Clinical Practice Guideline
Tóm tắt
Allergic rhinitis (AR) is one of the most common diseases affecting adults. It is the most common chronic disease in children in the United States today and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5 billion in direct health expenditures annually. It can impair quality of life and, through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually. Not surprisingly, myriad diagnostic tests and treatments are used in managing this disorder, yet there is considerable variation in their use. This clinical practice guideline was undertaken to optimize the care of patients with AR by addressing quality improvement opportunities through an evaluation of the available evidence and an assessment of the harm‐benefit balance of various diagnostic and management options.
The primary purpose of this guideline is to address quality improvement opportunities for all clinicians, in any setting, who are likely to manage patients with AR as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The guideline is intended to be applicable for both pediatric and adult patients with AR. Children under the age of 2 years were excluded from the clinical practice guideline because rhinitis in this population may be different than in older patients and is not informed by the same evidence base. The guideline is intended to focus on a limited number of quality improvement opportunities deemed most important by the working group and is not intended to be a comprehensive reference for diagnosing and managing AR. The recommendations outlined in the guideline are not intended to represent the standard of care for patient management, nor are the recommendations intended to limit treatment or care provided to individual patients.
The development group made a
The panel
The panel group made the following options: (1) Clinicians may advise avoidance of known allergens or may advise environmental controls (ie, removal of pets; the use of air filtration systems, bed covers, and acaricides [chemical agents formulated to kill dust mites]) in patients with AR who have identified allergens that correlate with clinical symptoms. (2) Clinicians may offer intranasal antihistamines for patients with seasonal, perennial, or episodic AR. (3) Clinicians may offer combination pharmacologic therapy in patients with AR who have inadequate response to pharmacologic monotherapy. (4) Clinicians may offer, or refer to a surgeon who can offer, inferior turbinate reduction in patients with AR with nasal airway obstruction and enlarged inferior turbinates who have failed medical management. (5) Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with AR who are interested in nonpharmacologic therapy. The development group provided
Từ khóa
Tài liệu tham khảo
National ambulatory medical care utilization estimates for 2006, 2008, Natl Health Stat Report, 8, 1
Vuurman EF, 1993, Seasonal allergic rhinitis and antihistamine effects on children’s learning, Ann Allergy, 71, 121
Rosenfeld RM, 2009, Clinical practice guideline development manual: a quality‐driven approach for translating evidence into action, Otolaryngol Head Neck Surg, 140, S1, 10.1016/j.otohns.2009.04.015
ShiffmanRN ShekelleP OverhageJ et al.Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization.Ann Intern Med.2003;139(6):493–498.
Oxford Centre for Evidence‐Based Medicine.OCEBM Levels of Evidence Working Group. The Oxford 2011 levels of evidence.http://www.cebm.net/index.aspx?o=5653.Accessed April 24 2014.
Long A, 2002, Management of allergic and non‐allergic rhinitis
Allergic Rhinitis Guideline Team.UMHS clinical guideline on allergic rhinitis.University of Michigan Health System.October 2013.http://www.med.umich.edu/1info/fhp/practiceguides/allergic/allergic.pdf.Accessed April 24 2014.
McCrory DC, 2003, Management of allergic rhinitis in the working‐age population, Evid Rep Technol Assess (Summ), 1
Anon JB, 1993, Introduction to in vivo allergy testing, Otolaryngol Head Neck Surg, 109, 593
Consumerhealthchoices.org.Allergy tests: when you need them—and when you don’t.2012.http://consumerhealthchoices.org/wp‐content/uploads/2012/07/ChoosingWiselyAllergyTestsAAAAI‐ER.pdf.Accessed July 17 2014.
Romero JN, 1992, Eosinophilia in nasal secretions compared to skin prick test and nasal challenge test in the diagnosis of nasal allergy, Rhinology, 30, 169
American College of Radiology.ACR position statement on recent studies regarding CT scans and increased cancer risk.2009.http://www.acr.org/About‐Us/Media‐Center/Position‐Statements/Position‐Statements‐Folder/ACR‐Statement‐on‐Recent‐Studies‐Regarding‐CT‐Scans‐and‐Increased‐Cancer‐Risk.Accessed March 4 2014.
American College of Radiology (ACR) appropriateness criteria.Sinonasal disease.2012.http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/SinonasalDisease.pdf.Accessed March 4 2014.
Sheikh A, 2010, House dust mite avoidance measures for perennial allergic rhinitis, Cochrane Database Syst Rev, CD001563
Sheikh A, 2001, House dust mite avoidance measures for perennial allergic rhinitis, Cochrane Database Syst Rev, CD001563
Sheikh A, 2003, House dust mite avoidance measures for perennial allergic rhinitis: a systematic review of efficacy, Br J Gen Pract, 53, 318
Sheikh A, 2007, House dust mite avoidance measures for perennial allergic rhinitis, Cochrane Database Syst Rev, CD001563
Kapsali T, 1997, Rhinitis is ubiquitous in allergic asthmatics, J Allergy Clin Immunol, 99, S138
Chyrek‐Borowska S, 1995, The effects of a new generation of H(1) antihistamines (cetirizine and loratadine) on histamine release and the bronchial response to histamine in atopic patients, J Investig Allergol Clin Immunol, 5, 103
Abramson MJ, 2010, Injection allergen immunotherapy for asthma, Cochrane Database Syst Rev, CD001186
Vlastos I, 2009, Impaired mucociliary clearance in allergic rhinitis patients is related to a predisposition to rhinosinusitis, Ear Nose Throat J, 88, E17
Gurevich F, 2005, The effect of intranasal steroid budesonide on the congestion related sleep disturbance and daytime somnolence in patients with perennial allergic rhinitis, Allergy Asthma Proc, 26, 268
Craig T, 2003, The effect of topical nasal fluticasone on objective sleep testing and the symptoms of rhinitis, sleep and daytime somnolence in perennial allergic rhinitis, Allergy Asthma Proc, 24, 53
Mason M, 2013, Drug therapy for obstructive sleep apnoea in adults, Cochrane Database Syst Rev, CD003002
DeWester J, 2003, The efficacy of intranasal fluticasone propionate in the relief of ocular symptoms associated with seasonal allergic rhinitis, Allergy Asthma Proc, 24, 331
Taramarcaz P, 2003, Intranasal corticosteroids for asthma control in people with coexisting asthma and rhinitis, Cochrane Database Syst Rev, CD003570
Klosek JM, 2001, Local safety of intranasal triamcinolone acetonide: clinical and histological aspects of nasal mucosa in the long term treatment of perennial allergic rhinitis, Rhinology, 39, 17
Knight A, 1983, Long term efficacy and safety of beclomethasone dipropionate aerosol in perennial rhinitis, Ann Allergy, 50, 81
Minshall E, 1998, Assessment by nasal biopsy of longterm use of mometosone furoate aqueous nasal spray in the treatment of perennial rhinitis, Otolaryngol Head Neck Surg, 118, 648
2008, Norvir [package insert].
2005, Kaletra [package insert].
2010, Prezista [package insert].
Allen DB, 2002, No growth suppression in children treated with the maximum recommended dose of fluticasone propionate aqueous nasal spray for one year, Allergy Asthma Proc, 23, 407
Ciprandi G, 2005, Levocetirizine improves nasal symptoms and airflow in patients with persistent allergic rhinitis, Eur Ann Allergy Clin Immunol, 37, 25
Day JH, 2005, Comparative efficacy of cetirizine and fexofenadine for seasonal allergic rhinitis, 5‐12 hours postdose, in the environmental exposure unit, Allergy Asthma Proc, 26, 275
Juniper EF, 1997, First‐line treatment of seasonal (ragweed) rhinoconjunctivitis: a randomized management trial comparing a nasal steroid spray and a nonsedating antihistamine, CMAJ, 156, 1123
Gonyeau MJ, 2003, A clinical review of montelukast in the treatment of seasonal allergic rhinitis, Formulary, 38, 368
Merck Sharp & Dohme Corp. Singulair product information.2012.uspi‐0476‐mf‐1308r030.www.merck.com/product/usa/pi_circulars/s/singulair/singulair_pi.pdf.Accessed January 22 2014.
Food and Drug Administration.Follow‐up to the March 27 2008 communication about the ongoing safety review of montelukast (Singulair).2009.http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm079523.htm.Accessed July 17 2014.
Nasser M, 2010, Antihistamines used in addition to topical nasal steroids for intermittent and persistent allergic rhinitis in children, Cochrane Database Syst Rev, CD006989
Schenkel E, 2002, Efficacy of once‐daily desloratadine/pseudoephedrine for relief of nasal congestion, Allergy Asthma Proc, 23, 325
Grosclaude M, 1997, Cetirizine and pseudoephedrine retard, given alone or in combination, in patients with seasonal allergic rhinitis, Rhinology, 35, 67
Chervinsky P, 2005, Efficacy and safety of desloratadine/pseudoephedrine tablet, 2.5/120 mg two times a day, versus individual components in the treatment of patients with seasonal allergic rhinitis, Allergy Asthma Proc, 26, 391
Watanasomsiri A, 2008, Efficacy of montelukast and loratadine as treatment for allergic rhinitis in children, Asian Pac J Allergy Immunol, 26, 89
Lombardo G, 2006, Concomitant levocetirizine and montelukast in the treatment of seasonal allergic rhinitis: influence on clinical symptoms, Italian Journal of Allergy and Clinical Immunology, 16, 63
Lau SK, 1990, A clinical comparison of budesonide nasal aerosol, terfenadine and a combined therapy of budesonide and oxymetazoline in adult patients with perennial rhinitis, Asian Pac J Allergy Immunol, 8, 109
Matreja PS, 2012, Efficacy of fluticasone and oxymetazoline as the treatment for allergic rhinitis, J Clin Diagn Res, 6, 85
Calderon MA, 2007, Allergen injection immunotherapy for seasonal allergic rhinitis, Cochrane Database Syst Rev, CD001936
Wilson DR, 2003, Sublingual immunotherapy for allergic rhinitis, Cochrane Database Syst Rev, CD002893
Lin SY, 2013, Allergen‐specific immunotherapy for the treatment of allergic rhinoconjunctivitis and/or asthma: comparative effectiveness review. No. 111. (Prepared by the Johns Hopkins University Evidence‐based Practice Center under Contract No. 290‐2007‐10061‐I.)
Food and Drug Administration (FDA) Briefing Document (Oralair Grastek and Ragwitek package insert).Biologic License Application (BLA) for Sweet Vernal Orchard Perennial Rye Timothy and Kentucky Blue Grass Mixed Pollens Allergen Extract Tablet for Sublingual Use(11 December 2013). APAC Briefing document:1–16.http://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/bloodvaccinesandotherbiologics/allergenicproductsadvisorycommittee/ucm377852.pdf.Accessed June 10 2014.
Food and Drug Administration.Oralair package insert.2014.http://www.fda.gov/downloads/BiologicsBloodVaccines/Allergenics/UCM391580.pdf.Accessed June 10 2014.
Food and Drug Administration.Grastek package insert.2014.http://www.fda.gov/downloads/BiologicsBloodVaccines/Allergenics/UCM393184.pdf.Accessed June 10 2014.
Food and Drug Administration.Ragwitek package insert.2014.http://www.fda.gov/downloads/biologicsbloodvaccines/allergenics/ucm393600.pdf.Accessed June 10 2014.
Wolkenstein E, 1998, Protective effect of acupuncture on allergen provoked rhinitis, Wien Med Wochenschr, 148, 450
Petti FB, 2002, Study on cytokines IL‐2, IL‐6, IL‐10 in patients of chronic allergic rhinitis treated with acupuncture, J Tradit Chin Med, 22, 104
Park YC, 2005, Effect of acupuncture on nasal obstruction in patients with persistent allergic rhinitis: a randomized controlled trial, J Kor Acu Mox, 22, 229
Rao YQ, 2006, Therapeutic effect of acupuncture on allergic rhinitis and its effects on immunologic function [in Chinese], Zhongguo Zhen Jiu, 26, 557
Li YM, 2007, Effects of electroacupuncture on allergic plasma vasoactive intestinal peptide and substance P in perennial allergic rhinitis patients, Acupunct Res, 32, 136
Brinkhaus B, 2008, Acupuncture in patients with allergic rhinitis: a pragmatic randomized trial, Ann Intern Med, 101, 535
Chen K, 1999, Certain progress of clinical research on Chinese integrative medicine, Chin Med J, 112, 934
Maddalozzo J, 2013, Complementary and Integrative Therapies for ENT Disorders, An Issue of Otolaryngologic Clinics
Seidman MD, 1999, Allergies and asthma: alternatives in treatment, Hearing Health, 15, 34