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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

1. Use fhir_search to pull all AllergyIntolerance resources for the patient (active, inactive, resolved)
2. Use fhir_search to pull active MedicationRequest resources for cross-reference
3. Classify allergies by type: drug, food, environmental, biologic
4. For drug allergies, cross-reference against active medications and flag any contraindicated prescriptions
5. Identify allergy documentation gaps: no known allergies (NKA) vs not assessed vs documented allergies
6. 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