# Langcare Langcare MCP Fhir Allergy Adverse Reaction Summary > Allergy & Adverse Reaction Summary - Skill: `tomevault-io/langcare-langcare-mcp-fhir-allergy-adverse-reaction-summary` (Agent Skill, multi-file: 2 files) - Install (CLI): `npx skillmds@latest add tomevault-io/langcare-langcare-mcp-fhir-allergy-adverse-reaction-summary` - Raw SKILL.md: https://api.skillmd.com/api/skills/tomevault-io/langcare-langcare-mcp-fhir-allergy-adverse-reaction-summary/raw - Safety review: pending (external: skill-scanner PASS, skillspector PASS) - Works with: Claude Code, Claude.ai, OpenAI Codex - Category: AI & ML - Author: tomevault-io (https://skillmd.com/u/tomevault-io) - Updated: 2026-09-17 - Page: https://skillmd.com/skills/tomevault-io/langcare-langcare-mcp-fhir-allergy-adverse-reaction-summary --- # Allergy & Adverse Reaction Summary ## Overview Pull all AllergyIntolerance resources for a patient. Categorize by type (drug, food, environmental). Grade severity and criticality. Flag high-risk allergies that require special clinical attention (anaphylaxis history, contrast dye, latex, NSAID sensitivity). Cross-reference against current medications to detect active conflicts. Output a structured summary with actionable safety flags. ## FHIR Resources Used | Resource | Purpose | Search Parameters | |----------|---------|-------------------| | AllergyIntolerance | Allergy and intolerance records | patient, clinical-status | | MedicationRequest | Current medications for conflict detection | patient, status=active | | Observation | IgE levels if available | patient, code (LOINC) | ## Instructions ### Step 1: Pull All AllergyIntolerance Resources ``` Tool: fhir_search resourceType: "AllergyIntolerance" queryParams: "patient=[patient-id]" ``` Retrieve all records regardless of clinical status to capture full history. For each entry extract: - `code.coding`: Substance (RxNorm for drugs, SNOMED CT for non-drugs) - `clinicalStatus`: active, inactive, resolved - `verificationStatus`: confirmed, unconfirmed, refuted, entered-in-error - `type`: allergy vs intolerance - `category`: food, medication, environment, biologic - `criticality`: low, high, unable-to-assess - `reaction[]`: Each reaction event - `manifestation[].coding[].display`: What happened (hives, anaphylaxis, rash, etc.) - `severity`: mild, moderate, severe - `onset`: When the reaction occurred - `substance`: Specific substance if different from the top-level code - `onsetDateTime`: When allergy was first identified - `recorder`: Who documented it - `note`: Free-text notes ### Step 2: Categorize Allergies Group into four categories: **Drug Allergies** (`category` = "medication"): - Identify drug class from the substance code or name - Check for class-level allergies vs specific drug allergies - Note if the allergy is to a drug class (e.g., "penicillins") vs specific drug (e.g., "amoxicillin") **Food Allergies** (`category` = "food"): - Common: peanuts, tree nuts, shellfish, milk, eggs, wheat, soy, fish - Note severity -- food allergies with anaphylaxis history are high-risk **Environmental Allergies** (`category` = "environment"): - Pollen, dust mites, mold, animal dander, insect venom - Usually lower clinical urgency unless anaphylaxis to insect stings **Biologic/Other** (`category` = "biologic" or uncategorized): - Latex, contrast dye, blood products, vaccines ### Step 3: Flag High-Risk Allergies Scan the allergy list for the following high-risk patterns: **Anaphylaxis History:** - Any allergy where `reaction[].manifestation` includes SNOMED 39579001 (Anaphylaxis) or display text contains "anaphylaxis" or "anaphylactic" - Flag with: "ANAPHYLAXIS RISK -- Ensure epinephrine availability" **Contrast Dye Allergy:** - Substance code or display contains "iodine", "contrast", "iodinated contrast" - Flag with: "CONTRAST ALLERGY -- Premedication protocol required for CT with contrast" **Latex Allergy:** - Substance = SNOMED 111088007 (Latex) or display contains "latex" - Flag with: "LATEX ALLERGY -- Use non-latex gloves and equipment" - Check for cross-reactive foods: banana, avocado, kiwi, chestnut **NSAID Sensitivity:** - Allergy to aspirin, ibuprofen, naproxen, or "NSAIDs" as a class - Flag with: "NSAID SENSITIVITY -- Avoid all COX inhibitors. Consider acetaminophen as alternative." - Check for aspirin-exacerbated respiratory disease (Samter's triad): NSAID allergy + asthma + nasal polyps **Sulfonamide Allergy:** - Allergy to "sulfa", "sulfamethoxazole", "trimethoprim-sulfamethoxazole", or sulfonamide antibiotics - Note: Sulfonamide antibiotic allergy does NOT contraindicate non-antibiotic sulfonamides (furosemide, thiazides, celecoxib) -- cross-reactivity is negligible but document awareness **Opioid Allergy:** - If allergy to one opioid, check if it is a true allergy (e.g., anaphylaxis) or a side effect misclassified as allergy (nausea, itching are common opioid side effects, not allergies) - Flag specific opioid vs opioid class ### Step 4: Check Cross-Reactivity Patterns Apply known cross-reactivity rules: **Penicillin Cross-Reactivity:** - Penicillin allergy -> ~2% cross-reactivity with cephalosporins (1st gen > 2nd gen > 3rd gen) - Penicillin allergy -> ~1% cross-reactivity with carbapenems - If penicillin allergy with anaphylaxis: avoid all beta-lactams pending allergy testing - If penicillin allergy with mild rash only: cephalosporins (2nd gen+) generally safe **Cephalosporin Cross-Reactivity:** - 1st gen cephalosporins (cephalexin, cefazolin) have highest cross-reactivity with penicillin - Cross-reactivity is side-chain dependent, not ring-structure dependent (current evidence) **ACE Inhibitor Angioedema:** - ACE inhibitor-induced angioedema -> contraindication to all ACE inhibitors - ARBs are generally safe alternatives (low cross-reactivity) - Document as a separate allergy entry if not already present **Statin Myopathy:** - Myopathy/rhabdomyolysis with one statin does not necessarily contraindicate all statins - Hydrophilic statins (rosuvastatin, pravastatin) may be tolerated ### Step 5: Cross-Reference with Active Medications ``` Tool: fhir_search resourceType: "MedicationRequest" queryParams: "patient=[patient-id]&status=active" ``` For each active medication, check against the allergy list: - Direct match: medication name/code matches allergy substance - Class match: medication belongs to same drug class as allergy substance - Cross-reactivity match: medication has known cross-reactivity with allergy substance **Flag any active conflict as:** ``` ACTIVE CONFLICT: Patient is on [medication] but has documented allergy to [substance] Reaction history: [manifestation] - Severity: [severity] Action required: Verify with prescriber. This may be a monitored override or a documentation error. ``` ### Step 6: Assess Documentation Quality Flag documentation issues: - Allergy with no reaction documented (`reaction` array empty) - Allergy with no severity specified - `verificationStatus` = "unconfirmed" for allergies older than 1 year (should be confirmed or refuted) - `type` not specified (allergy vs intolerance distinction missing) - No allergies documented AND no "No Known Allergies" entry (allergy status unknown vs NKDA) ### Step 7: Format Output ``` ALLERGY & ADVERSE REACTION SUMMARY ==================================== Patient: [name] ([patient-id]) Reviewed: [timestamp] Total Entries: [count] Allergy Status: [Reviewed / Not Reviewed / NKDA] HIGH-RISK ALERTS ================ [!] ANAPHYLAXIS RISK: [substance] - ensure epinephrine access [!] CONTRAST ALLERGY: Premedication required [!] LATEX ALLERGY: Non-latex equipment required [!] ACTIVE CONFLICT: On [medication] with allergy to [substance] DRUG ALLERGIES ============== 1. [Substance] (RxNorm: [code]) Type: Allergy | Status: Active | Criticality: High Reaction: [manifestation] | Severity: Severe Cross-reactivity note: [if applicable] Documented: [date] by [recorder] 2. ... FOOD ALLERGIES ============== 1. [Substance] - Reaction: [manifestation] - Severity: [severity] 2. ... ENVIRONMENTAL ALLERGIES ======================= 1. [Substance] - Reaction: [manifestation] - Severity: [severity] 2. ... INTOLERANCES (Non-Allergic) ============================ 1. [Substance] - Type: Intolerance - Reaction: [manifestation] 2. ... DOCUMENTATION QUALITY ===================== - [N] allergies missing reaction details - [N] allergies with unconfirmed verification status - [Notes on documentation gaps] CROSS-REACTIVITY NOTES ======================= - [Relevant cross-reactivity information based on documented allergies] ``` ## Examples ### Example 1: Patient With Multiple Drug Allergies **User says:** "Check allergies for patient 33221" **Actions:** 1. `fhir_search` AllergyIntolerance?patient=33221 -- returns 5 entries 2. `fhir_search` MedicationRequest?patient=33221&status=active -- returns 8 medications **Result:** ``` ALLERGY & ADVERSE REACTION SUMMARY ==================================== Patient: David Park (33221) Reviewed: 2026-02-07T10:00:00Z Total Entries: 5 Allergy Status: Reviewed HIGH-RISK ALERTS ================ [!] ANAPHYLAXIS RISK: Penicillin - ensure epinephrine access [!] ACTIVE CONFLICT: On cephalexin (Keflex) with documented penicillin allergy (anaphylaxis history) - IMMEDIATE REVIEW REQUIRED DRUG ALLERGIES ============== 1. Penicillin (RxNorm: 7980) Type: Allergy | Status: Active | Criticality: High Reaction: Anaphylaxis | Severity: Severe Cross-reactivity: 2% risk with cephalosporins. Given anaphylaxis history, avoid all beta-lactams pending formal allergy testing. Documented: 2019-05-12 2. Codeine (RxNorm: 2670) Type: Intolerance | Status: Active | Criticality: Low Reaction: Nausea, vomiting | Severity: Mild Note: Likely opioid side effect, not true allergy. Other opioids may be tolerated. Consider reclassifying as intolerance if not already. Documented: 2020-08-03 FOOD ALLERGIES ============== 1. Shellfish (SNOMED: 278840001) Reaction: Urticaria, throat tightness | Severity: Moderate Note: Monitor for iodinated contrast cross-reactivity (historically cited but evidence is weak; shellfish allergy is protein-based, not iodine-based) ENVIRONMENTAL ALLERGIES ======================= 1. Dust mites (SNOMED: 260147004) Reaction: Rhinitis | Severity: Mild INTOLERANCES ============ 1. Lactose (SNOMED: 782415009) Type: Intolerance | Reaction: Bloating, diarrhea | Severity: Mild DOCUMENTATION QUALITY ===================== - Codeine entry classified as "allergy" but reaction pattern suggests intolerance - Dust mite allergy missing severity in FHIR record (inferred as mild from manifestation) ``` ### Example 2: No Allergies Documented -- Ambiguous Status **User says:** "Does patient 99001 have any allergies?" **Actions:** 1. `fhir_search` AllergyIntolerance?patient=99001 -- returns 0 entries **Result:** ``` ALLERGY & ADVERSE REACTION SUMMARY ==================================== Patient: Lisa Chen (99001) Reviewed: 2026-02-07T10:15:00Z Total Entries: 0 Allergy Status: ** NOT REVIEWED ** HIGH-RISK ALERTS ================ [!] ALLERGY STATUS UNKNOWN: No allergy records found. This does NOT mean "No Known Allergies" -- it means allergies have never been documented. Allergy history MUST be collected before prescribing. RECOMMENDATION ============== Ask the patient about: 1. Drug allergies (especially antibiotics, NSAIDs, anesthetics) 2. Food allergies 3. Environmental allergies 4. Latex sensitivity 5. Contrast dye reactions 6. Previous adverse drug reactions If patient reports no allergies, document a "No Known Allergies" entry: Tool: fhir_create resourceType: "AllergyIntolerance" resource: { "clinicalStatus": {"coding": [{"system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", "code": "active"}]}, "verificationStatus": {"coding": [{"system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", "code": "confirmed"}]}, "code": {"coding": [{"system": "http://snomed.info/sct", "code": "716186003", "display": "No known allergy"}]}, "patient": {"reference": "Patient/99001"} } ``` ## Troubleshooting ### AllergyIntolerance Uses Free Text Instead of Coded Substances - Some EHR systems populate `code.text` but not `code.coding`. Use the display text for matching. - Attempt fuzzy matching against known drug names and classes for cross-reference purposes. - Flag these entries for coding improvement: "Allergy to [free text] should be coded with RxNorm/SNOMED for interoperability." ### Medication Conflict Detected But May Be Intentional Override - Clinicians sometimes prescribe medications despite documented allergies after risk-benefit analysis (e.g., penicillin allergy but documented tolerance to amoxicillin after skin testing). - Check for `note` or extension fields that indicate a deliberate override. - Present the conflict but note: "This may be a monitored override. Verify with the prescribing clinician before recommending discontinuation." ### AllergyIntolerance Resources Have verificationStatus = "entered-in-error" - Exclude these from the active summary entirely. - If the user specifically asks about historical or retracted allergies, include them in a separate "Retracted Entries" section. ## Related Skills - `patient-demographics-summary` -- for complete patient overview including insurance and contacts - `problem-list-review` -- for cross-referencing allergies with conditions - `clinical-summary-generator` -- for allergies in the context of a full CCD summary --- > Converted and distributed by [TomeVault](https://tomevault.io/claim/langcare) — claim your Tome and manage your conversions.