Feedback on Guide for Using LOINC Allergy Terms

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 3 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 3 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. 2 months ago

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 3 months ago

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. 2 months ago

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 3 months ago

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. 2 months ago

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. 2 months ago

"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. 2 months ago

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. 2 months ago

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. 2 months ago

I think that for the antibody tests (IgE, IgG/IgG4, etc.), IA could be used for the method Bruce Goldberg, Kaiser Permanente 3 months ago

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 3 months ago

The naked panel option would be my preference Bruce Goldberg, Kaiser Permanente 3 months ago

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. 2 months ago

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. 2 months ago

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. 2 months ago

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. 2 months ago

Please amend question to read 5. "Which Component structure is correct for a multidisk allergen combination test:" Pam Banning, 3M Health Information Systems, Inc. 2 months ago