Allergic Rhinitis and its Impact on Asthma - ARIA

Recommendations

Info

ALLERGIC RHINITIS AND ITS IMPACT ON ASTHMA GUIDELINES ● 2010 – V. 9/8/2010 Should oral H1-antihistamines be used for treatment of asthma in patients with allergic rhinitis <strong>and</strong> asthma? ................................................................................................................................... 88 Question 43 .................................................................................................................................... 90 Question 44 .................................................................................................................................... 91 Question 45 .................................................................................................................................... 93 Should leukotriene receptor antagonists be used for treatment of asthma in patients with allergic rhinitis <strong>and</strong> asthma?....................................................................................................................... 93 Question 46 .................................................................................................................................... 95 Should subcutaneous allergen-specific immunotherapy be used in patients with allergic rhinitis <strong>and</strong> asthma? ................................................................................................................................... 95 Question 47 .................................................................................................................................... 97 Question 48 .................................................................................................................................... 99 Should a monoclonal antibody against IgE be used for treatment of asthma in patients with allergic rhinitis <strong>and</strong> asthma? ......................................................................................................... 99 Priorities for revision of the guidelines ............................................................................................ 102 Priorities for research ....................................................................................................................... 103 Adaptation <strong>and</strong>/or localisation of guidelines ................................................................................... 105 Panel members <strong>and</strong> contributors (in alphabetical order) ................................................................. 105 Potential conflicts of interest ............................................................................................................ 105 Acknowledgments ............................................................................................................................ 106 Appendix – search strategies ............................................................................................................ 107 References ........................................................................................................................................ 111 Executive summary Introduction <strong>Allergic</strong> rhinitis represents a global health problem affecting 10 to 20% of the population. In theory, evidence-based guidelines are the ideal way to inform <strong>and</strong> guide clinical decision makers. This document presents a revision of the clinical recommendations of the <strong>Allergic</strong> <strong>Rhinitis</strong> <strong>and</strong> <strong>its</strong> <strong>Impact</strong> on Asthma (ARIA) guidelines developed in collaboration with the World Health Organization in 2001 (1) <strong>and</strong> recently updated in 2008 (2). This revision, however, differs from these previous guidelines. It results from a complete re-review of the underlying evidence based on systematic <strong>and</strong> transparent assessments of the quality of this evidence in evidence profiles. Furthermore, we have used a new process for developing recommendations following the GRADE approach. An evidence-based way of making health care decisions acknowledges that evidence alone is insufficient, <strong>and</strong> that values <strong>and</strong> preferences, clinical circumstances as well as clinical expertise inevitably influence decisions (3). The GRADE system builds on the previous grading systems <strong>and</strong> combines their advantages (4). The GRADE approach is recommended by the ―Guidelines for WHO guidelines‖ (5) <strong>and</strong> is being used increasingly by many organizations, including the World Health Organization (WHO), American Thoracic Society, American College of Chest Physicians PAGE 8 OF 153
ALLERGIC RHINITIS AND ITS IMPACT ON ASTHMA GUIDELINES ● 2010 – V. 9/8/2010 <strong>and</strong> the UK National Institute of Health <strong>and</strong> Clinical Excellence, <strong>and</strong> other organizations around the world (6). <strong>Allergic</strong> rhinitis is defined clinically by the symptoms caused by immunologically mediated (most often IgE-dependent) inflammation after the exposure of the nasal mucous membranes to offending allergens. Symptoms of allergic rhinitis include rhinorrhea, nasal obstruction or blockage, nasal itching, sneezing, <strong>and</strong> postnasal drip that reverse spontaneously or after treatment. <strong>Allergic</strong> conjunctivitis often accompanies allergic rhinitis. Following ARIA guidance we classified allergic rhinitis as ―intermittent‖ or ―persistent‖ according to the duration of symptoms, <strong>and</strong> as ―mil d‖ or ―moderate-severe‖ depending on <strong>its</strong> severity. Methodology We briefly describe the methodology used to develop <strong>and</strong> grade recommendations <strong>and</strong> the quality of the supporting evidence to facilitate the interpretation of the guidelines. For the more detailed description see the section on methods. We assessed the evidence according to the system described by the GRADE working group. Quality of evidence is classified as either ―high‖, ―moderate‖, ―low‖ or ―very low‖ based on methodological characteristics of the available evidence for a specific health care problem. The GRADE definitions of each category are: High: Further research is very unlikely to change confidence in the estimate of effect. Moderate: Further research is likely to have an important impact on confidence in the estimate of effect <strong>and</strong> may change the estimate. Low: Further research is very likely to have an important impact on confidence in the estimate of effect <strong>and</strong> is likely to change the estimate. Very low: Any estimate of effect is very uncertain. According to the GRADE system, the strength of a recommendation is either strong or conditional (weak) <strong>and</strong> has explicit implications (Table 1). Underst<strong>and</strong>ing the interpretation of these two grades – either strong or conditional – of the strength of recommendations is essential for sagacious clinical decision making. How to use these guidelines The ARIA guidelines provide clinicians <strong>and</strong> their patients with a basis for rational decisions in the management of allergic rhinitis. Clinicians, patients, third-party payers, institutional review committees, other stakeholders, or the courts should never view these recommendations as dictates. No recommendation can take into account all of the often-compelling unique features of individual clinical circumstances. Therefore, nobody charged with evaluating clinicians’ actions should attempt to apply the recommendations from these guidelines as rote or in a blanket fashion. Key questions The clinical questions covered by this document were developed in consultation with the ARIA guideline panel. The key questions are: PAGE 9 OF 153
Page 1 and 2: ALLERGIC RHINITIS AND ITS IMPACT ON
Page 7: ALLERGIC RHINITIS AND ITS IMPACT ON
Page 59 and 60:
ALLERGIC RHINITIS AND ITS IMPACT ON
Page 61 and 62:
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

Create successful ePaper yourself

Delete template?

Save as template?