Environmental Allergen

Aka: Environmental Allergen, Allergen Control, Airborne Allergen

1. See Also
   1. Extrinsic Asthma (Allergic Asthma)
   2. Allergic Rhinitis
   3. Dust mite
2. Indications
   1. Atopic Triad
   2. Allergic Rhinitis
   3. Eczematous Dermatitis (Atopic Dermatitis)
   4. Asthma
3. Efficacy
   1. Overall evidence for Dust mite avoidance is limited
   2. Mite acaricides and bedroom Allergen Control may be reasonable
   3. However, impermeable dust covers are unlikely to be beneficial
   4. Sheikh (2010) Cochrane Database Syst Rev (7):CD001563 +PMID:20614426 [PubMed]
4. Management: Furniture, Bedding and stuffed animals (house Dust mite)
   1. Replace heavily infested bedding
   2. Launder bedding weekly in hot water (130 degrees F)
   3. Routinely clean carpets and furniture
   4. Remove stuffed animals from sleeping area
   5. Encase pillows and mattresses in semipermeable covers (not supported by evidence)
      1. Plastic covers with cloth backing available
      2. Feels like real cloth or upholstery
      3. Not found in studies to improve symptoms
         1. Terreehorst (2003) N Engl J Med 349:237-46 [PubMed]
5. Management: Housework (house Dust mite)
   1. Avoid vacuuming if dust sensitive (or use mask)
   2. Vacuum carpets and clean floors frequently
      1. HEPA (High efficiency particulate air) filter bags
      2. Double-thickness vacuum bags
   3. Replace bedroom carpet with hardwood or linoleum
      1. Especially carpets overlying concrete
   4. Minimize dust-collecting surfaces (e.g. shelves)
      1. Wipe with moist cloth once weekly
   5. Cover windows with shades and washable curtains
   6. Clean shades often (avoid Venetian blinds)
   7. Treat carpet with Acaricide or denaturer (tannic acid)
      1. Low efficacy and must be repeated often
6. Management: Ventilation (house Dust mite and pollen sensitive)
   1. Ensure well-ventilated rooms
   2. Install bedroom high-density particulate air filter (may not be evidence-based)
   3. Use air conditioner to reduce humidity/Temperature
7. Management: Damp Areas (Mold sensitivity)
   1. Avoid damp, poorly ventilated areas (basement, attic)
   2. Clean shower, basement, and windowsill frequently
   3. Check Cooling System frequently for mold
   4. Clean vaporizers and humidifiers
   5. Remove sources of mold growth (piles of leaves)
   6. Consider dehumidifier to control humidity (<50%)
      1. Also reduces Dust mite growth
      2. Humidity <35% eliminates mite growth completely
   7. Increase ventilation
   8. Remove under house water
   9. Consider fungicides
8. Management: Miscellaneous
   1. Irritants
      1. Avoid Second hand smoke
   2. Pollen (Pollen sensitivity)
      1. Avoid grass/outdoor allergen exposures
      2. Eliminate houseplants, especially in bedroom
   3. Animal sensitivity
      1. Remove pet from house if possible
      2. Keep pets out of bedroom (e.g. outside or garage)
      3. Wash the pet weekly in water
      4. Follow other environmental recommendations above
         1. Vacuum bedroom carpets weekly
         2. Eliminate carpeting and upholstered furniture
9. References
   1. Bierman (1996) Immunol Allergy Clin North Am 16:753-64 [PubMed]
   2. German (2002) Am Fam Physician 66(3):421-6 [PubMed]
   3. Tovey (1999) J Allergy Clin Immunol 103(2 pt 1):179-91 [PubMed]
   4. Tsitoura (2002) Arch Pediatr Adolesc Med 156:1021-7 [PubMed]