ValueSet "Auslösende Substanz"

Inhalte

Die Codes und Konzepte in diesem ValueSet geben an, durch welche Substanz eine allergische oder andere Überempfindlichkeitsreaktion ausgelöst wurde.

Kommentierung

Hier finden Sie das ValueSet zur Direktansicht und die dazugehörigen Hintergrundinformationen. Als FHIR-Package steht das ValueSet auf dem nationalen Terminologie-Server des BfArMs nach Abschluss des Benehmens- und Einvernehmensverfahrens zur Verfügung. Sollten Sie an der eher technischen Information interessiert sein, findet sich das ValueSet auch im json Format unterhalb der Tabelle.

Hintergrund

Die Dokumentation allergieauslösender Substanzen erfolgt derzeit in Primärsystemen meist entweder basierend auf proprietären Listen oder sogar nur als Freitext. Sowohl Fachgesellschaften als auch Systemhersteller haben sich hier für eine Harmonisierung ausgesprochen, um eine durchgehende interoperable Weiternutzung von Informationen zu Patientenallergien zu ermöglichen.

Für die Abbildung der Allergie-auslösenden Substanzen sollen z.B. SNOMED CT®-Konzepte verwendet werden (siehe Stichpunkt "Auswahl des Codesystems"). In SNOMED CT® gibt es allerdings mehr als 27.000 mögliche Konzepte, die Substanzen beschreiben. Aufgrund dieser unhandlichen Menge ist es sinnvoll, die wählbaren Konzepte einzuschränken, also ein ValueSet mit einer überschaubaren Menge an möglichen und vor allem relevanten Konzepten zu erstellen.

Darüber hinaus bestünde durch eine zu große Auswahlmöglichkeit das Risiko, dass versehentlich eine falsche Codierung vorgenommen wird. Zudem könnte es vorkommen, dass dieselbe Allergie mit unterschiedlichen Konzepten codiert wird, was wiederum dazu führen könnte, dass bei der Abfrage einer Allergie nach einem bestimmten Konzept unvollständige Ergebnisse geliefert werden. Durch eine Einschränkung der möglichen Werte soll also eine reproduzierbare Dokumentation erleichtert werden (also beispielsweise stets das Basismolekül anstelle wechselnder Salzformen desselben Wirkstoffs zu dokumentieren).

Sollten in Zukunft alle SNOMED CT®-Konzepte auf deutsch verfügbar sein und nicht durch jedes Primärsystem auf gut lesbare Begriffe gemappt werden müssen, kann und sollte auch eine Weiterentwicklung der ValueSets diskutiert werden.

Am Anfang stand die Herausforderung für die ValueSets ausgewählte Inhalte mit vertretbarem Aufwand zu identifizieren. Am hilfreichsten wäre eine Liste, mit den häufigsten Allergenen, die man dann in SNOMED CT®-Konzepte codieren und als ValueSet zur Verfügung stellen könnte. Eine übergreifende Statistik existiert allerdings nicht. Daher wurden zunächst Daten zu spezifischen Überempfindlichkeitsreaktionen verwendet. Folgende wurden berücksichtigt:

Daten aus dem europäischen Anaphylaxie-Register → Erfassung anaphylaktischer Reaktionen
Daten des Informationsverbund Dermatologischer Kliniken (IVDK) → Erfassung von Sensibilisierungen auf Kontaktallergene

Diese Daten umfassen nur bestimmte Reaktionen (also nur anaphylaktische Reaktionen oder nur nachgewiesene Sensibilisierungen ohne zwingenden Anhalt für die klinische Relevanz). Außerdem gibt es auch Konzepte, die zwar nicht sehr häufig, jedoch unter Umständen sehr relevant sein können. Daher wurden darüber hinaus auch andere Quellen zur Orientierung genutzt.

Zum Beispiel wurden auch (hoch-) verdächtige Auslöser der epidermalen Nekrolyse (laut der aktuellen Leitlinie) berücksichtigt. Auch bereits bestehende ValueSets aus anderen nationalen Spezifikationen (z.B. Schweiz, Österreich, USA, Frankreich) sowie Wertelisten der Arzneimitteldatenbankanbieter wurden zum Abgleich herangezogen. Allerdings ist dort oft nicht nachvollziehbar worauf die Auswahl der Konzepte beruht. Daher können alle diese Daten und Kataloge zwar zur Orientierung herangezogen werden, müssen jedoch von Fachexpert:innen überprüft werden.

Des weiteren gibt es folgenden Konsens zum Vorgehen bei der Erstellung der ValueSets:

Auswahl des Codesystems: SNOMED CT® bietet als einziges aktuell verfügbares und verbreitetes Codesystem eine Abdeckung aller Bereiche von Substanzen aus dem Bereich Arzneimittel in Kombination mit weiteren Substanzen wie Nahrungsmittel, Insektengifte und weitere. Zudem erleichtert SNOMED CT® aufgrund der angestrebten Verbreitung und Verfügbarkeit in mehreren Sprachen einen internationalen Austausch von Gesundheitsinformationen, wie sie mittelfristig auch für den European Health Data Space (EHDS) notwendig sein wird. Auch die beteiligten Arzneimitteldatenbank-Anbieter, die bereits Wertelisten erstellt haben, haben entweder bereits ihre Kataloge mit SNOMED CT®-Konzepten ergänzt oder halten dies zumindest für sinnvoll.
Codierung der Erkrankung vs. Codierung der auslösenden Substanz: Alle beteiligten Arzneimitteldatenbank-Anbieter sowie einige der bereits vorhandenen ValueSets anderer Länder codieren die Substanz (Pollen) und nicht die Erkrankung (Pollen-Allergie). Auch in den Fachgesellschaften gab es keinen Widerspruch.
Detailgrad der auslösenden Substanz:
- Größtenteils Einigkeit herrschte bei der Frage, ob Stammstoffe oder Salze einer Substanz erfasst werden sollen. Bis auf wenige Ausnahmen ist eine Dokumentation der Stammstoffe ausreichend.
- Unterschiedliche Meinungen gab es beim Thema Dokumentation von Produkten (v.a. mit PZN). Die Idee dahinter ist, das meistens nur das verabreichte Produkt bekannt ist, nach dem die Reaktion auftrat. Theoretisch könnten also auch Hilfsstoffe die Auslöser sein. Als Gegenargument wurde diskutiert, dass in den allermeisten Fällen tatsächlich der Wirkstoff der Auslöser ist und sich im seltenen Fall, dass ein Hilfsstoff ursächlich ist, der klinische Verlauf auffällig genug ist (z.B. allergische Reaktionen auf mehrere Produkten mit ganz unterschiedlichen Wirkstoffen), um eine spezifische Diagnostik einzuleiten. Außerdem würde somit bei jeder AMTS-Prüfung auf sämtliche Inhaltsstoffe geprüft werden müssen, was wiederum der Übersichtlichkeit solcher Ergebnisse im Wege steht. Eine Erfassung auf Produkt-Ebene mit PZN würde zudem einen Austausch auf EU-Ebene erschweren; die Abbildung von Produkten mithilfe von internationalen Codesystemen wie SNOMED CT® ist aufgrund mangelnder Abdeckung der auf dem deutschen Markt verfügbareren Produkte nicht zielführend. In Zusammenschau wurde daher ein ValueSet auf Ebene der Substanzen erstellt.
Gruppierende Konzepte: In vielen gesichteten ValueSets (sowohl in Spezifikationen anderer Nationen als auch in den Wertelisten beteiligter Arzneimitteldatenbank-Anbieter) gibt es gruppierende Konzepte wie "Cephalosporine" zusätzlich zu einzelnen Substanzen wie "Cefuroxim". Aus den gruppierenden Konzepten sollte klar hervorgehen, welche Substanzen inbegriffen sind, um reproduzierbare Ergebnisse bei AMTS-Überprüfungen zu erhalten.
In den Abstimmungsrunden mit den Fachgesellschaften wurde dies jedoch ausdrücklich nicht gewünscht, da nicht alle Gruppen allergologisch relevant sind (v.a. bei Substanzen aus der Kategorie Arzneimittel) und somit eine ungenaue Dokumentation ermöglicht wird. Zudem wird durch die Codierung von ganzen Substanzklassen gerade bei den Arzneimitteln die automatisierte AMTS-Prüfung erschwert. Da in der alltäglichen Anwendung manche dieser Konzepte jedoch häufig vorkommen, werden zunächst einige wenige aufgenommen; diese sind größtenteils auch in dieser Granularität als häufigste Allergene im EU-Anaphylaxie-Register erfasst worden.
Umfang des ValueSets: Bereits bestehende ValueSets haben oft mehrere Hundert bis mehrere Tausend Konzepte. Auch wenn dies bereits eine Verbesserung zu den ca. 27.000 SNOMED CT®-Konzepten darstellt wurde eine weitere Einschränkung diskutiert. Wiederholt angemerkt wurde, dass prinzipiell auch eine größere Menge an Konzepten gut umgesetzt werden könnte, wenn die SNOMED CT®-Konzepte alle übersetzt und somit nicht erst im Primärsystem auf gut lesbare Begriffe gemappt werden müsste. Zudem bräuchte man einen guten Such-Algorithmus, sodass eine eintragende Person mit wenig Aufwand den passenden Begriff vorgeschlagen bekommt. Da die Voraussetzungen noch nicht überall erfüllt werden (können), wurde zunächst ein kleineres ValueSet erstellt.
Kontext europäischer Datenaustausch: Im Rahmen des EHDS sollen auch Informationen über Allergien und Unverträglichkeiten grenzüberschreitend ausgetauscht werden können. In den geplanten europäischen Spezifikationen ist als Codesystem für die Abbildung von Nicht-Arzneimitteln ebenfalls SNOMED CT® vorgesehen. Für Arzneimittel als Allergie-Auslöser sollen ATC-Codes verwendet werden. Dieses Codesystem halten wir jedoch an vielen Stellen für nicht feingranular genug, da die Klassifizierung nach Wirkmechanismus erfolgt und nicht nach allergologischer Relevanz. In Zusammenarbeit mit dem BfArM wird zum einen ein Mapping der im ValueSet vorhandenen SNOMED CT®-Konzepte auf die entsprechenden ATC-Codes für den europäischen Austausch erstellt und zum anderen auf europäischer Ebene angeregt, SNOMED CT® auch für die Abbildung von Arzneimittel-Allergien zu ermöglichen.

Aspekte zur Abbildung mit der FHIR-Ressource "AllergyIntolerance":

Mögliches FHIR-Datenelement: AllergyIntolerance.code
ValueSet-Binding:
- Hintergrund: Hierbei gibt es unter den Beteiligten keine klare Meinung, da es für beide Vorgehensweisen gute Argumente gibt.
  - ValueSet-Binding required: Hierbei darf nur das vorgegebene ValueSet verwendet werden. Es dürfen keine anderen Konzepte aus demselben Codesystem oder ein anderes Codesystem genutzt werden. Die striktere Vorgabe des required-Binding hat den Vorteil, das lesende Systeme genau wissen, welche Konzepte sie erwarten können und ggf. verarbeiten müssen. Nachteil ist, das hier Substanzen, die nicht im ValueSet enthalten sind als Freitext erfasst werden müssen, selbst wenn es prinzipiell passende SNOMED CT®-Konzepte gäbe (auch eine regelmäßige Anpassung des ValueSets wäre hier nicht ausreichend). Das wiederum reduziert die Interoperabilität, v.a. gerade im Hinblick auf den perspektivisch stattfindenden Austausch von Gesundheitsinformationen im EU-Ausland.
  - ValueSet-Binding extensible: Hierbei soll ein Konzept aus dem vorgegebenen ValueSet verwendet werden, sofern es ein passendes Konzept gibt. Soll eine Substanz abgebildet werden, die nicht über ein Konzept aus dem ValueSet abgebildet werden kann (nach Ermessen des Anwenders), darf ein anderer Code verwendet werden. Vorteil ist, dass auch nicht bereits im ValueSet enthaltene Werte als SNOMED CT®-Konzept eingetragen werden können. Nachteil ist, dass lesende Systeme potenziell eine sehr große Anzahl an SNOMED CT®-Konzepten verarbeiten können müssen oder sich auf die Verarbeitung der ebenfalls über das Profil zur Verfügung gestellte textuelle Information beschränken müssen.
- Vorläufiges Vorgehen: extensible-Binding mit Fixierung des Codesystems auf SNOMED CT®; bei nicht-Verwendung eines SNOMED CT®-Konzeptes sollen keine anderen, im schlimmsten Fall proprietären Codesysteme, sondern notfalls nur ein Freitext möglich sein. In diesem Fall sollte im Anschluss eine Anpassung des ValueSets angestoßen werden, ggf. basierend auf Analysen häufig verwendeter Freitext Einträge.
- Perspektivisch: Ab der HL7® FHIR®-Version R5 gibt es die Möglichkeit ein minimales und ein maximales ValueSet anzugeben. Dies könnte (sobald ein Wechsel auf diese Version stattfindet) genutzt werden, um das aktuell erarbeitete ValueSet als Minimalanforderung und die SNOMED CT®-Hierarchie "substance" als maximale Wertemenge einzuschränken.

Werteliste

Hinweis: Das entstandene ValueSet erhebt keinesfalls Anspruch auf Vollständigkeit, sondern stellt lediglich einen ersten Aufschlag und eine erste Minimalanforderung dar, die im Optimalfall nach und nach verbessert wird. Manche Konzepte werden erst in den nächsten Versionen ergänzt, da sie zwar als notwendig erachtet wurden, es jedoch noch keine passenden SNOMED CT®-Konzepte dazu existieren (siehe auch Offene Themen/Backlog). Dasselbe gilt für die fehlenden deutschen Übersetzungen, die bis zur tatsächlichen Anwendung des ValueSets vorhanden sein werden.

SNOMED CT: Concept ID	SNOMED CT: Fully Specified Name	Sofern vorhanden: SNOMED CT: Bevorzugtes deutsches Synonym (offizielle Übersetzung)	Sofern (noch) keine offizielle Übersetzung: Vorgeschlagene deutsche Übersetzung
255881006	2-bromo-2-nitropropane-1,3-diol	2-Brom-2-Nitro-1,3-Propandiol
788297005	2-methyl-4-isothiazolin-3-one		Methylisothiazolinon
711090003	Acarus siro protein	Mehlmilbenprotein
256261008	Alder pollen		Erlen-Pollen
387135004	Allopurinol	Allopurinol
256350002	Almond	Mandel
711234000	Alternaria alternata protein antigen		Alternaria alternata Antigen
387542008	Amdinocillin pivoxil		Pivmecillinam
372821002	Amiodarone	Amiodaron
386864001	Amlodipine	Amlodipin
372687004	Amoxicillin	Amoxicillin
387170002	Ampicillin	Ampicillin
735215001	Apple	Apfel
386961008	Aprotinin	Aprotinin
703107005	Articain	Articain
256266003	Ash pollen		Eschen-Pollen
11526002	Aspartame	Aspartam
121012000	Aspergillus fumigatus antigen		Aspergillus fumigatus Antigen
387458008	Aspirin	Acetylsalicylsäure
373444002	Atorvastatin	Atorvastatin
387531004	Azithromycin	Azithromycin
2649007	Azo dye		Azo-Farbstoffe
255842006	Balsam of Peru		Perubalsam
256307007	Banana	Banane
288328004	Bee venom	Bienengift
64686009	Benzalkonium chloride		Benzalkoniumchlorid
387350000	Benzoic acid	Benzoesäure
55902002	Benzyl alcohol		Benzylalkohol
146691000146104	Bird protein		Vogel-Protein
386868003	Bisoprolol	Bisoprolol
256351003	Brazil nut	Paranuss
226723006	Buckwheat - cereal	Buchweizen
288460008	Bumble bee venom	Hummelgift
387150008	Bupivacaine	Bupivacain
228104004	Butylated hydroxyanisole		Butylhydroxyanisol
372512008	Candesartan	Candesartan
387222003	Carbamazepine	Carbamazepin
256319004	Carrot	Karotte
227493005	Cashew nut	Cashewnuss
387270009	Cefaclor	Cefaclor
372651006	Cefadroxil		Cefadroxil
387536009	Cefixime	Cefixim
387534007	Cefpodoxime	Cefpodoxim
372670001	Ceftriaxone	Ceftriaxon
372833007	Cefuroxime	Cefuroxim
116081000	Celecoxib	Celecoxib
256326004	Celery	Sellerie
764147003	Cephalosporin	Cephalosporin
255884003	Chlorocresol		Chlorocresol
767206002	Chromium and/or chromium compound		Chrom und Chrom-Verbindungen
259119007	Cineole	Cineol
227388008	Cinnamon	Zimt
372840008	Ciprofloxacin	Ciprofloxacin
711242004	Cladosporium herbarum protein antigen		Cladosporium herbarum Antigen
387487009	Clarithromycin	Clarithromycin
395939008	Clavulanic acid	Clavulansäure
372786004	Clindamycin	Clindamycin
54808007	Cobalt	Kobalt
735245003	Cod	Kabeljau
255840003	Colophony	Kolophonium
1354800008	Compositae allergen patch test substance		Kompositen Epikutantestreihen-Substanz
3718001	Cow's milk	Kuhmilch
372584003	Dexamethasone	Dexamethason
7034005	Diclofenac	Diclofenac
387461009	Digoxin	Digoxin
372682005	Diphenhydramine	Diphenhydramin
143491000146106	Domestic cat protein		Katzen-Protein
143481000146109	Domestic dog protein		Hunde-Protein
143501000146101	Domestic Guinea pig protein		Meerschweinchen-Protein
372478003	Doxycycline	Doxycyclin
720687003	Dust mite protein	Hausstaubmilbenprotein
703894008	Empagliflozin	Empagliflozin
372658000	Enalapril	Enalapril
65345002	Epoxy resin	Epoxidharz
372694001	Erythromycin	Erythromycin
409134009	Etoricoxib	Etoricoxib
256262001	European white birch pollen	Silberbirkenpollen
409149001	Ezetimibe	Ezetimib
373492002	Fentanyl	Fentanyl
735971005	Fish	Fisch
111095003	Formaldehyde	Formaldehyd
1354797006	Fragrance mix I		Duftstoff-Mix I
1354798001	Fragrance mix II		Duftstoff-Mix II
58202007	Fructose	Fruktose
387475002	Furosemide	Furosemid
1348311005	Gadolinium-based contrast media		Gadolinium-haltiges Kontrastmittel
38182007	Galactose	Galactose
89811004	Gluten	Gluten
83595008	Goat's milk	Ziegenmilch
256277009	Grass pollen	Gräserpollen
256263006	Hazel pollen	Haselpollen
256353000	Hazelnut	Haselnuss
286550009	Hen's egg		Hühnerei
372877000	Heparin	Heparin
387341002	Heroin	Heroin
227598003	Honey	Honig
288326000	Hornet venom	Hornissengift
146651000146106	Horse protein		Pferde-Protein
387525002	Hydrochlorothiazide	Hydrochlorothiazid
138761000146100	Hydroxyisohexyl 3-cyclohexene carboxaldehyde		Lyral/HICC/4-(4-Hydroxy-4-methylpentyl)-3-cyclohexankarboxaldehyd
387207008	Ibuprofen	Ibuprofen
373513008	Indometacin	Indometacin
426722004	Iodinated contrast media		Iodhaltiges Kontrastmittel
256030008	Jasmine synthetic		Synthethisches Jasminöl
373464007	Ketamine	Ketamin
260176001	Kiwi	Kiwi
47703008	Lactose	Laktose
387562000	Lamotrigine	Lamotrigin
42416001	Lanolin	Lanolin
111088007	Latex	Latex
395986007	Lercanidipine	Lercanidipin
387552007	Levofloxacin	Levofloxacin
421208001	Levomenthol		Levomenthol
387480006	Lidocaine	Lidocain
386873009	Lisinopril	Lisinopril
373567002	Losartan	Losartan
710179004	Lupine seed	Lupinensamen
735977009	Marine crustacean	Krustentier
387055000	Meloxicam		Meloxicam
387414008	Menthol		Menthol
59560006	Mepivacaine	Mepivacain
767273009	Mercury and/or mercury compound		Quecksilber und/oder Quecksilberverbindungen
780831000	Metamizole	Metamizol
372567009	Metformin	Metformin
387286002	Methadone	Methadon
256216009	Methyldibromoglutaronitrile		Methyldibromo Glutaronitril
372826007	Metoprolol	Metoprolol
386847004	Mirtazapine	Mirtazapin
770326002	Mollusk	Weichtier
373529000	Morphine	Morphin
412439003	Moxifloxacin	Moxifloxacin
256293000	Mugwort pollen	Beifuß-Pollen
51905005	Mustard	Senf
372588000	Naproxen	Naproxen
386898005	Nevirapine	Nevirapin
43921001	Nickel compound		Nickel-Verbindungen
256225003	N-isopropyl-N'-phenyl paraphenylenediamine		N-Isopropyl-N’-phenyl-p-phenylendiamin (IPPD)
373543005	Nitrofurantoin	Nitrofurantoin
13577000	Nut	Nuss
387551000	Ofloxacin	Ofloxacin
387137007	Omeprazole	Omeprazol
387025007	Oxcarbazepin	Oxcarbazepin
395821003	Pantoprazole	Pantoprazol
412046002	Paraben and/or paraben derivative		Paraben und/oder Paraben-Derivate
387517004	Paracetamol	Paracetamol
255667006	Paraffin	Paraffin
735049002	Peach	Pfirsich
762952008	Peanut	Erdnuss
764146007	Penicillin		Penicilline
372725003	Penicillin V		Phenoxymethylpenicillin
410457007	Permethrin	Permethrin
373505007	Phenobarbital	Phenobarbital
63004003	Phenylalanine	Phenylalanin
387220006	Phenytoin	Phenytoin
227511008	Pine nut	Pinienkern
372836004	Piperacillin	Piperacillin
387153005	Piroxicam	Piroxicam
227512001	Pistachio nut	Pistazie
8030004	Polyethylene glycol	Macrogol
28230009	Poultry	Geflügel
116601002	Prednisolone	Prednisolon
387256009	Primidone	Primidon
255970007	Propolis		Propolis
227313005	Pulse vegetable	Hülsenfrucht
764148008	Quinolone		Chinolone
256303006	Ragweed pollen	Ambrosiapollen
386872004	Ramipril	Ramipril
226915003	Red meat	Rotes Fleisch
386839004	Remifentanil	Remifentanil
387159009	Rifampin	Rifampicin
700067006	Rosuvastatin	Rosuvastatin
54107004	Sandalwood oil		Sandelholzöl
372594008	Sertraline	Sertralin
260167008	Sesame seed	Sesamsamen
387584000	Simvastatin	Simvastatin
28421003	Sorbic acid	Sorbinsäure
255905003	Sorbitan sesquioleate		Sorbitansesquioleat
19839007	Sorbitol		Sorbitol
7791007	Soybean protein	Sojaprotein
11320009	Sucrose	Saccharose
74523009	Sulfadiazine	Sulfadiazin
363528007	Sulfamethoxazole	Sulfamethoxazol
387248006	Sulfasalazine	Sulfasalazin
767406000	Sulfite and/or sulfite derivative	Sulfit und/oder Sulfitderivat
372509005	Tamsulosin	Tamsulosin
387069000	Telmisartan	Telmisartan
419852003	Thiuram derivative		Thiuram-Mix
373562008	Tilidine		Tilidin
108476002	Torsemide	Torasemid
386858008	Tramadol	Tramadol
782576004	Tree pollen		Baum-Pollen
387179001	Trimethoprim		Trimethoprim
386876001	Valsartan	Valsartan
256352005	Walnut - nut	Walnuss - Nuss
256440004	Wasp venom	Wespengift
412071004	Wheat	Weizen
256037006	Ylang-ylang oil		Ylang-ylang-Öl

ValueSet "Auslösende Substanz" im json Format

{
  "resourceType": "ValueSet",
  "id": "allergy-intolerance-substance-snomed-ct-1-0-0",
  "meta": {
    "profile": [ "http://hl7.org/fhir/StructureDefinition/shareablevalueset" ]
  },
  "language": "de-DE",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/artifact-author",
    "valueContactDetail": {
      "name": "mio42 GmbH",
      "telecom": [ {
        "system": "url",
        "value": "https://www.mio42.de"
      }, {
        "system": "email",
        "value": "hello@mio42.de"
      }, {
        "system": "phone",
        "value": "+49 30 40 05 29 00"
      } ]
    }
  } ],
  "url": "https://fhir.kbv.de/ValueSet/KBV_VS_AllergyIntolerance_Substance_SNOMED_CT",
  "version": "1.0.0",
  "name": "KBV_VS_AllergyIntolerance_Substance_SNOMED_CT",
  "title": "Allergien Überempfindlichkeitsreaktionen Auslösende Substanz",
  "status": "active",
  "experimental": false,
  "date": "2025-10-27",
  "publisher": "mio42 GmbH",
  "contact": [ {
    "telecom": [ {
      "system": "url",
      "value": "https://www.mio42.de"
    }, {
      "system": "email",
      "value": "hello@mio42.de"
    } ]
  } ],
  "description": "Dieses Valueset enthält Konzepte über auslösende Substanzen von allergischen und anderen Überempfindlichkeitsreaktionen. Es erhebt keinen Anspruch auf Vollständigkeit, sondern wird bedarfsgesteuert weiterentwickelt werden.",
  "copyright": "Die Urheberrechte für die Zusammenstellung dieses Valuesets liegen bei der mio42 GmbH.",
  "compose": {
    "include": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-ValueSet.compose.include.copyright",
        "valueString": "Dieses Valueset enthält SNOMED Clinical Terms® (SNOMED CT®), die mit Genehmigung der International Health Terminology Standards Development Organisation (IHTSDO) verwendet werden. Alle Rechte vorbehalten. SNOMED CT® wurde ursprünglich vom College of American Pathologists entwickelt. 'SNOMED' und 'SNOMED CT' sind eingetragene Warenzeichen der IHTSDO. Die Implementierer dieses Artefakts müssen über die entsprechende SNOMED CT-Partnerlizenz verfügen."
      } ],
      "system": "http://snomed.info/sct",
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  }
}

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