Harmonizing allergy and hypersensitivity nomenclature and
definitions
As demonstrated in Figure 2, we observed a similar pattern of responses
relating to the accuracy evaluation of the new ICD-11 Allergic and
hypersensitivity conditions classification. All of the sections had the
score 3 (good accuracy) selected by the majority of respondents.
The nomenclature and definitions of “allergic rhinitis”, “allergic
asthma” and “anaphylaxis” received the best scores (3 and/or 4). On
the other hand, in contrast with other sections, “Dermatitis or
eczema”, “non-allergic asthma” and the “Allergic or hypersensitivity
reactions to arthropods” subsection presented higher proportion of
scores 1 and 2 (Figure 2). We received 49 responses to open questions
with suggestions covering missing conditions (e.g ., primary
immunodeficiency), inclusion of underlying mechanism or causes and
requests for simplification of the section.
LESSONS FROM THE ENGAGEMENT PROCESS
The implementation phase of ICD-11 is currently ongoing. The main
framework of the new classification was presented to the WHA in May 2019
(41). Refinements of ICD-11 are led by the ICD-11 governance team and
supported by the WHO-FIC networks comprising the reference groups and
advisory committees of WHO. The Montpellier WHO CC CSS plays a special
role in supporting the WHO through its academic and research projects.
The data provided by these initiatives will be essential for fine-tuning
improvements in the Allergic and hypersensitivity conditionssection of ICD. In fact, this section has been serving as a model for
the refinement process, since it is the first time that many of these
conditions have been represented together in a single location by means
of the polyhierarchical design of ICD-11. Considering the fact that
every change to the existing framework can have consequences not only
for the allergy specialty but also for other specialties, all
modifications have to be carefully and deeply considered and agreed with
the concerned parts. Input mechanisms required demonstrated scientific
evidence and consensus across all ICD stakeholders.
The outcomes of this engagement process have provided a snapshot view of
how the international classifications are currently being used and of
how we will be able to work together with WHO to assist adoption of the
new A/H classification. For instance, those countries in which no
classification system is used are being targeted for early adoption of
ICD-11, and other countries using ICD-9 (or national adaptations) will
be able to transfer directly to ICD-11.
In this survey, we decided to include only the main terms and
definitions in the new A/H classification in order to simplify the task
for our respondents and in the hope of thereby obtaining a higher
response rate. For this reason many of the 49 responses to the open
question of the survey were related to entities not mentioned in the
proposed survey. However, all the comments have been taken into account,
considering that ICD-11 is not intended to be a specialty classification
but a system for use by a broad range of end-users.
Appropriate usage of codes for recording disorders is a key issue to
prevent misclassification. The results of the current survey underline
the need for increasing awareness of ICD-11 and its coding procedures as
well as for educational programs to support ICD-11 end-users. These are
two further goals of the Montpellier WHO CC.
Over recent decades the allergy community has been concerned to improve
terminology and definitions in the field of allergy, as evidenced in
many documents which have been published to date (44-74). The
harmonization of A/H terminology and definitions is critical for our
community in today’s globalized world with its international multicentre
clinical trials and with the development of “personalized medicine”.
All the main published international consensuses and guidelines in the
field of A/H have been considered in the drafting of the ICD-11Allergic and hypersensitivity conditions classification in the
ICD-11 chapter. The ICD-11 is recognized by the allergy community as the
main official means to reach global harmonization in nomenclature and
definitions to support the allergy community in the years to come. The
allergy community recognizes the ICD-11 as a clinical tool and
classification, in strong contrast to ICD-10 that designed for
statistics only. This is an important finding of the survey which you
should also highlight. Meanwhile, immunological disorders have been
updated under the same chapter, including for example immunodeficiencies
and rare diseases.
Many quality measures, such as those from US HealthGrades and the Agency
for Healthcare Research and Quality, rely on the WHO ICD codes.
Improving the specification of conditions will help clarify the
connection between a provider’s performance and the patient’s condition.
Accurate and updated diagnostic and procedure codes will improve data on
the outcomes, efficacy, and costs of new medical technology and will
facilitate fair reimbursement policies. It will help payers and
providers to identify patients in need of disease management more easily
and will more effectively tailor disease management programs (27).
By allowing all the relevant diagnostic terms for allergic and
hypersensitivity conditions to be included in ICD-11, WHO has recognized
their importance not only to clinicians but also to public health and
those involved in studying and managing it, including epidemiologists,
statisticians, health care planners and other stakeholders. Importantly,
the new classification will enable the collection of more accurate
epidemiological data to support quality management of patients with
allergies and to better facilitate health care planning and
decision-making, including public health measures to prevent and reduce
the mortality and morbidity attributable to A/H. The improved
ontological structure of ICD-11 and standardized terminology and
definitions throughout the ICD-11 will also facilitate international
comparisons of quality care and the sharing of best practice globally.
An important limitation of the survey is the differential response rate
by regional area. We consider, however, that it is the quality of
responses received rather than their quantity or their geographical
representativeness that is most important. Although this did not affect
our overall data analysis, it may highlight the need for allergy
specialty development in the areas where the number of responders was
low. Despite the specific response rate, the survey represented a unique
opportunity to give voice to colleagues from 74 countries. In some
countries, notably China, the most populous nation in the world, we
received fewer responses than might have been expected. We hypothesise
that recipients may not have been able to access the survey due to
national regulations prohibiting Google® accounts.
Other factors which may have influenced the response rate include the
high number of questions for busy doctors and health professionals to
answer, difficulty in accessing the online questionnaire and
difficulties with the English language. Also it was not possible to have
the initial sample size parameter since the survey has been disseminated
by e-mail, social media and through national or regional allergy
academies.
We believe that, in addition to helping during the implementation phase
of the new ICD-11 “Allergic and hypersensitivity conditions”
classification, 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 patients with allergic and
hypersensitivity disorders. The efforts presented in this manuscript are
aligned to additional ongoing national and international actions in
order to ensure quality of allergy and hypersensitivity conditions data
in the forthcoming years.
ABREVIATIONS
A/H: allergic and hypersensitivity conditions
AAAAI: American Academy of Allergy Asthma and Immunology
ACAAI: American College of Allergy Asthma and Immunology
AFRO: primarily sub-Saharan Africa
APAAACI: Asia Pacific Association of Allergy, Asthma and Clinical
Immunology
EAACI: European Academy of Allergy and Clinical Immunology
EMRO: Eastern Mediterranean/North Africa
EURO: Europe
ICD: International Classification of Diseases
MMS: Mortality and morbidity statistics
PAHO: the Americas
SEARO: Southeast Asia
SLAAI: Latin American Society of Allergy, Asthma and Immunology
WAO: World Allergy Organization
WHA: World Heal Assembly
WHO: World Health Organization
WHO-FIC: World Health Organization - Family of International
Classifications
WHO CC: World Health Organization Collaborating Centre
WPRO: Western Pacific
References
- Cornet R, Chute CG. Health Concept and Knowledge Management:
twenty-five Year of Evolution. Yearb Med Inform. 2016 Aug 2;Suppl
1:S32-41.
- Demoly P, Tanno LK, Akdis CA, Lau S, Calderon MA, Santos AF, et al.
Global classification and coding of hypersensitivity diseases – An
EAACI – WAO survey, strategic paper and review. Allergy 2014; 69:
559–570.
- World Heath Organization ICD-11 website (cited, available:
https://www.who.int/classifications/icd/en/ accessed February
2020).
- Knibbs GH. The International classification of disease and causes of
death and its revision. Med J Aust 1929;1:2-12.
- Moriyama IM, Loy RM, Robb-Smith AHT. History of the statistical
classification of diseases and causes of death. Rosenberg HM, Hoyert
DL, eds. Hyattsville, MD: National Center for Health Statistics 2011.
- National Academy on an Aging Society. Chronic Conditions: A challenge
for the 21st Century. 2000.
- Centers for Disease Control. “CDC Fast Facts A-Z,” Vital Health
Statistics. 2003 [cited 28 Oct 2011].
http://www.cdc.gov/nchs/fastats/allergies.htm,
http://www.aafa.org/display.cfm?id=9&sub=30 (accessed 5 Sept 2011)
- Center of Disease Control and Prevention (CDC) website. (cited,
available:
https://www.cdc.gov/nchs/fastats/health-expenditures.htm
accessed February 2020)
- Tanno LK, Calderon MA, Goldberg BJ, Akdis CA, Papadopoulos NG, Demoly
P. Categorization of Allergic Disorders in the New World Health
Organization International Classification of Diseases. Clin Transl
Allergy 2014; 4: 42.
- Tanno LK, Ganem F, Demoly P, Toscano CM, Bierrenbach AL.
Undernotification of anaphylaxis deaths in Brazil due to difficult
coding under the ICD-10. Allergy 2012; 67: 783–789.
- Papadopoulos NG, Agache I, Bavbek S, Bilo BM, Braido F, Cardona V et
al. Research needs in allergy: an EAACI position paper, in
collaboration with EFA. Clin Transl Allergy 2012;2:21.
- Pawankar R, Canonica GW, ST Holgate ST, Lockey RF, Blaiss M. The WAO
White Book on Allergy (Update. 2013)
- Tanno LK, Calderon MA, Smith HE, Sanchez-Borges M, Sheikh A, Demoly P;
Joint Allergy Academies. Dissemination of definitions and concepts of
allergic and hypersensitivity conditions. World Allergy Organ J. 2016;
9: 24.
- World Health Organization, ICD-11 Beta Draft website. (cited,
available:
http://apps.who.int/classifications/icd11/browse/l-m/en January
2020).
- Tanno LK, Casale T, Papadopoulos NG, Sanchez-Borges M, Thiens F,
Pawankar R, Calderon MA, Gómez M, Sisul JC, Ansotegui IJ, Sublett J,
Demoly P. 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 Jul 1;38(4):54-55.
- Tanno LK, Calderon MA, Goldberg BJ, Gayraud J, Bircher AJ, Casale T et
al. Constructing a classification of hypersensitivity/allergic
diseases for ICD-11 by sourcing the allergist community. Allergy 2015;
70: 609-15.
- Tanno LK, Calderon MA, Demoly P; on behalf the Joint Allergy
Academies. New Allergic and Hypersensitivity Conditions Section in the
International Classification of Diseases-11. Allergy Asthma Immunol
Res 2016; 8: 383-8.
- Tanno LK, Simons FE, Annesi-Maesano I, Calderon MA, Aymé S, Demoly P;
Joint Allergy Academies. Fatal anaphylaxis registries data support
changes in the who anaphylaxis mortality coding rules. Orphanet J Rare
Dis 2017; 12: 8.
- Tanno LK, Bierrenbach AL, Simons FER, Cardona V, Thong BY, Molinari N,
Calderon MA, Worm M, Chang YS, Papadopoulos NG, Casale T, Demoly P; on
behalf the Joint Allergy Academies. Critical view of anaphylaxis
epidemiology: open questions and new perspectives. Allergy Asthma Clin
Immunol 2018; 14: 12.
- Tanno LK, Calderon M, Papadopoulos NG, 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: 20.
- Tanno LK, Calderon MA, Demoly P; on behalf the Joint Allergy
Academies. Making allergic and hypersensitivity conditions visible in
the International Classification of Diseases-11. Asian Pac Allergy
2015; 5: 193-6.
- Tanno LK, Calderon MA, Demoly P; on behalf the Joint Allergy
Academies. Optimization and simplification of the allergic and
hypersensitivity conditions classification for the ICD-11. Allergy
2016; 71: 671-6.
- Tanno LK, Calderon MA, Papadopoulos NG, Sanchez-Borges M, Rosenwasser
LJ, 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: 643-9.
- Tanno LK, Calderon MA, Li J, Casale T, Demoly P. Updating
Allergy/Hypersensitivity diagnostic procedures in the WHO ICD-11
revision. J Allergy Clin Immunol Pract 2016; 4: 650-7.
- Tanno LK, Calderon MA, Papadopoulos NG, Sanchez-Borges M, Moon HB,
Sisul JC, Jares EJ, Sublett JL, Casale T, Demoly P; Joint Allergy
Academies. Surveying the new allergic and hypersensitivity conditions
chapter of the International classification of diseases (ICD)-11.
Allergy 2016; 71: 1235-40.
- Tanno LK, Calderon M, Demoly P; Joint Allergy Academies. Supporting
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: 149-56.
- Tanno LK, Calderon M, Sublett JL, Casale T, Demoly P; Joint Allergy
Academies. Smoothing 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: 1265-7.
- Tanno LK, Bierrenbach AL, Calderon MA, Sheikh A, Simons FE, Demoly P;
Joint Allergy Academies. Decreasing the undernotification of
anaphylaxis deaths in Brazil through the International Classification
of Diseases (ICD)-11 revision. Allergy 2017; 72: 120-5.
- Tanno LK, I Ansotegui, P Demoly. Globalization and anaphylaxis. Curr
Opin Allergy Clin Immunol 2018; in press - doi:
10.1097/ACI.0000000000000467
- Tanno LK, Molinari N, Bruel S, Bourrain JL, Calderon M, Aubas P,
Demoly P; Joint Allergy Academies. Field-testing the New Anaphylaxis’
Classification for the WHO International Classification of Diseases
(ICD)-11 Revision. Allergy. 2017 May;72(5):820-826. doi:
10.1111/all.13093.
- Tanno LK, Sublett JL, Meadows JA, Calderon M, Gross GN, Casale T,
Demoly P; Joint Allergy Academies. Perspectives of the International
Classification of Diseases (ICD)-11 in Allergy Clinical Practice in
the United States of America. Ann Allergy Asthma Immunol. 2017
Feb;118(2):127-132.
- Tanno LK, Chalmers RJ, Calderon MA, Aymé S, Demoly P; on behalf the
Joint Allergy Academies. Reaching multidisciplinary consensus on
classification of anaphylaxis for the eleventh revision of the World
Health Organization’s (WHO) International Classification of Diseases
(ICD-11).Orphanet J Rare Dis. 2017 Mar 16;12(1):53.
- Tanno LK, Calderon MA, Linzer JFSr, Chalmers RJG, Demoly P, on behalf
of the Joint Allergy Academies. Collaboration between specialties for
respiratory allergies in the international classification of diseases
(ICD)-11. Respiratory Research 2017, Feb 10;18(1):34.
- Tanno LK, Haahtela T, Calderon MA, Cruz A, Demoly P; Joint Allergy
Academies. Implementation gaps for asthma prevention and control.
Respir Med. 2017 Sep;130:13-19.
- Tanno LK, Torres MJ, Castells M, Demoly P; Joint Allergy Academies.
What can we learn in drug allergy management from World Health
Organization’s International classifications? Allergy. 2018
May;73(5):987-992.
- Tanno LK, Demoly P. Lessons of Drug Allergy Management Through the
World Health Organization’s International Classification of Diseases
(ICD)-11. Curr Treatment Opin in Allergy, 2018 March 5 (1):52-59.
- Tanno LK, Demoly P, on behalf of the Joint Allergy Academies. How can
the World Health Organization’s International Classification of
Diseases (ICD)-11 change the clinical management of anaphylaxis?
Expert Rev Clin Immunol. 2018 Sep 11:1-4. doi:
10.1080/1744666X.2018.1520094.
- Tanno LK, Demoly P; Joint Allergy Academies. Are outcome measures in
allergic diseases relevant for the WHO’s International Classification
of Diseases in allergology? Curr Opin Allergy Clin Immunol. 2019
Jun;19(3):198-203.
- Tanno LK, Chalmers R, Bierrenbach AL, Simons FER, Molinari N,
Annesi-Maesano et al. on behalf Joint Allergy Academies. Changing the
history of anaphylaxis mortality statistics througth the World Health
Organization’s International Classification of Diseases (ICD)-11. J
Allergy Clin Immunol. 2019 Sep;144(3):627-633.
- Demoly P, Tanno LK. Le modèle de l’anaphylaxie : une nouvelle version
de la Classification Internationale des Maladies de l’Organisation
Mondiale de la Santé pour 2019. Bulletin de l’Académie nationale
de médecine 2020, in press
- The Lancet. ICD-11. Lancet. 2019 Jun 8;393(10188):2275.
- World Health Organization, Collaborating Centres list website. (cited,
available:
http://apps.who.int/whocc/Detail.aspx?cc_ref=FRA-133&designation_date1=1/6/2018&designation_date2=18/7/2018&
December 2019)
- World Health Organization, MSAC website. (cited, available:
https://www.who.int/classifications/icd/revision/en/ December
2019)
- Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for
allergy for global use: Report of the Nomenclature Review Committee of
the World Allergy Organization, October 2003. J Allergy Clin Imunnol
2004; 113: 832-6.
- The European Academy of Allergy and Clinical Immunology (EAACI). A
European Declaration on Allergen Immunotherapy. Available at
http://www.eaaci.org/resources/immunotherapy- declaration.html
- Demoly P, Adkinson NF, Brockow K, Castells M, Chiriac AM, Greenberger
PA, Khan DA, Lang DM, Park H-S, Pichler W, Sanchez-Borges M, Shiohara
T, Thong BY-H. International Consensus on drug allergy. Allergy 2014;
69: 420–437.
- Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA,
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– 397.
- Scadding G, Hellings P, Alobid I, Bachert C, et al., Diagnostic tools
in Rhinology EAACI position paper. Clinical and Translational Allergy
201110;1(1):2.
- Fokkens W, Lund V, Mullol J; European Position Paper on Rhinosinusitis
and Nasal Polyps. Rhinol Suppl 2007;(20):1-136.
- Bousquet J, Schu ̵̈nemann HJ, Zuberbier T, Bachert C, Baena-Cagnani CE,
Bousquet PJ, et al. In collaboration with the WHO Collaborating Center
of Asthma and Rhinitis (Montpellier). Development and implementation
of guide- lines in allergic rhinitis – an ARIA-GA2LEN paper. Allergy
2010; 65: 1212–1221.
- L. B. Bacharier, A. Boner, K.-H. Carlsen, P. A. Eigenmann, T.
Frischer, M. Gçtz et al. Diagnosis and treatment of asthma in
childhood: a PRACTALL consensus report. Allergy 2008: 63: 5–34.
- Asthma. Quick asthma facts & The Faces of asthma [Internet].
Geneva: World Health Organization; 2010. Available from:
http://www.who.int/respiratory/asthma/en/.
- Matthew Masoli, Denise Fabian, Shaun Holt, Richard Beasley for the
Global Initiative for Asthma (GINA) Program. The global burden of
asthma: executive summary of the GINA. Dissemination Committee Report.
Allergy 2004: 59: 469–478.
- Bateman ED, Bousquet J, Keech ML, Busse WW, Clark TJ, Pedersen SE.The
correlation between asthma control and health status: the GOAL study.
Eur Respir J 2007; 29: 56-62.
- Papadopoulos NG, Arakawa H, Carlsen K-H, Custovic A, Gern J, Lemanske
R, et al.. International consensus on (icon) pediatric asthma. Allergy
2012; 67: 976–997.
- Burks AW, Tang M, Sicherer S, Muraro A,
Eigenmann PA, Ebisawa M,
Fiocchi A, Chiang W, Beyer K, Wood R, Hourihane J, Jones SM,
Lack G,
Sampson HA. International consensus on (ICON) Food Allergy. J Allergy
Clin Immunol 2012; 129: 906-920.
- Simons FE, Ardusso LR, Bilò MB, Cardona V, Ebisawa M, El-Gamal YM, et
al. International consensus on (ICON) Anaphylaxis. World Allergy Organ
J 2014 30;7: 9.
- Moscato G, Pala G, Cullinan P, Folletti I, Gerth van Wijk R, Pignatti
P et al. EAACI Position Paper on assessment of cough in the workplace.
Allergy 2014;69: 292-304.
- Leonardi A, Bogacka E, Fauquert J-L, Kowalski ML, Groblewska A,
Jedrzejczak-Czechowicz M, et al. Ocular allergy: recognizing and
diagnosing hypersensitivity disorders of the ocular surface. Allergy
2012; 67: 1327–1337.
- La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S, et
al. Allergic conjunctivitis: a comprehensive review of the literature.
Italian J Pediatrics 2013, 39:18.
- Bonini S, Coassin M, Aronni S, Lambiase A. Vernal
keratoconjunctivitis. Eye 2004; 18: 345–351.
- Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M,
Eigenmann PA, et al. Diagnosis and treatment of atopic dermatitis in
children and adults: European Academy of Allergology and Clinical
Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL
Consensus Report. Allergy 2006: 61: 969–987.
- Bonitsis NG, Tatsioni A, Bassioukas K, Ioannidis JP.Allergens
responsible for allergic contact dermatitis among children: a
systematic review and meta-analysis. Contact Dermatitis 2011;64:
245-57.
- Tan CH, Rasool S, Johnston GA.Contact dermatitis: allergic and
irritant. Clin Dermatol 2014;32:116-24.
- Cicardi M, Bork K, Caballero T, Craig T, Li HH, Longhurst H,et al.
Evidence-based recommendations for the therapeutic management of
angioedema owing to hereditary C1 inhibitor deficiency: consensus
report of an International Working Group. Allergy. 2012;67: 147-57.
- Craig T, Aygören Pürsün E, Bork K, Bowen T, Boysen H, Farkas H, et al.
WAO Guideline for the Management of Hereditary Angioedema. WAO J 2012;
5: 182–199.
- Soares-Weiser K, Panesar SS, Rader T, Takwoingi Y, Werfel T, Muraro A,
et al. The diagnosis of food allergy: protocol for a systematic
review. Clin Transl Allergy 2013, 3:18.
- Bircher A, Scherer K. Delayed cutaneous manifestations of drug
hypersensitivity.Med Clin North Am. 2010;94:711-25.
- Pirmohamed M, Friedmann PS, Molokhia M, Loke YK, Smith C, Phillips E,
La Grenade L, Carleton B, Papaluca-Amati M, Demoly P, Shear
NH.Phenotype standardization for immune-mediated drug-induced skin
injury. Clin Pharmacol Ther 2011;89:896-901.
- Roujeau JC. Clinical heterogeneity of drug hypersensitivity.
Toxicology 2005; 15;209:123-129.
- Biló BM, Rueff F, Mosbech H, Bonifazi F, Oude-Elberink JN; EAACI
Interest Group on Insect Venom Hypersensitivity.Diagnosis of
Hymenoptera venom allergy.Allergy. 2005;60:1339-1349.
- Bonifazi F, Jutel M, Biló BM, Birnbaum J, Muller U; EAACI Interest
Group on Insect Venom Hypersensitivity.Prevention and treatment of
hymenoptera venom allergy: guidelines for clinical practice. Allergy
2005;60: 1459-1470.
- Time to revisit the definition and clinical criteria for anaphylaxis?
Turner PJ, Worm M, Ansotegui IJ, El-Gamal Y, Rivas MF, Fineman S,
Geller M, Gonzalez-Estrada A, Greenberger PA, Tanno LK, Borges MS,
Senna G, Sheikh A, Thong BY, Ebisawa M, Cardona V; WAO Anaphylaxis
Committee. World Allergy Organ J. 2019 Oct 31;12(10):100066.
- Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D,
Ballmer-Weber B, et al. The EAACI/GA²LEN/EDF/WAO guideline for the
definition, classification, diagnosis and management of urticaria.
Allergy. 2018 Jul;73(7):1393-1414.
FUNDING:
Pascal Demoly and Luciana Kase Tanno received an unrestricted Novartis
and MEDA/Mylan Pharma grants through CHUM administration. LKT received a
research AllerGOS grant.
CONFLICT OF INTERESTS:
The authors declare that they do not have conflict of interests related
to the contents of this article.
CONTRIBUTIONS:
The first and last authors contributed to the construction of the
document (designed the study, including the questionnaire, analysed and
interpreted the data, and wrote the manuscript). All the authors
critically revised and approved the final version of the manuscript and
agree to be accountable for all the aspects of the work.
AKNOWLEDGEMENTS:
We are grateful to all the representatives of the ICD-11 revision with
whom we have been carrying on fruitful discussions, helping us to tune
the here 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.
We would like to thank very much the national and international
academies, and colleagues who supported the dissemination of the online
survey. We are grateful for the participants for their responses.
LIST OF TABLES
Table 1: Responder to the international survey, response rates,
demographic characteristics, and classification in use
Table 2: Responses to open ended questions from a web international
survey fielded in 2019: what is expected by a classification system and
what the ICD-11 is able to bring