Coding the way to better occupational allergy care

Published on October 1, 2012 at 5:15 PM · No Comments

By Helen Albert, Senior medwireNews Reporter

The 11th draft of the International Classification of Diseases (ICD), due to be released in 2015, will allow a much more detailed specification of occupational allergy and contact dermatitis than the current draft, say dermatologists involved in the revision.

The changes come after it was recognized at the World Health Organization (WHO) Global Workshop on Occupational Skin Diseases in February 2011 that occupational skin disorders are substantially underreported worldwide and that there is a lack of global awareness about relevant irritants and contact allergens.

Speaking to medwireNews at the European Academy of Dermatology and Venereology annual congress in Prague, Czech Republic, presenter Vera Mahler (University Hospital of Erlangen, Germany) explained that "currently certain dermatological diseases are just not visible because we don't have the tools. For example, all occupational hand eczema cannot be displayed with ICD-10."

She went on to say that not only does the ICD-10 coding system (endorsed by the WHO in 1990) not allow physicians to specify the predominant location of the hands in occupational hand eczema, there is also no option to specify the disease-eliciting contact allergen, or the profession of the patient.

"Therefore it's important to have first of all a more refined option to code and record lesions of the hands, which are predominant in occupational allergy," said Mahler. "What we have currently is much too rough."

Following the WHO meeting in 2011, a group of experts in contact and occupational dermatitis have identified a set of globally significant contact allergens for inclusion in the new classification. In total, 120 allergens have been identified as "essential" and another 407 deemed "important" for inclusion in ICD-11.

When asked about the impact of the changes on clinicians and patients, Mahler emphasized the importance of ICD-11 for assessing the prevalence of occupational allergy in developing countries where "there are no numbers at all about hand eczema and the importance of contact allergens" at present.

She said: "In developing countries it might be different allergens which are of importance… and it may be that we can give advice about how you can substitute one substance for another. For example, glyceryl monothioglycolate for hair dressing is not in use in Germany anymore and there are substitutes for that."

Robert Chalmers (University of Manchester, UK), who is also working on the new classification, said: "ICD has been very much restricted by the information-gathering mechanisms that have been there up until recently, but now with very much more sophisticated electronic platforms then there is the opportunity to try and get more precise data… We hope that by the time ICD-11 comes into use it will be possible to categorize and classify skin disease accurately, whereas at the moment skin disease is very poorly covered by the current ICD."

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