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Wise et al.

Page 58

VIII.C. Radiology

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Routine radiographic imaging is not recommended for the diagnosis of AR, although may be considered to rule in/out other conditions (ie, rhinosinusitis). Some recent studies have established the association between central compartment mucosal disease and aeroallergen sensitivity. 787,788 However, concerns regarding unnecessary exposure to ionizing radiation, with the risk for future cancer development, preclude recommendations for routine use. 789,790

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Aggregate Grade of Evidence: Not applicable.*

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Benefit: None appreciated.

• Harm: Unnecessary radiation exposure with concern for tumor development. • Cost: High equipment and processing costs. • Benefits-Harm Assessment: Preponderance of harm over benefit. • Value Judgments: Long-term risks of unnecessary ionizing radiation exposure outweigh potential benefit. • Policy Level: Recommend against. • Intervention: Routine imaging is not recommended in the evaluation of suspected AR, but may be considered to rule in/out other sinonasal conditions. *Due to recent publication and in accordance with ICAR methodology, DelGaudio et al. 787 and Brunner et al. 788 are excluded from the Aggregate Grade of Evidence. Validated clinical outcome surveys and questionnaires may be used as precise clinical assessment instruments to evaluate patients with suspected AR. Clinicians often use SPT, sIgE serology, and other laboratory tests to confirm or refute the diagnosis, but these tests are only useful in the context of an effective clinical history. 791 Validated clinical assessment tools offer a more structured way to expose important historical elements. Furthermore, in regions where resources are scarce, SPT and laboratory testing may not be as readily available. Advancing technologies such as multiplex allergen screening, component serology, and automated SPT imaging devices may be expensive and unattainable by some clinicians. 792-795 In these settings, validated surveys offer a rapid and simple point-of-care tool to formally evaluate allergic disease. Symptom Score (TNSS) and health-related QOL questionnaires, such as the RQLQ. Additional surveys measure aspects such as medication usage (Daily Medication Score), disease prediction (Respiratory Allergy Prediction) and disease control (Rhinitis Control Test). Each of these surveys examines slightly different, although related aspects of clinical outcomes. Several of these instruments have been used extensively in many large clinical trials to determine the effectiveness of drugs and biologics for treating AR. 797-802 SPT and nasal challenge may be used to cross-validate these clinical survey tools but ultimately, how Patient reported outcome measures (PROMs) can assess a number of different aspects of how AR affects patients. 796 These include symptom severity surveys, such as the Total Nasal

VIII.D. Use of validated survey instruments

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.