How an online survey on the treatment of allergic rhinitis and its impact on asthma (ARIA) detected specialty-specific knowledge-gaps

World Allergy Organization Journal

José Lozano Sáenz³  Miguel Alejandro Medina Ávalos²  Désirée ES Larenas Linnemann¹ 

[1] Hospital Médica Sur, Torre 2, cons. 602 Puente de Piedra 150; Colonia Toriello Guerra, Delegación Tlalpan 14050, México D.F., México;Department of Allergy, ISSSTE Veracruz, Veracruz, Mexico;Private clinic, Jalapa, Veracruz, Mexico

关键词: Allergen immunotherapy;    Leukotriene receptor antagonists;    Intranasal corticosteroids;    Antihistamines;    Asthma;    Allergic rhinitis;    Medical education;    Guideline dissemination;   

Others  :  1206312
DOI  :  10.1186/s40413-015-0064-1

 received in 2015-02-06, accepted in 2015-03-10,  发布年份 2015

【 摘 要 】

Background

To enhance the dissemination of the ARIA document (Allergic rhinitis (AR) and its impact on asthma) in Mexico, a Working Group composed of 35 specialists of 8 professional medical societies developed a transculturized ARIA México 2014 guideline. The ARIA guidelines use the GRADE system, which builds recommendations and suggestions around clinical questions (CQ).

Methods

As part of the dissemination strategy and to detect the physicians’ view and knowledge-gaps concerning the treatment of AR an online survey was sent out to members of participating societies containing the CQ of ARIA México. Replies were analyzed per specialty against the ARIA México 2014 experts’ recommendations/suggestions; differences between specialties were analyzed with Pearson’s Chi-squares.

Results

807 surveys were returned, 657 completed (81%). We analyze replies from 158 alergists, 188 ENTs, 64 pulmonologists, 220 pediatricians and 177 GPs/family doctors. More than half of the surveyed physicians of all specialties would give an allergen reduced diet to pregnant/lactating women and avoid pets at home, which is against ARIA experts’ suggestions. ARIA experts suggest intranasal antihistamines can be part of the AR treatment: 46-63% of the ENTs, pulmonologists and pediatricians disagree; and experts prefer oral H1-antihistamines over leukotriene receptor antagonists (LTRA) for the treatment of AR: 52-36% of the pulmonologists, pediatricians and GPs prefer LTRAs. Concerning glucocorticosteroids (GCS): GPs are more reluctant to use intranasal GCS (p < 0.001) and 47% prefers oral H1-antihistamines. As for the treatment of recalcitrant AR ARIA experts suggest the use of oral, but not intramuscular, GCS: a quarter of pulmonologists, pediatricians and GPs considers they should not be used. Contrarily, 40% of ENTs favors intramuscular GCS. In patients with AR and comorbid asthma several physicians of all specialties –except pulmonologists- erroneously considers antihistamines, intranasal GCS and LTRAs useful for the treatment of asthma, while first-line recommended asthma treatment is inhaled GCS.

Conclusion

On certain issues in the treatment of AR the physicians’ opinion diverges from the recommendations/suggestions of ARIA experts. Moreover, physicians’ opinions depend on their specialty. As such, an online survey can help to detect knowledge-gaps and guide the development of more focused and specialty-specific postgraduate learning tools.

【 授权许可】

   
2015 Larenas Linnemann et al.; licensee BioMed Central.

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