RESUMO
BACKGROUND: Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS: Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS: The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION: This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
Assuntos
Rinite Alérgica/diagnóstico , Corticosteroides/uso terapêutico , Alérgenos/análise , Produtos Biológicos/uso terapêutico , Terapias Complementares/métodos , Citocinas/fisiologia , Diagnóstico Diferencial , Quimioterapia Combinada , Endoscopia/métodos , Exposição Ambiental/efeitos adversos , Métodos Epidemiológicos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Imunoglobulina E/fisiologia , Microbiota , Descongestionantes Nasais/uso terapêutico , Doenças Profissionais/diagnóstico , Exame Físico/métodos , Probióticos/uso terapêutico , Qualidade de Vida , Mucosa Respiratória/fisiologia , Rinite Alérgica/etiologia , Rinite Alérgica/terapia , Fatores de Risco , Solução Salina/uso terapêutico , Testes Cutâneos/métodos , Fatores SocioeconômicosRESUMO
Working Group 3 (Sensitivity to Organic Dusts-Atopy and Gene Polymorphisms) was convened to review the current understanding of how effects of inhaled organic dust may be modified by genetic factors-both those that increase as well as those that may reduce susceptibility. Furthermore, the group was asked to suggest areas that require more investigation in this field. The discussion focused on individual sensitivity to inhaled agents as the most important determinant of inter-individual heterogeneiety in responses to exposures. Genetic modifiers are known for a number of pathologic conditions (including asthma, atopy, chronic obstructive pulmonary disease, and hypersensitivity pneumonitis) associated with inhalation of organic dusts; modifiers are likely to be identified for a number of other disease states. Further studies are required to delineate more precisely the contribution (and the role in inflammatory cascade modulation) of these known polymorphisms, as well as to identify novel genetic factors.
