Use this page to provide your feedback about the Guide for Using LOINC Allergy Terms and/or to review the comments that other users have already submitted. All of these comments will be considered for future versions of the guide.
If you need help or have a question or comment that is not related to the Guide for Using LOINC Allergy Terms document, please submit it through the Contact Us page.
Deadline for comments was August 14, 2020
Comments
Entire Document
Good document. I have been in the LOINC game for a while now and it was great to get a review on the topic.
One item I found, the LOINC on page 11 94591-1 is not as described. Said to be a Multiplex allergen panel -Serum or Plasma. When you click the link it is a non-valid LOINC for Chromosome rearrangement -Blood or Tissue.
For the options on LOINC Panels. I prefer option 2 the "naked" panel. I think it helps free up Order mapping, by not having such a strict set of children pre-assigned
Chris Gordon, 3M
6 months ago
Chris, thank you for your feedback. The Multiplex panel code should be 94593-1 (https://loinc.org/94593-1/). I updated the code and the link in the working copy.
Swapna Abhyankar, Regenstrief Institute
6 months ago
I would tend to agree with Daniel Rutz in that the purpose of this guide is not clear as it is named. In vitro allergy tests comprise not only IgE but also IgA, IgG/IgG4, IgM. There are also the LHR tests and immunodiffusion for precipitating abs. If the intent is to just represent IgE and LHR then the document name should indicate immediate (type I) allergy. The role of abs other than IgE in allergy is controversial
Bruce Goldberg, Kaiser Permanente
6 months ago
Bruce, thank you for your comment. The purpose is to describe the set of LOINC allergy lab terms that currently exist and to help people choose the ones that best correspond to their tests. We left out some types of existing terms and will add those for the next round.
Also, we are planning to rename the series "LOINC Mapping Guides" and then add the specific domain for each individual guide - e.g., LOINC Mapping Guides - Microbiology lab tests, LOINC Mapping Guides - Allergy lab tests.
Swapna Abhyankar, Regenstrief Institute
5 months ago
Agree there are several mechanisms for testing allergens, both by clinical settings (skin prick tests, etc) and laboratory testing. Aside from the Allergen Class (which is Type 1- Lab), there is the SKINCHAL Class (also Type 1-Lab). Perhaps the introduction could be redone to allude to both and apply a new section to the SKINCHAL entries (the Wheal reactions to different precipitins). This is the extent of submissions from the public, so a note that domain will be augmented when public requests.
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
Pam, thanks for your comment. The purpose is to describe the allergy lab testing terms in LOINC. We need to review the SKINCHAL terms - I'm not sure that they belong in Type 1-Lab. We will be updating the introduction to clarify the purpose of this guide for the next draft.
Swapna Abhyankar, Regenstrief Institute
5 months ago
1 Introduction
1.1 Scope of this Guide
Re: the introduction, & in fact the name of the guide itself, it is not at all clear that this guide is simply about LOINC codes for the laboratory tests which assess IgE levels in a specimen. The name of the guide, "LOINC Allergy Terms" is misleading and indicates it's a LOINC-based categorization for assessments of a patient's allergies (a fraught topic that HL7/Dave Parker partially tackled several years ago).
I suggest revising the name to "LOINC Allergen Lab Testing Terms" & intro too*
Daniel Rutz, Epic
6 months ago
Dan, thanks for your comment. We are going to update the introduction to clarify the purpose (describing the set of LOINC allergy lab terms that currently exist and helping people choose the right ones). We also plan to rename the series "LOINC Mapping Guides" and then add the specific domain for each individual guide - e.g., LOINC Mapping Guides - Allergy lab tests.
This guide definitely does not cover LOINC-based categorization for assessments of a patient's allergies! =)
Swapna Abhyankar, Regenstrief Institute
5 months ago
1.2 Conventions used in this guide
1.2.2 Key points - the examples given don't pertain to Allergens (Positive/Negative/3 mg/dL). You could use Rast Class 0-6 to portray LOINC Scale -->Ordinal and units of kU/L to portray LOINC Scale --> Quantitative
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
Good point! We will update the examples.
Swapna Abhyankar, Regenstrief Institute
5 months ago
2 Choosing the right Component
2.1 General rules for naming Components in allergy
As LOINC has codes for many allergen mixes as well as for discrete order panels, these should be contrasted with a few examples in the same rather than separate sections.
Bruce Goldberg, Kaiser Permanente
6 months ago
Good point - we are trying to present information based on the LOINC term structure followed by other relevant information (e.g., panels), but I agree that pointing out the differences and giving some examples in the same section would be useful. We will add this for the next draft.
Swapna Abhyankar, Regenstrief Institute
5 months ago
2.1 General rules for naming Components in allergy
2.1.2 Allergen Codes
the code f1 is not specific of a search enough to bring up Egg White IgE. It also brings up Hemoglobin F1 and Prostaglandin F1. Rather than bring up 3 egg allergens, how about covering the prefixes, one for each: f-food, t-trees, g-grasses, fp or fm for food panel. One example of allergens enfolding (like egg parts) are the trees: tree pollen and the nuts (tree products). Try Hickory (F201, T022, T22) or Hazelnut (F017, F17, T004, T040, T4, T40 in related names)
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
Good ideas for 2.1 and 2.2 - will incorporate for the next draft.
Swapna Abhyankar, Regenstrief Institute
5 months ago
2.2 Special cases
2.2.2 Plants with multiple types of allergens- I believe my suggestion of 2.2.1 sets up 2.2.2 nicely for comprehension. A different view of the same material.
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
3 Property and Scale
3.1 Properties and Units of measure
"Naturally, MCnc terms lead with a mass unit and are divided by a unit of volume, such as
ug/mL or pg/mL sLT." I do not know what the last "word" is: sLT. The sentence reads well ending with "...or pg/mL."
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
I had to look it up - sulphidoleukotriene. =)
Agree - will make the change.
Swapna Abhyankar, Regenstrief Institute
5 months ago
3.2 Examples of using units to choose the correct LOINC code
I really like the deductive reasoning documentation at the end of this section. "If, however, there were no example units in LOINC, how would you determine the correct Property?
Based on the parts of the unit of measure, ug and mL, we know that the correct LOINC Property will be a
mass-based concentration." It enables the reader to apply that reasoning throughout.
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
3.3 Qualitative allergy terms
Regarding PrThr property accounting for all but three terms w ordinal. The other two ACNC and Threshold are deprecated terms from the migration away from ACNC/ORDs. I searched "allergen ord" and "allergen prthr" to see what was trying to be said. I think that sentence can be dropped. If you want to state that rast class result fields are ordinal (reiteration from section above) with the property of PrThr, I think the readers will be successful
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
Thank you, and agree this is confusing. We will update for the next version.
Swapna Abhyankar, Regenstrief Institute
5 months ago
4 System
No Comments
5 Method
5.1 Entire section
I think that for the antibody tests (IgE, IgG/IgG4, etc.), IA could be used for the method
Bruce Goldberg, Kaiser Permanente
6 months ago
We currently only have 10 existing allergy antibody terms with IA as the Method. I'm not sure if you are suggesting that we include information about these 10 terms in Section 5 of the guide (which we will do) or that we add IA as the Method to all of the allergy antibody terms (which would require discussion with the Lab LOINC Committee and is out of scope for the current work on mapping guides).
Swapna Abhyankar, Regenstrief Institute
5 months ago
5.1 Entire section
For cell-based assays measuring basophil bound Ab (which should be IgE) the basophil activation test (measuring CD63, CD203c expression by flow cytometry) and cytokine release assays are gaining ground over histamine release assays. LONC has 75023-2 CD63 (Activated) Basophils/100 basophils in Blood by Flow cytometry (FC) but not for specific allergens
Bruce Goldberg, Kaiser Permanente
6 months ago
This guide is meant to reflect the terms that currently exist in LOINC, but we can add a sentence about newer methods and requesting new terms where there are gaps.
Swapna Abhyankar, Regenstrief Institute
5 months ago
6 Allergen panels
6.1 Entire section
The naked panel option would be my preference
Bruce Goldberg, Kaiser Permanente
6 months ago
6.1 Entire section
Enter the word "multidisk" in the sentence: y. Note that this is different from the ___multidisk___ combination testing
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
Thanks - I updated the sentence in our internal working copy to "Note that this is different from the multidisk combination testing described in 2.1.3 above, in which multiple allergens are included in the test but individual allergens are not distinguished in the results." This change will be reflected publicly for the next public comment period, after pilot testing.
Swapna Abhyankar, Regenstrief Institute
5 months ago
6.1 Entire section
Link is still broken in " 94591-1 Multiplex allergen panel" as of 8/14/2020. Unless you didn't upload a new version for review after marking it fixed.
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
Sorry for the confusion - I meant that I updated the link in our internal working copy. The fix will be reflected publicly for the next round of public review, which will be after pilot testing.
Swapna Abhyankar, Regenstrief Institute
5 months ago
6.1 Entire section
Comments have already been provided on behalf of our clients that have regional panels that cannot utilize current allergen panels in LOINC. I believe this was in the 2018 time period, but email archival is difficult to retrieve. Option 2 in the document would be my preference.
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
7 Putting it all together - Mapping practice
7.1 Question 1
1. At the beginning of Q1 and Q3 is the note, Answer options follow this model:
LOINC Code: Component:Property:Timing:System:Scale:Method
But there's no colons after the LOINCs and this format is just the Fully Specified Name (FSN). Can't we just read "Answer options are LOINC Code and Fully Specified Name"
2. Rephrase Q2 to "Which attributes would further determine an exact match?" The existing question makes me think something is hidden in the client display. That is wrong direction.
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
1. Good point - we describe the LOINC FSN format in 1.2 Conventions used in this guide, so I removed the "Answer options follow..." text after Q1 and Q3.
2. For Q2, I rephrased to "What additional local test information is needed to determine an exact LOINC match for the test in question 1?"
Swapna Abhyankar, Regenstrief Institute
5 months ago
7.5 Question 5
Please amend question to read 5. "Which Component structure is correct for a multidisk allergen
combination test:"
Pam Banning, 3M Health Information Systems, Inc.
5 months ago
Done for the next version.
Swapna Abhyankar, Regenstrief Institute
5 months ago
Appendix A - Answer Key
No Comments