Representing Patient Allergies and Intolerances; Food Substances | Interoperability Standards Advisory (ISA)

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Standard	SNOMED CT®	Final	Production		No	Free	N/A

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
Feedback is requested as to the extent the suggested value sets using SNOMED CT parent and child codes for food allergens are sufficient to meet the needs for starter value set.	Adverse Clinical Reaction (2.16.840.1.113883.3.2074.1.1.30) (SNOMED CT® disorder and finding value set) Propensity to adverse reactions to food (disorder) (SNOMEDCT 418471000) is parent SNOMED CT code to: Food allergy (disorder) (SNOMEDCT 414285001) Food intolerance (disorder) (SNOMEDCT 235719002) Food Allergen (2.16.840.1.113762.1.4.1156.1) (SNOMED CT® disorder and finding value set-Steward Partners Healthcare) Common dietary substances for allergy and intolerance documentation (2.16.840.1.113762.1.4.1186.3) (SNOMED CT® disorder and finding value set-Steward HL7 Patient Care Work Group)

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

Feedback is requested as to the extent the suggested value sets using SNOMED CT parent and child codes for food allergens are sufficient to meet the needs for starter value set.

Adverse Clinical Reaction (2.16.840.1.113883.3.2074.1.1.30) (SNOMED CT® disorder and finding value set)
Propensity to adverse reactions to food (disorder) (SNOMEDCT 418471000) is parent SNOMED CT code to:
- Food allergy (disorder) (SNOMEDCT 414285001)
- Food intolerance (disorder) (SNOMEDCT 235719002)
Food Allergen (2.16.840.1.113762.1.4.1156.1) (SNOMED CT® disorder and finding value set-Steward Partners Healthcare)
Common dietary substances for allergy and intolerance documentation (2.16.840.1.113762.1.4.1186.3) (SNOMED CT® disorder and finding value set-Steward HL7 Patient Care Work Group)

Comment

Submitted by kwboone on 2017-11-20

Food substances too broad

There are over 4000 of these codes in SNOMED CT. It is still way to broad to be useful. Would suggest that a value set that would be useful would cover top 100 food items. Avoid repetition like

256349002	Peanut - dietary (substance)
229889003	Peanut brittle (substance)
102260001	Peanut butter (substance)
412047006	Peanut containing products (substance)

How many different ways do we need to say an interpret Peanut containing products? Would you feed peanuts to someone with a peanut butter allergy? That kind of clinical decision making needs to go into the making of these value sets.

UNII code system and value set is specific to FDA Product labeling and is not all that helpful for clinical use. SNOMED CT is much better suited for this purpose.

Submitted by gdixon on 2018-09-12

What is the state of UNII, its not listed

What is the state of UNII, its not listed? UNII has been problematic when implementing related to the volume of choices. SNOMED has a similar issue. Establish a top used list for Food Substances as core implementation list. Allow outliers where needed, this will improve implementation and interoperability.

Submitted by cmcdonald on 2018-10-01

UNII has broad coverage and…

UNII has broad coverage and connections to many other code systems and to chemical structures. Also includes what food and/or allergens. Would not dismiss it out of hand.

Submitted by cmcdonald on 2018-10-01

Should use the American Allergy and Immunology list

It is short (but longer than the one below), uncluttered by special forms of food and is authoritative. While any food can cause an adverse reaction, eight types of food account for about 90% of all reactions:

http://acaai.org/allergies/types/food-allergy

Eggs, Milk, Peanuts, Tree nuts, Fish, Shellfish, Wheat, Soy