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Wise et al.

Page 460

Author Manuscript Author Manuscript Author Manuscript Author Manuscript TABLE XI.

level Interpretation

Risk factors for AR Genetics 5 (GWAS) C — Some genes have been associated with development of AR and other atopic diseases. In utero or early exposure (mites) 6 C — Data inconclusive. In utero or early exposure (pollen) 2 C — Data inconclusive. In utero or early exposure (animal dander) 39 C — Data inconclusive. In utero or early exposure (fungal allergens) 13 C — Data inconclusive. Restricted diet (during pregnancy and early childhood)

5 A — Maternal diet restriction while the child is in utero does not influence the development of AR. Food allergy during childhood is a risk factor for AR. Pollution 14 C — Data inconclusive.

Tobacco smoke 9 A — Most studies found no association between active or passive tobacco smoke exposure and AR. Specific patient populations and temporal variations (ie, length of exposure) should be further evaluated. Socioeconomic status 10 C — Most studies show an association between high SES and AR, but this is not a consistent finding across all studies. Potential protective effect on the development of AR

Breastfeeding 2 (SRs) C Option Option for breastfeeding for the specific purpose of AR prevention. In general, breastfeeding has been strongly recommended due to its multiple beneficial effects. Pet exposure 6 C — No evidence that pet avoidance in childhood prevents AR later in life. Early pet exposure, especially dog exposure in non-allergic families early in childhood, may be protective. Microbial diversity (“hygiene hypothesis”) 15 B — Microbial diversity of the skin, airways, and gut is important for the prevention of sensitization and allergic disease in populations. Disease burden QOL 33 B Recommendation AR has significant effects on general and disease-specific. QOL Treatment of AR is recommended to improve QOL.

Effect on sleep 46 B Recommendation AR has significant negative effects on sleep. Treatment of AR is recommended to decrease sleep disturbance. Evaluation and diagnosis Clinical examination (history and physical)

4 D Recommendation Despite the lack of studies to address clinical examination in the diagnosis of AR, history taking is essential and physical examination is recommended. Multiple prior guideline documents support this recommendation.

Recommendation

Aggregate grade of evidence

Number of

listed studies

Aggregate grades of evidence and recommendation levels Topic

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