Pragmatic randomised controlled trial of an allergy intervention for children aged 6 to 16 with asthma and rhinitis in general practice

摘要

Background:ududIt is widely believed that for allergic rhinitis and asthma, avoidance of specific triggers can improve symptom control. Whilst many children with asthma or rhinitis are sensitised to airborne allergens, primary care diagnostic and management decisions are often made without a detailed history of the allergic triggers or allergy testing. Thus, treatment decisions are empirical and allergen avoidance advice is either not given or, if given, not tailored to the child’s sensitivities.ududObjective:ududTo ascertain whether allergy assessment and tailored advice in General Practice enhances outcomes of children with asthma and rhinitis.ududMethod:ududPragmatic RCT of allergy intervention (structured allergy history, skin prick testing and appropriate allergy avoidance advice) versus usual care in children with asthma and/or rhino-conjunctivitis. A blinded observer assessed outcomes at 12 months. Main outcome measures were symptom scores and disease-specific health-related QoL. Secondary outcomes were health care utilisation, days unable to pursue usual activities, and self-rated improvement.ududResults:udud335 participants were randomised to formal allergy assessment or normal care. There were no differences in participants’ demographic or clinical characteristics at baseline (all p>.05). At 12 months, participants receiving the allergy intervention had fewer rhinitis symptoms (MD -3.14, 95% CI -6.01, -0.81) and an improvement in QoL (MD -0.50, 95% CI 0.32, 0.68). There were no significant changes in asthma symptoms, health care utilisation or number of days unable to pursue usual activities.ududConclusion:ududAmongst children with known asthma and/or rhinitis in primary care, taking a structured allergy history with skin prick testing and tailored advice on allergy avoidance resulted in reduced symptoms of rhinitis and improved QoL.