A Novel Approach to Consider Planetary Health in Guideline Development: A GRADE Approach Using the Allergic Rhinitis and its Impact on Asthma (ARIA) 2024-2025 Guidelines as a Case Study

Abstract

The concept of planetary health emphasizes the inherent connection between the health of humans and the health of the planet, on which human health depends. The planetary boundaries framework describes 9 planetary life support systems, including climate change and biodiversity, and defines a safer operating space for humanity. The health care sector, while striving to improve human health, contributes significantly to exceeding these planetary boundaries, for instance, through greenhouse gas emissions, water use, and waste generation. The integration of planetary health considerations into health guidelines is, therefore, essential to achieve a delicate sustainable balance between improving individual human health and minimizing planetary health impacts. The Grading of Recommendations, Assessment, Development and Evaluation Working Group is developing guidance for incorporating planetary health into the health guideline development process. In this article, we address the need for evidence to support planetary health considerations in allergic disease guidelines. In addition, we review sources of evidence, such as lifecycle assessment studies, which provide evidence about the environmental impacts of medical products over the full lifecycle from production to disposal. Finally, we present the 2024-2025 Allergic Rhinitis and its Impact on Asthma guidelines as an example of how to account for planetary health when direct quantitative evidence is limited, showcasing how planetary health considerations were embedded into the guideline development process through a dedicated criterion in the Evidence-to-Decision framework.

Keywords: Allergic rhinitis; Asthma; GRADE; Health guidelines; Planetary health.