Grading quality of evidence and strength of recommendations in clinical practice guidelines Part 3 of 3. The GRADE approach to developing recommendations

J. L. Broazek, E. A. Akl, E. Compalati, J. Kreis, L. Terracciano, A. Fiocchi, E. Ueffing, J. Andrews, P. Alonso-Coello, J. J. Meerpohl, D. M. Lang, R. Jaeschke, J. W. Williams, B. Phillips, A. Lethaby, P. Bossuyt, P. Glasziou, M. Helfand, J. Watine, M. AfilaloV. Welch, A. Montedori, I. Abraha, A. R. Horvath, J. Bousquet, G. H. Guyatt, H. J. Schünemann

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116 Citations (Scopus)


This is the third and last article in the series about the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the quality of evidence and the strength of recommendations in clinical practice guidelines and its application in the field of allergy. We describe the factors that influence the strength of recommendations about the use of diagnostic, preventive and therapeutic interventions: the balance of desirable and undesirable consequences, the quality of a body of evidence related to a decision, patients values and preferences, and considerations of resource use. We provide examples from two recently developed guidelines in the field of allergy that applied the GRADE approach. The main advantages of this approach are the focus on patient important outcomes, explicit consideration of patients values and preferences, the systematic approach to collecting the evidence, the clear separation of the concepts of quality of evidence and strength of recommendations, and transparent reporting of the decision process. The focus on transparency facilitates understanding and implementation and should empower patients, clinicians and other health care professionals to make informed choices.

Original languageEnglish
Pages (from-to)588-595
Number of pages8
JournalAllergy: European Journal of Allergy and Clinical Immunology
Issue number5
Publication statusPublished - May 2011
Externally publishedYes


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