Volume 18 Issue 4 December 2009
Guidelines for allergic rhinitis need to be used in
primary care
Pages 250-257
David J Costaa, Philippe J Bousquetb,h, Dermot Ryanc, David Priced, Pascal Demolye,h, Jan Brozekf,h, Holger J Schünemannf,h, *Jean Bousquetg,h
a
Département de Médecine Générale, Université de Montpellier-Nimes, France
b
Département d’Epidémiologie Clinique, Biostatistique, Santé Publique et Information Médicale, Groupe Hospitalo-Universtaire Carémeau, Nîmes, France
c
Woodbrook Medical Centre, Loughborough, UK; Department of General Practice and Primary Care, University of Aberdeen
d
GPIAG Professor of Primary Care Respiratory Medicine, Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen UK
e
Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, Montpellier, France and INSERM U657
f
McMaster University, Hamilton, Ontario, Canada
g
Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, Montpellier, France and INSERM UMR780
h
Members of GA2LEN (Global Allergy and Asthma European Network), supported by the Sixth EU Framework program for research, contract n° FOOD-CT-2004-506378
Received 6 January 2009 • Accepted 27 April 2009 • Online 9 June 2009
Abstract
Clinical Practice Guidelines for allergic rhinitis have been developed over the past 15 years and have been found to improve the care for
patients with allergic rhinitis. The ARIA (allergic rhinitis and its impact on asthma) guideline was the first of these evidenced-based
guidelines, developed with primary care physicians. Subsequent guidelines include those by the IPCRG, BSACI, the AAAAI/ACAAI Practice
Parameters for the diagnosis and management of rhinitis, and the ARIA 2008 Update. These guidelines were based on various evidencebased
models, but the first to use GRADE methodology (Grading of Recommendations Assessment, Development and Evaluation) is the
ARIA 2009 Revision. Since primary care physicians treat the majority of patients with allergic rhinitis it is essential that they are involved
in the development and implementation of guidelines for allergic rhinitis. Prior to their implementation, guidelines should be evaluated
for their accuracy and user friendliness – specifically for primary care physicians – but such validation is rarely performed. This is of great
importance, in particular as regards evaluating the applicability of evidence from high quality randomised controlled trials (RCTs) which
are often based on highly selected patients not representing the population of patients seen in day-to-day practice.
Cite as: Costa DJ, Bousquet PJ, Ryan D, Price D, Demoly P, Brozek J, Schunemann HJ, Bousquet J. Guidelines for allergic rhinitis need to be used in
primary care. Prim Care Respir J 2009;18(4):250-257. DOI: http://dx.doi.org/10.4104/pcrj.2009.00028
Keywords
Allergic rhinitis, primary care, guideline, guideline evolution, methodology, ARIA, implementation
* Corresponding author. Jean Bousquet Tel: +33-467-41-67-00 Fax: +33-467-41-67-01 Email: jean.bousquet@inserm.fr | |
