A systematic review of quality and consistency of clinical practice guidelines on the primary prevention of food allergy and atopic dermatitis

Elizabeth Huiwen Tham; Agnes Sze Yin Leung; Kiwako Yamamoto-Hanada; Lamia Dahdah; Thulja Trikamjee; Vrushali Vijay Warad; Matthew Norris; Elsy Navarrete; Daria Levina; Miny Samuel; Andre van Niekerk; Santiago Martinez; Anne K Ellis; Leonard Bielory; Hugo van Bever; Dana Wallace; Derek K Chu; Daniel Munblit; Mimi Lk Tang; James Sublett; Gary Wing Kin Wong

doi:10.1016/j.waojou.2023.100770

A systematic review of quality and consistency of clinical practice guidelines on the primary prevention of food allergy and atopic dermatitis

Elizabeth Huiwen Tham, Agnes Sze Yin Leung, Kiwako Yamamoto-Hanada, Lamia Dahdah, Thulja Trikamjee, Vrushali Vijay Warad, Matthew Norris, Elsy Navarrete, Daria Levina, Miny Samuel, Andre van Niekerk, Santiago Martinez, Anne K Ellis, Leonard Bielory, Hugo van Bever, Dana Wallace, Derek K Chu, Daniel Munblit, Mimi Lk Tang, James SublettGary Wing Kin Wong

Department of Ophthalmology, National University of Singapore and National University Health System, Singapore 119228, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117597, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore; Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore 169857, Singapore.
Fetal Medicine Research Institute, King's College London; The Chinese University of Hong Kong, Hong Kong, China.
Allergy Center Wiesbaden
Translational Research in Pediatric Specialities Area, Division of Allergy, IRCCS Bambino Gesù Children's Hospital Rome Italy
University of Cape Town
Sai Allergy Asthma Eye Children's Hospital
Penn State Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
WAO Center of Excellence
Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia.
Singapore Eye Research Institute, Singapore National Eye Center, Singapore 169856, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
Department of Plant and Soil Sciences University of Pretoria Pretoria South Africa
University of Florida
Queen's University, School of Medicine
The Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center and Hackensack Meridian School of Medicine
Nova Southeastern Allopathic Medical School
McMaster Univ, McMaster University, University of Manitoba, Hlth Sci Ctr, Dept Med
Royal Childrens Hosp, Murdoch Children's Research Institute, Royal Children's Hospital Brisbane, Murdoch Childrens Res Inst
University of Louisville

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8 Citations (Scopus)

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Abstract

BACKGROUND AND AIMS: With an increasing number of Clinical Practice Guidelines (CPGs) addressing primary prevention of food allergy and atopic dermatitis, it is timely to undertake a comprehensive assessment of the quality and consistency of recommendations and evaluation of their implementability in different geographical settings.

METHODS: We systematically reviewed CPGs from 8 international databases and extensive website searches. Seven reviewers screened records in any language and then used the AGREE II and AGREE REX instruments to critically appraise CPGs published between January 2011 and April 2022.

RESULTS: Our search identified 2138 relevant articles, of which 30 CPGs were eventually included. Eight (27%) CPGs were shortlisted based on our predefined quality criteria of achieving scores >70% in the "Scope and Purpose" and "Rigour of Development" domains of the AGREE II instrument. Among the shortlisted CPGs, scores on the "Applicability" domain were generally low, and only 3 CPGs rated highly in the "Implementability" domain of AGREE-REX, suggesting that the majority of CPGs fared poorly on global applicability. Recommendations on maternal diet and complementary feeding in infants were mostly consistent, but recommendations on use of hydrolysed formula and supplements varied considerably.

CONCLUSION: The overall quality of a CPG for Food Allergy and Atopic Dermatitis prevention did not correlate well with its global applicability. It is imperative that CPG developers consider stakeholders' preferences, local applicability, and adapt existing recommendations to each individual population and healthcare system to ensure successful implementation. There is a need for development of high-quality CPGs for allergy prevention outside of North America and Europe.

PROSPERO REGISTRATION NUMBER: CRD42021265689.

Original language	English
Article number	100770
Pages (from-to)	100770
Journal	The World Allergy Organization journal
Volume	16
Issue number	4
DOIs	https://doi.org/10.1016/j.waojou.2023.100770
Publication status	Published - Apr 2023

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10.1016/j.waojou.2023.100770

WAO prevention MS 101122_150323(clean) (1)Accepted author manuscript, 331 KB

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Tham, E. H., Leung, A. S. Y., Yamamoto-Hanada, K., Dahdah, L., Trikamjee, T., Warad, V. V., Norris, M., Navarrete, E., Levina, D., Samuel, M., van Niekerk, A., Martinez, S., Ellis, A. K., Bielory, L., van Bever, H., Wallace, D., Chu, D. K., Munblit, D., Tang, M. L., ... Wong, G. W. K. (2023). A systematic review of quality and consistency of clinical practice guidelines on the primary prevention of food allergy and atopic dermatitis. The World Allergy Organization journal, 16(4), 100770. Article 100770. https://doi.org/10.1016/j.waojou.2023.100770

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abstract = "BACKGROUND AND AIMS: With an increasing number of Clinical Practice Guidelines (CPGs) addressing primary prevention of food allergy and atopic dermatitis, it is timely to undertake a comprehensive assessment of the quality and consistency of recommendations and evaluation of their implementability in different geographical settings.METHODS: We systematically reviewed CPGs from 8 international databases and extensive website searches. Seven reviewers screened records in any language and then used the AGREE II and AGREE REX instruments to critically appraise CPGs published between January 2011 and April 2022.RESULTS: Our search identified 2138 relevant articles, of which 30 CPGs were eventually included. Eight (27%) CPGs were shortlisted based on our predefined quality criteria of achieving scores >70% in the {"}Scope and Purpose{"} and {"}Rigour of Development{"} domains of the AGREE II instrument. Among the shortlisted CPGs, scores on the {"}Applicability{"} domain were generally low, and only 3 CPGs rated highly in the {"}Implementability{"} domain of AGREE-REX, suggesting that the majority of CPGs fared poorly on global applicability. Recommendations on maternal diet and complementary feeding in infants were mostly consistent, but recommendations on use of hydrolysed formula and supplements varied considerably.CONCLUSION: The overall quality of a CPG for Food Allergy and Atopic Dermatitis prevention did not correlate well with its global applicability. It is imperative that CPG developers consider stakeholders' preferences, local applicability, and adapt existing recommendations to each individual population and healthcare system to ensure successful implementation. There is a need for development of high-quality CPGs for allergy prevention outside of North America and Europe.PROSPERO REGISTRATION NUMBER: CRD42021265689.",

author = "Tham, {Elizabeth Huiwen} and Leung, {Agnes Sze Yin} and Kiwako Yamamoto-Hanada and Lamia Dahdah and Thulja Trikamjee and Warad, {Vrushali Vijay} and Matthew Norris and Elsy Navarrete and Daria Levina and Miny Samuel and {van Niekerk}, Andre and Santiago Martinez and Ellis, {Anne K} and Leonard Bielory and {van Bever}, Hugo and Dana Wallace and Chu, {Derek K} and Daniel Munblit and Tang, {Mimi Lk} and James Sublett and Wong, {Gary Wing Kin}",

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year = "2023",

month = apr,

doi = "10.1016/j.waojou.2023.100770",

language = "English",

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Tham, EH, Leung, ASY, Yamamoto-Hanada, K, Dahdah, L, Trikamjee, T, Warad, VV, Norris, M, Navarrete, E, Levina, D, Samuel, M, van Niekerk, A, Martinez, S, Ellis, AK, Bielory, L, van Bever, H, Wallace, D, Chu, DK, Munblit, D, Tang, ML, Sublett, J & Wong, GWK 2023, 'A systematic review of quality and consistency of clinical practice guidelines on the primary prevention of food allergy and atopic dermatitis', The World Allergy Organization journal, vol. 16, no. 4, 100770, pp. 100770. https://doi.org/10.1016/j.waojou.2023.100770

A systematic review of quality and consistency of clinical practice guidelines on the primary prevention of food allergy and atopic dermatitis. / Tham, Elizabeth Huiwen; Leung, Agnes Sze Yin; Yamamoto-Hanada, Kiwako et al.
In: The World Allergy Organization journal, Vol. 16, No. 4, 100770, 04.2023, p. 100770.

Research output: Contribution to journal › Article › peer-review

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T1 - A systematic review of quality and consistency of clinical practice guidelines on the primary prevention of food allergy and atopic dermatitis

AU - Tham, Elizabeth Huiwen

AU - Leung, Agnes Sze Yin

AU - Yamamoto-Hanada, Kiwako

AU - Dahdah, Lamia

AU - Trikamjee, Thulja

AU - Warad, Vrushali Vijay

AU - Norris, Matthew

AU - Navarrete, Elsy

AU - Levina, Daria

AU - Samuel, Miny

AU - van Niekerk, Andre

AU - Martinez, Santiago

AU - Ellis, Anne K

AU - Bielory, Leonard

AU - van Bever, Hugo

AU - Wallace, Dana

AU - Chu, Derek K

AU - Munblit, Daniel

AU - Tang, Mimi Lk

AU - Sublett, James

AU - Wong, Gary Wing Kin

PY - 2023/4

Y1 - 2023/4

N2 - BACKGROUND AND AIMS: With an increasing number of Clinical Practice Guidelines (CPGs) addressing primary prevention of food allergy and atopic dermatitis, it is timely to undertake a comprehensive assessment of the quality and consistency of recommendations and evaluation of their implementability in different geographical settings.METHODS: We systematically reviewed CPGs from 8 international databases and extensive website searches. Seven reviewers screened records in any language and then used the AGREE II and AGREE REX instruments to critically appraise CPGs published between January 2011 and April 2022.RESULTS: Our search identified 2138 relevant articles, of which 30 CPGs were eventually included. Eight (27%) CPGs were shortlisted based on our predefined quality criteria of achieving scores >70% in the "Scope and Purpose" and "Rigour of Development" domains of the AGREE II instrument. Among the shortlisted CPGs, scores on the "Applicability" domain were generally low, and only 3 CPGs rated highly in the "Implementability" domain of AGREE-REX, suggesting that the majority of CPGs fared poorly on global applicability. Recommendations on maternal diet and complementary feeding in infants were mostly consistent, but recommendations on use of hydrolysed formula and supplements varied considerably.CONCLUSION: The overall quality of a CPG for Food Allergy and Atopic Dermatitis prevention did not correlate well with its global applicability. It is imperative that CPG developers consider stakeholders' preferences, local applicability, and adapt existing recommendations to each individual population and healthcare system to ensure successful implementation. There is a need for development of high-quality CPGs for allergy prevention outside of North America and Europe.PROSPERO REGISTRATION NUMBER: CRD42021265689.

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JO - The World Allergy Organization journal

JF - The World Allergy Organization journal

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A systematic review of quality and consistency of clinical practice guidelines on the primary prevention of food allergy and atopic dermatitis

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