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Allergy. 2018 Mar;73(3):664-672. doi: 10.1111/all.13316. Epub 2017 Oct 17.

National clinical practice guidelines for allergen immunotherapy: An international assessment applying AGREE-II.

Author information

1
Investigational Unit, Hospital Medica Sur, Mexicocity, Mexico.
2
Servicio de Enfermedades del Sistema Inmune-Alergia, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain.
3
Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain.
4
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
5
Royal Liverpool University Hospital and Liverpool Hope University, Liverpool, United Kingdom.
6
Universidad de Guadalajara, Guadalajara, Mexico.
7
Hannover Medical School, Hannover, Germany.
8
University Hospital of Salamanca, Salamanca, Spain.
9
Fundación Ayre (Education & Research), Salta, Argentina.
10
Red Cross Children's Hospital and School of Adolescent and Child Health, University of Cape Town, Cape Town, South Africa.
11
Universidad de Hidalgo, Pachuca, Mexico.
12
Center for Rhinology and Allergology, Wiesbaden, Germany.
13
Universidade Federal do Paraná, Curitiba, Brazil.
14
Padua University, Padua, Italy.
15
Department of Allergy & Clinical Immunology, Transylvania University, Brasov, Romania.
16
MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.
17
Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Scotland, UK.
18
Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Abstract

BACKGROUND:

Since 1988, numerous allergen immunotherapy guidelines (AIT-GLs) have been developed by national and international organizations to guide physicians in AIT. Even so, AIT is still severely underused.

OBJECTIVE:

To evaluate AIT-GLs with AGREE-II, developed in 2010 by McMaster University methodologists to comprehensively evaluate GL quality.

METHODS:

Allergist, from different continents, knowledgeable in AIT and AGREE-II trained were selected into the project team. The project received methodologists' guidance. AIT-GLs in any language were sought from 1980 to 2016; AIT-GLs were AGREE II-evaluated by at least 2 team members, independently; discrepancies were resolved in a second round, by team discussion or methodologists' consulting.

RESULTS:

We found 31 AIT-GLs (15 post-2010), ranging from local consensus reports to international position papers (EAACI, AAAAI-ACAAI, WAO). Pre-2010 GLs scored 1.6-4.6 (23%-67%) and post-2010 GLs scored 2.1-6 (30%-86%), on a 7-point Likert scale. The highest scores went to: German-Austrian-Swiss (6.0), Mexican (5.1), and the AAAAI/ACAAI AIT-GL (4.7). These were also the only 3 GLs that received "yes" of both evaluators to the item: "I would recommend this GL for use." The domains of "Stakeholder involvement" and "Rigor of Development" only scored 3/7, and "Applicability" scored the lowest. Strikingly, newer GLs only scored clearly better in "Editorial independence" and "Global evaluation."

CONCLUSIONS:

In AIT-GLs, there is still a lot of room for improvement, especially in domains crucial for the dissemination. For some GLs, the "Scientific rigor" domain flawed. When resources are limited, transculturizing a high-quality GL might be preferable over developing a GL from zero. Our study and AGREE-II could help to select the best candidate.

CLINICAL IMPLICATIONS:

We here evaluate allergen immunotherapy guideline (AIT-GL) quality. Only high-quality AIT-GLs should be consulted for AIT management decisions. In low-resource settings, transculturization of these is preferred over developing low-quality guidelines.

KEYWORDS:

AGREE II instrument; allergen immunotherapy; allergic rhinitis; subcutaneous immunotherapy; sublingual immunotherapy

PMID:
28940450
DOI:
10.1111/all.13316
[Indexed for MEDLINE]
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