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

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 H1-antihistamines, intranasal H1-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.

Surgical emergencies during pediatric interventional catheterization.

OBJECTIVE: To determine the incidence of catheter-related surgical emergencies during pediatric interventional catheterization procedures. STUDY DESIGN: We reviewed all interventional catheter procedures (n = 578) over a 4-year period (April 1996 to April 2000) to determine any complication during interventional catheterization that required surgery within 24 hours after catheterization. RESULTS: The overall incidence of surgical emergencies was 1.9% (70% confidence limits, 1.5% to 2.7%). Complications that required surgical intervention occurred with balloon dilation (valvuloplasty, angioplasty, n = 4), device deployment (coils, stents, atrial-septal defect devices, n = 5), transhepatic access (n = 1), and atrial transseptal puncture (n = 1). For the majority of interventions, the incidence of surgical emergencies was <4% except for two procedures (conduit and pulmonary artery angioplasty) with limited numbers of patients. There were no surgical emergencies during endomyocardial biopsy, coarctation angioplasty, or balloon atrial septostomy. CONCLUSIONS: Surgery was required in 1.9% of all interventional catheter procedures. Surgical emergencies occurred during a wide variety of catheter interventions and could not be predicted by the type of procedure performed.