 2019; 144:627-633. [PMID: 31229269 DOI: 10.1016/j.jaci.2019.05.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/14/2019] [Accepted: 05/03/2019] [Indexed: 02/06/2023]
Abstract
We review the history of the classification and coding changes for anaphylaxis and provide current and perspective information in the field. In 2012, an analysis of Brazilian data demonstrated undernotification of anaphylaxis-related deaths because of the difficulties of coding using the International Classification of Diseases, 10th Revision. This work triggered strategic international actions supported by the Joint Allergy Academies and the International Classification of Diseases World Health Organization (WHO) leadership to update the classification of allergic disorders for the International Classification of Diseases, 11th Revision (ICD-11), which resulted in construction of the pioneer "Allergic and hypersensitivity conditions" chapter. The usability of the new framework has been tested by evaluating the same data published in 2012 from the ICD-11 perspective. Coding accuracy was much improved, reaching 95% for definite anaphylaxis. As the results were provided to the WHO Mortality Reference Group, coding rules have been changed, allowing anaphylaxis to be recorded as an underlying cause of death in official mortality statistics. The mandatory use of ICD-11 from January 2022 for documenting cause of death could have 2 immediate consequences: (1) the reported number of anaphylaxis-related deaths might increase because of more appropriate coding and (2) the cross-sectional and longitudinal mortality data generated might ultimately lead to a better understanding of anaphylaxis epidemiology and improved health policies directed at reducing anaphylaxis-related mortality.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio-Libanês, São Paulo, Brazil; University Hospital Montpellier, Montpellier, France; Sorbonne Université, INSERM UMR-S 1136, Paris, France; World Health Organization Collaborating Centre on Scientific Classification Support, Montpellier, France; ICD-11 Medical and Scientific Advisory Committee, World Health Organization, Geneva, Switzerland.
| | - Robert Chalmers
- ICD-11 Medical and Scientific Advisory Committee, World Health Organization, Geneva, Switzerland; Centre for Dermatology, University of Manchester, Manchester, United Kingdom
| | - Ana Luiza Bierrenbach
- Hospital Sírio-Libanês, São Paulo, Brazil; Sanas Epidemiology and Research and the Teaching Research Institute (IEP), Hospital Sírio Libanês, São Paulo, Brazil
| | - F Estelle R Simons
- Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bryan Martin
- Medicine and Pediatrics, Ohio State University, Columbus, Ohio
| | | | | | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergy, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Victoria Cardona
- Internal Medicine Department, Allergy Section, Hospital Vall d'Hebron, Barcelona, Spain
| | - Nikolaos G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, United Kingdom; Department of Allergy, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Lanny J Rosenwasser
- Department of Pediatrics, Division of Immunology Research, Children's Mercy Hospitals and Clinics, Kansas City, Mo
| | - Ignacio Ansontegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia Erandio, Bilbao, Spain
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
| | - Juan Carlos Sisul
- Past President of the Latin-American Society of Allergy, Asthma and Immunology, Asunción, Paraguay
| | - Edgardo Jares
- LIBRA Foundation and CMP SA Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Gomez
- Research and Education, Fundación Ayre, Allergy and Asthma Unit, Hospital San Bernardo, Catholic University of Salta, Salta, Argentina
| | | | - Peter Hellings
- ENT Clinical Department, University Hospital Leuven, Leuven, Belgium; Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - Francis Thien
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia; Department of Respiratory Medicine, Eastern Health, Boxhill, Australia
| | | | - James L Sublett
- Family Allergy & Asthma and the Section of Allergy and Immunology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Ky
| | - Thomas Casale
- Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Pascal Demoly
- University Hospital Montpellier, Montpellier, France; Sorbonne Université, INSERM UMR-S 1136, Paris, France
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Are outcome measures in allergic diseases relevant for the WHO's International Classification of Diseases in allergology? Curr Opin Allergy Clin Immunol 2019; 19:198-203. [DOI: 10.1097/aci.0000000000000524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mendes D, Alves C, Silverio N, Batel Marques F. Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis. Eur Thyroid J 2019; 8:130-143. [PMID: 31259155 PMCID: PMC6587201 DOI: 10.1159/000499751] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 03/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with undiagnosed hypothyroidism are not treated for the disease and are at high risk of developing serious complications, with major impact on public health. There is a need to systematically review the available evidence on this topic. OBJECTIVE To identify the prevalence of undiagnosed hypothyroidism in Europe. METHODS A systematic review of the literature (Medline, EMBASE, and Cochrane Central) was performed to identify epidemiological studies on the prevalence of undiagnosed hypothyroidism among European populations published between January 2008 and April 2018. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Random-effects meta-analyses were performed to pool estimates of proportions (with 95% confidence intervals [CIs]) of undiagnosed (1) subclinical, (2) overt, and (3) total hypothyroidism. RESULTS The search returned 15,565 citations (4,526 duplicates). Twenty papers were included in the study. Fourteen and 6 studies were of good and moderate methodological quality, respectively. The results of the meta-analyses were as follows for the prevalence of undiagnosed hypothyroidism: subclinical, 4.11% (95% CI 3.05-5.31%, I2 = 99.32%); overt, 0.65% (95% CI 0.38-0.99%, I2 = 96.67%); and total, 4.70% (95% CI 2.98-6.79%, I2 = 99.53%). According to the sensitivity analysis, the prevalence of hypothyroidism tends to be higher in female patients, in those aged ≥65 years, among studies with lower sample sizes, in those with thyroid-stimulating hormone levels <4.5 mIU/L, and in Eastern and Southern Europe. CONCLUSIONS The current evidence suggests that a considerable proportion of the European population has hypothyroidism, particularly subclinical hypothyroidism, which is undiagnosed. This issue deserves further investigation because of possible deleterious consequences for public health.
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Affiliation(s)
- Diogo Mendes
- Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Carlos Alves
- Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
| | | | - Francisco Batel Marques
- Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
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Nguyen VT, Benchoufi M, Young B, Ghosn L, Ravaud P, Boutron I. A scoping review provided a framework for new ways of doing research through mobilizing collective intelligence. J Clin Epidemiol 2019; 110:1-11. [PMID: 30772456 DOI: 10.1016/j.jclinepi.2019.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/14/2019] [Accepted: 02/04/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES New forms of research involving collective intelligence (CI) of diverse individuals mobilized through crowdsourcing is successfully emerging in various fields. This scoping review aimed to describe these methods across different fields and propose a framework for implementation. STUDY DESIGN AND SETTING We searched seven electronic databases for reports describing projects that had mobilized CI with crowdsourcing. We used content analysis to develop themes and categories of the methods. RESULTS We identified 145 reports. CI was mobilized to generate ideas, conduct evaluations, solve problems, and create intellectual outputs. Most projects (n = 110, 76%) were open to the public without restrictions on participants' expertise. Participants contributed to projects by independent contribution (i.e., no interaction with other participants) (n = 50, 34%), collaboration (n = 41, 28%), competitions (n = 33, 23%), and playing games (n = 16, 11%). In total, 61% of articles (n = 89) reported methods to evaluate participants' contribution and decision-making process: 43% used an independent panel of experts and 18% involved end users. We identified challenges in implementation and sustainability of CI and proposed solutions. CONCLUSION New research methods based on CI through crowdsourcing could transform clinical research. This framework facilitates the implementation of these methods.
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Affiliation(s)
- Van Thu Nguyen
- INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Methods of Therapeutic Evaluation of Chronic Diseases Team (METHODS), Paris, F-75014 France; Paris Descartes University, Sorbonne Paris Cité, France; Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool L69 3GB, UK.
| | - Mehdi Benchoufi
- INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Methods of Therapeutic Evaluation of Chronic Diseases Team (METHODS), Paris, F-75014 France; Paris Descartes University, Sorbonne Paris Cité, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Bridget Young
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool L69 3GB, UK
| | - Lina Ghosn
- INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Methods of Therapeutic Evaluation of Chronic Diseases Team (METHODS), Paris, F-75014 France; Paris Descartes University, Sorbonne Paris Cité, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Methods of Therapeutic Evaluation of Chronic Diseases Team (METHODS), Paris, F-75014 France; Paris Descartes University, Sorbonne Paris Cité, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Isabelle Boutron
- INSERM, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Methods of Therapeutic Evaluation of Chronic Diseases Team (METHODS), Paris, F-75014 France; Paris Descartes University, Sorbonne Paris Cité, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
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González-López G, García-Doval I, Molina-Leyva A, Descalzo-Gallego M, Taberner R, Gilaberte Y, Buendía-Eisman A, Fernández-Peñas P. Difficulties Coding Dermatological Disorders Using the ICD-10: The DIADERM Study. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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23
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González-López G, García-Doval I, Molina-Leyva A, Descalzo-Gallego MA, Taberner R, Gilaberte Y, Buendía-Eisman A, Fernández-Peñas P. Difficulties Coding Dermatological Disorders Using the ICD-10: The DIADERM Study. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:893-899. [PMID: 30268517 DOI: 10.1016/j.ad.2018.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/10/2018] [Accepted: 06/14/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) has some shortcomings when it comes to coding certain dermatological disorders. To overcome these shortcomings, a compatible version of the ICD-10 specifically adapted to dermatology was produced in Spain in 1999. The recent DIADERM study recorded 10 999 dermatological diagnoses using a representative sample of dermatologists working at outpatient clinics in Spain. The aims of the current study were to identify diagnoses from the DIADERM study that could not be coded using the adapted ICD-10, determine why, and check if they could be coded using the draft ICD-11. MATERIAL AND METHODS We included all dermatological diagnoses from the DIADERM study that could not be assigned a code from the adapted ICD-10. We then quantified and recorded all the diagnoses that could not be coded using either the adapted ICD-10 or the draft ICD-11. RESULTS Of the 10 999 diagnoses analyzed, 41 had not been assigned a code. Of these, 19 were assigned an adapted ICD-10 code on reassessment. However, the adapted ICD-10 and the draft ICD-11 lacked specific codes for 22 and 17 diagnoses, respectively. CONCLUSIONS The adapted ICD-10 can be used to correctly code the vast majority of dermatological diagnoses seen in routine clinical practice. Nevertheless, the system does have some minor shortcomings when it comes to coding certain diseases, particularly newly discovered and emerging diseases. Some of these problems, however, were resolved with the new ICD-11. Based on our findings, we propose some modifications to the ICD-11.
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Affiliation(s)
- G González-López
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España.
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana AEDV, Madrid, España; Servicio de Dermatología, Complejo Hospitalario de Vigo, Vigo, Pontevedra, España
| | - A Molina-Leyva
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España
| | | | - R Taberner
- Servicio de Dermatología, Hospital Son Llàtzer, Palma de Mallorca, Baleares, España
| | - Y Gilaberte
- Unidad de Dermatología, Hospital San Jorge de Huesca, Huesca, España
| | | | - P Fernández-Peñas
- The University of Sydney, Department of Dermatology, Westmead Hospital, Westmead, Sídney, New South Wales, Australia
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Tanno LK, Demoly P. How can the World Health Organization’s International Classification of Diseases (ICD)-11 change the clinical management of anaphylaxis? Expert Rev Clin Immunol 2018; 14:783-786. [DOI: 10.1080/1744666x.2018.1520094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Luciana K Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- INSERM, IPLESP, University Hospital of Montpellier, Montpellier and Sorbonne Université, Paris, France
| | - Pascal Demoly
- INSERM, IPLESP, University Hospital of Montpellier, Montpellier and Sorbonne Université, Paris, France
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Tanno LK, Torres MJ, Castells M, Demoly P. What can we learn in drug allergy management from World Health Organization's international classifications? Allergy 2018; 73:987-992. [PMID: 29105793 DOI: 10.1111/all.13335] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 12/13/2022]
Abstract
Drug hypersensitivity reactions (DHRs) represent growing health problem worldwide, affecting more than 7% of the general population, and represent an important public health problem. However, knowledge in DHRs morbidity and mortality epidemiological data is still not optimal and international comparable standards remain poorly accessed. Institutional databases worldwide increasingly use the WHO International Classification of Diseases (ICD) system to classify diagnoses, health services utilization, and death data. The misclassification of disorders in the ICD system contributes to a lack of ascertainment and recognition of their importance for healthcare planning and resource allocation. It also hampers clinical practice and prevention actions. To further inform the allergy community and to ensure that the revision process is transparent as advised in the WHO ICD-11 revision agenda, we report the advances and use of the pioneering "Drug hypersensitivity" subsection of ICD-11 and implementation in the WHO International Classification of Health Interventions (ICHI). The new classification addressed to DHRs will enable the collection of more accurate epidemiological data to support quality management of patients with drug allergies and better facilitate healthcare planning and decision-making and public health measures to prevent and reduce the morbidity and mortality attributable to DHRs.
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Affiliation(s)
- L. K. Tanno
- Hospital Sírio Libanês; São Paulo Brazil
- University Hospital of Montpellier; Montpellier France
- UMR-S 1136, IPLESP, Equipe EPAR; Sorbonne Universités; UPMC Paris 06; Paris France
| | - M. J. Torres
- Allergy Unit; IBIMA-Regional University Hospital of Malaga, UMA; Malaga Spain
| | - M. Castells
- Division of Rheumatology, Immunology and Allergy; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - P. Demoly
- University Hospital of Montpellier; Montpellier France
- UMR-S 1136, IPLESP, Equipe EPAR; Sorbonne Universités; UPMC Paris 06; Paris France
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Tanno LK, Bierrenbach AL, Simons FER, Cardona V, Thong BYH, Molinari N, Calderon MA, Worm M, Chang YS, Papadopoulos NG, Casale T, Demoly P. Critical view of anaphylaxis epidemiology: open questions and new perspectives. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2018; 14:12. [PMID: 29632547 PMCID: PMC5883526 DOI: 10.1186/s13223-018-0234-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/01/2018] [Indexed: 11/18/2022]
Abstract
In contrast to the majority of allergic or hypersensitivity conditions, worldwide anaphylaxis epidemiological data remain sparse with low accuracy, which hampers comparable morbidity statistics. Data can differ widely depending on a number of variables. In the current document we reviewed the forms on which anaphylaxis has been defined and classified; and how it can affect epidemiological data. With regards to the methods used to capture morbidity statistics, we observed the impact of the anaphylaxis coding utilizing the World Health Organization's International Classification of Diseases. As an outcome and depending on the anaphylaxis definition, we extracted the cumulative incidence, which may not reflect the real number of new cases. The new ICD-11 anaphylaxis subsection developments and critical view of morbidity statistics data are discussed in order to reach new perspectives on anaphylaxis epidemiology.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- University Hospital of Montpellier, Montpellier, France
- Sorbonne Université, INSERM, IPLESP, 75013 Paris, France
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 371, av. du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Ana Luiza Bierrenbach
- Sanas Epidemiology and Research, São Paulo, Brazil
- Teaching Research Institute (IEP), Hospital Sírio Libanês, São Paulo, Brazil
| | - F. Estelle R. Simons
- Section of Allergy & Clinical Immunology, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Moises A. Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - Margitta Worm
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do South Korea
| | - Nikolaos G. Papadopoulos
- Centre for Paediatrics and Child Health Institute of Human Development, University of Manchester, Manchester, UK
- Department of Allergy, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Thomas Casale
- American Academy of Allergy Asthma and Immunology, and Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France
- Sorbonne Université, INSERM, IPLESP, 75013 Paris, France
| | - on behalf the Joint Allergy Academies
- Hospital Sírio Libanês, São Paulo, Brazil
- University Hospital of Montpellier, Montpellier, France
- Sorbonne Université, INSERM, IPLESP, 75013 Paris, France
- Sanas Epidemiology and Research, São Paulo, Brazil
- Teaching Research Institute (IEP), Hospital Sírio Libanês, São Paulo, Brazil
- Section of Allergy & Clinical Immunology, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
- IMAG, UMR 5149, DIM CHRU de Montpellier, Montpellier, France
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do South Korea
- Centre for Paediatrics and Child Health Institute of Human Development, University of Manchester, Manchester, UK
- Department of Allergy, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- American Academy of Allergy Asthma and Immunology, and Morsani College of Medicine, University of South Florida, Tampa, FL USA
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 371, av. du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
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Han J, Ye YM, Lee S. Epidemiology of drug hypersensitivity reactions using 6-year national health insurance claim data from Korea. Int J Clin Pharm 2018; 40:1359-1371. [PMID: 29611015 DOI: 10.1007/s11096-018-0625-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 03/15/2018] [Indexed: 12/17/2022]
Abstract
Background Drug hypersensitivity reactions (DHRs) constitute a large portion of adverse drug reactions (ADRs), but studies for DHR incidence based on national data are scarce. Objective This study aimed to estimate the incidence and patterns of DHRs in a Korean population and the associated utilization of medical resources using the national claims data. Setting The retrospective cohort study performed using the national insurance claim database of the Health Insurance Review and Assessment (HIRA) in Korea. Methods The International Classification of Disease 10th revision code was used to identify DHRs with 20 drug induced DHR codes. The claim data with a diagnosis of DHR in the 2009-2014 periods were analyzed. Main outcome and measure The annual incidence and the 6-year incidence rates were calculated. Incidence rate coefficients were analyzed by sex, age, and year. DHRs following with visits of emergency department (ED) or intensive care unit (ICU) were assessed for utilization of medical resources and risk of ER or ICU visits by sex and age Results A total of 535,049 patients with 1,083,507 claims were assessed in the HIRA database for 6 years. DHR incidence was high in the elderly. The risk of ED and ICU visit with DHR was also higher in the elderly than in the young [highest relative risk, RR of ED 2.59 (1.65-4.07), ICU 5.04 (2.50-10.18)]. DHRs related to blood were high in the young age. Conclusion Incidence of DHRs in the real-world clinical practice was higher in the elderly and female. Clinical consequence was more severe in the elderly.
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Affiliation(s)
- JaeEun Han
- Division of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea.,Department of Pharmacy, Ajou University Hospital, Suwon, Republic of Korea
| | - Young-Min Ye
- Department of Allergy, College of Medicine, Ajou University, Suwon, Republic of Korea
| | - Sukhyang Lee
- Division of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea. .,Division of Clinical Pharmacy Practice Education, Ajou University Hospital, Suwon, Republic of Korea.
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Lessons of Drug Allergy Management Through the World Health Organization’s International Classification of Diseases (ICD)-11. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0157-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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One voice for anaphylaxis in France: The vision of the centre of reference in rare diseases. REVUE FRANCAISE D ALLERGOLOGIE 2017. [DOI: 10.1016/j.reval.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Tanno L, Demoly P. Anaphylaxis in France: Rate, characteristics and unmet needs. REVUE FRANCAISE D ALLERGOLOGIE 2017. [DOI: 10.1016/j.reval.2017.02.242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Rodríguez Del Rio P, Pitsios C, Tsoumani M, Pfaar O, Paraskevopoulos G, Gawlik R, Valovirta E, Larenas-Linnemann D, Demoly P, Calderón MA. Physicians' experience and opinion on contraindications to allergen immunotherapy: The CONSIT survey. Ann Allergy Asthma Immunol 2017; 118:621-628.e1. [PMID: 28477792 DOI: 10.1016/j.anai.2017.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 02/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Allergen immunotherapy (AIT) is the only disease-modifying treatment in allergy but several contraindications limit its use. OBJECTIVE To collect the outcome of using AIT in theoretically contraindicated situations in real patients in the Contraindications to Specific ImmunoTherapy (CONSIT) survey. METHODS The CONSIT is an electronic European Academy of Allergy and Clinical Immunology survey conducted to gather the safety outcomes of patients undergoing subcutaneous, sublingual, or venom AIT and the opinions of physicians on each of 17 selected conditions: children younger than 5 years; starting AIT during pregnancy; controlled severe asthma; arrhythmias; coronary disease; cancer; autoimmune disease; bone marrow and solid organ transplantation; human immunodeficiency virus and acquired immunodeficiency syndrome; previous anaphylaxis during AIT; use of β-blockers, angiotensin-converting inhibitors, cyclosporine, and methotrexate; and inability to communicate. Safety using AIT was reported in a 3-point scale: 1, "no problems"; 2, "minor problems" (requiring only dose modifications); and 3, "major problems" (AIT not tolerated). Each physician was asked about the degree of contraindication that each condition should have: no contraindication (score 1), relative contraindication (score 2), or absolute contraindication (score 3). RESULTS Five hundred twenty physicians (75% Europeans, 89% allergists) reported on approximately 45,000 patients undergoing AIT with any of these conditions. Major problems were infrequent, occurring more frequently in patients with asthma (9.9%) and with previous anaphylaxis from AIT (9.5%). Regarding opinions, experienced physicians scored a significantly lower mean for all conditions than non-experienced physicians for all routes. CONCLUSION Major problems were infrequent and experienced physicians were less likely to be restrictive in the use of AIT.
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Affiliation(s)
| | | | - Marina Tsoumani
- Centre for Respiratory Medicine and Allergy, University Hospital of South Manchester and Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Radoslaw Gawlik
- Department of Internal Medicine, Allergy and Clinical Immunology, Silesian University of Medicine, Katowice, Poland
| | - Erkka Valovirta
- Terveystalo Turku, Allergy Clinic, University of Turku, Turku, Finland
| | | | - Pascal Demoly
- Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier; Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013, Paris, France
| | - Moises A Calderón
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute and Royal Brompton Hospital NSH, London, United Kingdom
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Tanno LK, Haahtela T, Calderon MA, Cruz A, Demoly P. Implementation gaps for asthma prevention and control. Respir Med 2017; 130:13-19. [PMID: 29206628 DOI: 10.1016/j.rmed.2017.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 12/22/2022]
Abstract
Asthma and allergic diseases can start in childhood and persist throughout life, but could also be manifested later, at any time for still misunderstood reasons. They are major chronic multifactorial respiratory diseases, for which prevention, early diagnosis and treatment is recognized as a priority for the Europe's public health policy and the United Nations. Given that allergy triggers (including infections, rapid urbanization leading to loss in biodiversity, pollution and climate changes) are not expected to change in a foreseeable future, it is imperative that steps are taken to develop, strengthen and optimize preventive and treatment strategies. Currently there are good treatments for asthma, several risk factors are known (e.g., allergies, rhinitis, tobacco smoke) and tools to control the disease have been developed. However, we are still uncertain how to prevent patients from developing asthma and allergic diseases. In this paper, we list the positive and negative experiences in this field as well as analyze the missing links in the process. This critical analysis will be the basis of setting-up an effective program for prevention and making, a process labeled as "implementation gaps".
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Affiliation(s)
- Luciana K Tanno
- Hospital Sírio Libanês, São Paulo, Brazil; Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, and Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France.
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Central Hospital, FI-00029 Helsinki, Finland
| | - Moises A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Alvaro Cruz
- ProAR-Núcleo de Excelência em Asma da Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, and Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France
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Tanno LK, Molinari N, Bruel S, Bourrain JL, Calderon MA, Aubas P, Demoly P. Field-testing the new anaphylaxis' classification for the WHO International Classification of Diseases-11 revision. Allergy 2017; 72:820-826. [PMID: 27874204 DOI: 10.1111/all.13093] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND To consolidate the new classification model addressed to the allergic and hypersensitivity conditions according to the International Classification of Diseases (ICD)-11 revision timeline, we here propose real-life application of quality assurance methodology to evaluate sensitivity and accuracy of the 'Anaphylaxis' subsection. METHODS We applied field-testing methodology by analysing all the consecutive inpatients' files documented as allergies from the University Hospital of Montpellier electronic database for the period of 1 year. The files clinically validated as being anaphylaxis were manually blind-coded under ICD-10 and current ICD-11 beta draft. The correspondence of coding and the impressions regarding sensibility were evaluated. RESULTS From all 2318 files related to allergic or hypersensitivity conditions, 673 had some of the anaphylaxis ICD-10 codes; 309 files (46%) from 209 patients had anaphylaxis and allergic or hypersensitivity comorbidities description. The correspondence between the two coders was perfect for 162 codes from all 309 entities (52.4%) (Cohen-kappa value 0.63) with the ICD-10 and for 221 codes (71.5%) (Cohen-kappa value 0.77) with the ICD-11. There was a high agreement regarding sensibility of the ICD-11 usability (Cohen-kappa value 0.75). CONCLUSION We here propose the first attempt of real-life application to validate the new ICD-11 'Anaphylaxis' subsection. Clearer was the improvement in accuracy reaching 71.5% of agreement when ICD-11 was used. By allowing all the relevant diagnostic terms for anaphylaxis to be included into the ICD-11 framework, WHO has recognized their importance not only to clinicians but also to epidemiologists, statisticians, healthcare planners and other stakeholders.
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Affiliation(s)
- L. K. Tanno
- Hospital Sírio Libanês; São Paulo Brazil
- University Hospital of Montpellier; Montpellier France
- UPMC Paris 06; UMR-S 1136; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
| | - N. Molinari
- IMAG UMR 5149; DIM CHRU de Montpellier; Montpellier France
| | - S. Bruel
- University Hospital of Montpellier; Montpellier France
| | | | - M. A. Calderon
- Section of Allergy and Clinical Immunology; Imperial College London; National Heart and Lung Institute; Royal Brompton Hospital; London UK
| | - P. Aubas
- University Hospital of Montpellier; Montpellier France
| | - P. Demoly
- University Hospital of Montpellier; Montpellier France
- UPMC Paris 06; UMR-S 1136; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
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Reaching multidisciplinary consensus on classification of anaphylaxis for the eleventh revision of the World Health Organization's (WHO) International Classification of Diseases (ICD-11). Orphanet J Rare Dis 2017; 12:53. [PMID: 28302183 PMCID: PMC5356259 DOI: 10.1186/s13023-017-0607-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 03/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background Although currently misclassified in the International Classification of Diseases (ICD) and still not officially listed as a rare disease, anaphylaxis is a well-known clinical emergency. Anaphylaxis is now one of the principal headings in the “Allergic and hypersensitivity conditions” section recently compiled for the forthcoming 11th Revision of ICD (ICD-11). We here report the building process used for the pioneering “Anaphylaxis” subsection of ICD-11 in which we aimed for transparency as recommended in the ICD-11 revision guidelines. Results During an online intensive scientific and technical discussions with ICD-11 Topic Advisory Groups and Expert Working Groups, we drafted a total of 35 proposals for the classification of anaphylaxis. From all the 35 proposals, 77% were implemented, 20% remain to be implemented, and the others being partially implemented (1.5%) or rejected (1.5%). Conclusion For the first time, anaphylaxis is now properly classified and has attained greater visibility within ICD. In addition to all the benefits expected from the actions we have undertaken in updating the terminology, definitions and classification of allergic and hypersensitivity conditions for ICD-11, we strongly believe that anaphylaxis should be a public health priority and that it should therefore be formally added into the list of rare diseases in order to support awareness and quality clinical management of patients.
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Tanno LK, Calderon M, Linzer JF, Chalmers RJG, Demoly P. Collaboration between specialties for respiratory allergies in the International Classification of Diseases (ICD)-11. Respir Res 2017; 18:34. [PMID: 28187789 PMCID: PMC5301440 DOI: 10.1186/s12931-017-0513-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/18/2017] [Indexed: 11/15/2022] Open
Abstract
Background The International Classification of Diseases (ICD) has been grouping the allergic and hypersensitivity disorders involving the respiratory tract under topographic distribution, regardless of the underlying mechanisms, triggers or concepts currently in use for allergic and hypersensitivity conditions. In order to strengthen awareness and deliberate the creation of the new “Allergic or hypersensitivity disorders involving the respiratory tract” section of the ICD-11, we here propose make the building process public. Methods The new frame has been constructed to cover the gaps previously identified and was based on consensus academic reports and ICD-11 principles. Constant and bilateral discussion was kept with relevant groups representing specialties and resulted in proposals submission into the ICD-11 online platform. Results The “Allergic or hypersensitivity disorders involving the respiratory tract” section covers 64 entities distributed across five main categories. All the 79 proposals submitted resulted from an intensive collaboration of the Allergy working group, relevant Expert working groups and the WHO ICD governance. Conclusion The establishment of the ICD-11 “Allergic or hypersensitivity disorders involving the respiratory tract” section will allow the dissemination of the updated concepts to be used in clinical practice by many different specialties and health professionals.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil. .,Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 371, av. du Doyen Gaston Giraud - 34295, Montpellier Cedex, 5, France. .,Sorbonne Université, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013, Paris, France.
| | - Moises Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Jeffrey F Linzer
- Division of Pediatric Emergency Medicine, Children's Healthcare of Atlanta at Egleston, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert J G Chalmers
- Co-Chair and Managing Editor, Dermatology Topic Advisory Group, ICD-11 Revision Steering Group, University of Manchester, Manchester, UK
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 371, av. du Doyen Gaston Giraud - 34295, Montpellier Cedex, 5, France
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Tanno LK, Simons FER, Annesi-Maesano I, Calderon MA, Aymé S, Demoly P. Fatal anaphylaxis registries data support changes in the who anaphylaxis mortality coding rules. Orphanet J Rare Dis 2017; 12:8. [PMID: 28086972 PMCID: PMC5237226 DOI: 10.1186/s13023-016-0554-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/13/2016] [Indexed: 02/01/2023] Open
Abstract
Anaphylaxis is defined as a severe life-threatening generalized or systemic hypersensitivity reaction. The difficulty of coding anaphylaxis fatalities under the World Health Organization (WHO) International Classification of Diseases (ICD) system is recognized as an important reason for under-notification of anaphylaxis deaths. On current death certificates, a limited number of ICD codes are valid as underlying causes of death, and death certificates do not include the word anaphylaxis per se. In this review, we provide evidences supporting the need for changes in WHO mortality coding rules and call for addition of anaphylaxis as an underlying cause of death on international death certificates. This publication will be included in support of a formal request to the WHO as a formal request for this move taking the 11th ICD revision.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil. .,University Hospital of Montpellier, Montpellier, France. .,Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013, Paris, France.
| | - F Estelle R Simons
- Section of Allergy & Clinical Immunology, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
| | | | - Moises A Calderon
- Section of Allergy and Clinical Immunology, National Heart and Lung Institute, Royal Brompton Hospital, Imperial College London, London, UK
| | | | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013, Paris, France
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Tanno LK, Bierrenbach AL, Calderon MA, Sheikh A, Simons FER, Demoly P. Decreasing the undernotification of anaphylaxis deaths in Brazil through the International Classification of Diseases (ICD)-11 revision. Allergy 2017; 72:120-125. [PMID: 27537103 DOI: 10.1111/all.13006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND In 2012, an analysis of the Brazilian mortality database demonstrated undernotification of anaphylaxis deaths due, at least in part, to difficult coding under the International Classification of Diseases (ICD)-10. This work triggered a cascade of strategic international actions supported by the Joint Allergy Academies and the ICD World Health Organization (WHO) representatives to update the classifications of allergic disorders for the ICD-11 revision. These efforts have resulted in the construction of the new 'Allergic and hypersensitivity conditions' section under the 'Disorders of the Immune system' chapter. OBJECTIVE To analyze the capacity of the new ICD-11 revision to capture anaphylaxis deaths. METHODS We re-estimated the anaphylaxis deaths that occurred in Brazil during the period 2008 to 2010, utilizing this new framework and the database of the Brazilian mortality information system that had initially been extracted in May 2011. However, in 2016, a manual review of each of the 3638 records was performed. RESULTS We identified 639 anaphylaxis deaths, of which 95% were classified as 'definitive anaphylaxis deaths'. In contrast to the 2012 published data, we found a higher number of cases; moreover, all 606 definitive anaphylaxis deaths would be considered as underlying causes of death utilizing the ICD-11 revision. CONCLUSION This study is the first example of how the new 'Allergic and hypersensitivity conditions' section of the forthcoming ICD-11 can improve the quality of official vital statistics data and the visibility of an important public health concern. This research will facilitate comprehensive, comparable population-based epidemiologic data collection on anaphylaxis.
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Affiliation(s)
- L. K. Tanno
- Hospital Sírio Libanês; São Paulo Brazil
- University Hospital of Montpellier; Montpellier France
- UPMC Paris 06; UMR-S 1136; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
| | - A. L. Bierrenbach
- Hospital Sírio Libanês; São Paulo Brazil
- Sanas Epidemiology and Research; São Paulo Brazil
- Teaching Research Institute (IEP); Hospital Sírio Libanês; São Paulo Brazil
| | - M. A. Calderon
- Section of Allergy and Clinical Immunology; Imperial College London; National Heart and Lung Institute; Royal Brompton Hospital; London UK
| | - A. Sheikh
- Asthma UK Centre for Applied Research; Usher Institute of Population Health Sciences and Informatics; The University of Edinburgh; Edinburgh UK
| | - F. E. R. Simons
- Section of Allergy and Clinical Immunology; Department of Pediatrics & Child Health; University of Manitoba; Winnipeg MB Canada
| | - P. Demoly
- University Hospital of Montpellier; Montpellier France
- UPMC Paris 06; UMR-S 1136; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
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Tanno LK, Sublett JL, Meadows JA, Calderon M, Gross GN, Casale T, Demoly P. Perspectives on the International Classification of Diseases, 11th Revision, developments in allergy clinical practice in the United States. Ann Allergy Asthma Immunol 2016; 118:127-132. [PMID: 28010916 DOI: 10.1016/j.anai.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil; University Hospital of Montpellier, Montpellier, France; Sorbonne Universités, Paris, France.
| | - James L Sublett
- Family Allergy & Asthma, Louisville, Kentucky; Section of Allergy & Immunology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | | | - Moises Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Garry N Gross
- Department of Medicine, University of Texas Southwestern Medical School, Dallas, Texas
| | - Thomas Casale
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France; Sorbonne Universités, Paris, France
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Mukherjee M, Wyatt JC, Simpson CR, Sheikh A. Usage of allergy codes in primary care electronic health records: a national evaluation in Scotland. Allergy 2016; 71:1594-1602. [PMID: 27146325 DOI: 10.1111/all.12928] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The UK's NHS intends to move from the current Read code system to the international, detailed Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to facilitate more clinically appropriate coding of conditions and associated risk factors and outcomes. Given concerns about coding behaviour of general practitioners, we sought to study the current coding patterns in allergies and identify lessons for the future migration to SNOMED-CT. METHODS Data from 2 014 551 primary care consultations in over 100 000 patients with one or more of 11 potentially allergic diseases (anaphylaxis, angioedema, asthma, conjunctivitis, drug allergies, eczema, food allergy, rhinitis, urticaria, venom allergy and other probable allergic disorders) from the Scottish Primary Care Clinical Informatics Unit Research (PCCIU-R) database were descriptively analysed and visualized to understand Read code usage patterns. RESULTS We identified 352 Read codes for these allergic diseases, but only 36 codes (10%) were used in 95% of consultations; 73 codes (21%) were never used. Half of all usage was for Quality and Outcomes Framework codes for asthma. Despite 149 detailed codes (42%) being available for allergic triggers, these were infrequently used. CONCLUSIONS This analysis of Read codes use suggests that introduction of the more detailed SNOMED-CT, in isolation, will not improve the quality of allergy coding in Scottish primary care. The introduction of SNOMED-CT should be accompanied by initiatives aimed at improving coding quality, such as the definition of terms/codes, the availability of terminology browsers, a recommended list of codes and mechanisms to incentivize detailed coding of the condition and the underlying allergic trigger.
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Affiliation(s)
- M. Mukherjee
- Edinburgh Clinical Trials Unit (ECTU); The University of Edinburgh; Edinburgh UK
- Asthma UK Centre for Applied Research; Centre for Medical Informatics; Usher Institute of Population Health Sciences and Informatics; The University of Edinburgh; Edinburgh UK
| | - J. C. Wyatt
- Faculty of Medicine; Wessex Institute of Health & Research; University of Southampton; Southampton UK
| | - C. R. Simpson
- Asthma UK Centre for Applied Research; Centre for Medical Informatics; Usher Institute of Population Health Sciences and Informatics; The University of Edinburgh; Edinburgh UK
| | - A. Sheikh
- Asthma UK Centre for Applied Research; Centre for Medical Informatics; Usher Institute of Population Health Sciences and Informatics; The University of Edinburgh; Edinburgh UK
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Tanno LK, Calderon MA, Papadopoulos NG, Sanchez-Borges M, Moon HB, Sisul JC, Jares EJ, Sublett JL, Casale T, Demoly P. Surveying the new Allergic and hypersensitivity conditions chapter of the International Classification of Diseases (ICD)-11. Allergy 2016; 71:1235-40. [PMID: 27253871 DOI: 10.1111/all.12945] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L. K. Tanno
- Hospital Sírio Libanês; São Paulo Brazil
- University Hospital of Montpellier; Montpellier France
- UPMC Paris 06; UMR-S 1136; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
| | - M. A. Calderon
- Section of Allergy and Clinical Immunology; Imperial College London; National Heart and Lung Institute; Royal Brompton Hospital; London UK
| | - N. G. Papadopoulos
- Centre for Paediatrics and Child Health; Institute of Human Development; University of Manchester; Manchester UK
- Department of Allergy; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | - M. Sanchez-Borges
- Allergy and Clinical Immunology Department; Centro Medico Docente La Trinidad; Caracas Venezuela
| | - H.-B. Moon
- Department of Allergy and Clinical Immunology; Asia Pacific Association of Allergy and Clinical Immunology; Asan Medical Center; University of Ulsan; Seoul Korea
| | - J. C. Sisul
- Fellow of the American College of Allergy Asthma and Immunology and Latin American Society of Allergy; Asthma and Immunology, Asunción; Paraguay
| | - E. J. Jares
- LIBRA Foundation and CMP SA Buenos Aires; Buenos Aires Argentina
| | - J. L. Sublett
- Family Allergy & Asthma; University of Louisville School of Medicine; Section of Allergy & Immunology; Department of Pediatrics; University of Louisville School of Medicine; Louisville KY USA
| | - T. Casale
- American Academy of Allergy Asthma and Immunology; Morsani College of Medicine; University of South Florida; Tampa FL USA
| | - P. Demoly
- University Hospital of Montpellier; Montpellier France
- UPMC Paris 06; UMR-S 1136; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
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Smoothing the transition from International Classification of Diseases, Tenth Revision, Clinical Modification to International Classification of Diseases, Eleventh Revision. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:1265-1267. [PMID: 27546357 DOI: 10.1016/j.jaip.2016.06.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 05/31/2016] [Accepted: 06/28/2016] [Indexed: 11/23/2022]
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Tanno LK, Calderon MA, Smith HE, Sanchez-Borges M, Sheikh A, Demoly P. Dissemination of definitions and concepts of allergic and hypersensitivity conditions. World Allergy Organ J 2016; 9:24. [PMID: 27551327 PMCID: PMC4977713 DOI: 10.1186/s40413-016-0115-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Allergy and hypersensitivity can affect people of any age and manifest with problems in a range of organ systems. Moreover, they can have a significant impact on the quality of life of patients and their families. Although once rare, there is presently an epidemic of allergic disorders with associated considerable societal consequences. Our understanding of the pathophysiology of these disorders has changed substantially over the last 20 years. In the light of these developments, the Joint Allergy Academies have made concerted efforts to ensure that these are reflected in the current definitions and concepts used in clinical allergy and to ensure these are reflected in the forthcoming International Classification of Diseases-11 (ICD-11). OBJECTIVE In this review, we seek to provide an update on the current definitions and concepts in relation to allergic disorders. RESULTS Once the new section has been built in the ICD-11 to address allergic and hypersensitivity conditions, we have been moving actions to try to support awareness by disseminating updated concepts in the field. Aligned with the ICD and the WAO philosophy of being global, this document presents fundamental and broad allergy concepts to strengthen the understanding by different health professionals worldwide, besides to support the formation of in training students. CONCLUSION This current review intends to be accepted and used universally by all health professionals involved in diseases' classification and coding and, therefore, contribute to improve care and outcomes in this increasing sub-section of the world's population.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - Moises A. Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - Helen E. Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
| | - on behalf of Joint Allergy Academies
- Hospital Sírio Libanês, São Paulo, Brazil
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
- Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013 Paris, France
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Tanno LK, Calderon M, Demoly P. Supporting the validation of the new allergic and hypersensitivity conditions section of the World Health Organization International Classification of Diseases-11. Asia Pac Allergy 2016; 6:149-56. [PMID: 27489786 PMCID: PMC4967614 DOI: 10.5415/apallergy.2016.6.3.149] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/20/2016] [Indexed: 01/28/2023] Open
Abstract
Background The new International Classification of Diseases (ICD)-11 "Allergic and hypersensitivity conditions" section has been constructed as a result of a detailed and careful action plan based on scientific evidences for the necessity of changes and collaboration with the World Health Organization (WHO) ICD-11 revision governance. All the efforts are being acknowledged by the Joint Allergy Academies. Objective Considering the new classification model addressed to the allergic and hypersensitivity conditions and following the ICD WHO agenda, we believe it is the appropriate time to start supporting the validation process in collaboration with the WHO ICD governance. Methods We conducted a mapping of ICD-10 allergic and hypersensitivity conditions in the ICD-11 beta phase structure and categorized the conditions as fitting by "precoordination," "postcoordination," "indexed to the ICD-11 Foundation," "no code fit properly" or "no correspondence" in the ICD-11. Results From overall 125 ICD-10 entities spread in 6 chapters, 57.6% were able to be precoordinated, 4% postcoordinated, 12% indexed to the Foundation, 9.6% had no code fitting properly and 18.6% had no correspondence in the ICD-11 framework. Conclusion We have been able to demonstrate that 83.2% of the ICD-10 allergic and hypersensitivity conditions could be captured by the current ICD-11 beta draft framework. We strongly believe that our findings constitute a key step forward for a softer transition of the ICD-10 allergic and hypersensitivity conditions to the ICD-11, supporting the WHO in this process as well as strengthening the visibility of the Allergy specialty and ensuring quality management of allergic patients.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo 01308-050, Brazil.; Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, and Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France
| | - Moises Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, and Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France
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Ansotegui IJ, Sánchez-Borges M, Cardona V. Current Trends in Prevalence and Mortality of Anaphylaxis. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0094-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Updating Allergy and/or Hypersensitivity Diagnostic Procedures in the WHO ICD-11 Revision. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:650-7. [DOI: 10.1016/j.jaip.2016.01.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/17/2015] [Accepted: 01/13/2016] [Indexed: 11/18/2022]
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Tanno LK, Calderon MA, Demoly P. Optimization and simplification of the Allergic and Hypersensitivity conditions classification for the ICD-11. Allergy 2016; 71:671-6. [PMID: 26728868 DOI: 10.1111/all.12834] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Since 2013, an international collaboration of Allergy Academies, including first the World Allergy Organization (WAO), the American Academy of Allergy Asthma and Immunology (AAAAI), and the European Academy of Allergy and Clinical Immunology (EAACI), and then the American College of Allergy, Asthma and Immunology (ACAAI), the Latin American Society of Allergy, Asthma and Immunology (SLAAI), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI), has spent tremendous efforts to have a better and updated classification of allergic and hypersensitivity conditions in the forthcoming International Classification of Diseases (ICD)-11 version by providing evidences and promoting actions for the need for changes. The latest action was the implementation of a classification proposal of hypersensitivity/allergic diseases built by crowdsourcing the Allergy Academy leaderships. METHODS Following bilateral discussions with the representatives of the ICD-11 revision, a face-to-face meeting was held at the United Nations Office in Geneva and a simplification process of the hypersensitivity/allergic disorders classification was carried out to better fit the ICD structure. RESULTS We are here presenting the end result of what we consider to be a model of good collaboration between the World Health Organization and a specialty. CONCLUSION We strongly believe that the outcomes of all past and future actions will impact positively the recognition of the allergy specialty as well as the quality improvement of healthcare system for allergic and hypersensitivity conditions worldwide.
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Affiliation(s)
- L. K. Tanno
- Hospital Sírio Libanês; São Paulo Brazil
- University Hospital of Montpellier; Montpellier France
- UPMC Paris 06; UMR-S 1136; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
| | - M. A. Calderon
- Section of Allergy and Clinical Immunology; Imperial College London; National Heart and Lung Institute; Royal Brompton Hospital; London UK
| | - P. Demoly
- University Hospital of Montpellier; Montpellier France
- UPMC Paris 06; UMR-S 1136; IPLESP; Equipe EPAR; Sorbonne Universités; Paris France
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Tanno LK, Calderon MA, Demoly P. New Allergic and Hypersensitivity Conditions Section in the International Classification of Diseases-11. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:383-8. [PMID: 27126732 PMCID: PMC4853516 DOI: 10.4168/aair.2016.8.4.383] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 11/27/2015] [Indexed: 11/20/2022]
Abstract
Allergy and hypersensitivity, originally perceived as rare and secondary disorders, are one of the fastest growing conditions worldwide, but not adequately tracked in international information systems, such as the International Classification of Diseases (ICD). Having allergic and hypersensitivity conditions classification able to capture conditions in health international information systems in a realistic manner is crucial to the identification of potential problems, and in a wider system, can identify contextually specific service deficiencies and provide the impetus for changes. Since 2013, an international collaboration of Allergy Academies has spent tremendous efforts to have a better and updated classification of allergies in the forthcoming International Classification of Diseases (ICD)-11 version, by providing scientific and technical evidences for the need for changes. The following bilateral discussions with the representatives of the ICD-11 revision, a simplification process was carried out. The new parented "Allergic and hypersensitivity conditions" section has been built under the "Disorders of the Immune System" chapter through the international collaboration of Allergy Academies and upon ICD WHO representatives support. The classification of allergic and hypersensitivity conditions has been updated through the ICD-11 revision and will allow the aggregation of reliable data to perform positive quality-improvements in health care systems worldwide.
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Affiliation(s)
- Luciana K Tanno
- Hospital Sírio Libanês, São Paulo, Brazil.,University Hospital of Montpellier, Montpellier, and Sorbonne Universités, Paris, France
| | - Moises A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, and Sorbonne Universités, Paris, France.
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Tanno LK, Calderon MA, Papadopoulos NG, Sanchez-Borges M, Rosenwasser LJ, Bousquet J, Pawankar R, Sisul JC, Cepeda AM, Li J, Muraro A, Fineman S, Sublett JL, Katelaris CH, Chang YS, Moon HB, Casale T, Demoly P. Revisiting Desensitization and Allergen Immunotherapy Concepts for the International Classification of Diseases (ICD)-11. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:643-9. [PMID: 26969269 DOI: 10.1016/j.jaip.2015.12.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 12/27/2015] [Accepted: 12/30/2015] [Indexed: 01/29/2023]
Abstract
Allergy and hypersensitivity intervention management procedures, such as desensitization and/or tolerance induction and immunotherapy, have not been pondered up to now in the content of International Classification of Diseases (ICD) context because the focus has been on prioritizing the condition implementations. Tremendous efforts have been devoted to implementing allergic and hypersensitivity conditions in the forthcoming ICD-11. However, we consider that it is crucial now to have nomenclature and classification universally accepted for these procedures to be able to provide scientifically consistent proposals into the new ICD-11 platform for the best practice parameters of our specialty. With the aim of promoting a harmonized comprehension and aligning it with the ICD-11 revision, we have reviewed the definitions and concepts currently used for desensitization and/or tolerance induction and immunotherapy. We strongly believe that this review is a key instrument to support the allergy specialty identity into the ICD-11 framework and serves as a platform to perform positive quality improvement in clinical practice.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo, Brazil; Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, France; Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France
| | - Moises A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Nikolaos G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, United Kingdom; Department of Allergy, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Lanny J Rosenwasser
- Division of Immunology Research, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Mo
| | - Jean Bousquet
- Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, France; Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France
| | - Ruby Pawankar
- Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Juan Carlos Sisul
- American College of Allergy, Asthma and Immunology, Asunción, Paraguay
| | - Alfonso Mario Cepeda
- Latin American Society of Allergy, Asthma and Immunology, Unidad Médica Portoazul, Corredor Universitario, Puerto Colombia, Colombia
| | - James Li
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Antonella Muraro
- Department of Women and Child Health Padua General University Hospital, Padua, Italy
| | - Stanley Fineman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - James L Sublett
- Section of Allergy and Immunology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Ky
| | - Constance H Katelaris
- Department of Immunology and Allergy, Western Sydney University and Campbelltown Hospital, Sydney, NSW, Australia
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Thomas Casale
- Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, Montpellier, France; Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, Paris, France.
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Tanno LK, Calderon MA, Demoly P. Making allergic and hypersensitivity conditions visible in the International Classification of Diseases-11. Asia Pac Allergy 2015; 5:193-6. [PMID: 26539400 PMCID: PMC4630456 DOI: 10.5415/apallergy.2015.5.4.193] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/01/2015] [Indexed: 11/23/2022] Open
Abstract
Understanding that the International Classification of Diseases (ICD)-11 revision would be an opportunity to standardize the code definitions for all allergic and hypersensitivity conditions, an international collaboration of Allergy Academies, including first the World Allergy Organization, the American Academy of Allergy Asthma and Immunology and the European Academy of Allergy and Clinical Immunology, has been coordinating tremendous efforts since 2013 to provide a better classification of these disorders in the new ICD-11. During this process, a strategic action plan has been constructed to keep bilateral dialog with representatives of the ICD revision by providing them scientific and technical evidences for the need of changes in the ICD framework. As a major achievement of this process, was the construction of the "allergic and hypersensitivity conditions" parented subchapter guided by the World Health Organization ICD representatives and further supported by three more regional allergy societies: the Latin American Society of Allergy, Asthma and Immunology, the American College of Allergy Asthma and Immunology, and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology. Believing that the outcomes of all past and future actions will impact positively to the Allergy specialty, we expect for the full approval by the United Nations in 2017.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio Libanês, São Paulo 01308-050, Brazil. ; University Hospital of Montpellier, Montpellier 34090, Paris, France. ; Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013, Paris, France
| | - Moises A Calderon
- Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier 34090, Paris, France. ; Sorbonne Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, 75013, Paris, France
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Simons FER, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, Lockey RF, El-Gamal YM, Brown SG, Park HS, Sheikh A. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J 2015; 8:32. [PMID: 26525001 PMCID: PMC4625730 DOI: 10.1186/s40413-015-0080-1] [Citation(s) in RCA: 317] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis provide a unique global perspective on this increasingly common, potentially life-threatening disease. Recommendations made in the original WAO Anaphylaxis Guidelines remain clinically valid and relevant, and are a widely accessed and frequently cited resource. In this 2015 update of the evidence supporting recommendations in the Guidelines, new information based on anaphylaxis publications from January 2014 through mid- 2015 is summarized. Advances in epidemiology, diagnosis, and management in healthcare and community settings are highlighted. Additionally, new information about patient factors that increase the risk of severe and/or fatal anaphylaxis and patient co-factors that amplify anaphylactic episodes is presented and new information about anaphylaxis triggers and confirmation of triggers to facilitate specific trigger avoidance and immunomodulation is reviewed. The update includes tables summarizing important advances in anaphylaxis research.
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Affiliation(s)
- F Estelle R Simons
- Department of Pediatrics & Child Health and Department of Immunology, College of Medicine, Faculty of Health Sciences, The University of Manitoba, Room FE125, 820 Sherbrook Street, Winnipeg, R3A 1R9 MB Canada
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidad, Caracas, Venezuela
| | - Bernard Y Thong
- Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Margitta Worm
- Allergie-Centrum-Charite, Klinik fur Dermatologie, Venerologie und Allergologie, Campus Charite Mitte, Universitatsmedizin, Berlin, Germany
| | - Luciana Kase Tanno
- Department of Allergy and Clinical Immunology, Hospital Servidor Publico Estadual de Sao Paulo and Hospital Sirio-Libanes, Sao Paulo, Brazil
| | | | - Yehia M El-Gamal
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Simon Ga Brown
- Royal Hobart Hospital, Tasmania, and University of Western Australia and Royal Perth Hospital, Perth, Western Australia
| | - Hae-Sim Park
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Seoul, South Korea
| | - Aziz Sheikh
- Allergy & Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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