Making the GRADE in anaphylaxis management

Abstract

asthma chair, scientific chair, and Young Investigator Award chair and serves on the board of directors and Scientific Committee of Interasma. Ronna Campbell has served as a peer reviewer for EB Medicine and an author for UpToDate. Derek Chu has served as a member of the GRADE Working Group; is supported by Canadian Allergy, Asthma, and Immunology Foundation, Canadian Society of Allergy and Clinical Immunology, and AllerGen; and has received an Emerging Clinician Scientist Award. Chitra Dinakar has received financial support from Propeller Health, DBV Technologies, ACAAI (stipend for editorial board of AllergyWatch), the American Association of Allergists of Indian Origin; serves on the board of directors of the AAAAI and on the medical advisory board of Food Equity Initiative; and is assistant editor of AllergyWatch.

Clinician Adoption of US Peanut Introduction Guidelines—A Case for Conditional Recommendations and Contextual Considerations to Empower Shared Decision-Making

“…7 In contrast, a conditional recommendation indicates that shared decision-making is appropriate on the basis of individual patient values and preferences. 7 Because GRADE explicitly and transparently separates certainty of evidence from the strength of recommendations, it is a useful lens through which to view the 2017 guidelines. 3,7 In translating evidence to recommendations, GRADE considers key features, including whether the problem is a priority, the balance of harms and benefits, values, resources required, cost-effectiveness, equity, acceptability, and feasibility.…”

“…1,3,6 Briefly, GRADE is a guideline-development framework that results in either a strong or a conditional recommendation for or against any given strategy. 7 A strong recommendation would be appropriate for most patients, would be advisable for most practitioners to follow, and could be adopted as a quality metric. 7 In contrast, a conditional recommendation indicates that shared decision-making is appropriate on the basis of individual patient values and preferences.…”

“…7 A strong recommendation would be appropriate for most patients, would be advisable for most practitioners to follow, and could be adopted as a quality metric. 7 In contrast, a conditional recommendation indicates that shared decision-making is appropriate on the basis of individual patient values and preferences. 7 Because GRADE explicitly and transparently separates certainty of evidence from the strength of recommendations, it is a useful lens through which to view the 2017 guidelines.…”

“…3,7 In translating evidence to recommendations, GRADE considers key features, including whether the problem is a priority, the balance of harms and benefits, values, resources required, cost-effectiveness, equity, acceptability, and feasibility. 7 Because the certainty of evidence for screening is very low and many of the domains within an evidence-to-recommendations matrix would not favor a screening approach over an approach allowing careful, gradual peanut introduction at home, early peanut introduction would receive a strong recommendation within GRADE, but screening would not. 1,3,6,7 In a formal GRADE parameter, the issues of timing vs method of introduction would be addressed as separate questions.…”

“…7 Because the certainty of evidence for screening is very low and many of the domains within an evidence-to-recommendations matrix would not favor a screening approach over an approach allowing careful, gradual peanut introduction at home, early peanut introduction would receive a strong recommendation within GRADE, but screening would not. 1,3,6,7 In a formal GRADE parameter, the issues of timing vs method of introduction would be addressed as separate questions.…”