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Developing practice parameters that improve health of patients and populations

2021; Elsevier BV; Volume: 9; Issue: 2 Linguagem: Inglês

10.1016/j.jaip.2020.12.016

2213-2201

David B.K. Golden, Marcus Shaker,

Food Allergy and Anaphylaxis Research

We must compliment Hamilton et al1Hamilton R.G. Hemmer W. Nopp A. Kleine-Tebbe J. Advances in IgE testing for diagnosis of allergic disease.J Allergy Clin Immunol Pract. 2020; 8: 2495-2504Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar on their review of advances in allergy diagnostic testing. We would like to offer an update in response to the authors' concerns about Allergy Diagnostic Practice Parameters and clarify how the Joint Task Force on Practice Parameters (JTFPP) is evolving to serve the needs of the practicing allergist-immunologist.2AAAAI/ACAAI Joint Task Force on Practice Parameters.http://allergyparameters.orgGoogle Scholar The JTFPP is fully engaged in producing not only focused Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines but also full-spectrum traditional practice parameters.2AAAAI/ACAAI Joint Task Force on Practice Parameters.http://allergyparameters.orgGoogle Scholar, 3Shaker M.S. Oppenheimer J. Wallace D.V. Golden D.B.K. Lang D.M. Joint Task Force for Allergy Practice Parameters, et al. Making the GRADE in anaphylaxis management: toward recommendations integrating values, preferences, context, and shared decision making.Ann Allergy Asthma Immunol. 2020; 124: 526-535.e2Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar, 4GRADE Working Group.http://www.gradeworkinggroup.org/Google Scholar More than 5 years ago, advancements in evidence-based medicine (EBM) led the American Academy of Allergy, Asthma, and Immunology (AAAAI), the American College of Allergy, Asthma, and Immunology (ACAAI), and JTFPP to re-focus selected guidelines using the GRADE method.3Shaker M.S. Oppenheimer J. Wallace D.V. Golden D.B.K. Lang D.M. Joint Task Force for Allergy Practice Parameters, et al. Making the GRADE in anaphylaxis management: toward recommendations integrating values, preferences, context, and shared decision making.Ann Allergy Asthma Immunol. 2020; 124: 526-535.e2Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar, 4GRADE Working Group.http://www.gradeworkinggroup.org/Google Scholar, 5Instute of Medicine (US)Committe on Standards for Developing Trustworthy Clinical Practice Guidelines. National Academies Press (US). Clinical practice guidelines we can trust.2011https://www.ncbi.nlm.nih.gov/books/NBK209539/Google Scholar This was for good reason. The Institute of Medicine recommendations for the EBM approach to guidelines had led developers to more carefully evaluate not only the type of evidence (eg, randomized controlled trial [RCT] vs observational) but also the certainty of that evidence (including imprecision, inconsistency, and indirectness), and the risk of bias that can be present even in large RCTs.3Shaker M.S. Oppenheimer J. Wallace D.V. Golden D.B.K. Lang D.M. Joint Task Force for Allergy Practice Parameters, et al. Making the GRADE in anaphylaxis management: toward recommendations integrating values, preferences, context, and shared decision making.Ann Allergy Asthma Immunol. 2020; 124: 526-535.e2Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar, 4GRADE Working Group.http://www.gradeworkinggroup.org/Google Scholar, 5Instute of Medicine (US)Committe on Standards for Developing Trustworthy Clinical Practice Guidelines. National Academies Press (US). Clinical practice guidelines we can trust.2011https://www.ncbi.nlm.nih.gov/books/NBK209539/Google Scholar In addition to a rigorous evaluation of evidence, the GRADE approach incorporates a broad societal perspective that considers the balance of effects, benefits, burdens, harms, equity, acceptability, feasibility, and cost.3Shaker M.S. Oppenheimer J. Wallace D.V. Golden D.B.K. Lang D.M. Joint Task Force for Allergy Practice Parameters, et al. Making the GRADE in anaphylaxis management: toward recommendations integrating values, preferences, context, and shared decision making.Ann Allergy Asthma Immunol. 2020; 124: 526-535.e2Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar,4GRADE Working Group.http://www.gradeworkinggroup.org/Google Scholar GRADE guidelines begin with systematic reviews and meta-analyses, and then apply a comprehensive assessment of evidence certainty, while also adopting a nuanced understanding of values, preferences, and context to transparently deliver recommendations to guide clinical practice.3Shaker M.S. Oppenheimer J. Wallace D.V. Golden D.B.K. Lang D.M. Joint Task Force for Allergy Practice Parameters, et al. Making the GRADE in anaphylaxis management: toward recommendations integrating values, preferences, context, and shared decision making.Ann Allergy Asthma Immunol. 2020; 124: 526-535.e2Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar,4GRADE Working Group.http://www.gradeworkinggroup.org/Google Scholar More than 110 organizations from 19 countries have endorsed GRADE, including the Centers for Disease Control and Prevention, the Agency for Health Research and Quality, the American College of Physicians, and UpToDate.4GRADE Working Group.http://www.gradeworkinggroup.org/Google Scholar,6Agency for Healthcare Research and QualityGuidelines and measures.https://www.ahrq.gov/gam/index.htmlGoogle Scholar In addition to evolving with the standard of guideline development, the JTFPP, AAAAI, and ACAAI realized that GRADE was a requirement for inclusion of guidelines in the National Guideline Clearinghouse, which made them more likely to be considered by third-party payors and policymakers.6Agency for Healthcare Research and QualityGuidelines and measures.https://www.ahrq.gov/gam/index.htmlGoogle Scholar In this environment, the JTFPP leveraged skills and resources to apply GRADE methodology to specific allergy-immunology practice parameters.2AAAAI/ACAAI Joint Task Force on Practice Parameters.http://allergyparameters.orgGoogle Scholar This led to the publication of the first JTFPP GRADE guideline in 2017, and subsequent development and publication of multiple GRADE guidelines including anaphylaxis, eosinophilic esophagitis, and peanut allergy diagnosis.2AAAAI/ACAAI Joint Task Force on Practice Parameters.http://allergyparameters.orgGoogle Scholar Importantly, the core principles of GRADE have always applied to JTFPP practice parameters. The need to carefully evaluate evidence and incorporate the perspective of both patients and clinicians is not new. Although the standards and transparency of evaluations have evolved,4GRADE Working Group.http://www.gradeworkinggroup.org/Google Scholar,6Agency for Healthcare Research and QualityGuidelines and measures.https://www.ahrq.gov/gam/index.htmlGoogle Scholar the JTFPP continues to apply these same principles to traditional practice parameters for the clinical practice of allergy-immunology. Although GRADE parameters provide a highly granular evaluation of targeted questions key to the specialty, traditional practice parameters continue to inform broad topic areas and often include the results of more targeted GRADE analyses. For example, the 2020 Rhinitis Traditional Parameter extended recommendations of the previously published 2017 Rhinitis GRADE Guideline.2AAAAI/ACAAI Joint Task Force on Practice Parameters.http://allergyparameters.orgGoogle Scholar At any point in time, the JTFPP is actively developing 2 GRADE guidelines and 2 traditional practice parameters simultaneously.2AAAAI/ACAAI Joint Task Force on Practice Parameters.http://allergyparameters.orgGoogle Scholar We are grateful to the dedicated individuals of the JTFPP and guideline workgroups who have volunteered countless hours to produce practice parameters for the specialty, to the AAAAI and ACAAI, and to the members of these premier professional societies for their support. In our practices, laboratories, journals, and societies, each allergist-immunologist continues the work to improve the health care we deliver to patients every day. Hamilton et al1Hamilton R.G. Hemmer W. Nopp A. Kleine-Tebbe J. Advances in IgE testing for diagnosis of allergic disease.J Allergy Clin Immunol Pract. 2020; 8: 2495-2504Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar make clear the need to further understand the clinical application of the rapid advancements in our field to support and inform the development of guidelines, and improve the health of patients and populations alike. Advances in IgE Testing for Diagnosis of Allergic DiseaseThe Journal of Allergy and Clinical Immunology: In PracticeVol. 8Issue 8PreviewSince its discovery in 1967, IgE antibody detection in skin and blood has identified a state of allergic sensitization and served as a necessary but not sufficient risk factor that requires objective symptoms to make the definitive diagnosis of human allergic disease. More recently, quantitative IgE antibody levels in serum against allergenic extracts, molecules, and epitopes have pushed its application into more accurately identifying the specificity of the allergic response for targeting immunotherapy, predicting allergic symptom severity after allergen exposure, and attempting to distinguish tolerance from food allergy. Full-Text PDF Reply to "Developing practice parameters that improve health of patients and populations"The Journal of Allergy and Clinical Immunology: In PracticeVol. 9Issue 2PreviewThe authors thank Golden and Shaker1 for their update regarding the development of allergy specialty–related practice parameters and comments as they relate to utility of diagnostic method delimited practice parameters such as the classic Bernstein et al report2 that we discussed in our review on diagnostic allergy methods.3 We appreciate their work on the Joint Task Force on Practice Parameters, which has been involved in preparing evidence-based guidelines for the allergy community using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method that considers the type and certainty of evidence. Full-Text PDF