Quality Evaluation of Allergen Immunotherapy Guidelines Worldwide Using AGREE-II

Since 1988 numerous AIT-guidelines (AIT-GLs) have been developed by national and international organizations to guide physicians in AIT. Even so, AIT is still severely under-used. AGREE-II was developed in 2010 by Mc Master university methodologists to evaluate guideline quality. The project team consisted of allergists, knowledgable in AIT, trained in AGREE II, with methodologist’s guidance. AIT-GLs in any language were sought from 1980-today in Medline, Embase and contacting local AIT experts; AIT-GLs were AGREE II evaluated by 2 independent reviewers; discrepancies were resolved in a 2nd round, by team-discussion or methodologists’ consulting. We found 31 AIT-GLs (16 post-2010), ranging from local consensus reports to international position papers (EAACI, AAAAI-ACAAI, WAO). Pre-2010 GLs’ score ranged 1.6-5.2/7 and post-2010 GLs’ 1.6-6/7. The best evaluations went to the German AIT-GL (6.0) followed by the AAAAI/ACAAI (5.2) and the Mexican GL (5.1). These were the also the only 3 GLs that received ‘yes’ of both evaluators to the last item: ‘I would recommend this GL for use’. The domains of Stakeholder involvement and Rigor of Development only scored 3/7, but Domain ‘Applicability’ scored the lowest. Strikingly, newer guidelines only scored better in ‘Editorial Independence’ and ‘Global evaluation’. In AIT-GLs there is still a lot of room for improvement, especially in two domains, crucial in dissemination (stakeholder involvement and applicability). For some the ‘Scientific rigor’ domain flawed. In situations with limited resources, transculturizing a high-quality existing GL might be appropriate. AGREE-II could help to pick quality candidate GLs for such procedure.