GLOBAL IMPLEMENTATION OF THE WORLD HEALTH ORGANIZATION’S INTERNATIONAL CLASSIFICATION OF DISEASES (ICD)-11: THE ALLERGIC AND HYPERSENSITIVITY CONDITIONS MODEL
Luciana Kase Tanno 1,2,3,4,5* , Robert Chalmers5,6, Robert Jacob 7, Nenad Kostanjsek 7, Ana Luiza Bierrenbach1,8, Bryan Martin 9, Nicolas Molinari 10, Isabella Annesi-Maesano3, Nikolaos G. Papadopoulos11, Mario Sanchez-Borges 12 , Lanny J Rosenwasser13, Ignacio Ansontegui14, Motohiro Ebisawa15, Juan Carlos Sisul16, Edgardo Jares17, Maximiliano Gomez18, Ioana Agache19, Antonella Muraro20, Gary WK Wong 21, Francis Thien22,23, Ruby Pawankar24, Todd A. Mahr 25, James L. Sublett26, David M Lang27, Thomas Casale28, Pascal Demoly 2,3,4 , and on behalf of the Joint Allergy Academies**
1 Hospital Sírio-Libanês
2 University Hospital of Montpellier, Montpellier, France
3 Sorbonne Université, INSERM UMR-S 1136, IPLESP, Equipe EPAR, 75013, Paris, France
4 WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
5 ICD-11 Medical and Scientific Advisory Committee, WHO, Geneva
6 Centre for Dermatology, University of Manchester, UK
7 Classifications, Terminologies and Standards, World Health Organization, Geneva, Switzerland.
8 Sanas Epidemiology and Research, São Paulo, and Teaching Research Institute (IEP), Hospital Sírio Libanês, São Paulo, Brazil
9 Medicine and Pediatrics, The Ohio State University in Columbus, Ohio, USA
10 IMAG UMR 5149, DIM CHRU de Montpellier, France
11 Centre for Paediatrics and Child Health , Institute of Human Development, University of Manchester, United Kingdon and Department of Allergy, 2nd Pediatric Clinic, University of Athens, Athens, Greece
12 Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
13 Department of Pediatrics, Division of Immunology Research, Children’s Mercy Hospitals & Clinics, Kansas City, MO 64108, USA
14 Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia Erandio, Bilbao, Spain
15 Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Japan
16 Past President of the Latinalerican Society of Allergy, Asthma and Immunology and fellow of the American College of Allergy, Asthma and Immunology, Paraguay
17 LIBRA Foundation and CMP SA Buenos Aires, Argentina
18 Research & Education, Fundación Ayre. Allergy & Asthma Unit, Hospital San Bernardo. Salta, Catholic University of Salta, Argentina.
19 Transylvania University, Brasov, Romania
20 Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
21 Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
22 Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic Australia
23 Department of Respiratory Medicine, Eastern Health, Vic, Boxhill, Australia
24 Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
25 Pediatric allergy and clinical immunology, Gundersen Health System in La Crosse, USA
26 Managing Partner, Family Allergy & Asthma; Clinical Professor, Section of Allergy & Immunology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY USA
27 Department of Allergy and Clinical Immunology, Respiratory Institute , Cleveland Clinic, Ohio, USA
28 Morsani College of Medicine, University of South Florida, Tampa, FL, USA
* Corresponding author: Luciana Kase Tanno MD, PhD, Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 371, av. du Doyen Gaston Giraud - 34295, Montpellier cedex 5, France. Tel.: +33 467336107 Fax: +33 467633645
E-mail: luciana.tanno@gmail.com
** 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), Asia Pacific Academy of Pediatric Allergy, Respirology & Immunology (APAPARI), Latin American Society of Allergy, Asthma and Immunology (SLAAI)
ABSTRACT
The International Classification of Diseases (ICD) provides a common language for use worldwide as a diagnostic and classification tool for epidemiology, clinical purposes and health management. Since its first edition, the ICD has maintained a framework distributing conditions according to topography, with the result that some complex conditions, such as allergies and hypersensitivity disorders (A/H) including anaphylaxis, have been poorly represented.
The change in hierarchy in ICD-11 permitted the construction of the pioneer section addressed to A/H, which may result in more accurate mortality and morbidity statistics, including more accurate accounting for mortality due to anaphylaxis, strengthen classification, terminology and definitions. The ICD-11 was presented and adopted by the 72nd World Health Assembly in May 2019 and the implementation is ongoing worldwide.
We here present the outcomes from an online survey undertaken to reach out the allergy community worldwide in order to peer review the terminology, classification and definitions of A/H introduced into ICD-11 and to support their global implementation. Data are presented here for 406 respondents from 74 countries. All of the sub-sections of the new A/H section of the ICD-11 had been considered with good accuracy by the majority of respondents.
We believe that, in addition to help during the implementation phase, all the comments provided will help to improve the A/H classification and to increase awareness by different disciplines of what actions are needed to ensure more accurate epidemiological data and better clinical management of A/H patients.
KEY WORDS: allergy, classification, definition, hypersensitivity, International Classification of Diseases, implementation, terminology, World Health Organization
THE SCOPE OF THE PROBLEM