In 2017 the Joint Task Force on Practice Parameters (JTFPP) began to transition to using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for grading evidence as we developed our clinical guidelines. In contrast to the more traditional Practice Parameters, the GRADE guidelines are more focused, seeking to answer 2-4 clinical management or diagnostic questions. We have, thus far, developed 3 GRADE documents, Allergic Rhinitis (2017), Anaphylaxis (2019), and Peanut Allergy Diagnostic (2020). While the JTFPP acknowledges the many advantages of GRADE, due to the limited scope of each GRADE guideline, there are many clinical questions and updates pertaining to the various disease entities in allergy and clinical immunology that cannot be addressed. Therefore, the JTFPP will continue to develop, in a selective manner, the more traditional Practice Parameters, in addition to the newer GRADE guidelines. 

Advantages of GRADE over other systems

• Clear separation between quality of evidence and strength of recommendations
• Explicit evaluation of the importance of outcomes of  alternative management strategies
• Explicit, comprehensive criteria for downgrading and  upgrading quality of evidence ratings
• Transparent process of moving from evidence to recommendations
• Explicit acknowledgment of values and preferences
• Clear, pragmatic interpretation of strong versus conditional (weak) recommendations for clinicians, patients, and policy makers

The development of GRADE guidelines as well as the reading and interpretation of GRADE guidelines by our membership can be both time consuming and challenging. Therefore the JTFPP has identified a few resources to assist you in reviewing these guidelines.  Please take a  few minutes to review this video and the two British Medical Journal Articles which provide background on GRADE and the process of determining strength of recommendations before beginning your review:

What is GRADE? (BMJ)

https://bestpractice.bmj.com/info/us/toolkit/learn-ebm/what-is-grade/

Attachments (pdf)

British Medical Journal Articles 2008

Videos:

If you are looking for supplemental GRADE educational materials, these additional videos offer helpful information about GRADE and guideline development, evidence profiles, and evidence-to-decision frameworks: 

Overview of the GRADE approach in guideline development

(6 minutes)

https://youtu.be/OVOtk3TdkMo

Summarizing the evidence using the GRADE Evidence Profile

(11 minutes)

https://youtu.be/hxptlg6ilzU

Using the evidence-to-decision framework 

(10 minutes)

https://youtu.be/iGVEdNa1xFY

Strong and weak recommendations

(9 minutes)  

https://youtu.be/0ifM01mcewE

Applying GRADE to a 2020 Anaphylaxis Guideline

This article uses the Anaphylaxis GRADE Guideline to explain the transparency and the clinical application of recommendations developed in a GRADE guideline. 

Shaker, M., Oppenheimer,J., Wallace, D., et al. Making the GRADE in anaphylaxis management: Toward recommendations integrating values, preferences, context, and shared decision-making. Ann Allergy Asthma Immunol Vol 124, Issue 6 (2020):526-535.e2. Published online: March 18,2020.