title: Decreasing the undernotification of anaphylaxis deaths in Brazil through the International Classification of Diseases (ICD)-11 revision.
abstract: BACKGROUND
  In 2012, an analysis of the Brazilian mortality database demonstrated undernotification of anaphylaxis deaths due, at least in part, to difficult coding under the International Classification of Diseases (ICD)-10. This work triggered a cascade of strategic international actions supported by the Joint Allergy Academies and the ICD World Health Organization (WHO) representatives to update the classifications of allergic disorders for the ICD-11 revision. These efforts have resulted in the construction of the new 'Allergic and hypersensitivity conditions' section under the 'Disorders of the Immune system' chapter.
  
  
  OBJECTIVE
  To analyze the capacity of the new ICD-11 revision to capture anaphylaxis deaths.
  
  
  METHODS
  We re-estimated the anaphylaxis deaths that occurred in Brazil during the period 2008 to 2010, utilizing this new framework and the database of the Brazilian mortality information system that had initially been extracted in May 2011. However, in 2016, a manual review of each of the 3638 records was performed.
  
  
  RESULTS
  We identified 639 anaphylaxis deaths, of which 95% were classified as 'definitive anaphylaxis deaths'. In contrast to the 2012 published data, we found a higher number of cases; moreover, all 606 definitive anaphylaxis deaths would be considered as underlying causes of death utilizing the ICD-11 revision.
  
  
  CONCLUSIONS
  This study is the first example of how the new 'Allergic and hypersensitivity conditions' section of the forthcoming ICD-11 can improve the quality of official vital statistics data and the visibility of an important public health concern. This research will facilitate comprehensive, comparable population-based epidemiologic data collection on anaphylaxis.
authors.affiliation: Hospital Sírio Libanês, São Paulo, Brazil.|University Hospital of Montpellier, Montpellier, France.|UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Sorbonne Universités, Paris, France.
authors.forename: L K
authors.initials: LK
authors.lastname: Tanno
authors.affiliation: Hospital Sírio Libanês, São Paulo, Brazil.|Sanas Epidemiology and Research, São Paulo, Brazil.|Teaching Research Institute (IEP), Hospital Sírio Libanês, São Paulo, Brazil.
authors.forename: A L
authors.initials: AL
authors.lastname: Bierrenbach
authors.affiliation: Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Calderon
authors.affiliation: Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: Section of Allergy and Clinical Immunology, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: F E R
authors.initials: FE
authors.lastname: Simons
authors.affiliation: University Hospital of Montpellier, Montpellier, France.|UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Sorbonne Universités, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Demoly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D018563:Disease Notification / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: International Classification of Diseases; World Health Organization; anaphylaxis; classification; mortality