Allergen Avoidance: Is it worthwhile?

One of the common clinical diagnosis I make on daily basis is allergic rhinitis or allergic rhinosinusitis.

 
Just writing a nasal spray or antiallergic is not enough.Patient education about allergen avoidence is very important.

I have listed below the information on allergen avoidence.

First question before we proceed- Is allergen avoidence effective?

Evidence that allergen avoidance is effective

Many studies show that strict avoidance is effective in reducing the severity of asthma and allergic disease and the need for medications. People with asthma kept in environments free of dust mite for long periods of time improve their symptoms, but significantly, bronchial hyperresponsiveness also improves.

The big question is whether these measures can be transferred to real life situations and applied in a practical and cost-effective manner.

A meta-analysis of such studies reported in 1998 (3) purported to show that allergen avoidance was ineffective. However, this study was flawed in that it included studies where allergen reduction was not achieved, and other effective studies were excluded. In five of six studies where allergen exposure was documented for six months or more, there was significant improvement in the active group (4).
(courtsey allergy.org.au )

Lets talk about the main culprits -indoor allergens & pollen.Also mentioned in the tables below about avoidence measures.

Indoor Allergens

 The most important indoor allergens are house dust mite, cat, cockroach and mould. Carpets are reservoirs for dust mite and their food, and maintain an optimal environment for dust mite growth. They also accumulate other allergens such as cat, cockroach and mould allergens.Mattresses are a good home for dust mite. They should be vacuumed regularly, but can also be enclosed in an impervious cover.
 Also worth mentioning is the woollens- blankets or sweaters.They should be replaced with cotton one.Layered clothing than a thick woollen jacket!

Avoidance measures for Indoor Allergens

Ideal measures: Remove carpet and replace with hard surface (where practicle and affordable) Sweep and dust regularly with moist cloth to prevent dust rising Encase mattress and pillow in material impervious to dust mite Remove drapes and replace with roll-up blinds Get rid of soft toys Keep bedroom uncluttered Get rid of pets (if there is a confirmed pet allergy) Store clothes for changes of seasons in plastic bags after cleaning Less effective methods: Dry-clean carpets then vacuum regularly with machine with HEPA exhaust filter Exclude pets from the bedroom Do not use evaporative cooling which increases humidity and encourages growth of dust mite and mould Attend to leaks and damp in the home Rely on electricity for heating and cooking and avoid unflued gas heaters

 

Avoidance measures for other allergens

Pollen can travel great distances on wind and it may appear a hopeless task to avoid them, but there are some simple measures which can reduce exposure to them.It may not be possible to put into practice all these measures, but at least some of them will be effective in reducing allergen exposure.

Measures to reduce pollen exposure

During pollen seasons:  Avoid visiting high pollen areas in spring. Drive with car windows closed and airconditioner on recycle. Some models of cars have pollen filters incorporated in their airconditioning system. Keep windows of home closed . Avoid mowing of lawn and wear a mask if working out of doors. Try to do essential garden work after rain, which has removed pollen from the atmosphere. Avoid outdoors on windy days. Wear glasses or sunglasses to reduce the chances of pollen impacting on the conjunctivae. Shower and wash hair to remove pollen before going to bed. Use a clothes dryer or hang clothes indoors instead of line-drying. Choose garden plants which are low pollinators. Even though pollens travel great distances, some may cause problems if in high concentration in a local area such as a garden. Refer to pollen counts when available.

 

Cost-effectiveness of allergen avoidance

Patients are becoming more dissatisfied with the need for continuing drug therapy, and are seeking other ways of controlling disease. Some asthma studies have shown that allergen avoidance reduces the need for medications.

The advantages of allergen avoidance are:

• It is safe and without side-effects.
• It decreases the amount of medications required. This can lead to significant financial savings.
• It improves efficacy of medication.
• It is safe in pregnancy.
• It may reduce the risk of development of allergic disease in young children.

 Allergen avoidance measures often require a change in behaviour patterns.

Last but not the least.... food allergies especially if I am treating a child!

 Take care !