Guideline Resources
Allergic Rhinitis Tx | epocrates Guideline Synthesis
Key Points
OK to start tx after presumptive clinical dx w/o testing, per several societies. Intranasal steroids are superior to other meds and are effective for major sx. If specific allergen identified, consider avoidance/environmental control +/or allergen immunotherapy.
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Peer reviewed & based on multiple guidelines/recommendations from specialty societies/government agencies
Epocrates Guideline Synopsis Last Update: Jan 25, 2018
Source:
Epocrates
AAI-JTF 2017 Recommendation Strengths
[R1] Strong
[R2] Weak
AAI-JTF 2017 Evidence Quality
[E1] High: Very confident true effect lies close to effect estimate
[E2] Mod: Moderately confident true effect likely to be close to estimate effect; possibly substantially different
[E3] Low: Limited confidence in effect estimate; true effect may be substantially different
[E4] Very low: Very little confidence in effect estimate; true effect likely to be substantially different
AAI-JTF 2008 Recommendation Strengths/Evidence Quality
[E5] Meta-analysis of RCTs or ≥1 RCT
[E6] ≥1 nonrandomized controlled or quasi-experimental study; or extrapolated from “A” EV
[E7] Nonexperimental descriptive studies or extrapolated from “B” or “A” EV
[E8] Expert committee reports, opinions or experience of respected authorities, or extrapolated from “A”, “B”, “C”
AAO Recommendation Strengths
[R3] Strong recommendation: Desirable effects clearly outweigh undesirable effects, or vice versa (for rec against)
[R4] Recommendation: Desirable effects outweigh undesirable effects, or vice versa (for rec against)
[R5] Option: Little clear advantage of 1 approach vs other, or EV is suspect (Grade “D”)
[R6] No recommendation: Grade “D” EV + unclear balance between benefit and harm
AAO Evidence Grades
[E9] Well-designed RCTs done w/ subjects similar to guideline’s target population
[E10] RCTs or overwhelmingly consistent EV from observational studies
[E11] Observational studies (case-control or cohort)
[E12] Case reports or mechanism-based reasoning
[E13] Exceptional situations where validating studies cannot be performed and there is a clear preponderance of benefit over harm
BSACI Recommendation Grades
[R7] ≥1 high-quality/consistent EV from: meta-analysis; systematic review; RCT w/ decr bias risk + germane to target population
[R8] Obs studies: high-quality systematic reviews (case-control/cohort); decr bias risk + incr causality chance; extrapolated from “A
[R9] Well-conducted case-control/cohort studies w/ low risk of bias + mod probability of causality; or extrapolated from “B” EV
[R10] Case reports, case series, expert opinion; or extrapolated from “C” EV
[R11] Based on clinical experience of guideline development group
WHO-ARIA Recommendation Strengths
[R12] Strong recommendation
[R13] Conditional (weak) recommendation
WHO-ARIA Evidence Quality
[E14] High: Further research very unlikely to change confidence in estimate of effect
[E15] Mod: Further research likely to have important impact on confidence in estimate of effect + may change estimate
[E16] Low: Further research very likely to have important impact on confidence in estimate of effect + likely to change estimate
[E17] Very low: Any estimate of effect is very uncertain
Abbreviations
AAI-JTF AAAAI, ACAAI, JCAAI Joint Task Force
AAO American Academy of Otolaryngology - Head and Neck Surgery
ACE angiotensin-converting enzyme
ASA acetylsalicylic acid (aspirin)
BSACI British Society for Allergy and Clinical Immunology
CF cystic fibrosis
CSF cerebrospinal fluid
CVD cardiovascular disease
eos eosinophils
EV evidence
GI gastrointestinal
HIV human immunodeficiency virus
HTN hypertension
IM intramuscular
INS intranasal steroid
IOP intraocular pressure
LTRA leukotriene receptor antagonist
NARES nonallergic rhinitis w/ eosinophils
NSAID nonsteroidal anti-inflammatory drug
QOL quality of life
VMR vasomotor rhinitis
WHO World Health Organization