Applying GRADE for diagnosis 95 2 Avoidance measures Question: Avoidance measures compared to no avoidance measures for patients with allergic rhinitis Setting: Primary care Bibliography: Sheikh, 2010 [5] Certainty assessment Impact Certainty № of studies Study design Risk of bias Inconsistency Indirectness Imprecision Other considerations Symptoms 8 randomised trials very serious a not serious not serious seriousb none HEPA filters: Study Reisman 1990: 32 from 40 patients evaluated: aggregated rhinitis and asthma symptom scores/medication scores: lower after active filtration vs placebo: day 8.79 vs 10.38, night 8.28 vs 9.90 (no statistical testing for total score). Nasal congestion, discharge, eye irritation, and upper airway itching reduced statistically significant, whereas cough, asthma and medication use did not. Acaricides: Study Kniest 1991: 20 patients: symptom scores 9-12 months vs 0-3 months lower in acaricide group vs control group; no absolute symptom scores. Study Bernstein 1995: 32 children, no disaggregated symptom scores for asthma and rhinitis. Barrier bedding (=allergy control bedding): Study Moon 1999: 29 from 30 patients evaluated: Mean daily symptom scores: decreased after 4 weeks in experimental group with 2.9 vs 0.3 in control group, statistically significant. Study Terreehorst 2003: 232 patients from 279 evaluated). No significant differences in symptom scores. Study Ghazala 2004: 26 from 30 patients completed the study: no differences in symptom scores reported between intervention and placebo. Study Brehler 2006: 21 from 32 patients completed the study. No significant reduction in symptom scores between intervention and control. Barrier bedding and acaricides: Study Incorvaia 2008: 25 from 29 patients evaluated: unclear difference between intervention and placebo ⨁◯◯◯ VERY LOW a. Lack of information about randomisation procedures, lack of blinding in studies, absence of intention-totreat design, large lost-to-follow-up b. Few patients per specific intervention
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