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Wise et al.
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Throughout this document, certain topic areas have very strong evidence whereas other topics demonstrate relatively weak evidence. Many of our common practices in the diagnosis and care of the AR patient are based upon weak external evidence. As practitioners, academicians, and scientists, we must examine this evidence and strive to increase the strength of the evidence in areas where gaps exist. Within the ICAR:AR document, recommendations are given based on the evidence in a specific topic area. However, this document is a compilation of the best AR evidence, not a manual for the care of the AR patient. Evidence-based medicine requires that the clinician has the best evidence available, but also uses his/her expertise and takes the patient’s values and expectations into account. 2 Therefore, with a background of evidence-based knowledge, the practitioner must approach each patient as an individual to determine the most appropriate diagnostic and treatment modalities for that particular patient. Given the numerous potential conditions in the AR differential diagnosis, various diagnostic and treatment options available, and diverse comorbidities and associated conditions that may accompany AR, treatment of the AR patient with an evidence-based approach requires careful consideration. As previously stated by Orlandi et al., 1 the recommendations provided in an ICAR document must be interpreted based on the strength of the evidence that forms their foundation. The recommendations in this document are evidence-based. They do not define the standard of care or medical necessity. Recommendations written in this document, or any similar document, do not dictate the specific care of an individual patient. There are numerous other factors that enter into the treatment decisions for each individual patient. Finally, it is expected that these recommendations will change with time and with new evidence. We encourage new research, especially rigorous studies that aim to fill the identified knowledge gaps. With new evidence, recommendations will undergo necessary revisions and better patient outcomes should result. In a similar fashion to the 2016 ICAR:RS document by Orlandi et al., 1 this ICAR:AR document is formulated with the utmost reliance on published evidence. With the 2011 Rudmik and Smith 3 evidence-based review with recommendations (EBRR) method as its foundation, ICAR:AR strives to analyze the existing literature on each AR topic, grading the evidence and providing literature-based recommendations where appropriate. The subject of AR was initially divided into 103 topics or content areas. A senior author who is a recognized expert in allergy, rhinology, or the assigned topic was appointed to each topic. Authors were initially selected via online literature searches for each ICAR:AR topic. Authors of high-quality publications in each topic area were invited as ICAR:AR contributors. Other invited authors included experts in the EBRR process, experts in teaching/lecturing on specific AR topic areas, and those with knowledge of the systematic review process.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
II. Methods II.A. Topic development
Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.
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