Efficacy of environmental controls for inhalant allergies
ABSTRACT PURPOSE OF REVIEW: This review examines the efficacy of environmental controls as part of the management for inhalant allergic disease (allergic rhinitis and allergic asthma). RECENT FINDINGS: Evidence of efficacy of environmental controls for allergic disease can be categorized into two types of studies: environmental controls reducing measured allergen levels and environmental controls affecting clinical outcomes (e.g., symptom scores, medication use, or measured lung function). Multiple environmental control strategies have demonstrated efficacy in reducing allergen levels; however, clinical benefit secondary to allergen reduction has been variable. Clinical benefit is seen more consistently in studies that remove the allergic patient from a high allergen environment, than in studies that attempt to reduce the allergen level within the home. Prevention of sensitization using environmental controls in the prenatal and infant periods has been studied, but it has been difficult to demonstrate a consistent reduction in the development of allergic disease or decrease symptom severity. Allergen exposure early in life may paradoxically promote tolerance in some populations and sensitizations in others. SUMMARY: Although many studies evaluating a single environmental control strategy fail to show an improvement in clinical outcomes, comprehensive environmental controls may provide some benefit. Additionally, studies that relocate patients to low allergen environments tend to demonstrate clinical improvement.
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ABSTRACT: To study the long-term effects of avoiding domestic allergens, nine asthmatic patients who were allergic to dust mites lived in hospital rooms for two months or more. In all patients symptoms and early morning peak flows improved. In seven patients anti-asthma treatment could be reduced and it was possible to carry out repeated bronchial provocation with histamine. Five of these patients showed a progressive eightfold or greater increase in the concentration of histamine necessary to provoke a 30% fall in forced expiratory volume in one second (PD30). The increase in PD30 in the seven patients during their period of living in hospital was highly significant. Avoidance of important allergens seems not only to result in clinical remissions but in many cases also reduce bronchial hyperreactivity.The Lancet 10/1982; 2(8300):675-8. DOI:10.1016/S0140-6736(82)90709-7 · 45.22 Impact Factor
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ABSTRACT: Clinical and population studies have shown that exposure and sensitization to allergens derived from furred pets, particularly cats, represent an important risk factor of allergic respiratory disease and also a significant risk factor for asthma. In the framework of the multicenter European Community Respiratory Health Survey an analysis of the association of current and childhood exposure to cat with atopic sensitization to cat was conducted. This study included cross-sectional data from 35 centers representing 16 countries. Altogether, 18,097 subjects were included, of whom 13,509 (75%) provided a blood sample for the measurement of specific IgE. Exposure data and data for potential confounders were extracted from an interviewer-led questionnaire. The prevalence of sensitization to cat (serum specific IgE >0.35 kU/L) was 9%. Among those who did not report allergic symptoms in the presence of pets or house dust, those who owned cats were significantly more likely to be sensitized to cats than were those who did not (odds ratio [95% confidence interval] 1.57 [1.20-2.06]. Childhood exposure to pets including cats was associated with lower sensitization to cats in adulthood, particularly among those with a positive family history of atopy (odds ratio [95% confidence interval] 0.68 [0.51-0.93]. Positive correlations were found between the community prevalence of cat and the prevalences of sensitization to cat, respiratory symptoms, physician-diagnosed asthma, and current asthma medication. Current cat ownership represents a significant risk for sensitization to cat if cats are allowed indoors. Our results support the hypothesis that childhood exposure to pets, including cats, might modulate immunologic mechanisms and reduce sensitization to cat in adulthood. The significant correlation found between the community prevalence of cat ownership and community prevalence of specific sensitization to cat represents the first documentation of such a relationship.Journal of Allergy and Clinical Immunology 11/1999; 104(5):941-7. · 11.25 Impact Factor
Article: Genetics of allergic disease[Show abstract] [Hide abstract]
ABSTRACT: Allergic diseases are complex genetic diseases resulting from the effect of multiple genetic and interacting environmental factors on their pathophysiology. Recent years have seen considerable progress in unraveling the contribution of these factors to an individual subject's susceptibility to, subsequent development of, and severity of disease. This has resulted in increasing insight into novel areas of allergic disease pathophysiology, for example the significant role played by locally acting tissue susceptibility factors like epithelial/epidermal barrier function and remodeling, such as filaggrin, ADAM33, and GSDML/ORMDL3, in patients with atopic dermatitis and asthma. Furthermore, studies of gene-environment interactions and Mendelian randomization approaches have led to increased insight into the importance of environmental triggers for allergic disease. Studies of the timing of action of genetic variants in determining disease susceptibility have highlighted the importance of in utero development and early life in determining susceptibility to allergic disease. In the future, genetic discoveries in allergic disease will potentially lead to better endophenotyping, prognostication, prediction of treatment response, and insights into molecular pathways to develop more targeted therapy for these conditions.The Journal of allergy and clinical immunology 02/2010; 125(2 Suppl 2):S81-94. DOI:10.1016/j.jaci.2009.10.071 · 11.25 Impact Factor