米国小児食物アレルギー急増

米国：小児の食物アレルギー増加

Food Allergy Among Children in the United States
PEDIATRICS (doi:10.1542/peds.2009-1210)

18歳未満の子どもの食物アレルギーの横断調査（1997–2007 National Health Interview Survey, 2005–2006 National Health and Nutrition Examination Survey, 1993–2006 National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey, 1998–2006 National Hospital Discharge Survey）

食物アレルギー報告、血中IgE特異抗体、受診歴、入院など評価

2007年、3.9％の米国１８歳未満の子どもでの食物アレルギー報告
1997年から2007年まで、18％(z = 3.4; P < .01) 増加
2005－2006年、ピーナッツ血中IgE抗体は約9％
受診は1993年から2006年で三倍 (P < .01)



2003年から2006年で推定年間、317000の食物アレルギー関連受診数（95%信頼区間 195000–438000 回/年)で、緊急・EDや診療所報告
入院も1998－2000年から2004-2006年で　年2600から9500 (z = 3.4; P < .01)と増加


食物アレルギーVコード使用のためかもしれない

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V Codes Listing
V Codes Listingは、2000年に導入され、入院理由として明確化されたための分類上の問題かもしれない。

SUPPLEMENTARY CLASSIFICATION OF FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES (V01-V89)
This classification is provided to deal with occasions when circumstances other than a disease or injury classifiable to categories 001-999 (the main part of ICD) are recorded as "diagnoses" or "problems." This can arise mainly in three ways:
a)When a person who is not currently sick encounters the health services for some specific purpose, such as to act as a donor of an organ or tissue, to receive prophylactic vaccination, or to discuss a problem which is in itself not a disease or injury. This will be a fairly rare occurrence among hospital inpatients, but will be relatively more common among hospital outpatients and patients of family practitioners, health clinics, etc.
b)When a person with a known disease or injury, whether it is current or resolving, encounters the health care system for a specific treatment of that disease or injury (e.g., dialysis for renal disease; chemotherapy for malignancy; cast change).
c)When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury. Such factors may be elicited during population surveys, when the person may or may not be currently sick, or be recorded as an additional factor to be borne in mind when the person is receiving care for some current illness or injury classifiable to categories 001-999.
In the latter circumstances the V code should be used only as a supplementary code and should not be the one selected for use in primary, single cause tabulations. Examples of these circumstances are a personal history of certain diseases, or a person with an artificial heart valve in situ.

Cerebral circulatory conditions without residual deficits.
V12.54Transient ischemic attack (TIA), and cerebral infarction without residual deficits*
V12.54 Prolonged reversible ischemic neurological deficit (PRIND)*
V12.54 Reversible ischemic neurologic deficit (RIND)*
V12.54 Stroke NOS without residual deficits*
*Excludes: history of traumatic brain injury (V15.52)
*Excludes: late effects of cerebrovascular disease (438.0-438.9)

Allergies
V14.0Allergic to Penicillin
V14.1Allergic to antibiotic agent
V14.2Allergic to Sulfonamides
V14.3Allergic to Other anti-infective agent
V14.4Allergic to Anesthetic agent
V14.5Allergic to Narcotic agent
V14.6Allergic to analgesic agent
V14.7Allergic to serum or vaccine
V14.8Allergic to other specified medicinal agents [name medication, e.g., “V14.8 Allergic to buprenorphine”]
V14.9Allergic to unspecified medicinal agent
V15.0Allergy, other than to medicinal agents
Excludes: allergy to food used as base for medicinal agent (V14.0-V14.9)
Excludes: replacement by transplant or other means (V42.1-V42.2, V43.2-V43.4)

Personal history presenting hazards to health.
V15.41History of physical abuse*
V15.41 History of Rape*
V15.42History of emotional abuse*
V15.42 History of neglect*
* Excludes: history of condition classifiable to 290-316 (V11.0-V11.9)
V15.52History of traumatic brain injury. Excludes: personal history of cerebrovascular accident (cerebral infarction) without residual deficits (V12.54)
V15.81Noncompliance with medical treatment
V15.82History of tobacco use. Excludes: tobacco dependence (305.1)
V15.88History of fall
V15.88 At risk for falling

Family histories of importance
V17.0Family history of a psychiatric condition [If wanting to be general use V17.0. Otherwise use other V17 or V18 codes, infra.]
V17.2Family history of Huntington’s chorea
V18.4Family history of mental retardation
V19.8 Family history of another disorder [state disorder, e.g., “Family history of bipolar I disorder.”]

Conditions or circumstances influencing health.
V40.1Problems with communication [including speech]
V41.7Problems with sexual function.
Excludes: marital problems (V61.10)
Excludes: psychosexual disorders (302.0-302.9)
V45.01Cardiac pacemaker
V45.02Automatic implantable cardiac defibrillator
V49.89 Gender Variance [Note yet part of ICD-9-CM, but recommended by the Washington Psychiatric Society, so being listed here for those who wish to use it. Suggested only for children or adolescents with 1] a drive that compels the person to assume a gender roles and/or gender identity that differ substantially from the gender role the person was assigned at birth, socialized as a child, and/or expected to assume and associated behaviors, thought, feelings and fantasies. 2] Is associated with clinical distress or impairment. Not suggested for adults.
V60.0Lack of housing
V60.1Inadequate housing
V60.2Inadequate material resources, includes economic problems and poverty
V60.3Person living alone
V60.4No other household member able to render care
V60.5Holiday relief care
V60.6Person living in residential institution
V60.81Foster care (status)
V61.01Family disruption due to family member on military deployment*
V61.01 Individual or family affected by other family member being on deployment*
*Excludes: V61.08 family disruption due to family member on non-military extended absence from home
V61.02Family disruption due to return of family member from military deployment
V61.02 Individual or family affected by other family member having returned from deployment (current or past conflict)
V61.03Family disruption due to divorce or legal separation
V61.04Family disruption due to parent-child estrangement
Excludes: other family estrangement (V61.09)
V61.05Family disruption due to child in welfare custody
V61.06Family disruption due to child in foster care or in care of non-parental family member
V61.07Family disruption due to death of family member
Excludes: bereavement (V62.82)
V61.08Family disruption due to other extended absence of family member
Excludes: family disruption due to family member on military deployment (V61.01)
V61.1Counseling for marital and partner problems
Excludes: problems related to psychosexual disorders (302.0-302.9) or sexual function (V41.7)
V61.10Marital conflict
V61.10 Marital relationship problem
V61.10 Partner conflict
V61.10 Partner relationship problem
V61.11Counseling for victim of spousal and partner abuse
Excludes: encounter for treatment of current injuries due to abuse (995.80-995.85)
V61.12Counseling for perpetrator of spousal and partner abuse
V61.2Parent-child problems
V61.20Counseling for parent-child problem, unspecified
V61.20 Concern about behavior of child
V61.20 Parent-child conflict
V61.20 Parent-child relationship problem
V61.21Counseling for victim of child abuse
V61.21 Child battering
V61.21 Child neglect
Excludes: current injuries due to abuse (995.50-995.59)
V61.22Counseling for perpetrator of parental child abuse
Excludes: counseling for non-parental abuser (V62.83)
V61.23Counseling for parent-biological child problem
V61.23 Concern about behavior of biological child
V61.23 Parent-biological child conflict
V61.23 Parent-biological child relationship problem
V61.24Counseling for parent-adopted child problem
V61.24 Concern about behavior of adopted child
V61.24 Parent-adopted child conflict
V61.24 Parent-adopted child relationship problem
V61.25Counseling for parent (guardian)-foster child problem
V61.25 Concern about behavior of foster child
V61.25 Parent (guardian)-foster child conflict
V61.25 Parent (guardian)-foster child relationship problem
V61.29Other parent-child problems
V61.3Problems with aged parents or in-laws
V61.4Health problems within family
V61.41Anxiolyticism in family
V61.42 abuse in family
V61.49Care of sick or handicapped person in family or household
V61.49 Presence of sick or handicapped person in family or household
V61.7Unwanted pregnancy
V61.8Problems with family members
V61.8 Sibling relationship problem
V62.0Unemployment
Excludes: circumstances when main problem is economic inadequacy or poverty (V60.2)
V62.1Adverse effects of work environment
V62.21Personal current military deployment status. [Individual (civilian or military) currently deployed in theater or in support of military war, peacekeeping and humanitarian operations]
V62.22Personal history of return from military deployment. [Individual (civilian or military) with past history of military war, peacekeeping and humanitarian deployment (current or past conflict)]
V62.29Career choice problem
V62.29 Dissatisfaction with employment
V62.29 Occupational problem
V62.3Academic problem
V62.3 Dissatisfaction with school environment
V62.3 Educational handicap
V62.4Social maladjustment
V62.4 Acculturation problem
V62.4 Cultural deprivation
V62.4 Political, religious, or sex discrimination resulting is social isolation
V62.4 Political, religious, or sex discrimination resulting in persecution
V62.5Imprisonment
V62.5 Litigation
V62.5 Being legally prosecuted
V62.6Refusal of treatment for reasons of religion or conscience
V62.8Other psychological or physical stress, not elsewhere classified
V62.81Interpersonal problems, not elsewhere classified [=relational problems]
V62.82Bereavement, uncomplicated
Excludes: bereavement as adjustment reaction (309.0)
Excludes: family disruption due to death of family member (V61.07)
V62.83Counseling for perpetrator of physical/sexual abuse
Excludes: counseling for perpetrator of parental child abuse (V61.22)
Excludes counseling for perpetrator of spousal and partner abuse (V61.12)
V62.84Suicidal ideation
Excludes: suicidal tendencies (300.9)
V62.89Borderline intellectual functioning

Unavailability of other medical facilities for care
V63.0Residence remote from hospital or other health care facility
V63.1Medical services in home not available
Excludes: no other household member able to render care (V60.4)
V63.2Person awaiting admission to adequate facility elsewhere
V63.8Person on waiting list undergoing social agency investigation
V63.9Unspecified reason for unavailability of medical facilities

Consulting conditions or circumstances.
V65.1Person consulting on behalf of another person*
V65.1 Advice or treatment for nonattending third party*
*Excludes: concern (normal) about sick person in family (V61.41-V61.49)
V65.19Other person consulting on behalf of another person
V65.2Person feigning illness, Malingerer
V65.3Dietary surveillance and counseling
V65.4Other counseling, not elsewhere classified
V65.40Counseling NOS
V65.41Exercise counseling
V65.42Counseling on use and abuse
V65.43Counseling on injury prevention
V65.44Human immunodeficiency virus [HIV] counseling
V65.45Counseling on other sexually transmitted diseases
V65.49Other specified counseling
V65.5Person with feared complaint in whom no diagnosis was made
V65.5 Feared condition not demonstrated
V65.5 Problem was normal state
V65.5 "Worried well"
V65.9Unspecified reason for consultation

Clinical encounters not related to treatment.
V67.3Following psychotherapy and other treatment for mental disorder
V68Encounters for administrative purposes
V68.2Request for expert evidence
V68.81Referral of patient without examination or treatment

Problems related to lifestyle.
V69.0Lack of physical exercise
V69.1Inappropriate diet and eating habits
Excludes: anorexia nervosa (307.1)
Excludes bulimia (783.6)
Excludes: malnutrition and other nutritional deficiencies (260-269.9)
Excludes: other and unspecified eating disorders (307.50-307.59)
V69.2High-risk sexual behavior
V69.3Gambling and betting
Excludes: pathological gambling (312.31)
V69.4Lack of adequate sleep*
V69.4 Sleep deprivation*
*Excludes: insomnia (780.52)
V69.5Behavioral insomnia of childhood
V69.8Other problems related to lifestyle, includes self-damaging behavior

Health examinations of defined populations.
V70.1General psychiatric examination, requested by the authority
V70.4Examination for medicolegal reasons, e.g., blood-Anxiolytic tests and blood-drug tests
Excludes: examination and observation following:
accidents (V71.3, V71.4)
assault (V71.6)
rape (V71.5)
V70.5 Armed forces personnel
V70.5 Inhabitants of institutions
V70.5 Occupational health examinations
V70.5 Pre-employment screening
V70.5 Preschool children
V70.5 Prisoners
V70.5 Prostitutes
V70.5 Refugees
V70.5 School children
V70.5 Students
V70.6Health examination in population surveys
Excludes: special screening (V73.0-V82.9)
V70.7Examination of participant in clinical trial
V70.7 Examination of participant or control in clinical research
V70.8Other specified general medical examinations
V70.8 Examination of potential donor of organ or tissue
V71.0Observation for suspected mental condition
V71.01Adult antisocial behavior in someone who does not meet criteria of Antisocial P. Disorder
V71.01 Dyssocial behavior
V71.01 Gang activity in adult without manifest psychiatric disorder
V71.02Childhood or adolescent antisocial behavior
V71.02 Dyssocial behavior or gang activity in child or adolescent without manifest psychiatric disorder
V71.5Observation following alleged rape or seduction
V71.5 Examination of victim or culprit in rape situations
V71.6Observation following inflicted injury other than rape
V71.6 Examination of victim or culprit following injury other than rape
V71.81Abuse and neglect
Excludes: adult abuse and neglect (995.80-995.85)
Excludes: child abuse and neglect (995.50-995.59)
V72.62Laboratory examination ordered as part of a routine general medical examination

Screening
V79.0 Screening for depression
V79.1 Screening for Anxiolyticism
V79.2Screening for mental retardation
V79.3 Screening for developmental handicaps of early childhood
V79.8 Other psychiatric screening [Specify, e.g., “V79.8, screening for dementia.”]
V80.01Screening for traumatic brain injury

BMI
[Note:BMI adult codes are for use for persons over 20 years old]
V85.0Body Mass Index less than 19, adult
V85.1Body Mass Index between 19-24, adult
V85.2Body Mass Index between 25-29, adult
V85.21Body Mass Index 25.0-25.9, adult
V85.22Body Mass Index 26.0-26.9, adult
V85.23Body Mass Index 27.0-27.9, adult
V85.24Body Mass Index 28.0-28.9, adult
V85.25Body Mass Index 29.0-29.9, adult
V85.3Body Mass Index between 30-39, adult
V85.30Body Mass Index 30.0-30.9, adult
V85.31Body Mass Index 31.0-31.9, adult
V85.32Body Mass Index 32.0-32.9, adult
V85.33Body Mass Index 33.0-33.9, adult
V85.34Body Mass Index 34.0-34.9, adult
V85.35Body Mass Index 35.0-35.9, adult
V85.36Body Mass Index 36.0-36.9, adult
V85.37Body Mass Index 37.0-37.9, adult
V85.38Body Mass Index 38.0-38.9, adult
V85.39Body Mass Index 39.0-39.9, adult
V85.4Body Mass Index 40 and over, adult
V85.5Body Mass Index, pediatric
Note:BMI pediatric codes are for use for persons age 2-20 years old. These percentiles are based on the growth charts published by the Centers for Disease Control and Prevention (CDC)
V85.51Body Mass Index, pediatric, less than 5th percentile for age
V85.52Body Mass Index, pediatric, 5th percentile to less than 85th percentile for age
V85.53Body Mass Index, pediatric, 85th percentile to less than 95th percentile for age
V85.54Body Mass Index, pediatric, greater than or equal to 95th percentile for age