HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Ann Allergy Manuscript Author Asthma Immunol Manuscript Author . Author manuscript; available in PMC 2016 December 14. Published in final edited form as: Ann Allergy Asthma Immunol. 2013 December ; 111(6): 465–507. doi:10.1016/j.anai.2013.09.018. Environmental assessment and exposure control of dust mites: a practice parameter Jay Portnoy, MD, Jeffrey D. Miller, MD, P. Brock Williams, PhD, Ginger L. Chew, ScD*, J. David Miller, PhD, Fares Zaitoun, MD, Wanda Phipatanakul, MD, MS, Kevin Kennedy, MPH, Charles Barnes, PhD, Carl Grimes, CIEC, Désirée Larenas-Linnemann, MD, James Sublett, MD, David Bernstein, MD, Joann Blessing-Moore, MD, David Khan, MD, David Lang, MD, Richard Nicklas, MD, John Oppenheimer, MD, Christopher Randolph, MD, Diane Schuller, MD, Sheldon Spector, MD, Stephen A. Tilles, MD, and Dana Wallace, MD This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology Classification of recommendations and evidence There may be a separation between the strength of recommendation and the quality of evidence. Recommendation rating scale Statement Definition Implication Strong A strong recommendation means the benefits of the Clinicians should follow a strong recommendation recommended recommendation approach clearly exceed the harms (or that the harms unless a clear and compelling clearly exceed rationale for an the benefits in the case of a strong negative alternative approach is present. recommendation) and that the quality of the supporting evidence is excellent (grade A or B). In some *The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Members of the Joint Taskforce on Practice Parameters: David Bernstein, MD; Joann Blessing-Moore, MD; David Khan, MD; David Lang, MD; Richard Nicklas, MD; John Oppenheimer, MD; Jay Portnoy, MD; Christopher Randolph, MD; Diane Schuller, MD; Sheldon Spector, MD; Stephen A. Tilles, MD; Dana Wallace, MD Reprints: Joint Council of Allergy, Asthma, and Immunology, 50 N Brockway Street, #3-3, Palatine, IL 60067. Practice Parameter Workgroup: James Sublett, MD, co-chair; Kevin Kennedy, MPH, co-chair; Charles Barnes, PhD; Ginger Chew, ScD*; Carl Grimes, CIEC; Désirée Larenas-Linnemann, MD; Jeffrey D. Miller, MD; J. David Miller, PhD; Wanda Phipatanakul, MD, MS; P. Brock Williams, PhD; Fares Zaitoun, MD Disclaimer: The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing “Environmental Assessment and Exposure Control of Dust Mites: A Practice Parameter.” This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Portnoy et al. Page 2 Author ManuscriptAuthor Manuscript Author Manuscript Author Manuscript Author Statement Definition Implication clearly identified circumstances, strong recommendations may be made based on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms. Moderate A moderate recommendation means the benefits Clinicians also should generally recommendation exceed the harms (or that the follow a moderate harms clearly exceed the benefits in the case of a recommendation but should remain negative recommendation), alert to new but the quality of evidence is not as strong (grade B information and sensitive to patient or C). In some clearly identified values and circumstances, recommendations may be made based preferences. on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits outweigh the harms. Weak A weak recommendation means that the quality of Clinicians should be flexible in their recommendation evidence that exists is suspect decision (grade D) or that well-done studies (grade A, B, or C) making regarding appropriate show little clear advantage practice, although to one approach vs another. they may set bounds on alternatives; patient values and preferences should have a substantial influencing role. No recommendation No recommendation means there is a lack of pertinent Clinicians should feel little constraint evidence (grade D) and an in their decision unclear balance between benefits and harms. making and be alert to new published evidence that clarifies the balance of benefit vs harm; patient preferences and values should have a substantial influencing role. Category of evidence Ia Evidence from meta-analysis of randomized controlled trials Ib Evidence from at least 1 well-designed randomized controlled trial Ic Evidence from at least 1 randomized controlled trial that was not very well designed IIa Evidence from at least 1 controlled study without randomization IIb Evidence from at least 1 other type of quasi-experimental study IIc Evidence from 1 of the above that was not very well designed IIIa Evidence from well-designed nonexperimental descriptive studies, such as comparative studies IIIb Evidence from nonexperimental descriptive studies, such as comparative studies that were not very well designed IVa Evidence from expert committee reports or opinions or clinical experience of respected authorities or both Council of Allergy, Asthma, and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. Ann Allergy Asthma Immunol. Author manuscript; available in PMC 2016 December 14. Portnoy et al. Page 3 Strength of evidence Author ManuscriptAuthor Manuscript Author Manuscript Author Manuscript Author A Directly based on category I evidence that is well designed B Directly based on category II evidence or recommendation from category I evidence that is not well designed C Directly based on category III evidence or recommendation from category II evidence that is not well designed D Directly based on category IV or recommendation from category III evidence that is not well designed LB Laboratory based NR Not rated Summary of conflict-of-interest disclosures The following table is a summary of interests disclosed on Work Group Members’ Conflict- of-Interest Disclosure Statements (not including information concerning family member interests). Completed Conflict-of-Interest Disclosure Statements are available upon request. Work Group Member Disclosures James Sublett, MD (co-chair) Owner: AllergyZone Kevin Kennedy, MPH (co-chair) None Jay Portnoy, MD (Joint Taskforce liaison) Speaker: ThermoFisher Charles Barnes, PhD Consultant, research grant: Clorox Corp Ginger L. Chew, ScD None Carl Grimes, CIEC Owner: Healthy Habitats LLC Désirée Larenas-Linnemann, MD None Jeffrey D. Miller, MD Owner: Mission: Allergy, Inc J. David Miller, PhD None Wanda Phipatanakul, MD, MS None P. Brock Williams, PhD None Fares Zaitoun, MD None Resolution of potential conflicts of interest The Joint Taskforce (JTF) recognizes that experts in a field are likely to have interests that could come into conflict with the development of a completely unbiased and objective practice parameter. To take advantage of that expertise, a process has been developed to prevent potential conflicts from influencing the final document in a negative way. At the workgroup level, members who have a potential conflict of interest do not participate in discussions concerning topics related to the potential conflict; or, if they do write a section on that topic, the workgroup completely rewrites it without their involvement to remove potential bias. In addition, the entire document is reviewed by the JTF and any apparent bias Ann Allergy Asthma Immunol. Author manuscript; available in PMC 2016 December 14. Portnoy et al. Page 4 is removed at that level. The practice parameter is sent for review by invited reviewers and Author ManuscriptAuthor Manuscript Author Manuscript Author Manuscript Author by anyone with an interest in the topic by posting the document on the Web sites of the American College of Allergy, Asthma, and Immunology (ACAAI) and the American Academy of Allergy, Asthma, and Immunology (AAAAI). For example, Jeffrey D. Miller, MD, owns a company that sells a product discussed in this practice parameter. Dr Miller wrote a section on mattress encasings. This section was rewritten by other members of the workgroup without his participation. He did not provide subsequent input into that section. How this practice parameter was developed The JTF on Practice Parameters The JTF on Practice Parameters is a 13-member taskforce consisting of 6 representatives of the AAAAI, 6 of the ACAAI, and 1 of the Joint Council of Allergy and Immunology. This taskforce oversees the development of practice parameters; selects the workgroup chair(s); and reviews drafts of the parameters for accuracy, practicality, clarity,