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1. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update – XII – Recommendations on milk formula supplements with and without probiotics for infants and toddlers with CMA

Author

Antonio Bognanni, MD, PhD (c), Alessandro Fiocchi, MD, Stefania Arasi, MD, MSc, PhD, Derek K. Chu, MD, PhD, Ignacio Ansotegui, MD, PhD, Amal H. Assa'ad, MD, Sami L. Bahna, MD, DrPH, Roberto Berni Canani, MD, PhD, Martin Bozzola, MD, Lamia Dahdah, MD, Christophe Dupont, MD, PhD, Piotr Dziechciarz, MD, PhD, Motohiro Ebisawa, MD, PhD, Ramon T. Firmino, MD, Alexandro Chu, BHSc(Hons), Elena Galli, MD, PhD, Andrea Horvath, MD, PhD, Rose Kamenwa, MD, Gideon Lack, MBBCh, Haiqi Li, MD, Alberto Martelli, MD, Anna Nowak-Węgrzyn, MD, PhD, Nikolaos G. Papadopoulos, MD, PhD, Ruby Pawankar, MD, PhD, Yetiani Roldan, MD, Maria Said, RN, Mario Sánchez-Borges, MD, Raanan Shamir, MD, PhD, Jonathan M. Spergel, MD, PhD, Hania Szajewska, MD, Luigi Terracciano, MD, Yvan Vandenplas, MD, PhD, Carina Venter, PhD, RD, Siw Waffenschmidt, PhD, Susan Waserman, MD, MSc, Amena Warner, RN, SN (PG Dip), Gary W.K. Wong, MD, Holger J. Schünemann, MD, MSc, PhD, and Jan L. Brozek, MD, PhD

Subjects
Milk allergy, Milk replacement formulas, Probiotics, Clinical practice guidelines, GRADE, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Cow's milk allergy (CMA) is the most common food allergy in infants. The replacement with specialized formulas is an established clinical approach to ensure adequate growth and minimize the risk of severe allergic reactions when breastfeeding is not possible. Still, given the availability of multiple options, such as extensively hydrolyzed cow's milk protein formula (eHF-CM), amino acid formula (AAF), hydrolyzed rice formula (HRF) and soy formulas (SF), there is some uncertainty as to the most suitable choice with respect to health outcomes. Furthermore, the addition of probiotics to a formula has been proposed as a potential approach to maximize benefit. Objective: These evidence-based guidelines from the World Allergy Organization (WAO) intend to support patients, clinicians, and others in decisions about the use of milk specialized formulas, with and without probiotics, for individuals with CMA. Methods: WAO formed a multidisciplinary guideline panel balanced to include the views of all stakeholders and to minimize potential biases from competing interests. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to review by stakeholders. Results: After reviewing the summarized evidence and thoroughly discussing the different management options, the WAO guideline panel suggests: a) using an extensively hydrolyzed (cow's milk) formula or a hydrolyzed rice formula as the first option for managing infants with immunoglobulin E (IgE) and non-IgE-mediated CMA who are not being breastfed. An amino-acid formula or a soy formula could be regarded as second and third options respectively; b) using either a formula without a probiotic or a casein-based extensively hydrolyzed formula containing Lacticaseibacillus rhamnosus GG (LGG) for infants with either IgE or non-IgE-mediated CMA.The issued recommendations are labeled as “conditional” following the GRADE approach due to the very low certainty about the health effects based on the available evidence. Conclusions: If breastfeeding is not available, clinicians, patients, and their family members might want to discuss all the potential desirable and undesirable consequences of each formula in infants with CMA, integrating them with the patients' and caregivers’ values and preferences, local availability, and cost, before deciding on a treatment option. We also suggest what research is needed to determine with greater certainty which formulas are likely to be the most beneficial, cost-effective, and equitable.

Published
2024
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2. Frequency of postoperative cognitive dysfunction after non-cardiac surgery and its impact on functional outcomes: protocol for a systematic review

Author

Maura Marcucci, Yetiani Roldan, Shahzaib Khattak, Saif Samari, Olsen Chan, Meghan Pancucci, Praveen Sritharan, and Yasser Jamil

Subjects
Medicine
Abstract

Introduction Older surgical candidates are at increased risk of a phenomenon known as postoperative cognitive dysfunction (POCD). Several studies have looked at the incidence of POCD at different time points following surgery, using different study methods. Fewer have assessed whether changes in cognition after surgery are attributable to surgery and how they impact patient function and quality of life. The aim of this systematic review is to summarise and appraise studies addressing any of the following research questions (RQs): (RQ1) what is the frequency of POCD after non-cardiac surgery?; (RQ2) is non-cardiac surgery associated with an increased risk of cognitive decline?; (RQ3) is POCD after non-cardiac surgery associated with patient-important outcomes?Methods and analysis This protocol adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Three electronic databases (MEDLINE, PsycINFO and EMBASE) will be systematically searched from their inception date. Identified studies will be screened by two reviewers for eligibility using Covidence, and data will be extracted into a standardised electronic form. We will evaluate methodological quality of included studies using the Quality In Prognosis Studies and its adaptation to the overall prognosis question, and the CLARITY risk of bias for cohort and case–control studies. For RQ1, we will estimate an average POCD frequency at different time points by performing a meta-analysis of included studies when appropriate. For RQ2 and RQ3, we will extract and meta-analyse the effect measures for the association of surgery with cognitive decline when compared with the non-surgical comparator, and association of cognitive changes with functional changes, quality of life and other patient-important outcomes based on available evidence. We will narratively summarise and discuss the different methods implemented in the existing studies to answer the three RQs, and when meta-analysis is deemed infeasible, we will qualitatively report the results of the included studies.Ethics and dissemination This project involves the collection and analysis of data from previously published studies and therefore does not require ethics approval. We plan to present the findings of this research project at peer-reviewed conferences and publish the results in peer-reviewed journals.PROSPERO registration number CRD42022370674.

Published
2023
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3. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update – XIII – Oral immunotherapy for CMA – Systematic review

Author

Antonio Bognanni, MD, Derek K. Chu, MD, Ramon T. Firmino, DDS, PhD, Stefania Arasi, PhD, MSc, Siw Waffenschmidt, Arnav Agarwal, MD, Piotr Dziechciarz, MD, PhD, Andrea Horvath, MD, PhD, Rime Jebai, MSc, MPH, Hanako Mihara, MD, MPH, Yetiani Roldan, MD, Maria Said, RN, Raanan Shamir, MD, PhD, Martin Bozzola, MD, Sami Bahna, MD, DrPH, Alessandro Fiocchi, MD, Susan Waserman, MD, MSc, Holger J. Schünemann, MD, MSc, PhD, Jan L. Brożek, MD, PhD, Ignacio J. Ansotegui, MD, PhD, Stefania Arasi, MD, PhD, Amal H. Assa'ad, MD, Sami L. Bahna, MD, DrPH, Roberto Berni Canani, MD, PhD, Jan Brozek, MD, PhD, Derek K. Chu, MD, PhD, Lamia Dahdah, MD, Christophe Dupont, MD, PhD, Motohiro Ebisawa, MD, PhD, Ramon Targino Firmino, MD, Elena Galli, MD, PhD, Rose Kamenwa, MD, Gideon Lack, MBBCh, Haiqi Li, MD, Alberto Martelli, MD, Anna H. Nowak-Wegrzyn, MD, PhD, Nikolaos G. Papadopoulos, MD, PhD, Ruby Pawankar, MD, PhD, Mario Sánchez-Borges, MD, Jonathan M. Spergel, MD, PhD, Hania Szajewska, MD, Luigi Terracciano, MD, Yvan Vandenplas, MD, PhD, Carina Venter, PhD, RD, Amena Warner, RN, SN (PG Dip), and GaryW.K. Wong, MD

Subjects
Milk allergy, Oral immunotherapy, Systematic review, Meta-analysis, GRADE, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Allergy to cow's milk is the most common food allergy in infants and it is usually outgrown by 5 years of age. In some individuals it persists beyond early childhood. Oral immunotherapy (OIT, oral desensitization, specific oral tolerance induction) has been proposed as a promising therapeutic strategy for persistent IgE-mediated cow's milk allergy. We previously published the systematic review of OIT for cow's milk allergy (CMA) in 2010 as part of the World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines. Objective: To systematically synthesize the currently available evidence about OIT for IgE-mediated CMA and to inform the updated 2022 WAO guidelines. Methods: We searched the electronic databases including PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and the websites of selected allergy organizations. We included all studies irrespective of the language of the original publication. The last search was conducted in February 2021. We registered the protocol on Open Science Framework (10.17605/OSF.IO/AH2DT). Results: We identified 2147 unique records published between 2010 and 2021, including 13 randomized trials and 109 observational studies addressing cow's milk OIT. We found low-certainty evidence that OIT with unheated cow's milk, compared to elimination diet alone, increased the likelihood of being able to consume ≥150 ml of cow's milk in controlled settings (risk ratio (RR): 12.3, 95% CI: 5.9 to 26.0; risk difference (RD): 25 more per 100, 95% CI 11 to 56) as well as accidently ingest a small amount (≥5 ml) of cow's milk (RR: 8.7, 95% CI: 4.7 to 16.1; RD: 25 more per 100, 95% CI 12 to 50). However, 2–8 weeks after discontinuation of a successful OIT, tolerance of cow's milk persisted in only 36% (range: 20%–91%) of patients. OIT increased the frequency of anaphylaxis (rate ratio: 60.0, 95% CI 15 to 244; rate difference 5 more anaphylactic reactions per 1 person per year, 95% CI: 4 to 6; moderate evidence) and the frequency of epinephrine use (rate ratio: 35.2, 95% CI: 9 to 136.5; rate difference 268 more events per 100 person-years, 95% CI: 203 to 333; high certainty). OIT also increased the risk of gastrointestinal symptoms (RR 6.9, 95% CI 1.6–30.9; RD 28 more per 100, CI 3 to 100) and respiratory symptoms (RR 49.0, 95% CI 3.12–770.6; RD 77 more per 100, CI 62 to 92), compared with avoidance diet alone. Single-arm observational studies showed that on average 6.9% of OIT patients (95% CI: 3.8%–10%) developed eosinophilic esophagitis (very low certainty evidence). We found 1 trial and 2 small case series of OIT with baked milk. Conclusions: Moderate certainty evidence shows that OIT with unheated cow's milk in patients with IgE-mediated CMA is associated with an increased probability of being able to drink milk and, at the same time, an increased risk of serious adverse effects.

Published
2022
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4. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guideline update – XIV – Recommendations on CMA immunotherapy

Author

Jan L. Brozek, Ramon T. Firmino, Antonio Bognanni, Stefania Arasi, Ignacio Ansotegui, Amal H. Assa'ad, Sami L. Bahna, Roberto Berni Canani, Martin Bozzola, Derek K. Chu, Lamia Dahdah, Christophe Dupont, Piotr Dziechciarz, Motohiro Ebisawa, Elena Galli, Andrea Horvath, Rose Kamenwa, Gideon Lack, Haiqi Li, Alberto Martelli, Anna Nowak-Węgrzyn, Nikolaos G. Papadopoulos, Ruby Pawankar, Yetiani Roldan, Maria Said, Mario Sánchez-Borges, Raanan Shamir, Jonathan M. Spergel, Hania Szajewska, Luigi Terracciano, Yvan Vandenplas, Carina Venter, Siw Waffenschmidt, Susan Waserman, Amena Warner, Gary W.K. Wong, Alessandro Fiocchi, and Holger J. Schünemann

Subjects
Milk allergy, Immunotherapy, Practice guidelines, GRADE, Immunologic diseases. Allergy, RC581-607
Abstract

Background: The prevalence of cow's milk allergy (CMA) is approximately 2–4.5% in infants and less than 0.5% in adults. Most children outgrow cow's milk allergy in early childhood, particularly that to the baked milk products. Immunotherapy with unheated cow's milk has been used as a treatment option for those who have not yet outgrown CMA, but the benefits must be balanced with the adverse effects. Objective: These evidence-based guidelines from the World Allergy Organization (WAO) intend to support patients, clinicians, and others in decisions about the use of oral and epicutaneous immunotherapy for the treatment of IgE-mediated CMA. Methods: WAO formed a multidisciplinary guideline panel balanced to include the views of all stakeholders and to minimize potential biases from competing interests. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to public comment. Results: After a careful review of the summarized evidence and thorough discussions the WAO guideline panel suggests: a) using oral immunotherapy with unheated cow's milk in those individuals with confirmed IgE-mediated CMA who value the ability to consume controlled quantities of milk more than avoiding the large adverse effects of therapy, b) not using oral immunotherapy with unheated cow's milk in those who value avoiding large adverse effects of therapy more than the ability to consume controlled quantities of milk, c) using omalizumab in those starting oral immunotherapy with unheated cow's milk, d) not using oral immunotherapy with baked cow's milk in those who do not tolerate both unheated and baked milk, and e) not using epicutaneous immunotherapy outside of a research setting. The recommendations are labeled “conditional” due to the low certainty about the health effects based on the available evidence. Conclusions: Clinicians, patients, and their family members might want to discuss all the potential desirable and undesirable effects of oral immunotherapy for IgE-mediated CMA and integrate them with the patients' values and preferences before deciding on a treatment option. More robust research is needed to determine with greater certainty which interventions are likely to be the most beneficial with the least harms, and to develop safer, low-cost, and equitable treatments.

Published
2022
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5. In-Hospital Macro-, Meso-, and Micro-Drivers and Interventions for Antibiotic Use and Resistance: A Rapid Evidence Synthesis of Data from Canada and Other OECD Countries

Author

Rosa Stalteri Mastrangelo, Anisa Hajizadeh, Thomas Piggott, Mark Loeb, Michael Wilson, Luis Enrique Colunga Lozano, Yetiani Roldan, Hussein El-Khechen, Anna Miroshnychenko, Priya Thomas, Holger J. Schünemann, and Robby Nieuwlaat

Subjects
Infectious and parasitic diseases, RC109-216, Microbiology, QR1-502
Abstract

Hospitals continue to face challenges in reducing incorrect antibiotic use due to social and cultural factors at the level of the health system, the care facility, the provider, and the patient. The objective of this paper is to highlight the social and cultural drivers of antimicrobial use and resistance and targeted interventions for secondary and tertiary care settings in Canada and other OECD countries. This paper is an extension of the synthesis conducted for the Public Health Agency of Canada’s 2019 Spotlight Report: Preserving Antibiotics Now and Into the Future. We conducted a systematic review with a few modifications to meet rapid timelines. We conducted a search in Ovid MEDLINE and McMaster University’s evidence databases for systematic reviews and then for individual Canadian studies. To cast a wider net, we searched OECD organization websites and screened reference lists from systematic reviews. We synthesized the evidence narratively and categorized the evidence into macro-, meso-, and microlevel. A total of 70 studies were (a) from OCED countries and summarized evidence of potential sociocultural antimicrobial resistance and use barriers or facilitators and/or interventions addressing these challenges; (b) systematic reviews with 50% of included studies that are situated in secondary and tertiary settings; and (c) published in Canada’s two official languages, English and French. We found that hospital structures and policies may influence antibiotic utilization and variations in antimicrobial management. Microlevel factors may sway inappropriate prescribing among clinicians. The amount and type of antibiotics used may affect resistance rates. Interventions were mainly comprised of antibiotic stewardship and training that modify clinician behavior and that educate patients and carers. This evidence synthesis illustrates the various drivers of, and interventions for, antimicrobial use and resistance at the macro-, meso-, and microlevel in secondary and tertiary settings. We demonstrate that upstream drivers may lead to downstream events that influence antimicrobial resistance.

Published
2022
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6. American Society of Hematology living guidelines on use of anticoagulation for thromboprophylaxis for patients with COVID-19: executive summary

Author

Siegal, Deborah M., Tseng, Eric K., Schünemann, Holger J., Angchaisuksiri, Pantep, Cuker, Adam, Dane, Kathryn, DeSancho, Maria T., Diuguid, David, Griffin, Daniel O., Klok, Frederikus A., Lee, Alfred Ian, Neumann, Ignacio, Pai, Ashok, Righini, Marc, Sanfilippo, Kristen M., Terrell, Deirdra R., Akl, Elie A., Al Jabiri, Reyad, Al Jabiri, Yazan, Barbara, Angela M., Bognanni, Antonio, Akl, Imad Bou, Boulos, Mary, Brignardello-Petersen, Romina, Chan, Matthew, Charide, Rana, Colunga-Lozano, Luis E., Dearness, Karin, Darzi, Andrea J., Hussein, Heba, Karam, Samer G., Kolb, Philipp, Mansour, Razan, Morgano, Gian Paolo, Morsi, Rami Z., Schünemann, Giovanna Muti, Nadim, Menatalla K., Noori, Atefeh, Philip, Binu A., Piggott, Thomas, Qiu, Yuan, Benitez, Yetiani Roldan, Schünemann, Finn, Stevens, Adrienne, Solo, Karla, Wiercioch, Wojtek, Mustafa, Reem A., and Nieuwlaat, Robby

Published
2024
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7. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis for patients with COVID-19: March 2022 update on the use of anticoagulation in critically ill patients

Author

Cuker, Adam, Tseng, Eric K., Schünemann, Holger J., Angchaisuksiri, Pantep, Blair, Clifton, Dane, Kathryn, DeSancho, Maria T., Diuguid, David, Griffin, Daniel O., Kahn, Susan R., Klok, Frederikus A., Lee, Alfred Ian, Neumann, Ignacio, Pai, Ashok, Righini, Marc, Sanfilippo, Kristen M., Siegal, Deborah M., Skara, Mike, Terrell, Deirdra R., Touri, Kamshad, Akl, Elie A., Al Jabiri, Reyad, Al Jabiri, Yazan, Boulos, Mary, Brignardello-Petersen, Romina, Charide, Rana, Colunga-Lozano, Luis E., Dearness, Karin, Darzi, Andrea J., Karam, Samer G., Morgano, Gian Paolo, Morsi, Rami Z., Philip, Binu A., Benitez, Yetiani Roldan, Stevens, Adrienne, Solo, Karla, Wiercioch, Wojtek, Mustafa, Reem A., and Nieuwlaat, Robby

Published
2022
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8. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: January 2022 update on the use of therapeutic-intensity anticoagulation in acutely ill patients

Author

Cuker, Adam, Tseng, Eric K., Nieuwlaat, Robby, Angchaisuksiri, Pantep, Blair, Clifton, Dane, Kathryn, DeSancho, Maria T., Diuguid, David, Griffin, Daniel O., Kahn, Susan R., Klok, Frederikus A., Lee, Alfred Ian, Neumann, Ignacio, Pai, Ashok, Righini, Marc, Sanfilippo, Kristen M., Siegal, Deborah M., Skara, Mike, Terrell, Deirdra R., Touri, Kamshad, Akl, Elie A., Al Jabiri, Reyad, Al Jabiri, Yazan, Barbara, Angela M., Bognanni, Antonio, Boulos, Mary, Brignardello-Petersen, Romina, Charide, Rana, Colunga-Lozano, Luis E., Dearness, Karin, Darzi, Andrea J., Hussein, Heba, Karam, Samer G., Mansour, Razan, Morgano, Gian Paolo, Morsi, Rami Z., Muti-Schünemann, Giovanna, Nadim, Menatalla K., Philip, Binu A., Qiu, Yuan, Benitez, Yetiani Roldan, Stevens, Adrienne, Solo, Karla, Wiercioch, Wojtek, Mustafa, Reem A., and Schünemann, Holger J.

Published
2022
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9. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: July 2021 update on postdischarge thromboprophylaxis

Author

Cuker, Adam, Tseng, Eric K., Nieuwlaat, Robby, Angchaisuksiri, Pantep, Blair, Clifton, Dane, Kathryn, Davila, Jennifer, DeSancho, Maria T., Diuguid, David, Griffin, Daniel O., Kahn, Susan R., Klok, Frederikus A., Lee, Alfred Ian, Neumann, Ignacio, Pai, Ashok, Righini, Marc, Sanfilippo, Kristen M., Siegal, Deborah, Skara, Mike, Terrell, Deirdra R., Touri, Kamshad, Akl, Elie A., Al Jabiri, Reyad Nayif, Al Jabiri, Yazan Nayif, Barbara, Angela M., Bognanni, Antonio, Bou Akl, Imad, Boulos, Mary, Brignardello-Petersen, Romina, Charide, Rana, Chan, Matthew, Colunga-Lozano, Luis E., Dearness, Karin, Darzi, Andrea J., Hussein, Heba, Karam, Samer G., Kolb, Philipp, Mansour, Razan, Morgano, Gian Paolo, Morsi, Rami Z., Muti-Schünemann, Giovanna, Nadim, Menatalla K., Noori, Atefeh, Philip, Binu A., Piggott, Thomas, Qiu, Yuan, Benitez, Yetiani Roldan, Schünemann, Finn, Stevens, Adrienne, Solo, Karla, Wiercioch, Wojtek, Mustafa, Reem A., and Schünemann, Holger J.

Published
2022
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10. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19

Author

Adam Cuker, Eric K. Tseng, Robby Nieuwlaat, Pantep Angchaisuksiri, Clifton Blair, Kathryn Dane, Maria T. DeSancho, David Diuguid, Daniel O. Griffin, Susan R. Kahn, Frederikus A. Klok, Alfred Ian Lee, Ignacio Neumann, Ashok Pai, Marc Righini, Kristen M. Sanfilippo, Deborah M. Siegal, Mike Skara, Deirdra R. Terrell, Kamshad Touri, Elie A. Akl, Reyad Al Jabiri, Yazan Al Jabiri, Angela M. Barbara, Antonio Bognanni, Mary Boulos, Romina Brignardello-Petersen, Rana Charide, Luis E. Colunga-Lozano, Karin Dearness, Andrea J. Darzi, Heba Hussein, Samer G. Karam, Razan Mansour, Gian Paolo Morgano, Rami Z. Morsi, Giovanna Muti-Schünemann, Menatalla K. Nadim, Binu A. Philip, Yuan Qiu, Yetiani Roldan Benitez, Adrienne Stevens, Karla Solo, Wojtek Wiercioch, Reem A. Mustafa, and Holger J. Schünemann

Subjects
Acute Disease, Anticoagulants, COVID-19, Humans, Venous Thromboembolism, Hematology, United States
Abstract

Background: COVID-19–related acute illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines from the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in making decisions about the use of anticoagulation in patients with COVID-19. Methods: ASH formed a multidisciplinary guideline panel that included patient representatives and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process and performed systematic evidence reviews (through November 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations, which were subject to public comment. This is an update to guidelines published in February 2021 as part of the living phase of these guidelines. Results: The panel made one additional recommendation. The panel issued a conditional recommendation in favor of therapeutic-intensity over prophylactic-intensity anticoagulation in patients with COVID-19–related acute illness who do not have suspected or confirmed VTE. The panel emphasized the need for an individualized assessment of risk of thrombosis and bleeding. The panel also noted that heparin (unfractionated or low molecular weight) may be preferred because of a preponderance of evidence with this class of anticoagulants. Conclusion: This conditional recommendation was based on very low certainty in the evidence, underscoring the need for additional, high-quality, randomized controlled trials comparing different intensities of anticoagulation in patients with COVID-19–related acute illness.

Published
2022
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11. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis for patients with COVID-19

Author

Adam Cuker, Eric K. Tseng, Holger J. Schünemann, Pantep Angchaisuksiri, Clifton Blair, Kathryn Dane, Maria T. DeSancho, David Diuguid, Daniel O. Griffin, Susan R. Kahn, Frederikus A. Klok, Alfred Ian Lee, Ignacio Neumann, Ashok Pai, Marc Righini, Kristen M. Sanfilippo, Deborah M. Siegal, Mike Skara, Deirdra R. Terrell, Kamshad Touri, Elie A. Akl, Reyad Al Jabiri, Yazan Al Jabiri, Mary Boulos, Romina Brignardello-Petersen, Rana Charide, Luis E. Colunga-Lozano, Karin Dearness, Andrea J. Darzi, Samer G. Karam, Gian Paolo Morgano, Rami Z. Morsi, Binu A. Philip, Yetiani Roldan Benitez, Adrienne Stevens, Karla Solo, Wojtek Wiercioch, Reem A. Mustafa, and Robby Nieuwlaat

Subjects
Critical Illness, Anticoagulants, COVID-19, Humans, Hematology, Venous Thromboembolism, United States
Abstract

Background: COVID-19–related critical illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for patients with COVID-19. Methods: ASH formed a multidisciplinary guideline panel, including 3 patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline development process, including performing systematic evidence reviews (up to January 2022). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the GRADE approach to assess evidence and make recommendations, which were subject to public comment. This is an update to guidelines published in February 2021 and May 2021 as part of the living phase of these guidelines. Results: The panel made 1 additional recommendation: a conditional recommendation for the use of prophylactic-intensity over therapeutic-intensity anticoagulation for patients with COVID-19–related critical illness who do not have suspected or confirmed VTE. The panel emphasized the need for an individualized assessment of thrombotic and bleeding risk. Conclusions: This conditional recommendation was based on very low certainty in the evidence, underscoring the need for additional, high-quality, randomized controlled trials comparing different intensities of anticoagulation for patients with COVID-19–related critical illness.

Published
2022

13. Injectable and topical local anesthetics for acute dental pain: 2 systematic reviews

Author

Anna, Miroshnychenko, Sara, Ibrahim, Maria, Azab, Yetiani, Roldan, Juan Pablo, Diaz Martinez, Divyalakshmi, Tamilselvan, Leon, He, Olivia, Urquhart, Malavika, Tampi, Deborah E, Polk, Paul A, Moore, Elliott V, Hersh, Alonso, Carrasco-Labra, and Romina, Brignardello-Petersen

Abstract

Local anesthesia is essential for pain control in dentistry. The authors assessed the comparative effect of local anesthetics on acute dental pain after tooth extraction and in patients with symptomatic irreversible pulpitis.The authors searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the US Clinical Trials registry through November 21, 2020. The authors included randomized controlled trials (RCTs) comparing long- vs short-acting injectable anesthetics to reduce pain after tooth extraction (systematic review 1) and evaluated the effect of topical anesthetics in patients with symptomatic pulpitis (systematic review 2). Pairs of reviewers screened articles, abstracted data, and assessed risk of bias using a modified version of the Cochrane risk of bias 2.0 tool. The authors assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.Fourteen RCTs comparing long- vs short-acting local anesthetics suggest that bupivacaine may decrease the use of rescue analgesia and may not result in additional adverse effects (low certainty evidence). Bupivacaine probably reduces the amount of analgesic consumption compared with lidocaine with epinephrine (mean difference, -1.91 doses; 95% CI, -3.35 to -0.46; moderate certainty) and mepivacaine (mean difference, -1.58 doses; 95% CI, -2.21 to -0.95; moderate certainty). Five RCTs suggest that both benzocaine 10% and 20% may increase the number of people experiencing pain reduction compared with placebo when managing acute irreversible pulpitis (low certainty).Bupivacaine may be superior to lidocaine with epinephrine and mepivacaine with regard to time to and amount of analgesic consumption. Benzocaine may be superior to placebo in reducing pain for 20 through 30 minutes after application.

Published
2022

14. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: July 2021 update on post-discharge thromboprophylaxis

Author

Antonio Bognanni, David L. Diuguid, Susan R. Kahn, Andrea Darzi, Matthew T. V. Chan, Atefeh Noori, Deborah M. Siegal, Elie A. Akl, Reyad Nayif Al Jabiri, Gian Paolo Morgano, Eric Tseng, Binu A. Philip, Imad Bou Akl, Mary Boulos, Yazan Nayif Al Jabiri, Philipp Kolb, Pantep Angchaisuksiri, Giovanna Muti-Schünemann, Heba Hussein, Rana Charide, Holger J. Schünemann, Angela M. Barbara, Marc Philip Righini, Rami Z. Morsi, Samer G. Karam, Luis Enrique Colunga-Lozano, Frederikus A. Klok, Kamshad Touri, Kathryn Dane, Daniel O. Griffin, Karla Solo, Adam Cuker, Deirdra R. Terrell, Finn Schünemann, Robby Nieuwlaat, Thomas Piggott, Menatalla K. Nadim, Kristen M. Sanfilippo, Ashok Pai, Maria T. DeSancho, Alfred Ian Lee, Clifton Blair, Yuan Qiu, Karin Lee Dearness, Mike Skara, Yetiani Roldan Benitez, Reem A. Mustafa, Ignacio Neumann, Wojtek Wiercioch, Romina Brignardello-Petersen, Jennifer Davila, Razan Mansour, and Adrienne Stevens

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Post discharge, Aftercare, law.invention, practice guidelines, hospital discharge, Randomized controlled trial, law, Internal medicine, Health care, medicine, Humans, In patient, Intensive care medicine, Grading (education), anticoagulation, Hematology, Evidence-Based Medicine, business.industry, SARS-CoV-2, COVID-19, Anticoagulants, Guideline, Venous Thromboembolism, Patient Discharge, United States, Clinical Guideline, thromboprophylaxis, business
Abstract

BackgroundCOVID-19–related acute illness is associated with an increased risk of venous thromboembolism (VTE).ObjectiveThese evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19 who do not have confirmed or suspected VTE.MethodsASH formed a multidisciplinary guideline panel, including 3 patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including performing systematic evidence reviews (up to March 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the grading of recommendations assessment, development, and evaluation (GRADE) approach to assess evidence and make recommendations, which were subject to public comment.ResultsThe panel agreed on 1 additional recommendation. The panel issued a conditional recommendation against the use of outpatient anticoagulant prophylaxis in patients with COVID-19 who are discharged from the hospital and who do not have suspected or confirmed VTE or another indication for anticoagulation.ConclusionsThis recommendation was based on very low certainty in the evidence, underscoring the need for high-quality randomized controlled trials assessing the role of postdischarge thromboprophylaxis. Other key research priorities include better evidence on assessing risk of thrombosis and bleeding outcomes in patients with COVID-19 after hospital discharge.

Published
2021

15. Injectable and topical local anesthetics for acute dental pain

Author

Anna Miroshnychenko, Sara Ibrahim, Maria Azab, Yetiani Roldan, Juan Pablo Diaz Martinez, Divyalakshmi Tamilselvan, Leon He, Olivia Urquhart, Malavika Tampi, Deborah E. Polk, Paul A. Moore, Elliott V. Hersh, Alonso Carrasco-Labra, and Romina Brignardello-Petersen

Subjects
General Dentistry
Published
2023
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16. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: May 2021 update on the use of intermediate intensity anticoagulation in critically ill patients

Author

Gian Paolo Morgano, David L. Diuguid, Giovanna Muti-Schünemann, Alfred Ian Lee, Holger J. Schünemann, Deirdra R. Terrell, Luis Enrique Colunga-Lozano, Rami Z. Morsi, Frederikus A. Klok, Thomas Piggott, Clifton Blair, Yetiani Roldan, Binu A. Philip, Pantep Angchaisuksiri, Philipp Kolb, Adam Cuker, Kamshad Touri, Romina Brignardello-Petersen, Karla Solo, Atefeh Noori, Adrienne Stevens, Jennifer Davila, Susan R. Kahn, Razan Mansour, Finn Schünemann, Robby Nieuwlaat, Kathryn Dane, Antonio Bognanni, Imad Bou Akl, Eric Tseng, Deborah M. Siegal, Ignacio Neumann, Wojtek Wiercioch, Yuan Qiu, Mike Skara, Matthew T. V. Chan, Andrea Darzi, Marc Philip Righini, Reem A. Mustafa, Rana Charide, Daniel O. Griffin, Elie A. Akl, Mary Boulos, Karin Lee Dearness, Ashok Pai, Maria T. DeSancho, and Kristen M. Sanfilippo

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Critical Illness, MEDLINE, Internal medicine, Health care, Medicine, Humans, Intensive care medicine, Grading (education), anticoagulation, Hematology, practice guidelines, Evidence-Based Medicine, business.industry, Critically ill, SARS-CoV-2, COVID-19, Anticoagulants, Evidence-based medicine, Guideline, Venous Thromboembolism, United States, Clinical Guideline, thromboprophylaxis, business
Abstract

Background: COVID-19–related critical illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in making decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19–related critical illness who do not have confirmed or suspected VTE. Methods: ASH formed a multidisciplinary guideline panel that included 3 patient representatives and applied strategies to minimize potential bias from conflicts of interest. The McMaster University Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline development process by performing systematic evidence reviews (up to 5 March 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the GRADE approach to assess evidence and make recommendations, which were subject to public comment. This is an update on guidelines published in February 2021. Results: The panel agreed on 1 additional recommendation. The panel issued a conditional recommendation in favor of prophylactic-intensity over intermediate-intensity anticoagulation in patients with COVID-19–related critical illness who do not have confirmed or suspected VTE. Conclusions: This recommendation was based on low certainty in the evidence, which underscores the need for additional high-quality, randomized, controlled trials comparing different intensities of anticoagulation in critically ill patients. Other key research priorities include better evidence regarding predictors of thrombosis and bleeding risk in critically ill patients with COVID-19 and the impact of nonanticoagulant therapies (eg, antiviral agents, corticosteroids) on thrombotic risk.

Published
2021

17. In-Hospital Macro-, Meso-, and Micro-Drivers and Interventions for Antibiotic Use and Resistance: A Rapid Evidence Synthesis of Data from Canada and Other OECD Countries

Author

Rosa Stalteri Mastrangelo, Anisa Hajizadeh, Thomas Piggott, Mark Loeb, Michael Wilson, Luis Enrique Colunga Lozano, Yetiani Roldan, Hussein El-Khechen, Anna Miroshnychenko, Priya Thomas, Holger J. Schünemann, and Robby Nieuwlaat

Subjects
Microbiology (medical), Infectious Diseases
Abstract

Hospitals continue to face challenges in reducing incorrect antibiotic use due to social and cultural factors at the level of the health system, the care facility, the provider, and the patient. The objective of this paper is to highlight the social and cultural drivers of antimicrobial use and resistance and targeted interventions for secondary and tertiary care settings in Canada and other OECD countries. This paper is an extension of the synthesis conducted for the Public Health Agency of Canada’s 2019 Spotlight Report: Preserving Antibiotics Now and Into the Future. We conducted a systematic review with a few modifications to meet rapid timelines. We conducted a search in Ovid MEDLINE and McMaster University’s evidence databases for systematic reviews and then for individual Canadian studies. To cast a wider net, we searched OECD organization websites and screened reference lists from systematic reviews. We synthesized the evidence narratively and categorized the evidence into macro-, meso-, and microlevel. A total of 70 studies were (a) from OCED countries and summarized evidence of potential sociocultural antimicrobial resistance and use barriers or facilitators and/or interventions addressing these challenges; (b) systematic reviews with 50% of included studies that are situated in secondary and tertiary settings; and (c) published in Canada’s two official languages, English and French. We found that hospital structures and policies may influence antibiotic utilization and variations in antimicrobial management. Microlevel factors may sway inappropriate prescribing among clinicians. The amount and type of antibiotics used may affect resistance rates. Interventions were mainly comprised of antibiotic stewardship and training that modify clinician behavior and that educate patients and carers. This evidence synthesis illustrates the various drivers of, and interventions for, antimicrobial use and resistance at the macro-, meso-, and microlevel in secondary and tertiary settings. We demonstrate that upstream drivers may lead to downstream events that influence antimicrobial resistance.

Published
2021

18. American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19

Author

Rana Charide, Alfred Ian Lee, Rami Z. Morsi, David L. Diuguid, Adrienne Stevens, Thomas Piggott, Jennifer Davila, Razan Mansour, Daniel O. Griffin, Clifton Blair, Holger J. Schünemann, Elie A. Akl, Karla Solo, Kathryn Dane, Eric Tseng, Imad Bou Akl, Mike Skara, Mary Boulos, Andrea Darzi, Yetiani Roldan, Kristen M. Sanfilippo, Karin Lee Dearness, Matthew T. V. Chan, Adam Cuker, Romina Brignardello-Petersen, Yuan Qiu, Marc Philip Righini, Pantep Angchaisuksiri, Susan R. Kahn, Ashok Pai, Reem A. Mustafa, Maria T. DeSancho, Ignacio Neumann, Wojtek Wiercioch, Deborah M. Siegal, Atefeh Noori, Philipp Kolb, Luis Enrique Colunga-Lozano, Frederikus A. Klok, Kamshad Touri, Finn Schünemann, Robby Nieuwlaat, Matthew Ventresca, Gian Paolo Morgano, and Menaka Pai

Subjects
medicine.medical_specialty, MEDLINE, Guidelines as Topic, 030204 cardiovascular system & hematology, law.invention, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Multidisciplinary approach, law, Internal medicine, Health care, Outpatients, medicine, Humans, 030212 general & internal medicine, Enoxaparin, Grading (education), Intensive care medicine, Societies, Medical, Hematology, Evidence-Based Medicine, business.industry, SARS-CoV-2, Anticoagulants, COVID-19, Evidence-based medicine, Guideline, Venous Thromboembolism, business, Clinical Guidelines
Abstract

Background: Coronavirus disease 2019 (COVID-19)–related critical illness and acute illness are associated with a risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis for patients with COVID-19–related critical illness and acute illness who do not have confirmed or suspected VTE. Methods: ASH formed a multidisciplinary guideline panel and applied strict management strategies to minimize potential bias from conflicts of interest. The panel included 3 patient representatives. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic evidence reviews (up to 19 August 2020). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 2 recommendations. The panel issued conditional recommendations in favor of prophylactic-intensity anticoagulation over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19–related critical illness or acute illness who do not have confirmed or suspected VTE. Conclusions: These recommendations were based on very low certainty in the evidence, underscoring the need for high-quality, randomized controlled trials comparing different intensities of anticoagulation. They will be updated using a living recommendation approach as new evidence becomes available., Visual Abstract

Published
2020

19. American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism

Author

Tammy Capman, Paul Monagle, Leonardo R. Brandão, Nicole Schwab, Fiona Newall, Christoph Male, Sheila J. Hanson, Anthony K.C. Chan, Leslie Raffini, Carlos Cuello, Heleen van Ommen, Sarah H. O'Brien, Suzan Williams, Meha Bhatt, Sara K. Vesely, Caitlin Augustine, Mariana Bonduel, John Wiernikowski, Joerg J Meerpohl, Yetiani Roldan, Reem A. Mustafa, John J. Riva, and Pediatrics

Subjects
medicine.medical_specialty, Deep vein, MEDLINE, 030204 cardiovascular system & hematology, Antithrombins, Renal Veins, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Health care, medicine, Central Venous Catheters, Humans, 030212 general & internal medicine, Child, Intensive care medicine, Venous Thrombosis, Evidence-Based Medicine, Portal Vein, business.industry, Anticoagulants, Venous Thromboembolism, Hematology, Guideline, Evidence-based medicine, medicine.disease, Thrombosis, Portal vein thrombosis, Venous thrombosis, medicine.anatomical_structure, Purpura Fulminans, Pulmonary Embolism, business, Clinical Guidelines
Abstract

Background: Despite an increasing incidence of venous thromboembolism (VTE) in pediatric patients in tertiary care settings, relatively few pediatric physicians have experience with antithrombotic interventions. Objective: These guidelines of the American Society of Hematology (ASH), based on the best available evidence, are intended to support patients, clinicians, and other health care professionals in their decisions about management of pediatric VTE. Methods: ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews (up to April of 2017). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 30 recommendations, covering symptomatic and asymptomatic deep vein thrombosis, with specific focus on management of central venous access device–associated VTE. The panel also addressed renal and portal vein thrombosis, cerebral sino venous thrombosis, and homozygous protein C deficiency. Conclusions: Although the panel offered many recommendations, additional research is required. Priorities include understanding the natural history of asymptomatic thrombosis, determining subgroup boundaries that enable risk stratification of children for escalation of treatment, and appropriate study of newer anticoagulant agents in children.

Published
2018
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20. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision

Author

G. Walter Canonica, Peter Schmid-Grendelmeier, Sergio Kowalski, Behnam Sadeghirad, Joaquim Mullol, Antonella Muraro, Juan José Yepes-Nuñez, Peter J. Manning, Ruby Pawankar, Itziar Etxeandia-Ikobaltzeta, Torsten Zuberbier, Yuan Zhang, Gianni Passalacqua, Sinthia Bosnic-Anticevich, Holger J. Schünemann, Peter Hellings, Ivan D. Florez, Désirée Larenas-Linnemann, David Price, Wojtek Wiercioch, Jean Bousquet, Antonio Valero, Ioana Agache, Matthew Ventresca, Arunas Valiulis, Dermot Ryan, Ken Ohta, Romina Brignardello-Petersen, Karin C. Lødrup Carlsen, Erkka Valovirta, Claus Bachert, Ludger Klimek, Petr Panzner, Aziz Sheikh, Thomas B. Casale, Piotr Kuna, Alkis Togias, Pascal Demoly, Jan Brozek, Nikolaos G. Papadopoulos, John J. Riva, Wytske Fokkens, Dana Wallace, Niels H. Chavannes, Susan Waserman, Eli O. Meltzer, Hae-Sim Park, Mark S. Dykewicz, Arnav Agarwal, Bolesław Samoliński, Luo Zhang, Robyn E O'Hehir, Yetiani Roldan, Jaime Correia de Sousa, João Fonseca, Mihaela Zidarn, Carlos A. Cuello-Garcia, Alvaro A. Cruz, Magnus Wickman, Kaja-Triin Laisaar, AII - Inflammatory diseases, Ear, Nose and Throat, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Department of Allergy and Clinical Immunology, Transylvania University of Brasov, Ghent University Hospital, Woolcock Institute of Medical Research [Sydney], The University of Sydney, Allergy & Respiratory Diseases Clinic - DIMI, University of Genoa (UNIGE), University of South Florida [Tampa] (USF), Department of Public Health and Primary Care [leiden], Leiden University Medical Center (LUMC), ProAR – Nucleo de Excelencia em Asma, Universidade Federal da Bahia (UFBA), Center of Research in Health Technologies and Information Systems (CINTESIS), Universidade do Porto, Laboratory of clinical immunology, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), German Society for Otorhinolaryngology HNS, Medical University of Łódź (MUL), Department of Paediatrics [Oslo], Oslo University Hospital [Oslo], Allergy & Asthma Medical Group & Research Center, University of California [San Diego] (UC San Diego), University of California-University of California, Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Universita degli Studi di Padova, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital-Monash University Building, AMREP, Department of Allergology and Clinical Immunology, Medical Faculty in Pilsen-Charles University in Prague - the First Faculty of Medicine, Allergy & Respiratory Diseases, University of Genoa (UNIGE)-Department of Internal Medicine (DIMI), Department of Pediatrics, Nippon Medical School, Allergy and Respiratory Research Group, University of Edinburgh, Medical University of Warsaw - Poland, Allergy Unit - Department of Dermatology, Universität Zürich [Zürich] = University of Zurich (UZH), National Institute of Allergy and Infectious Diseases [Bethesda] (NIAID-NIH), National Institutes of Health [Bethesda] (NIH), Vilnius University Clinic of Children's Diseases, Department of Lung Diseases & Clinical Allergology, University of Turku, Sachs' Children's Hospital, National Institute of Environmental Medicine, Karolinska Institutet [Stockholm], National Key State Laboratory for ThermoStructural Composites (TSCM), Northwestern Polytechnical University [Xi'an] (NPU), Respiratory and Allergic Diseases, University Clinic of Respiratory and Allergic Diseases Golnik, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Departments of Clinical Epidemiology and Biostatistics and Medicine [Ontario], McMaster University [Hamilton, Ontario], and Universidade do Minho

Subjects
medicine.medical_specialty, Practice guideline, [SDV]Life Sciences [q-bio], Population, Immunology, Clinical Decision-Making, Medicina Clínica [Ciências Médicas], Allergic rhinitis, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Allergic, Health care, Anti-Allergic Agents, medicine, Journal Article, Immunology and Allergy, Humans, Animals, 030212 general & internal medicine, Intensive care medicine, Grading (education), education, Child, Ciências Médicas::Medicina Clínica, Asthma, Rhinitis, education.field_of_study, Science & Technology, business.industry, practice guideline, Guideline, ta3121, medicine.disease, Rhinitis, Allergic, 3. Good health, Work performance, Evidence-Based Practice, Histamine H1 Antagonists, Quality of Life, Systematic review, 030228 respiratory system, business
Abstract

Article in press, Background: Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update. Objective: We sought to provide a targeted update of the ARIA guidelines. Methods: The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations. Results: The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H-1-antihistamines, intranasal H-1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient. Conclusions: Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment., J. L. Brozek has received support for the development of systematic reviews in these guidelines from the ARIA Initiative. J. Bousquet has received personal fees from Almirall, Meda, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach, Chiesi, GlaxoSmithKline, and Menarini. S. Bosnic-Anticevich is on the advisory board for TEVA; has consultant arrangements with MEDA and GlaxoSmithKline; has received grants from TEVA; has received payment for lectures from TEVA, GlaxoSmithKline, and AstraZeneca; has received payment for manuscript preparation from MEDA; and has received payment for development of educational presentations from GlaxoSmithKline. T. Casale is the executive vice president of the American Academy of Allergy, Asthma & Immunology. J. Correia de Sousa has board memberships with Boehringer Ingelheim and Novartis, has received payment for lectures from Boehringer Ingelheim, and has received payment for development of educational presentations from Boehringer Ingelheim. A. A. Cruz has board memberships with Novartis, Boehringer Ingelheim, AstraZeneca, MEDA Pharma, and GlaxoSmithKline; has consultant arrangements with Boehringer Ingelheim; has provided expert testimony for Boehringer Ingelheim; has received grants from GlaxoSmithKline; and has received payment for lectures from Eurofarma, Chiesi, MEDA Pharma, and Hypermarcas-Ache. C.A. Cuello-Garcia has consultant arrangements with and has received payment for manuscript preparation and travel support from the World Allergy Organization. P. Demoly has received consulting fees from ALK-Abello, Stallergenes Greer, Thermo Fisher Scientific, MEDA, Chiesi, and Ysslab and has received grants from AstraZeneca. M. Dykewicz has consultant arrangements with Alcon and Merck and is the Workgroup Char for the Rhinitis Practice Parameter Update of the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma & Immunology ACAAI Joint Task Force on Practice Parameters. I. Etxeandia-Ikobaltzeta has received a consulting fee or honorarium from, info:eu-repo/semantics/publishedVersion

Published
2017
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