Allergic Rhinitis and its Impact on Asthma - ARIA

Recommendations

Info

ALLERGIC RHINITIS AND ITS IMPACT ON ASTHMA GUIDELINES ● 2010 – V. 9/8/2010 Should allergen avoidance methods be used by parents to prevent development of allergy in children? Should occupational allergen avoidance methods be used? Should patients with allergic rhinitis <strong>and</strong>/or conjunctivitis use H1-antihistamines, glucocorticosteroids, antileukotrienes, chromones, decongestants, or ipratropium bromide? What is the relative effect of these medications? Should allergen specific immunotherapy be used in patients with allergic rhinitis? What is the effect of subcutaneous, intranasal, <strong>and</strong> sublingual specific immunotherapy? Should complementary <strong>and</strong> alternative treatments be used for allergic rhinitis? Should medications for allergic rhinitis be used in patients with concomitant asthma for the treatment of symptoms of asthma? Recommendations I. Prevention of allergy Recommendation 1: We suggest exclusive breastfeeding for at least first three months for all infants irrespective of their family history of atopy (conditional recommendation | low quality evidence). Values <strong>and</strong> preferences This recommendation places a relatively high value on the prevention of allergy <strong>and</strong> asthma, <strong>and</strong> a relatively low value on challenges or burden of breastfeeding in certain situations. Remarks The evidence, that exclusive breastfeeding for at least the first three months reduces the risk of allergy or asthma, is not convincing <strong>and</strong>, therefore, the recommendation to exclusively breastfeed is conditional. This recommendation applies to situations in which other reasons do not suggest harm from breastfeeding (e.g. classic galactosemia, active untreated tuberculosis or human immunodeficiency virus infection in mother, antimetabolites or chemotherapeutic agents or radioactive isotopes being used in the mother for diagnostic or therapeutic purposes until they clear from the milk, <strong>and</strong> bacterial or viral infection of a breast). Recommendation 2: For pregnant or breastfeeding women, we suggest no antigen avoidance diet to prevent development of allergy in children (conditional recommendation | very low quality evidence). Underlying values <strong>and</strong> preferences This recommendation places a relatively high value on adequate nourishment of mothers <strong>and</strong> children, <strong>and</strong> a relatively low value on very uncertain effects on the prevention of allergy <strong>and</strong> asthma in this setting. Recommendation 3: In children <strong>and</strong> pregnant women, we recommend total avoidance of environmental tobacco smoke (i.e. passive smoking) (strong recommendation | very low quality evidence). Remarks Smoking <strong>and</strong> exposure to second-h<strong>and</strong> smoke are common health problems around the world causing a substantial burden of disease for children <strong>and</strong> adults. While it is very rare to make a strong recommendation based on low or very low quality evidence, the ARIA guideline panel felt that in the absence of important adverse effects associated with smoking cessation or reducing the exposure to second-h<strong>and</strong> smoke, the balance between the desirable <strong>and</strong> undesirable effects is clear. PAGE 10 OF 153
ALLERGIC RHINITIS AND ITS IMPACT ON ASTHMA GUIDELINES ● 2010 – V. 9/8/2010 Recommendation 4: In infants <strong>and</strong> preschool children, we suggest multifaceted interventions to reduce early life exposure to house dust mite (conditional recommendation | low quality evidence). Underlying values <strong>and</strong> preferences This recommendation places a relatively low value on the burden <strong>and</strong> cost of using multiple preventive measures (e.g. encasings to parental <strong>and</strong> child’s bed, washing bedding <strong>and</strong> soft toys at temperature exceeding 55°C [131°F], use of acaricide, smooth flooring without carpets, etc.), <strong>and</strong> relatively high value on an uncertain small reduction of the risk of developing wheeze or asthma. For some children at lower risk of developing asthma <strong>and</strong> in certain circumstances an alternative choice will be equally reasonable. Remarks Children at high risk of developing asthma are those with at least one parent or sibling with asthma or other allergic disease. Recommendation 5: In infants <strong>and</strong> preschool children, we suggest no special avoidance of exposure to pets at home (conditional recommendation | low quality evidence). Underlying values <strong>and</strong> preferences This recommendation places a relatively high value on possible psychosocial downsides of not having a pet, <strong>and</strong> relatively low value on potential reduction in the uncertain risk of developing allergy <strong>and</strong>/or asthma. Remarks Clinicians <strong>and</strong> patients may reasonably choose an alternative action, considering circumstances that include other sensitized family members. Recommendation 6: For individuals exposed to occupational agents, we recommend specific prevention measures eliminating or reducing occupational allergen exposure (strong recommendation | low quality evidence). Underlying values <strong>and</strong> preferences This recommendation places a relatively high value on reducing the risk of sensitisation to occupational allergens <strong>and</strong> developing occupational rhinitis <strong>and</strong>/or asthma with the subsequent adverse consequences, <strong>and</strong> a relatively low value on the feasibility <strong>and</strong> cost of specific strategies aimed at reducing occupational allergen exposure. Remarks Total allergen avoidance, if possible, seems to be the most effective primary prevention measure. II. Treatment of allergic rhinitis Reducing allergen exposure Recommendation 7: In patients with allergic rhinitis <strong>and</strong>/or asthma sensitive to house dust mite allergens, we recommend that clinicians do not administer <strong>and</strong> patients do not use currently available single chemical or physical preventive methods aimed at reducing exposure to house dust mites (strong recommendation | low quality evidence) or their combination (conditional recommendation | very low quality evidence), unless this is done in the context of formal clinical research. We suggest multifaceted environmental control programmes be used in inner-city homes to improve symptoms of asthma in children (conditional recommendation | very low quality evidence). Underlying values <strong>and</strong> preferences The recommendation to use multifaceted environmental control programmes in inner-city homes places a relatively high value on possible reduction in the symptoms of asthma in children, <strong>and</strong> relatively low value on the cost of such programmes. PAGE 11 OF 153
Page 1 and 2: ALLERGIC RHINITIS AND ITS IMPACT ON
Page 9: ALLERGIC RHINITIS AND ITS IMPACT ON
Page 61 and 62:
ALLERGIC RHINITIS AND ITS IMPACT ON
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153:
show all

Allergic Rhinitis and its Impact on Asthma - ARIA

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?