Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Division of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, Wis.
Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
J Allergy Clin Immunol Pract. 2023 Oct;11(10):3213-3220.e11. doi: 10.1016/j.jaip.2023.07.002. Epub 2023 Jul 13.
Management of urticaria can be optimized with clinical practice guidelines (CPGs). However, the quality of recent urticaria CPGs remains unclear.
To identify and appraise urticaria CPGs worldwide published in the last 5 years.
A search for relevant urticaria CPGs was conducted between January 1, 2017, and May 31, 2022, using the following databases: MEDLINE, Embase, National Institute for Health and Care Excellence (NICE) Evidence Search, Guidelines International Network, ECRI Guidelines Trust, Australian Clinical Practice Guidelines, Trip Medical Database, and DynaMed. The included CPGs were critically appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, Lenzer et al's red flags, and the Institute of Medicine (IOM) criteria of trustworthiness.
We included 21 urticaria CPGs. Most guidelines reviewed treatment recommendations of chronic spontaneous urticaria. The majority of guidelines were from European and Asian countries with high and high-middle sociodemographic index, written in English, and openly accessible. Seventeen guidelines (81%) had at least 1 AGREE II domain rated poor quality. Applicability, rigor of development, and stakeholder involvement were the 3 AGREE II domains that scored the lowest across guidelines. Appraisal with Lenzer et al's red flags showed that 18 guidelines (86%) raised at least 1 red flag indicating potential bias. The top 3 domains raising red flags were: no inclusion of nonphysician experts/patient representative/community stakeholders, no or limited involvement of a methodologist in the evaluation of evidence, and lack of external review. Based on IOM's criteria of trustworthiness, 20 guidelines (95%) had 1 or more criteria that did not meet best practice standards. The 3 domains with the highest number of best practice standards not met were updating procedures, rating strength of recommendations, and external review. Guidelines scored highest for the AGREE II domains of defining scope and purpose and clarity of presentation, and had the most fully met IOM's best practice standard for articulation of recommendations. However, only 1 urticaria CPG by NICE was identified as rigorously developed across all 3 appraisal tools.
The quality of urticaria CPGs in the last 5 years varied widely. Only the NICE urticaria guideline consistently demonstrated excellent quality, high trustworthiness, and low risk of bias. Use of a rigorous framework to rate certainty of evidence and grade strength of recommendation, involvement of methodologists, stakeholder engagement with external review, and clear guidance for updating can help improve the quality of future CPGs.
荨麻疹的管理可以通过临床实践指南（CPG）得到优化。然而，最近荨麻疹 CPG 的质量仍不清楚。
确定并评估过去 5 年内全球发布的荨麻疹 CPG。
2017 年 1 月 1 日至 2022 年 5 月 31 日，使用以下数据库进行相关荨麻疹 CPG 的检索：MEDLINE、Embase、国家卫生与保健卓越研究所（NICE）证据搜索、指南国际网络、ECRI 指南信托、澳大利亚临床实践指南、Trip 医疗数据库和 DynaMed。使用评估研究和评估指南（AGREE）II 工具、Lenzer 等人的红旗以及医学研究所（IOM）的可信度标准对纳入的 CPG 进行严格评估。
我们纳入了 21 项荨麻疹 CPG。大多数指南审查了慢性自发性荨麻疹的治疗建议。大多数指南来自欧洲和亚洲国家，社会人口指数高或中高，使用英语，并且可以公开获取。17 项指南（81%）至少有 1 个 AGREE II 领域被评为质量差。适用性、开发严谨性和利益相关者参与是指南中得分最低的 3 个 AGREE II 领域。使用 Lenzer 等人的红旗进行评估显示，18 项指南（86%）提出了至少 1 个红旗，表示存在潜在偏见。提出红旗的前 3 个领域是：没有纳入非医师专家/患者代表/社区利益相关者、没有或有限的方法学家参与证据评估、以及缺乏外部审查。根据 IOM 的可信度标准，20 项指南（95%）有 1 个或多个标准不符合最佳实践标准。不符合最佳实践标准最多的 3 个领域是更新程序、推荐强度评级和外部审查。指南在 AGREE II 领域的定义范围和目的以及表达的清晰度方面得分最高，并且在建议的表达方面最符合 IOM 的最佳实践标准。然而，只有 NICE 的 1 项荨麻疹 CPG 在所有 3 个评估工具中被认为是严格开发的。
过去 5 年内荨麻疹 CPG 的质量差异很大。只有 NICE 的荨麻疹指南在所有 3 个评估工具中一致表现出卓越的质量、高可信度和低偏倚风险。使用严格的框架来评估证据的确定性和推荐强度的分级、方法学家的参与、利益相关者与外部审查的参与以及更新的明确指导，可以帮助提高未来 CPG 的质量。
