Optimization of the allergen classification of the International Classification Of Diseases, 11th Revision (ICD-11)

Luciana Kase Tanno; Yann Briand; Mélissa Mary; David A Khan; James L Sublett; Mark L Corbett; Ruby Pawankar; Stefano Del Giacco; Maria Jose Torres; Ignacio J Ansontegui; Motohiro Ebisawa; Bryan Martin; Pascal Demoly; American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; the Asia Pacific Association of Allergy, Asthma and Clinical Immunology; the European Academy of Allergy and Clinical Immunology; and the World Allergy Organization

doi:10.1016/j.jaci.2023.03.019

Optimization of the allergen classification of the International Classification Of Diseases, 11th Revision (ICD-11)

J Allergy Clin Immunol. 2023 Jun;151(6):1655-1659.e3. doi: 10.1016/j.jaci.2023.03.019. Epub 2023 Apr 4.

Authors

Luciana Kase Tanno¹, Yann Briand², Mélissa Mary³, David A Khan⁴, James L Sublett⁵, Mark L Corbett⁶, Ruby Pawankar⁷, Stefano Del Giacco⁸, Maria Jose Torres⁹, Ignacio J Ansontegui¹⁰, Motohiro Ebisawa¹¹, Bryan Martin¹², Pascal Demoly¹³; American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; the Asia Pacific Association of Allergy, Asthma and Clinical Immunology; the European Academy of Allergy and Clinical Immunology; and the World Allergy Organization

Affiliations

¹ Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France; Desbrest Institute of Epidemiology and Public Health, University of Montpellier-INSERM, Montpellier, France; World Health Organization (WHO) Collaborating Centre on Scientific Classification Support, Montpellier, France. Electronic address: luciana.tanno@gmail.com.
² Agence Numerique de Santé, Paris, France; French WHO Collaborating Centre, Paris, France.
³ Agence Numerique de Santé, Paris, France.
⁴ Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex.
⁵ Family Allergy and Asthma, Louisville, Ky; Section of Allergy and Immunology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Ky; University of Louisville School of Medicine, Louisville, Ky.
⁶ University of Louisville School of Medicine, Louisville, Ky.
⁷ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁸ Department of Medical Sciences and Public Health, University of Cagliari, Monserrato-Cagliari, Italy.
⁹ Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina, Universidad de Málaga, Málaga, Spain.
¹⁰ Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia Erandio, Bilbao, Spain.
¹¹ Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan.
¹² Medicine and Pediatrics, The Ohio State University, Columbus, Ohio.
¹³ Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France; Desbrest Institute of Epidemiology and Public Health, University of Montpellier-INSERM, Montpellier, France; World Health Organization (WHO) Collaborating Centre on Scientific Classification Support, Montpellier, France.

PMID: 37019392
DOI: 10.1016/j.jaci.2023.03.019

Abstract

Background: Accurate diagnosis of triggers or causative allergens is essential for appropriate risk assessment, providing correct advice to patients with allergy and their caregivers and personalized treatment. However, allergens have never been represented in the World Health Organization International Classification of Diseases (ICD).

Objective: In this article, we present the process of selection of allergens to better fit the ICD, 11th Revision (ICD-11) structure and the outcomes of this process.

Methods: The Logical Observation Identifiers Names and Codes database, containing 1444 allergens, was used as the basis for the selection process. Two independent experts were responsible for the first selection of the allergens according to specific technical criteria. The second step of the selection process was based on real-life relevance of the allergens according to the frequency of requests regarding each of them.

Results: We selected 1109 allergens (76.8%) from all 1444 present in the Logical Observation Identifiers Names and Codes database, with considerable agreement between experts (Cohen κ = 8.6). After assessment of real-life data, 297 additional relevant allergens worldwide were selected and grouped as plants (36.4%), drugs (32.6%), animal proteins (21%), mold and other microorganisms (1.5%), occupational allergens (0.4%), and miscellaneous allergens (0.5%).

Conclusion: The stepwise approach allowed us to select the most relevant allergens in practice, which is the first step to building a classification of allergens for the WHO ICD-11. Aligned with the achievement in the construction of the pioneer section addressed to the allergic and hypersensitivity conditions in the ICD-11, the introduction of a classification for allergens can be considered timely and much needed in clinical practice.

Keywords: Allergy; International Classification of Diseases; World Health Organization; allergens; classification; coding; epidemiology; hypersensitivity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Allergens*
Databases, Factual
Humans
Hypersensitivity* / diagnosis
International Classification of Diseases
World Health Organization

Substances

Allergens