title: Pragmatic randomized controlled trial of an allergy intervention for children aged 6-16 with asthma and rhinitis in general practice.
abstract: It 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 sensitized 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.
  
  
  
  To ascertain whether allergy assessment and tailored advice in general practice enhances outcomes of children with asthma and rhinitis.
  
  
  
  Pragmatic RCT of allergy intervention (structured allergy history, skin prick testing and appropriate allergy avoidance advice) vs. usual care in children with asthma and/or rhinoconjunctivitis. A blinded observer assessed outcomes at 12 months. Main outcome measures were symptom scores and disease-specific health-related QoL. Secondary outcomes were healthcare utilization, days unable to pursue usual activities and self-rated improvement.
  
  
  
  A total of 335 participants were randomized to formal allergy assessment or normal care. There were no differences in participants' demographic or clinical characteristics at baseline (all P > 0.05). 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, healthcare utilization or number of days unable to pursue usual activities.
  
  
  
  Amongst 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.
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: H
authors.initials: H
authors.lastname: Smith
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: D
authors.initials: D
authors.lastname: Horney
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: C
authors.initials: C
authors.lastname: Jones
authors.affiliation: Clinical Investigation Research Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: S
authors.initials: S
authors.lastname: Goubet
authors.affiliation: Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mukhopadhyay
authors.affiliation: Department of Allergy & Respiratory Medicine, Royal Sussex County Hospital, Brighton, UK.
authors.forename: A
authors.initials: A
authors.lastname: Frew
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000175:diagnosis / Q000517:prevention & control*; D002648:Child; D018479:Early Intervention, Educational; D061345:Early Medical Intervention / Q000379:methods; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D011788:Quality of Life; D012220:Rhinitis / Q000175:diagnosis / Q000517:prevention & control*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D063189:Symptom Assessment
keywords: allergy assessment; asthma; evaluation; quality of life; rhinitis; skin prick testing; symptoms