ALLERGY in ICD-11 NINTH EDITION, OCTOBER 2018

ALLERGY  IN  ICD-­‐11  

ALLERGY in ICD-11
NEWSLETTER
NEWSLETTER  
 LUCIANA KASE TANNO, PASCAL DEMOLY
LUCIANA  KASE  TANNO,  PASCAL  DEMOLY  
The  core  Allergy  in  ICD-­‐11  operational  team  (Luciana  
 
Kase  Tanno  and  Pascal  Demoly),  is  an  independent  
group  working  for  the  Allergy  specialty  worldwide  
and  represents  the  Joint  Allergy  Academies*  into  the  
ICD-­‐11  and  other  WHO  classifications.  They  are  now  
heading  the  WHO  Collaborating  Centre  on  
Classification  Scientific  Support.    

NINTH  EDITION,  OCTOBER  2018  

ADRESSED TO:
The  Joint  Allergy  Academies  executive  committees:  
-­‐ European  Academy  of  Allergy  and  Clinical  Immunology  (EAACI):  Ioana  Agache,  Antonella  Muraro,  
Nikolaos  G.  Papadopoulos,  Peter  Hellings  
-­‐ World  Allergy  Organization  (WAO):  Lanny  Rosenwasser,  Mario  Sanchez-­‐Borges,  Ignacio  Ansotegui,  
Motohiro  Ebisawa  
-­‐ American  Academy  of  Allergy  Asthma  and  Immunology  (AAAAI):  Thomas  Casale,  Robert  Lemanske,  
Thomas  Fleisher,  James  Li,  Robert  A.  Wood,  David  Lang,  David  B.  Peden  
-­‐ American  College  of  Allergy,  Asthma  and  Immunology  (ACAAI):  James  Sublet,  Bryan  L.  Martin,  
Bradley  Chipps  
-­‐ Asia  Pacific  Association  of  Allergy,  Asthma  and  Clinical  Immunology  (APAAACI):  Hee-­‐Bom  Moon,  
Francis  Thien,  Yoon-­‐Seok  Chang,  Ruby  Pawankar    
-­‐ Latin  American  Society  of  Allergy,  Asthma  and  Immunology  (SLAAI):  Juan  Carlos  Sisul,  Edgardo  Jares,  
Maximiliano  Gomez,  Maria  Susana  Repka  de  Ramirez  
-­‐ Patients’  Organization  
-­‐ Junior  members  groups  
-­‐ The  World  Health  Organization  (WHO)  representatives/  staff  and  WHO-­‐Family  of  International  
Classifications  Network    
-­‐ Non-­‐governmental  organizations  
 

+ *   Joint   Allergy   Academies:   American   Academy   of   Allergy   Asthma   and   Immunology   (AAAAI),   European  
Academy   of   Allergy   and   Clinical   Immunology   (EAACI),   World   Allergy   Organization   (WAO),   American  
College   of   Allergy   Asthma   and   Immunology   (ACAAI),   Asia   Pacific   Association   of   Allergy,   Asthma   and  
Clinical  Immunology  (APAAACI),  Latin  American  Society  of  Allergy,  Asthma  and  Immunology  (SLAAI)  
Allergy in ICD-11 NINTH EDITION, OCTOBER 2018

WHO COLLABORATING CENTRE FOR

CLASSIFICATION SCIENTIFIC SUPPORT
The  World  Health   The  main  WHO  CC  CSS  tasks  are:    
Organization  has  designated   Ø To   provide   scientific   contribution   for   elaboration  
the  Department  of   and   conservation   of   the   WHO   products   in   the  
Pulmonology  and   domain  of  classification,  terminology  and  standards.  
Addictology,  Division  of   Ø To   participate   in   continuous   quality   of   the   WHO  
Allergy,  University  Hospital  of   products,   in   particular   related   to   definitions,  
Montpellier,  as  a  WHO   evaluation   of   end-­‐users   requirements,   conceptions  
Collaborating  Centre  for   and  developments  of  trials  and  formation  activities.  
Classification  Scientific   Ø  To   contribute   in   the   development   of   translational  
Support,  headed  by  Pascal   research   with   the   WHO   networks   and   online  
Demoly  and  Luciana  Kase   platforms.  
Tanno.  
As   the   only   WHO   CC   for   classifications   of   allergic   and   hypersensitivity   conditions,   we   also  
intend   to   establish   close   collaboration   with   national   bodies   in   order   to   implement   actions  
for   better   patients’   care,   monitor   and   prevention,   developments   in   research   and   launch  
measures   in   order   to   reduce   avoidable   deaths.   Besides,   to   extend   these   actions  
internationally   with   the   support   of   the   WHO-­‐Family   of   International   Classifications,  
academic   and   scientific   networks,   the   Joint   Allergy   Academies,   stakeholders   and   patients’  
organizations.   Our   WHO   CC   will   provide   the   means   through   which   governmental   and  
nongovernmental   collaborating   parties   can   combine   their   strengths   to   achieve   focused  
objectives,  avoiding  wasting  energy  and  resources.    

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Allergy in ICD-11 NINTH EDITION, OCTOBER 2018

WHO-FIC Network Meeting

2018
Seoul, Republic of South Korea
October 22th – 27th 2018

+ Better Health Information for Universal

Health Coverage: 40 Years after Alma Ata

The heads of the WHO CC Montpellier have

been invited to be part of the WHO-Family
of International Classifications Council.
   During   these   5   intensive   days   of   the   meeting,   more   than   200   STRATEGIC GOALS FOR THE 5-
professionals   from   all   WHO   regionals   joined   to   discuss   and   YEAR WORKPLAN:
share   technical   and   political   work,   views   and   experience  
1. ICD-11
regarding   the   WHO   family   of   international   classifications   key   2. Morbidity
developments,   deliverables   and   related   strategic   goals.     The   3. Mortality
WHO-­‐FIC  Network  is  composed  by:   4. Functioning
5. ICD updates
6. Informatics for the WHO-FIC
• WHO-­‐FIC  Collaborating  Centres  
7. Primary care
•  Academic  research  Collaborating  Centres  (such  as   8. ICHI
Department  of  Pulmonology  and  Addictology,  Division  of   9. Clinical terminology
Allergy,  University  Hospital  of  Montpellier)   10. WHO-FIC development
•  Non  governmental  organizations  in  official  relations  with   11. WHO-FIC education
the  WHO     12. Implementation of WHO-FIC
• Regional  Networks  
•  Members  of  states  and  invited  guests  
Currently:    
Ø ICD-­‐11  implementation  preparations  
Ø Interventions  classification  (ICHI)  in  final  
round  of  production  
Ø Implementation  of  ICF  (Functioning,  
Disability  and  Health  Classification)  worth  
improvement  
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Allergy in ICD-11 NINTH EDITION, OCTOBER 2018

The   meeting   was   opened   by   the   WHO   Director   of   Information,  

Evidence  and  Research,  Dr.  John  Grove  and  the  Korean  Minister  of  
Health,  and  counted  with  talks  of  the  ICD-­‐11  steering  committee.    

The   WHO-­‐FIC   network,   under   specific   committees,   could   discuss  

key  priorities  and  deliverables.      

This   meeting   gave   us   the   possibility   of   exchanging   ideas   and  

discussing   the   ways   to   optimize   the   implementation   process   from  
the   Allergy   perspective.   Since   the   “Allergy   and   hypersensitivity”  
section   is   an   innovation   in   the   ICD-­‐11   framework,   we   discussed   the  
possibility   of   using   it   as   a   model   in   this   new   step   in   to   the   new  
vision  of  the  WHO.    The  meeting  provided  us  a  higher  view  of  the   +The   key   priorities  
WHO-­‐FIC   activities   and   gave   us   the   possibility   to   collaborate   with  
and   deliverables  
other   WHO   CCs   in   different   tasks.     We   understood   the   technical  
pointed  out:    
lead  and  need  of  strong  political  support  to  the  WHO  CCs.    
− Support  for  universal  
The   ICD-­‐11   gains   a   different   perspective,   adapting   to   the   new   health  coverage  and  
technologies   and   integrating   updated   knowledge.   All   the   sustainable  development  
contributions   of   the   committees   have   been   acknowledged.   The   goals  
WHO-­‐FIC   is   a   result   of   intensive   and   collaborative   work   of   different   − Initiate  constructive  and  
teams  and  professionals  with  different  expertise.     productive  dialogue  with  
ICPC3  developers  
More   than   700   posters   have   been   displayed   and   16   have   been   also   towards  a  fully  
compatible  WHO-­‐FIC  PHC  
selected  for  oral  presentation.    The  poster   Changing  the  history  of   classification  
anaphylaxis   mortality   statistics   through   the   International  
− Assist  WHO  in  the  
Classification   of   Diseases   (ICD)-­‐11   has   been   selected   and   the   development  of  ICHI  
outcomes   have   been   acknowledged.     The   core   Allergy   in   ICD-­‐11  
− Initiate  work  on  
operational   team   thank   very   much   all   the   support   and   alignment  of  the  
acknowledgement   from   the   Allergy   community   and   all   the   WHO-­‐ conceptual  and  content  
FIC   members   who   allowed   a   better   representation   in   the   model  of  the  reference  
international  classifications.   classifications  (ICD  with  
ICD  and  ICHI)  
The  Montpellier  WHO  CC  leadership  would  like  to  congratulate  and  
− The  ICD-­‐11  global  
thank   very   much   the   excellent   organization   of   this   meeting,   in   action  plan  for  
particular   by   the   WHO   staff   and   our   colleagues   from   the   Korean   implementation    
WHO  CC  –  thank  you!  

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Allergy in ICD-11 NINTH EDITION, OCTOBER 2018

CHANGING  THE  HISTORY  OF  ANAPHYLAXIS  MORTALITY  

STATISTICS  THROUGH  THE  INTERNATIONAL  
CLASSIFICATION  OF  DISEASES  (ICD)-­‐11  

HISTORIC-­‐PROSPECTIVE  ACTIONS  TO  IMPROVE  ANAPHYLAXIS  

MORTALITY  STATISTICS  

• Anaphylaxis  has  never  been  considered  underlying  cause  of  

deaths  in  deaths  certificates,  in  part  due  to  deficiencies  of  coding  
under  the  ICD  framework.  
• Research  in  Brazil  proved  the  resulting  in  under-­‐notification  of  
anaphylaxis  deaths  (Allergy  2012)  and  triggered  actions  to  have  a  
better  representation  of  allergic  and  hypersensitive  conditions  in  
ICD-­‐11  –  the  ALLERGY  in  ICD-­‐11  initiative  
• All  the  actions  of  the  ALLERGY  in  ICD-­‐11  initiative  have  been  
documented  by  peer-­‐review  publications**  and  acknowledged  by  
the  WHO  ICD  Team  
• 2015:  first  “Allergic  and  hypersensitivity  conditions”  section  in  the  
ICD-­‐11  Beta  draft,  parented  chapter  in  the  “Diseases  of  the  Immune  
System”  chapter  
• 2016-­‐2017:  Field-­‐testing  mortality  (Allergy  2016)  and  morbidity  
(Allergy  2017)  statistics  
• 2018:  -­‐  Agreement  of  adding  allergy  and  hypersensitivity  
conditions  as  underlying  cause  of  death  in  death  certificates  
• 2018-­‐2019:  Implementation  process            
CONCLUSIONS:  
Ø The  use  of  ICD-­‐11  had  a  clearer  effect  on:  
§ Accuracy  reaching  95%  for  definite  anaphylaxis  
§ Increased  sensibility:  identification  of  25%  higher    
Ø The  ICD-­‐11  “anaphylaxis”  section  endorsed  by  the  WHO  =  
recognition  as  a  real  condition,  able  to  be  properly  diagnosed  and  
managed  
Ø Immediate  consequences  of  the  ICD-­‐11  new  classification:    
2019
§ although  currently  anaphylaxis  fatalities  are  perceived  as  
Presentation
rare,  the  reported  number  of  anaphylaxis  deaths  may  
of the ICD-11
increase  
to the World
§  cases  will  be  included  in  official  mortality  statistics,  
Health
providing  a  global  standard  for  comparability  and,  
Assembly
therefore,  for  decision-­‐making  and  prevention.  

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Allergy in ICD-11 NINTH EDITION, OCTOBER 2018

TIMELINE  of  the  ICD-­‐11:  

− Implementation  process:  translation,  education,  

refinements  
− 2019:  ICD  will  be  presented  to  the  World  Health  Assembly  
− 2019-­‐2022:  implementation  in  the  national  systems  for  final  use  

+ **  ALLERGY  in  ICD-­‐11  references:  

 
https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1398-­‐9995.2012.02829.x  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405839/pdf/13601_2014_Article_1071.pdf  
https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.12386  
https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.12604  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4482039/pdf/13601_2015_Article_63.pdf  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630456/pdf/apa-­‐5-­‐193.pdf  
https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.12834  
https://www.sciencedirect.com/science/article/pii/S2213219816000210?via%3Dihub  
https://www.sciencedirect.com/science/article/pii/S2213219816000507?via%3Dihub  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853516/pdf/aair-­‐8-­‐383.pdf  
https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.12945  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967614/pdf/apa-­‐6-­‐149.pdf  
https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.13006  
https://www.sciencedirect.com/science/article/pii/S2213219816302719?via%3Dihub  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977713/pdf/40413_2016_Article_115.pdf  
https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.13093  
https://www.sciencedirect.com/science/article/pii/S108112061631273X?via%3Dihub  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5237226/pdf/13023_2016_Article_554.pdf  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301440/pdf/12931_2017_Article_513.pdf  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356259/pdf/13023_2017_Article_607.pdf  
http://www.ingentaconnect.com/content/ocean/aap/2017/00000038/00000004;jsessionid=130lco3ne1ypk.x-­‐ic-­‐live-­‐01  
https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.12973  
https://onlinelibrary.wiley.com/doi/epdf/10.1111/pai.12828  
https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.13335  
https://www.sciencedirect.com/science/article/pii/S0954611117301932?via%3Dihub  
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883526/pdf/13223_2018_Article_234.pdf  
https://www.tandfonline.com/doi/full/10.1080/1744666X.2018.1520094  
https://insights.ovid.com/pubmed?pmid=30020260