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Wise et al.

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symptomatology. Assessment of both conjunctivitis and rhinitis symptoms as well as medication use can be performed with the Combined Score (RTSS + RMS) or the Rhinoconjunctivitis Allergy Control Score (RC-ACS). The RQLQ or mini-RQLQ can be used as an additional measure to incorporate disease impact on QOL and can be administered in person by the clinician. For quick assessments or to follow a patient’s therapeutic success, a simple visual analogue scale (VAS) or global assessment is acceptable. The RAP test can be used as quick and easy tool for primary care physicians to determine the need to refer to an allergist for further testing. Many validated options are available for AR and should be tailored to the patient and clinical setting. • Aggregate Grade of Evidence: A (Level 1a: 2 studies; Level 1b: 4 studies; Level 2b: 4 studies; Table VIII.D-2). Note: multiple additional studies were reviewed, but Grade A evidence was reached with these 10 studies, so an extensive listing of all studies employing validated survey instruments is not provided here. • Benefit: Validated surveys offer a simple point-of-care option for screening and tracking symptoms, QOL, and control of allergic disease. • Harm: Minimal to none. • Costs: No financial burden to patients. Some fees associated with validated tests used for clinical research. • Benefits-Harm Assessment: Preponderance of benefit over harm. Low risk of misdiagnoses leading to unnecessary additional testing. Likewise, there is a low risk that false negative responses may lead to delay in testing and further management. • Value Judgments: Level 1 evidence to use validated surveys as a screening tool and primary or secondary outcome measure. • Policy Level: Strong recommendation. • Intervention: Validated surveys may be used to screen for AR, follow treatment outcomes and as a primary outcome measure for clinical trials. Specific tests are optimized for various clinicopathological scenarios and should be tailored to the patient and clinical setting. VIII.E.1. Skin-prick testing (SPT)— SPT can be used, along with the history and physical examination, to confirm the diagnosis of AR and differentiate from non-allergic types of rhinitis. The confirmation of an IgE-mediated process guides avoidance measures and appropriate pharmacologic therapy. Skin testing is crucial to directing AIT, and therefore, should be utilized in eligible patients when AIT is being considered. According to the ARIA guidelines, patients should be considered for AIT when they have failed a 2-week to 4-week trial of moderatedose INCS combined with antihistamines. 101 When an antigen is applied to the skin of a sensitized patient, the antigen cross-links IgE antibodies on the surface of cutaneous mast cells resulting in degranulation and release of mediators (including histamine), which leads to the formation of a wheal and flare reaction within 15 to 20 minutes. 816,817 Given the limited depth of penetration, SPT is safe with very

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