Pragmatic randomized controlled trial of an allergy intervention for children aged 6–16 with asthma and rhinitis in general practice

Abstract

Summary Background It is widely believed that for allergic rhinitis and asthma, avoidance of specific triggers can improve symptom control. Whilst many children with asthma or rhinitis are sensitized to airborne allergens, primary care diagnostic and management decisions are often made without a detailed history of the allergic triggers or allergy testing. Thus, treatment decisions are empirical and allergen avoidance advice is either not given or, if given, not tailored to the child's sensitivities. Objective To ascertain whether allergy assessment and tailored advice in general practice enhances outcomes of children with asthma and rhinitis. Method Pragmatic RCT of allergy intervention (structured allergy history, skin prick testing and appropriate allergy avoidance advice) vs. usual care in children with asthma and/or rhinoconjunctivitis. A blinded observer assessed outcomes at 12 months. Main outcome measures were symptom scores and disease‐specific health‐related QoL. Secondary outcomes were healthcare utilization, days unable to pursue usual activities and self‐rated improvement. Results A total of 335 participants were randomized to formal allergy assessment or normal care. There were no differences in participants’ demographic or clinical characteristics at baseline (all P > 0.05). At 12 months, participants receiving the allergy intervention had fewer rhinitis symptoms (MD − 3.14, 95% CI − 6.01, − 0.81) and an improvement in QoL (MD − 0.50, 95% CI 0.32, 0.68). There were no significant changes in asthma symptoms, healthcare utilization or number of days unable to pursue usual activities. Conclusion Amongst children with known asthma and/or rhinitis in primary care, taking a structured allergy history with skin prick testing and tailored advice on allergy avoidance resulted in reduced symptoms of rhinitis and improved QoL.

Precision Medicine for Paediatric Severe Asthma: Current Status and Future Direction

“…31 The evidence however suggests that treatment of allergic rhinitis does not improve asthma symptoms in either children or adults where both conditions co-exist. 32 Home visits are important because they allow the asthma team to get an impression of the home environment. The visit can identify ongoing allergen exposure to dust, moulds, pets, exposure to second hand tobacco smoke or vaping and other pollutants.…”

Developments in the field of allergy in 2016 through the eyes of Clinical and Experimental Allergy

“…A significant proportion of clinical allergy services is devoted to making an accurate diagnosis, and the value of this is sometimes called into question. In a randomized controlled trial of allergy testing and appropriate allergen avoidance advice, for children aged 6‐16 years with allergic rhinoconjunctivitis or asthma, Smith et al identified clear, measurable improvements in rhinitis symptoms and quality of life 1 year after the intervention, thus supporting the value of allergy testing, when combined with appropriate interpretation and avoidance advice.…”

Allergen Avoidance in Allergic Asthma

“…Twenty general practices in two different English cities performed a RCT of 335 children aged 6–16 years suffering from allergic asthma and/or rhinitis to compare the effectiveness of allergen-specific interventions vs usual care (51). Specific allergen avoidance strategies (for tree and grass pollens, pets, HDM, or molds) were provided according to allergy history and SPT.…”

“…Specific allergen avoidance strategies (for tree and grass pollens, pets, HDM, or molds) were provided according to allergy history and SPT. After 1 year, patients receiving specific allergy intervention showed fewer nasal symptoms and a higher QoL index, while no significant changes were observed in bronchial symptoms, health-care utilization, or number of days with impaired daily activities (51). …”