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A Component-resolved Diagnostic Approach for a Study on Grass Pollen Allergens in Chinese Southerners with Allergic Rhinitis and/or Asthma
Published on: June 4, 2017
Pragmatic randomized controlled trial of an allergy intervention for children aged 6-16 with asthma and rhinitis in
1Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
Insights
Allergy assessment and tailored advice significantly reduced rhinitis symptoms and improved quality of life in children with asthma and rhinitis. This approach enhances symptom control beyond usual care in primary settings.
Area of Science:
- Pediatric Allergy and Immunology
- Primary Care Medicine
- Clinical Research
Background:
- Allergic rhinitis and asthma management often lack specific trigger identification in primary care.
- Children with these conditions are frequently sensitized to airborne allergens, yet diagnosis and treatment are often empirical.
- Current practices may not provide tailored allergen avoidance advice, impacting symptom control.
Purpose of the Study:
- To evaluate if allergy assessment and personalized advice in general practice improve outcomes for children with asthma and rhinitis.
- To determine the effectiveness of a structured allergy intervention compared to usual care.
Main Methods:
- A pragmatic randomized controlled trial (RCT) involving children with asthma and/or rhinoconjunctivitis.
- Intervention included a structured allergy history, skin prick testing, and tailored avoidance advice.
- Outcomes assessed by a blinded observer at 12 months included symptom scores and quality of life (QoL).
Main Results:
- The allergy intervention group showed a significant reduction in rhinitis symptoms (MD -3.14) and improved QoL (MD -0.50) at 12 months.
- No significant differences were observed in asthma symptoms, healthcare utilization, or days unable to pursue usual activities.
- 335 participants were randomized, with no baseline demographic or clinical differences between groups.
Conclusions:
- Structured allergy assessment, including skin prick testing and tailored advice, effectively reduces rhinitis symptoms in children within primary care.
- This targeted approach leads to improved health-related quality of life for pediatric patients with asthma and/or rhinitis.
- The findings support integrating comprehensive allergy evaluations into routine primary care for managing these conditions.
Background:
It is widely believed that for allergic rhinitis and asthma, avoidance of specific triggers can improve symptom control. Whilst many children with asthma or rhinitis are sensitized to airborne allergens, primary care diagnostic and management decisions are often made without a detailed history of the allergic triggers or allergy testing. Thus, treatment decisions are empirical and allergen avoidance advice is either not given or, if given, not tailored to the child's sensitivities.
Objective:
To ascertain whether allergy assessment and tailored advice in general practice enhances outcomes of children with asthma and rhinitis.
Method:
Pragmatic RCT of allergy intervention (structured allergy history, skin prick testing and appropriate allergy avoidance advice) vs. usual care in children with asthma and/or rhinoconjunctivitis. A blinded observer assessed outcomes at 12 months. Main outcome measures were symptom scores and disease-specific health-related QoL. Secondary outcomes were healthcare utilization, days unable to pursue usual activities and self-rated improvement.
Results:
A total of 335 participants were randomized to formal allergy assessment or normal care. There were no differences in participants' demographic or clinical characteristics at baseline (all P > 0.05). At 12 months, participants receiving the allergy intervention had fewer rhinitis symptoms (MD - 3.14, 95% CI - 6.01, - 0.81) and an improvement in QoL (MD - 0.50, 95% CI 0.32, 0.68). There were no significant changes in asthma symptoms, healthcare utilization or number of days unable to pursue usual activities.
Conclusion:
Amongst children with known asthma and/or rhinitis in primary care, taking a structured allergy history with skin prick testing and tailored advice on allergy avoidance resulted in reduced symptoms of rhinitis and improved QoL.
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