National clinical practice guidelines for Allergen Immunotherapy: an international assessment applying AGREE-II

Abstract

Background

Since 1988 numerous allergen immunotherapy guidelines (AIT-GLs) have been developed by national and international organizations to guide physicians in AIT. Even so, AIT is still severely under-used.

Objective

to evaluate AIT-GLs with AGREE-II, developed in 2010 by McMaster University methodologists to comprehensively evaluate GL-quality.

Methods

Allergist, from different continents, knowledgeable in AIT and AGREE-II trained were selected into the project team. The project received methodologists' guidance. AIT-GLs in any language were sought from 1980-2016; AIT-GLs were AGREE II evaluated by at least 2 team-members, independently; discrepancies were resolved in a second round, by team-discussion or methodologists' consulting.

Results

We found 31 AIT-GLs (15 post-2010), ranging from local consensus reports to international position papers (EAACI, AAAAI-ACAAI, WAO). Pre-2010 GLs' scored 1.6-4.6 (23-67%); post-2010 GLs' 2.1-6 (30-86%), on a 7-point Likert-scale. Best evaluated were: German-Austrian-Swiss (6.0), Mexican (5.1) and the AAAAI/ACAAI AIT-GL (4.7). These were also the only 3 GLs that received 'yes' of both evaluators to the item: 'I would recommend this GL for use'. The domains of 'Stakeholder involvement' and 'Rigor of Development' only scored 3/7, and 'Applicability' scored the lowest. Strikingly, newer GLs only scored clearly better in 'Editorial independence' and 'Global evaluation'.

Conclusions

In AIT-GLs there is still a lot of room for improvement, especially in domains crucial for the dissemination. For some GLs, the 'Scientific rigor' domain flawed. When resources are limited, transculturizing a high-quality GL might be preferable over developing a GL from zero. Our study and AGREE-II could help to select the best candidate.

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