Source cross-reactivity guidance from SCRATCH

MAINTAINERS.md

@@ -2,7 +2,7 @@
 
 ## Overview
 
-DREAM (Drug Reaction Evaluation & Anaesthetic Management) is a private, local-first clinical Progressive Web App designed for the Royal Prince Alfred Hospital (RPAH) Department of Clinical Immunology & Allergy. It guides clinicians through perioperative anaesthetic allergy workups—from REDCap patient record import and tailored testing plan creation to skin prick/intradermal test logging, patient handouts, and eMR-ready clinical reports—all processed locally in the browser without transmitting identifiable patient data. Drug protocol definitions and dilution concentrations are tied to the SCRATCH drug library (repository `monchee/drug-library`, hosted at [scratch.yuson.au](https://scratch.yuson.au)), which serves as the upcoming source of truth for drug protocol data that DREAM consumes as a pinned JSON snapshot.
+DREAM (Drug Reaction Evaluation & Anaesthetic Management) is a private, local-first clinical Progressive Web App designed for the Royal Prince Alfred Hospital (RPAH) Department of Clinical Immunology & Allergy. It guides clinicians through perioperative anaesthetic allergy workups—from REDCap patient record import and tailored testing plan creation to skin prick/intradermal test logging, patient handouts, and eMR-ready clinical reports—all processed locally in the browser without transmitting identifiable patient data. Drug protocol definitions, dilution concentrations, and cross-reactivity guidance are tied to the SCRATCH drug library (repository `monchee/drug-library`, hosted at [scratch.yuson.au](https://scratch.yuson.au)), which serves as the source of truth that DREAM consumes as a pinned JSON snapshot schema 1.1 (`src/shared/data/protocols.snapshot.json`). All protocol and cross-reactivity changes originate in SCRATCH.
 
 ---
 

scripts/sync-protocols.mjs

@@ -19,7 +19,11 @@ const DEFAULT_LOCAL_PATH = '/Users/monchee/Projects/scratch/docs/api/protocols.j
 // project only gets its requested *.pages.dev name if it is free, and it was not.
 export const PUBLISHED_PROTOCOLS_URL = 'https://scratch.yuson.au/api/protocols.json';
 
-const SUPPORTED_SCHEMA_VERSIONS = ['1.0'];
+export const SUPPORTED_SCHEMA_VERSIONS = ['1.0', '1.1'];
+
+export function isSupportedSchemaVersion(version) {
+  return typeof version === 'string' && SUPPORTED_SCHEMA_VERSIONS.includes(version);
+}
 
 export function computeDoseLevelDiff(oldSnapshot, newSnapshot) {
   const diffs = [];
@@ -238,10 +242,10 @@ export async function syncProtocols(options = {}) {
     newSnapshotRaw = JSON.parse(fileContent);
   }
 
-  if (!SUPPORTED_SCHEMA_VERSIONS.includes(newSnapshotRaw.schema_version)) {
-    console.error(`\nError: Unrecognised schema_version "${newSnapshotRaw.schema_version}".`);
-    console.error(`Supported versions: ${SUPPORTED_SCHEMA_VERSIONS.join(', ')}`);
-    process.exit(1);
+  if (!isSupportedSchemaVersion(newSnapshotRaw.schema_version)) {
+    const errorMsg = `Unrecognised schema_version "${newSnapshotRaw.schema_version}". Supported versions: ${SUPPORTED_SCHEMA_VERSIONS.join(', ')}`;
+    console.error(`\nError: ${errorMsg}`);
+    throw new Error(errorMsg);
   }
 
   let oldSnapshot = null;

src/features/info-pages/components/DrugReferencePage.test.tsx

@@ -0,0 +1,63 @@
+import { describe, expect, it, vi } from 'vitest';
+import { render, screen, fireEvent } from '@testing-library/react';
+import React from 'react';
+import DrugReferencePage from './DrugReferencePage';
+import { CROSS_REACTIVITY_ITEMS, CROSS_REACTIVITY_GOVERNANCE } from '@shared/data/crossReactivity';
+import snapshot from '@shared/data/protocols.snapshot.json';
+
+describe('DrugReferencePage Component', () => {
+  const setScreenMock = vi.fn();
+
+  it('renders all six cross-reactivity categories from the pinned snapshot/adapter', () => {
+    const { container } = render(<DrugReferencePage setScreen={setScreenMock} />);
+
+    expect(CROSS_REACTIVITY_ITEMS).toHaveLength(6);
+    expect(CROSS_REACTIVITY_ITEMS).toEqual(snapshot.cross_reactivity.items);
+
+    // Verify each category exists as an accordion trigger
+    const triggers = container.querySelectorAll('[data-radix-collection-item]');
+    expect(triggers.length).toBe(6);
+
+    for (let i = 0; i < CROSS_REACTIVITY_ITEMS.length; i++) {
+      const item = CROSS_REACTIVITY_ITEMS[i];
+      const trigger = triggers[i];
+      expect(trigger).toHaveTextContent(item.category);
+
+      // Open accordion item to verify content and alternatives
+      fireEvent.click(trigger);
+      expect(screen.getByText(item.info)).toBeInTheDocument();
+      expect(screen.getByText(item.alternatives, { exact: false })).toBeInTheDocument();
+    }
+  });
+
+  it('renders the "Alternatives:" label for each cross-reactivity item when expanded', () => {
+    const { container } = render(<DrugReferencePage setScreen={setScreenMock} />);
+
+    const triggers = container.querySelectorAll('[data-radix-collection-item]');
+    for (const trigger of triggers) {
+      fireEvent.click(trigger);
+    }
+
+    const altLabels = screen.getAllByText('Alternatives:');
+    expect(altLabels).toHaveLength(6);
+  });
+
+  it('renders the "Clinical review pending" notice when under_review is true', () => {
+    render(<DrugReferencePage setScreen={setScreenMock} />);
+
+    expect(CROSS_REACTIVITY_GOVERNANCE.under_review).toBe(true);
+    const notice = screen.getByText(/Clinical review pending/i);
+    expect(notice).toBeInTheDocument();
+  });
+
+  it('does not invent or render reviewer or date when fields are blank', () => {
+    render(<DrugReferencePage setScreen={setScreenMock} />);
+
+    expect(CROSS_REACTIVITY_GOVERNANCE.reviewed_by).toBe('');
+    expect(CROSS_REACTIVITY_GOVERNANCE.last_reviewed).toBe('');
+
+    // Ensure no fallback date/reviewer strings are rendered
+    expect(screen.queryByText(/Reviewed by/i)).not.toBeInTheDocument();
+    expect(screen.queryByText(/Review date/i)).not.toBeInTheDocument();
+  });
+});

src/features/info-pages/components/DrugReferencePage.tsx

@@ -1,46 +1,15 @@
 import React from 'react';
-import { Card, CardContent, Button, Accordion, AccordionItem, AccordionTrigger, AccordionContent } from '@/components/ui';
+import { Card, CardContent, Button, Accordion, AccordionItem, AccordionTrigger, AccordionContent, Badge } from '@/components/ui';
 import { Home, AlertTriangle, ArrowRight } from 'lucide-react';
 import { Screen } from '@shared/types';
 import { DRUG_CATEGORIES, CATEGORY_THEMES } from '@shared/utils/constants';
+import { CROSS_REACTIVITY_ITEMS, CROSS_REACTIVITY_GOVERNANCE } from '@shared/data/crossReactivity';
 
 interface DrugReferencePageProps {
   setScreen: (screen: Screen) => void;
 }
 
 const DrugReferencePage: React.FC<DrugReferencePageProps> = ({ setScreen }) => {
-  const crossReactivityInfo = [
-    {
-      category: "Muscle Relaxants",
-      info: "Quaternary ammonium compounds are thought to be responsible for most reactions. Cross-reactivity between agents is common due to structural similarities.",
-      alternatives: "Consider non-depolarising agents with different structures. Cisatracurium may have lower immunogenicity."
-    },
-    {
-      category: "Penicillins",
-      info: "Cross-reactivity with cephalosporins depends on side chain similarity. First-generation cephalosporins have higher cross-reactivity (~2%).",
-      alternatives: "Cephalosporins with dissimilar side chains, carbapenems (low cross-reactivity), or non-beta-lactams."
-    },
-    {
-      category: "Cephalosporins",
-      info: "Cross-reactivity is more related to R1 side chain similarity than the beta-lactam ring. Later generations have different side chains.",
-      alternatives: "Cephalosporins with different side chains, carbapenems, aztreonam (minimal cross-reactivity)."
-    },
-    {
-      category: "Local Anaesthetics",
-      info: "True allergy is rare (<1%). Most reactions are vasovagal or due to adrenaline. Amide types rarely cross-react with each other.",
-      alternatives: "Different amide local anaesthetic, or ester type if amide allergy confirmed."
-    },
-    {
-      category: "Opioids",
-      info: "Can cause direct mast cell degranulation (non-IgE mediated). Morphine and codeine are most histamine-releasing.",
-      alternatives: "Fentanyl or remifentanil (less histamine release), or non-opioid analgesia."
-    },
-    {
-      category: "Hypnotics",
-      info: "Propofol reactions may be to the lipid emulsion or specific to propofol. Egg/soya allergy is not a contraindication.",
-      alternatives: "Different induction agent (thiopentone, ketamine, etomidate)."
-    }
-  ];
 
   return (
     <div className="py-4 sm:p-6 space-y-6">
@@ -95,11 +64,22 @@ const DrugReferencePage: React.FC<DrugReferencePageProps> = ({ setScreen }) => {
 
           {/* Cross-Reactivity & Alternatives */}
           <div>
-            <h3 className="section-label mb-3">
-              Cross-Reactivity & Alternatives
-            </h3>
+            <div className="flex flex-wrap items-center justify-between gap-2 mb-3">
+              <h3 className="section-label mb-0">
+                Cross-Reactivity & Alternatives
+              </h3>
+              {CROSS_REACTIVITY_GOVERNANCE.under_review && (
+                <Badge
+                  variant="warning"
+                  className="rounded-none border border-status-warning/40 px-2 py-0.5 text-xs font-semibold"
+                >
+                  <AlertTriangle className="w-3.5 h-3.5 mr-1.5 shrink-0" aria-hidden="true" />
+                  Clinical review pending
+                </Badge>
+              )}
+            </div>
             <Accordion type="multiple" className="bg-card rounded-none border border-border px-4">
-              {crossReactivityInfo.map((item, idx) => (
+              {CROSS_REACTIVITY_ITEMS.map((item, idx) => (
                 <AccordionItem 
                   key={idx}
                   value={`item-${idx}`}

src/shared/data/__tests__/syncProtocols.test.ts

@@ -0,0 +1,104 @@
+import { describe, expect, it } from 'vitest';
+import {
+  SUPPORTED_SCHEMA_VERSIONS,
+  isSupportedSchemaVersion,
+  computeDoseLevelDiff,
+} from '../../../../scripts/sync-protocols.mjs';
+
+describe('sync-protocols schema version validation', () => {
+  it('supports schema versions 1.0 and 1.1', () => {
+    expect(SUPPORTED_SCHEMA_VERSIONS).toContain('1.0');
+    expect(SUPPORTED_SCHEMA_VERSIONS).toContain('1.1');
+    expect(SUPPORTED_SCHEMA_VERSIONS).toEqual(['1.0', '1.1']);
+  });
+
+  it('accepts schema version 1.0 and 1.1 via isSupportedSchemaVersion', () => {
+    expect(isSupportedSchemaVersion('1.0')).toBe(true);
+    expect(isSupportedSchemaVersion('1.1')).toBe(true);
+  });
+
+  it('rejects unrecognised or malformed schema versions', () => {
+    expect(isSupportedSchemaVersion('0.9')).toBe(false);
+    expect(isSupportedSchemaVersion('1.2')).toBe(false);
+    expect(isSupportedSchemaVersion('2.0')).toBe(false);
+    expect(isSupportedSchemaVersion('')).toBe(false);
+    expect(isSupportedSchemaVersion(undefined as unknown as string)).toBe(false);
+  });
+});
+
+describe('sync-protocols dose level diff review gate', () => {
+  it('detects no diff when drug protocols are identical', () => {
+    const snapshot = {
+      schema_version: '1.1',
+      drugs: [
+        {
+          slug: 'test-drug',
+          title: 'Test Drug',
+          version: '1.0',
+          last_reviewed: 'review-marker-before',
+          protocols: [
+            {
+              id: 'iv',
+              label: 'IV',
+              test_type: 'skin',
+              presentation: 'presentation-before',
+              diluent: 'diluent-placeholder',
+              under_review: false,
+              needs_pharmacy_verification: false,
+              spt: { dilution: 'dilution-before', concentration: 'concentration-before' },
+              idt: [{ dilution: 'dilution-before', concentration: 'concentration-before' }],
+              challenge: { interval: 'interval-placeholder', steps: [{ dose: 'dose-placeholder' }] },
+            },
+          ],
+        },
+      ],
+    };
+
+    const diffs = computeDoseLevelDiff(snapshot, snapshot);
+    expect(diffs).toEqual([]);
+  });
+
+  it('detects modifications in drug protocols', () => {
+    const oldSnapshot = {
+      drugs: [
+        {
+          slug: 'test-drug',
+          title: 'Test Drug',
+          version: '1.0',
+          last_reviewed: 'review-marker-before',
+          protocols: [
+            {
+              id: 'iv',
+              label: 'IV',
+              test_type: 'skin',
+              spt: { dilution: 'dilution-before', concentration: 'concentration-before' },
+            },
+          ],
+        },
+      ],
+    };
+
+    const newSnapshot = {
+      drugs: [
+        {
+          slug: 'test-drug',
+          title: 'Test Drug',
+          version: '1.1',
+          last_reviewed: 'review-marker-after',
+          protocols: [
+            {
+              id: 'iv',
+              label: 'IV',
+              test_type: 'skin',
+              spt: { dilution: 'dilution-after', concentration: 'concentration-after' },
+            },
+          ],
+        },
+      ],
+    };
+
+    const diffs = computeDoseLevelDiff(oldSnapshot, newSnapshot);
+    expect(diffs).toHaveLength(1);
+    expect(diffs[0].type).toBe('DRUG_MODIFIED');
+  });
+});