加拿大的集中过敏性鼻炎实践参数
Anne K Ellis1, Victoria Cook2, Paul K Keith3
1Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada. anne.ellis@kingstonhsc.ca.
加拿大对过敏性鼻炎 (AR) 治疗的实践参数证实了血清特异性IgE或皮肤刺伤测试对免疫疗法候选人是可以接受的. 它还澄清了AR管理的第一线治疗选择和免疫治疗选择.
科学领域:
- 过敏和免疫学 过敏和免疫学
- 药物治疗 药物治疗
- 临床实践指南 临床实践指南
背景情况:
- 过敏性鼻炎 (AR) 是加拿大的常见疾病,影响所有年龄组.
- 现有的AR管理指南显示区域差异和不同的药物治疗批准.
- 这个专注的实践参数解决了加拿大AR治疗的六个关键研究问题.
研究的目的:
- 为加拿大过敏性鼻炎的临床管理提供基于证据的建议.
- 解决有关AR诊断,药物治疗和免疫治疗的具体研究问题.
- 引导医疗保健专业人员优化AR治疗策略.
主要方法:
- 对2016年以来发表的研究进行了文献评论.
- 收集了证据,以支持对六个关于AR治疗的定义研究问题的答案.
- 一个工作组根据综合证据制定了建议.
主要成果:
- 血清特异性IgE和皮肤刺伤测试都可接受用于诊断AR和指导免疫治疗.
- 鼻内皮质类固醇 (INCS) 通常是第一线,但患者/提供者偏好可能有利于第二代口服抗胰岛素 (OAH).
- 结合性鼻内抗胰岛素/INCS配方优于INCS加OAH;对于大多数症状,LTRAs对OAH提供了有限的益处,但可能有助于夜间症状和喘患者.
- 语言下免疫疗法 (SLIT) 和皮下免疫疗法 (SCIT) 的选择取决于除了疗效之外的多个因素,尽管疗效数据支持广泛使用这两种疗法.
结论:
- 针对AR和免疫治疗候选人的诊断测试可以使用血清特异性IgE或皮肤刺伤测试.
- 对AR的治疗决策应考虑患者和处方者的偏好,INCS和OAH是可行的一线选择.
- 结合INAH/INCS疗法比INCS加OAH更有效;对于AR患者,应广泛考虑SLIT和SCIT等免疫疗法选择.
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