CH AllergyIntolerance (R4)
3.0.0 - trial-use Switzerland flag

This page is part of the CH-AllergyIntolerance (R4) (v3.0.0: STU 3) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Adverse Reaction & Manifestation

In this section, the relationship between adverse reactions and manifestations of allergies or intolerances and their mapping is described. The basics for this are explained in the Boundaries and Relationships section of the AllergyIntolerance resource. The practical use and the differences between the elements reaction and reaction.manifestation are described and shown exemplarily below.

Practical Use and Differences

  1. Multiple reaction entries are useful for capturing different reactions that may have occurred during separate exposures or for documenting a detailed history of the progression of the reactions.
  2. Multiple reaction.manifestation entries within a reaction capture the different symptoms that occurred simultaneously during the same episode of reaction.

Multiple reaction entries

Example 1: A patient has a penicillin allergy with documented reactions at two different times.

  • The first reaction records a moderate reaction during the patient’s first exposure, with eruption of skin as a symptom.
  • The second reaction documents a severe reaction during a later exposure, including dyspnea and lip swelling.
{
	"resourceType": "AllergyIntolerance",
	...
	"reaction": [
		{
			"substance": {
				"coding": [
					{
						"system": "http://snomed.info/sct",
						"code": "764146007",
						"display": "Penicillin"
					}
				]
			},
			"manifestation": [
				{
					"coding": [
						{
							"system": "http://snomed.info/sct",
							"code": "271807003",
							"display": "Eruption of skin"
						}
					]
				}
			],
			"description": "Initial reaction to penicillin during first exposure.",
			"onset": "2023-01-15",
			"severity": "moderate"
		},
		{
			"substance": {
				"coding": [
					{
						"system": "http://snomed.info/sct",
						"code": "764146007",
						"display": "Penicillin"
					}
				]
			},
			"manifestation": [
				{
					"coding": [
						{
							"system": "http://snomed.info/sct",
							"code": "267036007",
							"display": "Dyspnea"
						}
					]
				},
				{
					"coding": [
						{
							"system": "http://snomed.info/sct",
							"code": "699376002",
							"display": "Lip swelling"
						}
					]
				}
			],
			"description": "Second reaction to penicillin during subsequent exposure.",
			"onset": "2023-06-10",
			"severity": "severe"
		}
	]
}

Multiple reaction.manifestation entries

Example 2: A patient reacts to shrimps with a range of symptoms that appear all at once.

  • There is a single reaction entry representing one episode.
  • Multiple reaction.manifestation entries within this reaction document a range of symptoms (dyspnea, lip swelling, and nausea) that occurred simultaneously during this reaction.
{
	"resourceType": "AllergyIntolerance",
	...
	"reaction": [
		{
			"substance": {
				"coding": [
					{
						"system": "http://snomed.info/sct",
						"code": "278840001",
						"display": "Shrimp"
					}
				]
			},
			"manifestation": [
				{
					"coding": [
						{
							"system": "http://snomed.info/sct",
							"code": "267036007",
							"display": "Dyspnea"
						}
					]
				},
				{
					"coding": [
						{
							"system": "http://snomed.info/sct",
							"code": "699376002",
							"display": "Lip swelling"
						}
					]
				},
				{
					"coding": [
						{
							"system": "http://snomed.info/sct",
							"code": "422587007",
							"display": "Nausea"
						}
					]
				}
			],
			"description": "Reaction to shrimps consumption.",
			"onset": "2023-07-21",
			"severity": "severe"
		}
	]
}