ARIA México 2014. Adaptación de la Guía de Práctica Clínica ARIA 2010 para México. Metodología ADAPTE

Abstract

Antecedentes: la prevalencia de rinitis alérgica en todo el mundo es alta. El Estudio Internacional de Asma y Alergias en la Niñez (ISAAC de International Study of Asthma and Allergies in Childhood) Fase III reporta una prevalencia estimada total en México de 4.6%. Existen guías de práctica clínica basadas en evidencia de rinitis alérgica, pero su promoción, aceptación y validez no son óptimas ni adecuadas para México.Objetivo: generar una guía de tratamiento de la rinitis alérgica y su repercusión en el asma adaptando la guía ARIA 2010 a la realidad mexicana mediante un proceso de transculturización, por medio de la metodología ADAPTE.Material y método: a través de la metodología ADAPTE un grupo de desarrollo de la guía, integrado por múltiples especialistas que tratan pacientes con rinitis alérgica, valoró la calidad de la guía ARIA 2010, revisó y tradujo las preguntas clínicas clave y ajustó las recomendaciones, preferencias del paciente y comentarios a la realidad mexicana (seguridad, costos y aspectos culturales). Para lograrlo se corrieron páneles Delphi, con tantas rondas como fuera necesario hasta lograr un acuerdo. Por medio de una revisión sistemática de la bibliografía se creó una pregunta especial no incluida en ARIA 2010 de la utilidad de realizar lavados nasales en pacientes con rinitis alérgica.Resultados: se incluyeron 45 preguntas de la guía original ARIA 2010, divididas en seis bloques que abarcan prevención, tratamiento médico, inmunoterapia y terapias alternativas de pacientes con rinitis alérgica con o sin asma. La mayor parte de las preguntas alcanzaron acuerdo en una a dos rondas, sólo una requirió tres para ello.Conclusiones: se cuenta ahora con una guía de rinitis alérgica de uso sencillo, adaptada, actualizada y válida para México.

Global expert views on the diagnosis, classification and pharmacotherapy of allergic rhinitis in clinical practice using a modified Delphi panel technique

“…For both questions, respondents reached a consensus for all 4 treatment options (except monitoring of OAH plus INCS/INAH fixed-dose combination therapy; 72%); however, there was some disparity of opinion regarding the specific time period (≤1 month, 1–2 months, 2–3 months) before stepping down the different treatment options. This is thought to be related to the type of AR predominant in a given population: for example, in regions where seasonal AR is most common, physicians may de-escalate treatment more rapidly out-of-season, while physicians working in more tropical regions (eg, Brazil and Mexico), where house dust mites are the primary allergen responsible for perennial AR cases, 14 , 26 , 27 may opt for continuing therapy for at least 2–3 months before de-escalating therapy. Generally, step down of treatment is considered in patients with mild or controlled symptoms; for those with moderate–severe AR who have not improved after 2 weeks of INCS therapy, stepping up treatment by referral to a specialist and the use of other therapies, such as allergen immunotherapy or surgery, are considered.…”

“…Although there are disparities between real-world practice and guideline recommendations, several groups of guideline developers 2 , 9 , 14 are working to narrow knowledge gaps through educational initiatives with physicians (eg, online webinars and off-line on-demand courses) and patients (eg, the MASK-air diary as part of the aforementioned MASK study). Additionally, the ARIA severity classification which was promoted in 2008 (mild–moderate–severe AR) was recently replaced by the VAS scale.…”

“…Prominent AR treatment guidelines include the “European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) 2020” guideline, 9 , 10 “Allergic Rhinitis and its Impact on Asthma (ARIA) 2008” 2 and “ARIA 2020” 1 guidelines, and the “Rhinitis 2020: A practice parameter update” guidelines. 3 Other treatment guidelines have been published, including those developed for physicians in Britain, 11 the United States, 12 Japan, 13 Mexico, 14 and Brazil, 15 to name a few. There are various different validated severity scores and scales 13 , 16 , 17 , 18 , 19 that have been used to classify AR and to assess treatment response.…”