Wallace Dana V, Dykewicz Mark S
aAllopathic Medical School, Nova Southeastern University, David, Florida bSection of Allergy and Immunology, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Curr Opin Allergy Clin Immunol. 2017 Aug;17(4):286-294. doi: 10.1097/ACI.0000000000000375.
The review compares and contrasts seven major United States and international allergic rhinitis guidelines from 2008 to 2017.
Despite many treatment options for allergic rhinitis, patients often report lack of therapeutic control and a reduced quality of life. Guidelines intended to improve allergic rhinitis care have been evolving into evidence based, systematic reviews, with less reliance on consensus of expert opinion characteristic of more traditional guidelines. The first Grading of Recommendations Assessment, Development, and Evaluation-based guideline developed in the United States for seasonal allergic rhinitis was first published in 2017.
When critically analyzing the allergic rhinitis guidelines that use the rigorous Grading of Recommendations Assessment, Development, and Evaluation methodology, different groups of expert authors, using the same reference articles, will, at times, reach different conclusions regarding the quality of the evidence and the strength of the recommendation. Factors potentially contributing to these divergent determinations include: lack of objective primary outcome measures in allergic rhinitis, poorly defined Minimal Clinically Important Difference, failure to include all interested parties in guideline development, for example, patients, and subjectivity inherent in the expert panel.
本综述比较并对比了2008年至2017年美国和国际上的七项主要变应性鼻炎指南。
尽管变应性鼻炎有多种治疗选择，但患者常报告治疗控制不佳和生活质量下降。旨在改善变应性鼻炎治疗的指南已逐渐发展为基于证据的系统评价，对传统指南中专家意见共识的依赖减少。美国首部基于推荐分级评估、制定与评价的季节性变应性鼻炎指南于2017年首次发布。
在严格分析采用严谨的推荐分级评估、制定与评价方法的变应性鼻炎指南时，不同的专家作者团队使用相同的参考文献，有时会在证据质量和推荐强度方面得出不同结论。可能导致这些不同判定的因素包括：变应性鼻炎缺乏客观的主要结局指标、最小临床重要差异定义不明确、指南制定过程中未纳入所有相关方（如患者）以及专家小组固有的主观性。
