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W2950384414 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. 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. Rational disease classification dates back to Hippocrates, but the first modern medical classification considering true ontology of diseases was developed in 1735 by Carl Linnaeus, who divided diseases into 11 classes, 37 orders, and 325 species.1Pulteney R. Maton W.G. Troilius C. von Linné C. A general view of the writings of Linnaeus. J. Mawman, London1805Google Scholar Although this classification contained some errors from a modern perspective, this framework laid the foundation for work that eventually led to the first edition of the International Classification of Diseases (ICD), which was published in 1893.2Knibbs G.H. The International classification of disease and causes of death and its revision.Med J Aust. 1929; 1: 2-12Google Scholar It had been preceded in 1885 by the first “International List of Causes of Death,” which had been drafted by Jacques Bertillon and colleagues, and distinguished between systemic diseases and those localized to a particular organ or anatomic site; it was officially adopted for use in mortality registries in 1893.3Moriyama I.M. Loy R.M. Robb-Smith A.H.T. Rosenberg H.M. Hoyert D.L. History of the statistical classification of diseases and causes of death. National Center for Health Statistics, Hyattsville (MD)2011Google Scholar This classification, which was accepted by many countries, constituted the basis of the ICD. Anaphylaxis was not included in the original list of diseases because it was not formally described until 1902.3Moriyama I.M. Loy R.M. Robb-Smith A.H.T. Rosenberg H.M. Hoyert D.L. History of the statistical classification of diseases and causes of death. National Center for Health Statistics, Hyattsville (MD)2011Google Scholar Currently, most countries have been using the International Classification of Diseases, 10th Revision (ICD-10; or adaptations), for morbidity and mortality statistics. Although the ICD is generally reviewed by the World Health Organization (WHO) periodically, anaphylaxis has never been well captured in this international system. According to the WHO ICD rules, the underlying cause of death is defined as the disease or injury that initiated the train of morbid events leading directly to death.4WHO mortality Web site.https://www.who.int/topics/mortality/en/Google Scholar Although a well-known cause of death, particularly in the fields of allergy and emergency medicine, anaphylaxis has never been appropriately classified in the different versions of the ICD and has never been considered an underlying cause of death on death certificates, as demonstrated repeatedly and most recently confirmed in research performed in Brazil.5Tanno L.K. Ganem F. Demoly P. Toscano C.M. Bierrenbach A.L. Undernotification of anaphylaxis deaths in Brazil due to difficult coding under the ICD-10.Allergy. 2012; 67: 783-789Crossref PubMed Scopus (85) Google Scholar Mortality data provide a snapshot of current health problems, can point to persistent patterns of risk in specific communities, and show trends in specific causes of death over time. Many of the latter are preventable or treatable and therefore warrant the attention of public health officials.4WHO mortality Web site.https://www.who.int/topics/mortality/en/Google Scholar Mortality data provide valuable benchmarks for evaluating progress in increasing years of healthy life.6Hynes M. Mueller L.M. Li H. Amadeo F. Mortality & its risk factors in CT: 1989-1998.https://portal.ct.gov/-/media/Departments-and-Agencies/DPH/hisr/hcqsar/mortality/RiskFactorsReport/MortalityReportpdf.pdf?la=enDate accessed: January , 2019Google Scholar Adrenaline/epinephrine is the first-line treatment for anaphylaxis and therefore is listed by the WHO as an essential medication for the treatment of anaphylaxis. However, the availability of adrenaline autoinjectors (AAIs) for use in first-aid treatment is limited to just 32% of the world's 195 nations, the majority of them high-income countries.7Kase Tanno L. Demoly P. Joint Allergy AcademiesAction plan to reach the global availability of adrenaline auto-injectors.J Investig Allergol Clin Immunol. 2018; ([Epub ahead of print])Crossref Scopus (7) Google Scholar Key issues leading to the lack of availability of AAIs include high cost but also national regulations, lack of regional evidence about the value of epinephrine, and a paucity of accurate data on anaphylaxis epidemiology. Lack of accurate mortality information hinders understanding of the public health effect of anaphylaxis and of the need for appropriate therapeutic interventions and investments, such as AAIs, to reduce that effect. Because mortality monitoring is of such value to public health authorities, mortality registration is mandatory in almost all countries. Vital statistics systems record certain information on each death and periodically sum the number of deaths to calculate rates and trends. Analysis of mortality data typically involves comparisons of data sets. However, unless the data have been compiled using the same methods and according to the same standards, such comparisons have the potential to yield misleading results. For these reasons, the WHO has issued international instructions on data collection, coding, and classification and statistical presentation of causes of death. In most countries, mortality statistics are routinely compiled according to regulations and recommendations adopted by the World Health Assembly (WHA). The international mortality coding instructions presuppose that data have been collected with a death certificate conforming to the “International form of medical certificate of cause of death.”8World Health Organization International Classification of Diseases Web site.http://www.who.int/classifications/icd/en/Google Scholar It is the responsibility of the medical practitioner or other qualified certifier signing the death certificate to indicate which morbid conditions led directly to death and to state any antecedent conditions giving rise to or contributing to this cause. The WHO's mortality data reflect deaths registered by national civil death registration systems, with the underlying cause of death coded by the national authority.8World Health Organization International Classification of Diseases Web site.http://www.who.int/classifications/icd/en/Google Scholar If a condition or a disease is not considered an “underlying cause of death,” national registration systems are not able to capture related accurate data on cause of death. All definitions of anaphylaxis for clinical use by health care professionals incorporate the concept of a serious, generalized, allergic or hypersensitivity reaction that can be life-threatening and even fatal.9Simons F.E.R. Ardusso L.R. Bilò M.B. Cardona V. Ebisawa M. El-Gamal Y.M. et al.International consensus on (ICON) anaphylaxis.World Allergy Organ J. 2014; 7: 9Abstract Full Text Full Text PDF PubMed Scopus (275) Google Scholar All anaphylaxis guidelines9Simons F.E.R. Ardusso L.R. Bilò M.B. Cardona V. Ebisawa M. El-Gamal Y.M. et al.International consensus on (ICON) anaphylaxis.World Allergy Organ J. 2014; 7: 9Abstract Full Text Full Text PDF PubMed Scopus (275) Google Scholar, 10Simons F.E. Ardusso L.R. Bilò M.B. El-Gamal Y.M. Ledford D.K. Ring J. et al.World allergy organization guidelines for the assessment and management of anaphylaxis.World Allergy Organ J. 2011; 4: 13-37Abstract Full Text Full Text PDF PubMed Scopus (468) Google Scholar, 11Muraro A. Roberts G. Worm M. Bilò M.B. Brockow K. Fernández Rivas M. et al.Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology.Allergy. 2014; 69: 1026-1045Crossref PubMed Scopus (572) Google Scholar, 12Sampson H.A. Munoz-Furlong A. Campbell R.L. Adkinson Jr., N.F. Bock S.A. Branum A. et al.Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium.J Allergy Clin Immunol. 2006; 117: 391-397Abstract Full Text Full Text PDF PubMed Scopus (1380) Google Scholar, 13Lieberman P. Nicklas R.A. Oppenheimer J. Kemp S.F. Lang D.M. Bernstein D.I. et al.The diagnosis and management of anaphylaxis practice parameter: 2010 update.J Allergy Clin Immunol. 2010; 126: 477-480Abstract Full Text Full Text PDF PubMed Scopus (510) Google Scholar, 14Brown S.G. Mullins R.J. Gold M.S. Anaphylaxis: diagnosis and management.Med J Aust. 2006; 185: 283-289Crossref PubMed Scopus (109) Google Scholar consistently highlight the possibility of death during an anaphylactic episode. Anaphylaxis lethality has been estimated to be 17%.15Tanno L.K. Bierrenbach A.L. Simons F.E.R. Cardona V. Thong B.Y. Molinari N. Calderon M.A. et al.Critical view of anaphylaxis epidemiology: open questions and new perspectives.Allergy Asthma Clin Immunol. 2018; 14: 12Crossref PubMed Scopus (24) Google Scholar Good epidemiologic data are essential components for a nation's health service planning, including identifying priorities for reducing morbidity and mortality. In the case of anaphylaxis, however, there are only a limited number of population-based epidemiologic studies of mortality, particularly in the case of low- and middle-income countries.15Tanno L.K. Bierrenbach A.L. Simons F.E.R. Cardona V. Thong B.Y. Molinari N. Calderon M.A. et al.Critical view of anaphylaxis epidemiology: open questions and new perspectives.Allergy Asthma Clin Immunol. 2018; 14: 12Crossref PubMed Scopus (24) Google Scholar, 16Tanno L.K. Simons F.E.R. Annesi-Maesano I. Calderon M. Aymé S. Demoly P. Fatal anaphylaxis registries data support changes in the WHO Anaphylaxis Mortality Coding Rules.Orphanet J Rare Dis. 2017; 12: 8Crossref PubMed Scopus (24) Google Scholar, 17Turner P.J. Gowland M.H. Sharma V. Ierodiakonou D. Harper N. Garcez T. et al.Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012.J Allergy Clin Immunol. 2015; 135: 956-963Abstract Full Text Full Text PDF PubMed Scopus (349) Google Scholar, 18Pouessel G. Tanno L.K. Claverie C. Lejeune S. Labreuche J. Dorkenoo A. et al.Fatal anaphylaxis in children in France: analysis of national data.Pediatr Allergy Immunol. 2018; 29: 101-104Crossref PubMed Scopus (13) Google Scholar, 19Ansotegui I.J. Sánchez-Borges M. Cardona V. Current trends in prevalence and mortality of anaphylaxis.Curr Treat Options Allergy. 2016; 3: 205-211Crossref Scopus (8) Google Scholar, 20Pouessel G. Claverie C. Labreuche J. Dorkenoo A. Renaudin J.M. Eb M. et al.Fatal anaphylaxis in France: analysis of national anaphylaxis data, 1979-2011.J Allergy Clin Immunol. 2017; 140: 610-612Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 21Xu Y.S. Kastner M. Harada L. Xu A. Salter J. Waserman S. Anaphylaxis-related deaths in Ontario: a retrospective review of cases from 1986 to 2011.Allergy Asthma Clin Immunol. 2014; 10: 38Crossref PubMed Scopus (73) Google Scholar, 22Jerschow E. Lin R.Y. Scaperotti M.M. McGinn A.P. Fatal anaphylaxis in the United States, 1999-2010: temporal patterns and demographic associations.J Allergy Clin Immunol. 2014; 134: 1318-1328Abstract Full Text Full Text PDF PubMed Scopus (216) Google Scholar, 23Mullins R.J. Wainstein B.K. Barnes E.H. Liew W.K. Campbell D.E. Increases in anaphylaxis fatalities in Australia from 1997 to 2013.Clin Exp Allergy. 2016; 46: 1099-1110Crossref PubMed Scopus (132) Google Scholar, 24Kivistö J.E. Dunder T. Protudjer J.L. Karjalainen J. Huhtala H. Mäkelä M.J. Adult but no pediatric anaphylaxis-related deaths in the Finnish population from 1996 to 2013.J Allergy Clin Immunol. 2016; 138: 630-632Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 25Tanno L.K. Calderon M.A. Goldberg B.J. Akdis C.A. Papadopoulos N.G. Demoly P. Categorization of Allergic Disorders in the New World Health Organization International Classification of Diseases.Clin Transl Allergy. 2014; 4: 42Crossref PubMed Scopus (46) Google Scholar Underrecognition and undernotification of anaphylaxis led to sparse data and contributed to lack of recognition of the importance of anaphylaxis and the consequent neglect of health care strategies for improving diagnosis, treatment, and prevention at many levels of the health care system. In 2012, we estimated the magnitude of undernotification and underreporting of anaphylaxis-related deaths using information derived from both the underlying and contributing causes of death data from the Brazilian Mortality Information System (Sistema de Informação sobre Mortalidade). In this study we analyzed all 3,296,247 death records from 2008 to 2010 using ICD-10 and found a total of 498 anaphylaxis-related deaths based on secondary data, with an average anaphylaxis-related death rate of 0.87/million/y categorized as “definitive” or “possible” cases.5Tanno L.K. Ganem F. Demoly P. Toscano C.M. Bierrenbach A.L. Undernotification of anaphylaxis deaths in Brazil due to difficult coding under the ICD-10.Allergy. 2012; 67: 783-789Crossref PubMed Scopus (85) Google Scholar We considered as “possible anaphylaxis-related deaths” cases that had an isolated allergic or hypersensitivity clinical condition listed as a contributing cause of death (eg, angioedema or urticaria). We decided that such conditions, unless presented together with other more specific anaphylaxis codes, could only rarely be considered an underlying cause of death. All records described as anaphylaxis or having an allergic or hypersensitivity condition as the underlying cause of death associated with the possible trigger as contributing mortality data were classified as “definitive anaphylaxis-related deaths.” The remaining and unspecified cases (eg, missing immediate cause of death in the death certificates) were considered “death unrelated to anaphylaxis,” such as cases of septic shock. Two coders were responsible for the analysis, and there was a high agreement on classification procedures between them (Cohen κ value = 0.91).5Tanno L.K. Ganem F. Demoly P. Toscano C.M. Bierrenbach A.L. Undernotification of anaphylaxis deaths in Brazil due to difficult coding under the ICD-10.Allergy. 2012; 67: 783-789Crossref PubMed Scopus (85) Google Scholar The most striking observation derived from this study was that none of these deaths would have been attributed to anaphylaxis had we exclusively considered information from the underlying cause-of-death field.5Tanno L.K. Ganem F. Demoly P. Toscano C.M. Bierrenbach A.L. Undernotification of anaphylaxis deaths in Brazil due to difficult coding under the ICD-10.Allergy. 2012; 67: 783-789Crossref PubMed Scopus (85) Google Scholar The study called attention to the need for better coding not only for anaphylaxis-related deaths but also for all allergic and hypersensitivity conditions, which would otherwise be misclassified in ICD-10 and early International Classification of Diseases, 11th Revision (ICD-11; May 2014 version).26WHO International Classification of Diseases 10th edition (2016 version) Web site.https://icd.who.int/browse10/2016/enGoogle Scholar The timing of the study was opportune because the ICD-11 revision process was underway. An important reason for this misclassification is the difficulty of coding anaphylaxis fatalities under the WHO ICD system. In the ICD-10 (2016 version) platform,26WHO International Classification of Diseases 10th edition (2016 version) Web site.https://icd.who.int/browse10/2016/enGoogle Scholar anaphylaxis is classified under the “XIX Injury, poisoning and certain other consequences of external causes” chapter, specifically the “T78 Adverse effects, not elsewhere classified” section. It is striking that only severe cases of anaphylaxis are listed under the same category (“T78.2 Anaphylactic shock”) and that it is classified at the same level of “anaphylactic shock due to adverse food reaction,” “angioneurotic edema,” and “allergy, unspecified.” Causes of deaths are classified and grouped according to the ICD edition in use at the time, and the information on death certificates is collected by using the international form recommended by the WHO. However, a limited number of ICD-10 codes are considered to be valid for representing underlying causes of death on current death certificates, and with regard to anaphylaxis as such, there are simply no valid codes (Fig 1). Under development since 2007, ICD-11 is intended not only to rectify deficiencies in ICD-10 and to incorporate changes driven by scientific advances but also to take advantage of the revolution in electronic data handling since the publication of ICD-10 a quarter of a century ago.8World Health Organization International Classification of Diseases Web site.http://www.who.int/classifications/icd/en/Google Scholar ICD-11 can be regarded as a suite of classifications based on a detailed and comprehensive polyhierarchical Web-like Foundation (Fig 2) in which any single disease entity can be represented in more than 1 location.27Tanno L.K. Simons F.E.R. Sanchez-Borges M. Cardona V. Moon H.B. Calderon M.A. et al.Applying prevention concepts to anaphylaxis: a call for worldwide availability of adrenaline auto-injectors.Clin Exp Allergy. 2017; 47: 1108-1114Crossref PubMed Scopus (21) Google Scholar Considering the ICD-11 revision as a key window of opportunity, a detailed action plan was coordinated under the ALLERGY in ICD-11 Initiative (led by L.K.T. and P.D.), with the aim of creating a more appropriate classification for allergic and hypersensitivity conditions in this new edition of the ICD-11. Subsequently, we have produced technical and scientific evidence demonstrating the need for classification and coding changes, and we have participated in an ongoing dialogue with the WHO ICD-11 revision governance team. All these efforts have been documented in peer-reviewed publications5Tanno L.K. Ganem F. Demoly P. Toscano C.M. Bierrenbach A.L. Undernotification of anaphylaxis deaths in Brazil due to difficult coding under the ICD-10.Allergy. 2012; 67: 783-789Crossref PubMed Scopus (85) Google Scholar, 7Kase Tanno L. Demoly P. Joint Allergy AcademiesAction plan to reach the global availability of adrenaline auto-injectors.J Investig Allergol Clin Immunol. 2018; ([Epub ahead of print])Crossref Scopus (7) Google Scholar, 15Tanno L.K. Bierrenbach A.L. Simons F.E.R. Cardona V. Thong B.Y. Molinari N. Calderon M.A. et al.Critical view of anaphylaxis epidemiology: open questions and new perspectives.Allergy Asthma Clin Immunol. 2018; 14: 12Crossref PubMed Scopus (24) Google Scholar, 16Tanno L.K. Simons F.E.R. Annesi-Maesano I. Calderon M. Aymé S. Demoly P. Fatal anaphylaxis registries data support changes in the WHO Anaphylaxis Mortality Coding Rules.Orphanet J Rare Dis. 2017; 12: 8Crossref PubMed Scopus (24) Google Scholar, 25Tanno L.K. Calderon M.A. Goldberg B.J. Akdis C.A. Papadopoulos N.G. Demoly P. Categorization of Allergic Disorders in the New World Health Organization International Classification of Diseases.Clin Transl Allergy. 2014; 4: 42Crossref PubMed Scopus (46) Google Scholar, 27Tanno L.K. Simons F.E.R. Sanchez-Borges M. Cardona V. Moon H.B. Calderon M.A. et al.Applying prevention concepts to anaphylaxis: a call for worldwide availability of adrenaline auto-injectors.Clin Exp Allergy. 2017; 47: 1108-1114Crossref PubMed Scopus (21) Google Scholar, 28Tanno L.K. Demoly P. One voice for anaphylaxis in France: the vision of the Centre of Reference in Rare Diseases.Rev Fr Allergol. 2017; 57: 583-587Crossref Scopus (2) Google Scholar, 29Tanno L.K. Calderon M.A. Demoly P. on behalf the Joint Allergy AcademiesNew Allergic and Hypersensitivity Conditions section in the International Classification of Diseases-11.Allergy Asthma Immunol Res. 2016; 8: 383-388Crossref PubMed Scopus (36) Google Scholar, 30Demoly P. Tanno L.K. Akdis C.A. Lau S. Calderon M.A. Santos A.F. et al.Global classification and coding of hypersensitivity diseases—An EAACI–WAO survey, strategic paper and review.Allergy. 2014; 69: 559-570Crossref PubMed Scopus (51) Google Scholar, 31Tanno L.K. Calderon M.A. Goldberg B.J. Gayraud J. Bircher A.J. Casale T. et al.Constructing a classification of hypersensitivity/allergic diseases for ICD-11 by crowdsourcing the allergist community.Allergy. 2015; 70: 609-615Crossref PubMed Scopus (50) Google Scholar, 32Tanno L.K. Calderon M. Papadopoulos N.G. Demoly P. Mapping hypersensitivity/allergic diseases in the International Classification of Diseases (ICD)-11: cross-linking terms and unmet needs.Clin Transl Allergy. 2015; 5: 20Crossref PubMed Scopus (34) Google Scholar, 33Tanno L.K. Calderon M.A. Demoly P. on behalf the Joint Allergy AcademiesMaking allergic and hypersensitivity conditions visible in the International Classification of Diseases-11.Asian Pac Allergy. 2015; 5: 193-196Crossref PubMed Google Scholar, 34Tanno L.K. Calderon M.A. Demoly P. on behalf the Joint Allergy AcademiesOptimization and simplification of the allergic and hypersensitivity conditions classification for the ICD-11.Allergy. 2016; 71: 671-676Crossref PubMed Scopus (27) Google Scholar, 35Tanno L.K. Calderon M.A. Papadopoulos N.G. Sanchez-Borges M. Rosenwasser L.J. Bousquet J. et al.Revisiting desensitization and allergen immunotherapy concepts for the International Classification of Diseases (ICD)-11.J Allergy Clin Immunol Pract. 2016; 4: 643-649Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 36Tanno L.K. Calderon M.A. Li J. Casale T. Demoly P. Updating Allergy/Hypersensitivity diagnostic procedures in the WHO ICD-11 revision.J Allergy Clin Immunol Pract. 2016; 4: 650-657Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 37Tanno L.K. Calderon M.A. Papadopoulos N.G. Sanchez-Borges M. Moon H.B. Sisul J.C. et al.Surveying the new allergic and hypersensitivity conditions chapter of the International classification of diseases (ICD)-11.Allergy. 2016; 71: 1235-1240Crossref PubMed Scopus (21) Google Scholar, 38Tanno L.K. Calderon M. Demoly P. Joint Allergy AcademiesSupporting 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: 149-156Crossref PubMed Google Scholar, 39Tanno L.K. Calderon M. Sublett J.L. Casale T. Demoly P. Joint Allergy AcademiesSmoothing the transition from International Classification of Diseases, Tenth Revision, Clinical Modification to International Classification of Diseases, Eleventh Revision.J Allergy Clin Immunol Pract. 2016; 4: 1265-1267Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 40Tanno L.K. Calderon M.A. Smith H.E. Sanchez-Borges M. Sheikh A. Demoly P. et al.Dissemination of definitions and concepts of allergic and hypersensitivity conditions.World Allergy Organ J. 2016; 9: 24Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 41Tanno L.K. Bierrenbach A.L. Calderon M.A. Sheikh A. Simons F.E. Demoly P. et al.Decreasing the undernotification of anaphylaxis deaths in Brazil through the International Classification of Diseases (ICD)-11 revision.Allergy. 2017; 72: 120-125Crossref PubMed Scopus (33) Google Scholar, 42Tanno L.K. Ansotegui I. Demoly P. Globalization and anaphylaxis.Curr Opin Allergy Clin Immunol. 2018; 18: 365-369Crossref PubMed Scopus (5) Google Scholar, 43Tanno L.K. Casale T. Papadopoulos N.G. Sanchez-Borges M. Thiens F. Pawankar R. et al.A call to arms of specialty societies to review the WHO International Classification of Diseases, Eleventh Revision terms appropriate for the diseases they manage: the example of the Joint Allergy Academies.Allergy Asthma Proc. 2017; 38: 54-55Crossref PubMed Scopus (4) Google Scholar and are being acknowledged and supported by the Joint Allergy Academies comprising the American Academy of Allergy, Asthma & Immunology; the European Academy of Allergy and Clinical Immunology; the World Allergy Organization; the American College of Allergy, Asthma & Immunology; the Asia Pacific Association of Allergy, Asthma and Clinical Immunology; and the Latin American Society of Allergy, Asthma and Immunology.43Tanno L.K. Casale T. Papadopoulos N.G. Sanchez-Borges M. Thiens F. Pawankar R. et al.A call to arms of specialty societies to review the WHO International Classification of Diseases, Eleventh Revision terms appropriate for the diseases they manage: the example of the Joint Allergy Academies.Allergy Asthma Proc. 2017; 38: 54-55Crossref PubMed Scopus (4) Google Scholar The main outcome of this process has been construction of the section titled “Allergic and hypersensitivity conditions” under the new “Immune system disorders” chapter of ICD-11.16Tanno L.K. Simons F.E.R. Annesi-Maesano I. Calderon M. Aymé S. Demoly P. Fatal anaphylaxis registries data support changes in the WHO Anaphylaxis Mortality Coding Rules.Orphanet J Rare Dis. 2017; 12: 8Crossref PubMed Scopus (24) Google Scholar, 44World Health Organization ICD-11 Beta Draft Web site.http://apps.who.int/classifications/icd11/browse/l-m/enGoogle Scholar By consolidating all allergic conditions into a single ICD-11 section rather than distributing them over many chapters, as in ICD-10, and by allowing all the relevant codes to be used for mortality and morbidity outcomes, we aimed to make it simpler for clinicians, epidemiologists, statisticians, data custodians, and other relevant personnel to locate and document allergic disorders (Fig 1). As part of the validation process of this new framework, we analyzed the capacity of ICD-11 to capture anaphylaxis deaths by coding the original Brazilian data set of deaths attributed to anaphylaxis during the period 2008 to 2010 using ICD-11.5Tanno L.K. Ganem F. Demoly P. Toscano C.M. Bierrenbach A.L. Undernotification of anaphylaxis deaths in Brazil due to difficult coding under the ICD-10.Allergy. 2012; 67: 783-789Crossref PubMed Scopus (85) Google Scholar In 2016, a manual review of each of the records was performed. As a result, we identified 639 anaphylaxis-related deaths, of which 95% were classified as “definite anaphylaxis-related deaths.”41Tanno L.K. Bierrenbach A.L. Calderon M.A. Sheikh A. Simons F.E. Demoly P. et al.Decreasing the undernotification of anaphylaxis deaths in Brazil through the International Classification of Diseases (ICD)-11 revision.Allergy. 2017; 72: 120-125Crossref PubMed Scopus (33) Google Scholar In contrast to the 2012 published data, we found a greater number of cases; moreover, all 606 definite anaphylaxis-related deaths would be considered as underlying causes of death using ICD-11. Even more striking was the effect on accuracy, reaching 95% for definite anaphylaxis-related deaths when ICD-11 was used. This study was the first example of how the new “Allergic and hypersensitivity conditions” section of the forthcoming ICD-11 can improve the quality and accuracy of official vital statistics data and the visibility of an important public health concern (Fig 3).5Tanno L.K. Ganem F. Demoly P. Toscano C.M. Bierrenbach A.L. Undernotification of anaphylaxis deaths in Brazil due to difficult coding under the ICD-10.Allergy. 2012; 67: 783-789Crossref PubMed Scopus (85) Google Scholar, 41Tanno L.K. Bierrenbach A.L. Calderon M.A. Sheikh A. Simons F.E. Demoly P. et al.Decreasing the undernotification of anaphylaxis deaths in Brazil through the International Classification of Diseases (ICD)-11 revision.Allergy. 2017; 72: 120-125Crossref PubMed Scopus (33) Google Scholar Changes have been made to give allergic and hypersensitivity disorders greater representation in ICD-11. During the revision process, we have been in close contact with the WHO Mortality Reference Group because of our concerns that neither anaphylaxis nor other specified allergies could be officially considered underlying causes of death in the death certificate. A systematic review confirmed that countries other than Brazil have faced the same problem with recording anaphylaxis-related mortality methods.15Tanno L.K. Bierrenbach A.L. Simons F.E.R. Cardona V. Thong B.Y. Molinari N. Calderon M.A. et al.Critical view of anaphylaxis epidemiology: open questions and new perspectives.Allergy Asthma Clin Immunol. 2018; 14: 12Crossref PubMed Scopus (24) Google Scholar The result of our deliberations with the Mortality Reference Group is that coding rules have been changed by the addition of allergic conditions, including anaphylaxis, as underlying causes of deaths in official mortality statistics. ICD-11 was released in June 2018 in preparation for presentation to the WHA in May 2019.7Kase Tanno L. Demoly P. Joint Allergy AcademiesAction plan to reach the global availability of adrenaline auto-injectors.J Investig Allergol Clin Immunol. 2018; ([Epub ahead of print])Crossref Scopus (7) Google Scholar In June 2018, the WHO designated the University of Montpellier an official World Health Organization Collaborating Centre (WHO CC) for Classification Scientific Support, with Drs Tanno and Demoly as heads. This designation as the only WHO CC addressed to classification of allergic and hypersensitivity conditions is the result of recognition by the WHO of the work done by the ALLERGY in ICD-11 Initiative in providing academic, research, and scientific support to the WHO in the areas of our expertise in the implementation, refinement, and maintenance of the WHO Family of International Classifications (Fig 2).45WHO Web site WHO Collaborating Centres.http://apps.who.int/whocc/Detail.aspx?cc_ref=FRA-133&designation_date1=1/6/2018&designation_date2=18/7/2018&Google Scholar Once ICD-11 has been approved by the WHA, the process of implementation of ICD-11 into each country's health information systems will be formally started, and the use of ICD-11 is scheduled to January 2022. Once implemented, there will likely be 2 immediate consequences of the use of the new classification based on the logic of ICD-11: (1) the number of reported anaphylaxis-related deaths might increase and (2) inclusion of cases in official mortality statistics will provide a global standard for comparability and therefore for decision making and prevention. Because knowledge derived from populations is key information for more realistic decision making, the construction of the new section of ICD-11 addressing allergic and hypersensitivity conditions will facilitate collection of more accurate epidemiologic data. Ultimately, this will result in better health care planning to implement public health measures for prevention and reduction of the morbidity and mortality attributable to these conditions reflecting higher-quality patient management. As a continuation of the achievements in ICD-11, the heads of the WHO CC representing allergy (L.K.T. and P.D.) are working in an evidence-based process, together with allergy academies, experts, and stakeholders, to reach global availability of AAIs.7Kase Tanno L. Demoly P. Joint Allergy AcademiesAction plan to reach the global availability of adrenaline auto-injectors.J Investig Allergol Clin Immunol. 2018; ([Epub ahead of print])Crossref Scopus (7) Google Scholar Timely introduction of the new classification of allergic and hypersensitivity disorders in ICD-11 can be considered a much-needed milestone in the history of the allergy specialty. More reliable, accurate, comprehensive, and comparable anaphylaxis epidemiologic data are expected in the forthcoming years. This technical, economic, and political move might provide a more representative global picture of these conditions and is expected to support improvements in the management of allergic disorders worldwide. We thank all the representatives of the ICD-11 revision with whom we have been carrying on fruitful discussions, helping us fine-tune the presented classification: Robert Jakob, Linda Best, Nenad Kostanjsek, Linda Moskal, Robert J. G. Chalmers, Jeffrey Linzer, Linda Edwards, Ségolène Ayme, Bertrand Bellet, Rodney Franklin, Matthew Helbert, August Colenbrander, Satoshi Kashii, Paulo E. C. Dantas, Christine Graham, Ashley Behrens, Julie Rust, Megan Cumerlato, Tsutomu Suzuki, Mitsuko Kondo, Hajime Takizawa, Nobuoki Kohno, Soichiro Miura, Nan Tajima, and Toshio Ogawa." @default.
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W2950384414 date "2019-09-01" @default.
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W2950384414 title "Changing the history of anaphylaxis mortality statistics through the World Health Organization's International Classification of Diseases–11" @default.
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W2950384414 doi "https://doi.org/10.1016/j.jaci.2019.05.013" @default.
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