post-title Allergen Avoidance 2014-04-30 20:26:09 yes no Posted by

Allergen Avoidance

by Dr. Joseph Bullock Recently, there has been a marked increase in the occurrence of all allergic diseases which we believe may be due to changes in recent living conditions in modern Western civilization. We spend more time indoors in tight houses built to conserve energy. We have clean water and wear shoes. We have […]

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JosephBullockby Dr. Joseph Bullock

Recently, there has been a marked increase in the occurrence of all allergic diseases which we believe may be due to changes in recent living conditions in modern Western civilization. We spend more time indoors in tight houses built to conserve energy. We have clean water and wear shoes. We have eradicated helminth (worms) infestations. Vaccines have eradicated most of the usual childhood diseases. Our diets have trended towards eating too many calories, too much sodium and too much fat. We use too many broad spectrum antibiotics and Tylenol (acetaminophen) and we have decreased physical activity. All of these factors are believed to have caused the increase in allergy.

Whether one chooses to believe that the present climate change toward warmer average temperatures is primarily due to human activity or another global cycle of cooling and warming, the evidence is overwhelming that warming is occurring. This warming has had and will have an impact upon allergenic plants. An atmosphere is higher temperature and carbon dioxide produces ragweed, grass, trees and mold that have an increased biomass (height and density), flower earlier, and produce more pollen and spores which are more potent. This is especially true in urban sites where temperatures are two degrees higher and CO2 levels are 30 percent higher than rural sites. This increase in pollen and mold spore load has increased allergy symptoms in patients with allergic rhinitis, conjunctivitis and asthma.

Avoidance of Outdoor Allergens

Avoidance of outdoor pollen and mold exposure is accomplished by spending less time outdoors (the average American is already doing this by spending 23 hours of each day indoors and one hour outdoors). The good news is that by spending more time indoors, we are avoiding outdoor pollutants known to cause and trigger respiratory symptoms (outdoor pollutants include sulfur dioxide, carbon monoxide, ozone, nitrogen oxides, diesel exhaust fumes, particulate matter and volatile organic compounds).

Avoidance of Indoor Allergens

There is some controversy on the benefit of indoor allergen avoidance, but the recent prevailing evidence is clear that complete avoidance (hospitalization and high altitude clinics) is very effective in reducing symptoms of allergic rhinitis, allergic asthma and atopic dermatitis. Removing allergens from the house requires time (6-12 months), persistence and thoroughness.

House Dust Mite (Dermatophagoides Pteronyssinus and Farinae)

Removing 90% of dust mite load is very effective in reducing allergy symptoms. Avoidance measures are divided into two interventions:

Bedrooms

  1. Encase mattresses and pillows with impermeable covers.
  2. Wash all bedding at least weekly at 130 degrees Fahrenheit
  3. Remove carpeting, stuffed animals and clutter from the bedroom
  4. If carpeting cannot be removed, vacuum weekly (wearing a mask) using a vacuum cleaner with a double thickness bag or a high-efficiency particle air filter (HEPA); use a miticide on the carpeting once a month.

Rest of House

  1. Minimize the number of small carpets and upholstered furniture
  2. Reduce humidity below 45% relative humidity
  3. Treat carpeting with Benzyl Benzoate or Tannic acid miticide (National Allergy Supply)
  4. Avoid basements and/or use a dehumidifier

Domestic Animals (Cats and Dogs)

  1. Removing animals from the house is best
  2. Keeping animals outdoors is second best but there is a significant allergen load brought into the house by passive transfer
  3. Polished floors (no carpeting) or vacuum cleaning twice a week with a HEPA filter bag
  4. HEPA filter on the furnace
  5. Washing the animals twice a week

Caged Animals

  1. Removing from the house is best
  2. Keeping animals in the basement is second best
  3. Don’t allow the allergic patient to change the litter

Indoor Mold (Fungi)

  1. Keep relative humidity below 45%
  2. Remove sites of obvious mold growth
  3. Clean moldy surface with fungicide. Most fungicides have a strong odor, so this should be done by a non-allergic person.
  4. Avoid basements and use a dehumidifier

Cockroach

  1. Use of poison bait
  2. Careful housekeeping to enclose all sources of food
  3. Thorough cleaning to remove all cockroach parts
  4. Sealing as many access points to the house as possible (may require a professional exterminator)

Indoor Pollution

Avoid if possible:

  1. Biomass combustive products, (wood and coal stoves and fireplaces); using a Patsari stove may by of some benefit
  2. Nitrogen dioxide in unvented stoves
  3. Environmental tobacco smoke either actively or passively is a risk factor for asthma, ear infection, upper and lower respiratory infections
  4. Household chemicals (strong odors)

Dietary Considerations

The following dietary interventions appear to benefit patients with allergic diseases:

  1. A Mediterranean diet low in sodium and fats and high in fruits, vegetables and fish
  2. Having a body mass index within normal limits
  3. Getting adequate sunlight for Vitamin D, or supplement with oral Vitamin D

 

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