PROPERTIES AND UNITS IN THE CLINICAL LABORATORY SCIENCES

XVI. PROPERTIES AND UNITS IN CLINICAL ALLERGOLOGY 

(Technical report IUPAC-IFCC 1999)

 Prepared for publication by

 Ivan Bruunshuus1,  Lars K. Poulsen2 , Henrik Olesen1

 1Office of Laboratory Informatics, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
2Laboratory of Medical Allergology, TA 7542, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark

#The combined Memberships of the Commission and the Committee during the preparation of this report (1992 to 1996) were as follows:

Chairman: 1998 - 1999  X. Fuentes-Arderiu (Spain);  1996 - 1997 D. Kenny (Ireland); 1989 - 1995 H. Olesen (Denmark). Members: X. Fuentes-Arderiu (Spain; 1991-1997); J.G. Hill (Canada; 1987-1997); D. Kenny (Ireland; 1994-1997); H. Olesen (Denmark; 1985-1995);  PL Storring (United Kingdom; 1989-1995); P Soares de Araujo (Brazil; 1994-1997); René Dybkær (Denmark; 1996-1997); Clem McDonald (USA; 1996-1997).
Please forward comments to: I. Bruunshuus, Office of Laboratory Informatics 76-6-1, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. E-mail: brunshus@rh.dk

Synopsis

The subject field of clinical allergology deals  with many hundred different allergens from all parts of the human environment and the number steadily increases. Not all of the allergens are strictly defined in chemical terms and  procedures for detection of antibodies against the allergens  in the human vary.
     This document  deals with the presentation of request and report on such properties according to some international rules and the allocation of code values representing  the concept delineated.
     The coding scheme thus prepared is imperfect and needs further elaboration as allergens become more well defined. It is a step toward harmonization, in particular as concerns the coding system applied. 
     The net outcome is a coding scheme for use in electronic transmission.

Preface

The present document is the sixteenth part (XVI) of a series on properties observed in the clinical laboratory sciences initiated in 1987.
    The series will comprise the five general parts (I-IV and XI) and a series of special parts:

I         Syntax and semantic rules [1]
II        Kinds-of-property [2]
III       Elements (of properties) and their code values
IV       Properties and their code values 
V        Properties and units in Thrombosis and Haemostasis 
VI       Properties and units in IOC prohibited Drugs
VII      Properties and units in Inborn Errors of Metabolism
VIII     Properties and units in Clinical Bacteriology
IX       Properties and units in Trace Elements
X        Properties and units in General Clinical Chemistry
XI       Coding systems - structure and guidelines [3]
XII      Properties and units in Clinical Pharmacology and Toxicology
XIII     Properties and units in Reproduction and Fertility
XVI     Properties and units in Clinical Allergology (this report)

     The NCCLS code values are reproduced with permission, from NCCLS publication

I/LA20-P [4].

Foreword and Scope

Basic research in biology and medicine and innovations in laboratory methodology have greatly increased the range of properties available to medical practitioners to help them in decisions on diagnosis, treatment and prevention of disease.
     The plethora is now such that the individual doctor has insight in or understanding of only a limited number of properties offered to him from the various clinical laboratory specialities. 
     In the laboratory, local terms (jargon) may be well understood among colleagues, but they are not appropriate for communication with the outside world. Likewise, a laboratory and its local community of users, such as hospital or community physicians, may use a "local dialect" of the language of clinical laboratory sciences which is well understood by all concerned, but when the communication possibilities are wider, even transnational, risks of serious misunderstanding arise.
     In addition, the terminology used by one laboratory speciality may vary even within the speciality, and may be incomprehensible to another speciality. This is a minor inconvenience to the laboratory specialities, each one essentially operating within its own area of activity. However, for the user this is highly unsatisfactory and also it may hinder treatment of the patient.
     It is therefore essential to promote clear, unambiguous, meaningful and fully informative communication. Also coherence of statements made within and between medical specialities, and  uniformity in structure of presentation is to be strived for. This will facilitate transfer of information over cultural, alphabetic and language areas.
     The purpose of this document is to apply the syntax structures for request and report recommended by the European standards ENV 1614:1995 [6]  and ENV 12435:1996 [7] and by  IUPAC–IFCC [1, 5], providing formats and names of properties observed in the domain of Clinical Allergology, in order to facilitate unequivocal written or electronic communication between health care professionals.
     The systematic names recommended here are primarily for the purpose of unambiguous data exchange. Their use in routine language by clinicians or laboratory practitioners is optional but encouraged.

Special Features

The term “arbitrary” in princible cannot be related to a volume. In clinical chemistry however a less well defined “inhouse” or a regional calibrator is often referred to and is expressed in “arbitrary unit per litre” in order to enable comparison of patient data over time and regionally. In each of these instances further information should be given in the parenthesis “procedure”. This could be information on the calibrator used, f.ex. “BCR/CRM148/149R  or it could refer to the inlaboratory document “procedure xx”. which is available on request  (point 2.2.1 below).
    In the examples given, a question mark, “?”, has been used to represent the value of a result for properties including quantities.

1.             Names of component. Both in histamine release and for antibodies, part of the name is from food, dust, poison or other parts of the human environment. For identification of these complex materials, the NCCLS code values have been added as a specification after the kind-of-property.

EXAMPLE 1

          Basophilocytes(Blood)—
     Candida albicans induced HR;
          arbitrary concentration(NCCLS/m5; procedure)
          [NPU08867]
          Basocs.(B)—Candida albicans induced HR; arb.c.(NCCLS/m5; 0 1 2 3) = ?

   The NCCLS code values are also used for classification into lists for ease of  assembling panels by the individual clinical laboratory.

 2.       Kinds-of-property. These comprise:

 2.1     arbitrary concentration denoting an ordinal scale of the type 0 1 2; 0 1 2 3 4 5, etc.

EXAMPLE 2

              Plasma—
Candida albicans antibody(Immunoglobulin E);
    arbitrary concentration (NCCLS/m5; procedure)
    [NPU11311]
     P—Candida albicans antibody(IgE); arb.c.(NCCLS/m5; 0 1) = ?

2.2     arbitrary substance concentration, that is a ratio scale of the dimension L-3N, where the unit is not traceable to SI.

2.2.1  When the calibrator used is produced locally, arbitrary unit/litre applies.

EXAMPLE 3

          Plasma—
  Candida albicans antibody(Immunoglobulin E);
    
arbitrary substance concentration(NCCLS/m5; procedure) 
     arbitrary unit/litre
     [NPU13064]
     P—Candida albicans antibody(IgE); arb.subst.c.(NCCLS/m5) = ? × 10³ arb.unit/l

2.2.2  When the calibrator is traceable to an WHO international reference material, international unit/litre applies.

 EXAMPLE 4

          Plasma—
Candida albicans antibody(Immunoglobulin E);
    
arbitrary substance concentration(WHO75/502; NCCLS/m5; procedure)
    
10³ international unit/litre
    
[NPU10865]
     P—Candida albicans antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/m5) = ? × 10³ int.unit/l

3.       Specification after kind-of-property

          These may indicate the WHO international reference preparation(IRP) used for callibration, inform on the NCCLS identifier for the component, inform on the procedure used in that particular laboratory ("procedure 65" or "firm xx") or indicate that a list of properties follows.

EXAMPLE 5

          [NPU13456]P—Dust mite allergen antibody(IgE); arb.c.(list; NCCLS/d; proc.)
          [NPU11248] P—Acarus siro antibody(IgE); arb.c.(NCCLS/d70; proc.) = ?
          [NPU11325] P—Dermatophagoides farinae antibody(IgE); arb.c.(NCCLS/d2; proc.) = ?
          [NPU11326] P—Dermatophagoides microceras antibody(IgE); arb.c.(NCCLS/d3; proc.) = ?
          [NPU11327] P—Dermatophagoides pteronyssinus antibody(IgE); arb.c.(NCCLS/d1; proc.) = ?
          [NPU11353] P—Euroglyphus maynei antibody(IgE); arb.c.(NCCLS/d74; proc.) = ?
          [NPU11373] P—Glycyphagus domesticus antibody(IgE); arb.c.(NCCLS/d73; proc.) = ?
          [NPU11497] P—Lepidoglyphus destructor antibody(IgE); arb.c.(NCCLS/d71; proc.) = ?
          [NPU11669] P—Tyrophagus putrescentiae antibody(IgE); arb.c.(NCCLS/d72; proc.) = ?

EXAMPLE 6

          [NPU13457]P—Dust mite allergen antibody(IgE); arb.subst.c.(list; NCCLS/d; proc.)
          [NPU13001] P—Acarus siro antibody(IgE); arb.subst.c.(NCCLS/d70; proc.) = ? × 10³ arb.unit/l
          [NPU13078] P—Dermatophagoides farinae antibody(IgE); arb.subst.c.(NCCLS/d2; proc.) = ? × 10³ arb.unit/l
          [NPU13079] P—Dermatophagoides microceras antibody(IgE); arb.subst.c.(NCCLS/d3; proc.) = ? × 10³ arb.unit/l
          [NPU13080] P—Dermatophagoides pteronyssinus antibody(IgE); arb.subst.c.(NCCLS/d1; proc.) = ? × 10³ arb.unit/l
          [NPU13106] P—Euroglyphus maynei antibody(IgE); arb.subst.c.(NCCLS/d74; proc.) = ? × 10³ arb.unit/l
          [NPU13126] P—Glycyphagus domesticus antibody(IgE); arb.subst.c.(NCCLS/d73; proc.) = ? × 10³ arb.unit/l
          [NPU13250] P—Lepidoglyphus destructor antibody(IgE); arb.subst.c.(NCCLS/d71; proc.) = ? × 10³ arb.unit/l
          [NPU13422] P—Tyrophagus putrescentiae antibody(IgE); arb.subst.c.(NCCLS/d72; proc.) = ? × 10³ arb.unit/l

EXAMPLE 7

           [NPU13458]P—Dust mite allergen antibody(IgE); arb.subst.c.(list; IRP 75/502; NCCLS/d; proc.)
           [NPU10802] P—Acarus siro antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/d70; proc.) = ? × 10³ int.unit/l
           [NPU10879] P—Dermatophagoides farinae antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/d2; proc.) = ? × 10³ int.unit/l
           [NPU10880] P—Dermatophagoides microceras antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/d3; proc.) = ? × 10³ int.unit/l
           [NPU10881] P—Dermatophagoides pteronyssinus antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/d1; proc.) = ? × 10³ int.unit/l
            [NPU10907] P—Euroglyphus maynei antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/d74; proc.) = ? × 10³ int.unit/l
            [NPU10927] P—Glycyphagus domesticus antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/d73; proc.) = ? × 10³ int.unit/l
            [NPU11051] P—Lepidoglyphus destructor antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/d71; proc.) = ? × 10³ int.unit/l
            [NPU11223] P—Tyrophagus putrescentiae antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/d72; proc.) = ? × 10³ int.unit/l

4.       General approach

          The NCCLS coding scheme comprises 361 allergens. The approach, in a particular case of allergy, is to request a property that concerns a mixture of allergens at first.

          If the outcome is affirmative, then to request the properties included in the mixture, individually.

EXAMPLE 8

Initially:

NPU14814

 

P—

Occupational allergen antibody(IgE); arb.c.(NCCLS/(m3; m6; g15; g12); 0 1) = 1

Then:

 

 

 

NPU11259

 

P—

Alternaria alternata antibody(IgE); arb.c.(NCCLS/m6; 0 1) = 0

NPU11277

 

P—

Aspergillus fumigatus antibody(IgE); arb.c.(NCCLS/m3; 0 1) = 1

NPU11423

 

P—

Wheat grass antibody(IgE); arb.c.(NCCLS/g15; 0 1) = 0

NPU09341

 

P—

Rye antibody(IgE); arb.c.(NCCLS/g12; 0 1) = 0

Or:

 

 

 

NPU13012

 

P—

Alternaria alternata antibody(IgE); arb.subst.c.(NCCLS/m6; Firm A) = 0 × 10³ arb.unit/l

NPU13030

 

P—

Aspergillus fumigatus antibody(IgE); arb.subst.c.(NCCLS/m3; Firm A) = 200 × 10³ arb.unit/l

NPU13176

 

P—

Wheat grass antibody(IgE); arb.subst.c.(NCCLS/g15; Firm A) = 0 × 10³ arb.unit/l

NPU09343

 

P—

Rye antibody(IgE); arb.subst.c.(NCCLS/g12; Firm A) = 0 × 10³ arb.unit/l

Or:

 

 

 

NPU10813

 

P—

Alternaria alternata antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/m6; Firm B) = 0 × 10³ int.unit/l

NPU10831

 

P—

Aspergillus fumigatus antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/m3; Firm B) = 300 × 10³ int.unit/l

NPU10977

 

P—

Wheat grass antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/g15; Firm B) = 0 × 10³ int.unit/l

NPU09342

 

P—

Rye antibody(IgE); arb.subst.c.(IRP 75/502; NCCLS/g12; Firm B) = 0 × 10³ int.unit/l

For completion
some of:

 

 

 

NPU13471

 

P—

Fungus-antistof(IgE); arb.k.(liste; NCCLS/m; proc.)

NPU11259

 

P—

Alternaria alternata antibody(IgE); arb.c.(NCCLS/m6; proc.) = ?

NPU11260

 

P—

Alternaria tenuis antibody(IgE); arb.c.(NCCLS/m6; proc.) = ?

NPU11277

 

P—

Aspergillus fumigatus antibody(IgE); arb.c.(NCCLS/m3; proc.) = ?

NPU11279

 

P—

Aureobasidium pullulans antibody(IgE); arb.c.(NCCLS/m12; proc.) = ?

NPU11299

 

P—

Botrytis cinerea antibody(IgE); arb.c.(NCCLS/m7; proc.) = ?

NPU11311

 

P—

Candida albicans antibody(IgE); arb.c.(NCCLS/m5; proc.) = ?

NPU11314

 

P—

Cephalosporum acremonium antibody(IgE); arb.c.(NCCLS/m202; proc.) = ?

NPU11322

 

P—

Cladosporium herbarum antibody(IgE); arb.c.(NCCLS/m2; proc.) = ?

NPU11323

 

P—

Curvularia lunata antibody(IgE); arb.c.(NCCLS/m16; proc.) = ?

NPU11348

 

P—

Epicoccum purpurascens antibody(IgE); arb.c.(NCCLS/m14; proc.) = ?

NPU11362

 

P—

Fusarium moniliforme antibody(IgE); arb.c.(NCCLS/m9; proc.) = ?

NPU11399

 

P—

Helminthosporium halodes antibody(IgE); arb.c.(NCCLS/m8; proc.) = ?

NPU11525

 

P—

Mucor racemosus antibody(IgE); arb.c.(NCCLS/m4; proc.) = ?

NPU13484

 

P—

Penicillium expansum antibody(IgE); arb.c.(NCCLS/m28; proc.) = ?

NPU11570

 

P—

Penicillium notatum antibody(IgE); arb.c.(NCCLS/m1; proc.) = ?

NPU11572

 

P—

Penicillium roqueforti antibody(IgE); arb.c.(NCCLS/m30; proc.) = ?

NPU11575

 

P—

Phoma betae antibody(IgE); arb.c.(NCCLS/m13; proc.) = ?

NPU11581

 

P—

Pityrosporum orbiculare antibody(IgE); arb.c.(NCCLS/m70; proc.) = ?

NPU11582

 

P—

Pityrosporum ovale antibody(IgE); arb.c.(NCCLS/m40; proc.) = ?

NPU11599

 

P—

Rhizopus nigricans antibody(IgE); arb.c.(NCCLS/m11; proc.) = ?

NPU11600

 

P—

Rhodotorula rubra antibody(IgE); arb.c.(NCCLS/m35; proc.) = ?

NPU11642

 

P—

Stemphylium botryosum antibody(IgE); arb.c.(NCCLS/m10; proc.) = ?

NPU11663

 

P—

Trichoderma viride antibody(IgE); arb.c.(NCCLS/m15; proc.) = ?

NPU11664

 

P—

Trichosporon pullulans antibody(IgE); arb.c.(NCCLS/m203; proc.) = ?

NPU11665

 

P—

Tricophyton rubrum antibody(IgE); arb.c.(NCCLS/m205; proc.) = ?

NPU11670

 

P—

Ulocladium chartarum antibody(IgE); arb.c.(NCCLS/m204; proc.) = ?

NPU11677

 

P—

Ustilago nuda/tritici antibody(IgE); arb.c.(NCCLS/m201; proc.) = ?

Elements of an Entry

The terms recommended are given in bold, that is: the term for the type property, the unit, and the code value.

  1     Name of system and parenthetic specification spelled out in full, and followed by a long dash (em dash).

  2     Alphanumeric chemical prefixes to component name.

  3     Recommended name of component and parenthetic specification. Shifted to the left for alphabetical  sorting and searching, and followed by a semicolon.

  4     Kind-of-property and parenthetic specification.

  5     Unit.

  6      Other term(s).

  7      Note(s) with any further information.

  8      [NPUXXXXX]
Coding scheme identifier and code value, intended for interlaboratory transmission between databases.

 9       Example in abbreviated form.

References

1.       IUPAC– IFCC (International Union of Pure and Applied Chemistry–International Federation of Clinical Chemistry), Commission/Committee on Quantities and Units (in Clinical Chemistry). Properties and units in the clinical laboratory sciences. I. Syntax and semantic rules. Recommendations 1995. Prepared for publication by Olesen H. Pure & Appl Chem 1995; 67: 1563-74. Eur J Clin Chem Clin Biochem 1995; 33: 627-36. Clin Chim Acta 1996; 245: S5-S21.

2.       IUPAC–IFCC (International Union of Pure and Applied Chemistry–International Federation of Clinical Chemistry), Commission/Committee on Nomenclature, Properties and Units. Properties and units in the clinical laboratory sciences. II. Kinds-of-property. Recommendations 1996. Prepared for publication by Kenny D, Olesen H. Eur J Clin Chem Clin Biochem 1997; 35: 317-44.

3.       IUPAC–IFCC (International Union of Pure and Applied Chemistry– International Federation of Clinical Chemistry), Commission-Committee on Nomenclature, Properties and Units. Properties and units in the clinical laboratory sciences. XI. Coding systems - structure and guidelines. (Technical report 1997). Prepared for publication by H Olesen, D Kenny, R Dybkær, I Ibsen, I Bruunshuus, X Fuentes-Arderiu, G Hill, P Soares de Araujo, C McDonald. Pure and Appl Chem 1997; 35: 317-44.

4.       NCCLS. Evaluation Methods and Performance Characteristics of Immunological Assays for Human Immunoglobulin E (IgE) Antibodies of Defined Allergen Specificities; Proposed Guideline. NCCLS document I/LA20-P (ISBN 1-56238-304-3), NCCLS, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087, 1996.

5.       IUPAC–IFCC (International Union of Pure and Applied Chemistry–International Federation of Clinical Chemistry), Commission/Committee on Quantities and Units(in Clinical Chemistry), 1995. Compendium of terminology and nomenclature of properties in clinical laboratory sciences. Recommendations 1995. Prepared for publication by J.C. Rigg, S.S. Brown, R. Dybkaer, H. Olesen. Oxford: Blackwell Science, 290 pp.

6.       CEN/TC 251, 1995. European standard ENV 1614:1995. Medical informatics. Struc­ture for  nomenclature, classification and coding of properties in clinical laboratory sciences.

7.       CEN/TC 251, 1996. European standard ENV 12435:1996. Medical informatics. Expression of the results of measurement in health sciences.

 Index of Abbreviations

IFCC      International Federation of Clinical Chemistry
IRP        International Reference Preparation
IUPAC   International Union of Pure and Applied Chemistry
NCCLS  National Committee for Clinical Laboratory Standards
SI           International System of Units
WHO     World Health Organization