| name | langcare-allergy-review |
| description | Retrieves and organizes allergy and adverse reaction data from FHIR AllergyIntolerance resources. Cross-references against active medications for contraindications. Use when asked to review allergies, check for drug allergies, allergy summary, adverse reactions, or verify allergy documentation before prescribing.
|
Allergy and Adverse Reaction Review
When to Use This Skill
Use when a clinician needs a comprehensive view of documented allergies and adverse reactions, cross-referenced against current medications for safety validation.
Clinical Workflow
- Use
fhir_search to pull all AllergyIntolerance resources for the patient (active, inactive, resolved)
- Use
fhir_search to pull active MedicationRequest resources for cross-reference
- Classify allergies by type: drug, food, environmental, biologic
- For drug allergies, cross-reference against active medications and flag any contraindicated prescriptions
- Identify allergy documentation gaps: no known allergies (NKA) vs not assessed vs documented allergies
- Use
fhir_update to correct allergy records if authorized (e.g., mark resolved, update reaction details)
FHIR Resources
- AllergyIntolerance -- Allergy entries: clinicalStatus, type (allergy vs intolerance), category (food, medication, environment, biologic), code, reaction (substance, manifestation, severity), criticality
- MedicationRequest -- Active prescriptions for contraindication checking
- Patient -- Demographics for allergy context
FHIR Query Examples
Pull All Allergies
fhir_search(resourceType="AllergyIntolerance", queryParams="patient=[patient-id]")
Pull Active Medications for Cross-Reference
fhir_search(resourceType="MedicationRequest", queryParams="patient=[patient-id]&status=active&_count=100")
Clinical Guidelines
- Joint Commission NPSG.03.06.01 requires allergy documentation reconciliation at transitions of care
- Cross-reactivity groups: penicillins (ampicillin, amoxicillin, piperacillin), cephalosporins (~2% cross-reactivity with penicillin), sulfonamides, NSAIDs
- Distinguish allergy (immune-mediated: anaphylaxis, urticaria, angioedema) from intolerance (non-immune: GI upset, headache)
- Criticality: high = life-threatening potential, low = non-life-threatening, unable-to-assess
Interpretation Guide
- Present drug allergies first (highest prescribing safety impact), then food, then environmental
- For each allergy: substance, reaction type, severity, criticality, date recorded, verificationStatus
- Flag high-criticality allergies prominently
- When cross-referencing medications, check both exact matches and drug class cross-reactivity
- If AllergyIntolerance list is empty, distinguish NKA (code for "no known allergy" present) from "not assessed" (no AllergyIntolerance resources at all)
Safety
- Never fabricate clinical data -- only report what FHIR returns
- Flag critical/abnormal values immediately
- Scope all FHIR queries to the authenticated patient
- Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
- Present data in clinician-friendly format with reference ranges
