Categorization of allergic disorders in the new World Health Organization International Classification of Diseases

Abstract

BackgroundAlthough efforts to improve the classification of hypersensitivity/allergic diseases have been made, they have not been considered a top-level category in the International Classification of Diseases (ICD)-10 and still are not in the ICD-11 beta phase linearization. ICD-10 is the most used classification system by the allergy community worldwide but it is not considered as appropriate for clinical practice. The Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) on the other hand contains a tightly integrated classification of hypersensitivity/allergic disorders based on the EAACI/WAO nomenclature and the World Health Organization (WHO) may plan to align ICD-11 with SNOMED CT so that they share a common ontological basis.MethodsWith the aim of actively supporting the ongoing ICD-11 revision and the optimal practice of Allergology, we performed a careful comparison of ICD-10 and 11 beta phase linearization codes to identify gaps, areas of regression in allergy coding and possibly reach solutions, in collaboration with committees in charge of the ICD-11 revision.ResultsWe have found a significant degree of misclassification of terms in the allergy-related hierarchies. This stems not only from unclear definitions of these conditions but also the use of common names that falsely imply allergy. The lack of understanding of the immune mechanisms underlying some of the conditions contributes to the difficulty in classification.ConclusionsMore than providing data to support specific changes into the ongoing linearization, these results highlight the need for either a new chapter entitled Hypersensitivity/Allergic Disorders as in SNOMED CT or a high level structure in the Immunology chapter in order to make classification more appropriate and usable.

Fatal anaphylaxis registries data support changes in the who anaphylaxis mortality coding rules

“…Taking the window of opportunity presented by the ongoing ICD-11 revision, the under-notification of death data [10] triggered a cascade of strategic international actions supported by the Joint Allergy Academies and the ICD WHO governance [15–25] to update the classifications of allergic conditions for the new ICD edition. These efforts have resulted in the construction of the new “Allergic and hypersensitivity conditions” section under the “Disorders of the Immune system” chapter [21, 26].…”

Toward precision medicine and health: Opportunities and challenges in allergic diseases

“…For example, 1) what criteria should be used, and by which “official” organizations, to decide whether a proposed new “subtype” of asthma should now be generally accepted for purposes of diagnosis and treatment of individual asthmatic patients, and thereby officially included in a “new taxonomy” of asthma and allergic diseases? 20 2) What criteria should be used to decide whether a particular newly introduced “targeted treatment” (such as biologics directed at particular cytokines or their receptors, often used in conjunction with “biomarkers” that are thought to identify those patients with a “subtype” of disease that is more likely to benefit from such treatments) is clinically useful and therefore should become the standard of care? 3) What evidence is sufficient to conclude that a new “targeted” approach to prevention or treatment of allergic diseases is “cost-effective” (and what agency or groups will be entrusted to make such decisions)?…”

What can we learn in drug allergy management from World Health Organization's international classifications?

“…5,6,[11][12][13][14][15][16][17][18][19][20][21] Collaboration with the WHO ICD-11 revision governance has been intense and is ongoing so far, and all the efforts are being acknowledged by the Joint Allergy Academies.…”

“…10 However, due to the multiple ways in which these conditions may be coded, methodologies need to be developed to avoid doublecounting. Besides, the ICD-10 showed to be unable to capture accurate morbidity 12 and mortality 5 data of allergic and hypersensitivity conditions. The ICD-10 framework has initially inherited a structure from previous ICD revisions in which topographic distribution frequently takes precedence, leading to misclassification of complex and systemic disorders such as DHRs.…”