From Nova Southeastern University, Fort Lauderdale, Florida; Saint Louis University School of Medicine, St. Louis, Missouri; Rutgers New Jersey Medical School, Newark, New Jersey; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and Cleveland Clinic Foundation, Cleveland, Ohio.
Ann Intern Med. 2017 Dec 19;167(12):876-881. doi: 10.7326/M17-2203. Epub 2017 Nov 28.
The Joint Task Force on Practice Parameters, which comprises representatives of the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI), formed a workgroup to review evidence and provide guidance to health care providers on the initial pharmacologic treatment of seasonal allergic rhinitis in patients aged 12 years or older.
To update a prior systematic review, the workgroup searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 18 July 2012 to 29 July 2016 to identify studies that addressed efficacy and adverse effects of single or combination pharmacotherapy for seasonal allergic rhinitis. In conjunction with the Joint Task Force, the workgroup reviewed the evidence and developed recommendations about initial treatment approaches by using the Grading of Recommendations Assessment, Development and Evaluation approach. Members of the AAAAI, the ACAAI, and the general public provided feedback on the draft document, which the Joint Task Force reviewed before finalizing the guideline.
RECOMMENDATION 1: For initial treatment of seasonal allergic rhinitis in persons aged 12 years or older, routinely prescribe monotherapy with an intranasal corticosteroid rather than an intranasal corticosteroid in combination with an oral antihistamine. (Strong recommendation).
RECOMMENDATION 2: For initial treatment of seasonal allergic rhinitis in persons aged 15 years or older, recommend an intranasal corticosteroid over a leukotriene receptor antagonist. (Strong recommendation).
RECOMMENDATION 3: For treatment of moderate to severe seasonal allergic rhinitis in persons aged 12 years or older, the clinician may recommend the combination of an intranasal corticosteroid and an intranasal antihistamine for initial treatment. (Weak recommendation).
由美国过敏、哮喘和免疫学学会（AAAAI）和美国过敏、哮喘和免疫学学会（ACAAI）的代表组成的联合实践参数工作组，成立了一个工作组，旨在审查证据，并就 12 岁及以上患者季节性过敏性鼻炎的初始药物治疗向医疗保健提供者提供指导。
为了更新之前的系统评价，工作组搜索了 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库，时间为 2012 年 7 月 18 日至 2016 年 7 月 29 日，以确定解决季节性过敏性鼻炎单一或联合药物治疗的疗效和不良反应的研究。工作组与联合工作组一起，使用推荐分级的评估、制定与评价方法，审查证据并制定关于初始治疗方法的建议。AAAAI、ACAAI 的成员和公众对文件草案提出了反馈意见，联合工作组在最终确定指南之前对其进行了审查。
推荐 1：对于 12 岁及以上患者季节性过敏性鼻炎的初始治疗，常规处方鼻内皮质类固醇单药治疗，而不是鼻内皮质类固醇联合口服抗组胺药。（强烈推荐）。
推荐 2：对于 15 岁及以上患者季节性过敏性鼻炎的初始治疗，建议使用鼻内皮质类固醇而不是白三烯受体拮抗剂。（强烈推荐）。
推荐 3：对于 12 岁及以上中度至重度季节性过敏性鼻炎患者，临床医生可以推荐联合使用鼻内皮质类固醇和鼻内抗组胺药进行初始治疗。（弱推荐）。
