Aeroallergen Avoidance: Updated Evidence and How to Advise Patients
DOI:
https://doi.org/10.58931/cait.2023.3254Keywords:
en_CAAbstract
Allergic rhinitis (AR) is highly prevalent in Canada, affecting approximately 20–25% of the population. Asthma is estimated to affect approximately three million Canadians, and between 12% and 25% of Canadian children. Approximately two-thirds of individuals with asthma are allergic to aeroallergens, and these allergens act as triggers for asthma exacerbations. Overall, approximately 7.7 million individuals were affected by aeroallergens in Canada in 2016. High concentrations of ambient aeroallergens, including tree pollen and fungal spores have been associated with increased risk of premature birth, myocardial infarction (MI) and asthma-related Emergency Department visits and hospitalizations in cities across Canada. This demonstrates that nation-wide aeroallergen counts are associated with severe signs and symptoms.
Children exposed to various indoor allergens are placed at an increased risk of developing asthma in later life, with sensitization in these individuals being a strong predictor of disease morbidity. Common indoor exposures for infants include house dust mite, pet, cockroach, mould, and rodent allergens. Sensitization to at least one indoor allergen has been demonstrated to be present in nine of every ten children hospitalized with asthma.
It has been noted that more than 90% of children worldwide breathe polluted air. While the impact of climate change on aeroallergen exposure is not fully understood, there is increasing evidence that it may have an impact on outdoor aeroallergens and, by extension, asthma control in children. Global warming has been projected to influence the duration and intensity of pollen seasons, and may lead to increased pollen production, prolonged pollen seasons, and increased pollen protein allergenicity.
The changing weather patterns including rainfall and wind may cause pollen species to reach environments in which they had not previously been present, contributing to a shift in geographic pollen distributions.
References
Sierra-Heredia C, North M, Brook J, Daly C, Ellis AK, Henderson D, Henderson SB, Lavigne É, Takaro TK. Aeroallergens in Canada: distribution, public health impacts, and opportunities for prevention. International Journal of Environmental Research and Public Health. 2018 Aug;15(8):1577. doi:10.3390/ijerph15081577
Gray-Ffrench M, Fernandes RM, Sinha IP, Abrams EM. Allergen Management in Children with Type 2-High Asthma. Journal of Asthma and Allergy. 2022 Mar 29:381-94. doi:10.2147/JAA.S276994
Wise SK, Damask C, Greenhawt M, Oppenheimer J, Roland LT, Shaker MS, Wallace DV, Lang DM. A Synopsis of Guidance for Allergic Rhinitis Diagnosis and Management From ICAR 2023. The Journal of Allergy and Clinical Immunology: In Practice. 2023 Mar 1;11(3):773-96. doi:10.1016/j.jaip.2023.01.007
Gøtzsche PC, Johansen HK. House dust mite control measures for asthma. Cochrane Database of Systematic Reviews. 2008(2). doi:10.1111/j.1398-9995.2008.01690.x
Platts-Mills TA, Vaughan JW, Carter MC, Woodfolk JA. The role of intervention in established allergy: avoidance of indoor allergens in the treatment of chronic allergic disease. Journal of allergy and clinical immunology. 2000 Nov 1;106(5):787-804.
Platts-Mills TA. Allergen avoidance. J Allergy Clin Immunol. 2004;113(3):388-391. doi:10.1016/j.jaci.2003.12.027
Portnoy J, Miller JD, Williams PB, Chew GL, Miller JD, Zaitoun F, Phipatanakul W, Kennedy K, Barnes C, Grimes C, Larenas-Linnemann D. Environmental assessment and exposure control of dust mites: a practice parameter. Annals of Allergy, Asthma & Immunology. 2013 Dec 1;111(6):465-507.
van der Heide S, van Aalderen WM, Kauffman HF, Dubois AE, de Monchy JG. Clinical effects of air cleaners in homes of asthmatic children sensitized to pet allergens. Journal of Allergy and Clinical Immunology. 1999 Aug 1;104(2):447-51.
Gautier C, Charpin D. Environmental triggers and avoidance in the management of asthma. Journal of asthma and allergy. 2017 Mar 7:47-56. https://doi.org/10.2147/JAA.S121276
Bousquet J, Caimmi DP, Bedbrook A, Bewick M, Hellings PW, Devillier P, Arnavielhe S, Bachert C, Bergmann KC, Canonica GW, Chavannes NH. Pilot study of mobile phone technology in allergic rhinitis in European countries: the MASK-rhinitis study. Allergy. 2017 Jun;72(6):857-65. doi:10.1111/all.13125
Barnes CS, Dowling P, Van Osdol T, Portnoy J. Comparison of indoor fungal spore levels before and after professional home remediation. Annals of Allergy, Asthma & Immunology. 2007 Mar 1;98(3):262-8. doi:10.1016/S1081-1206(10)60716-8
Bush RK, Portnoy JM. The role and abatement of fungal allergens in allergic diseases. Journal of Allergy and Clinical Immunology. 2001 Mar 1;107(3):S430-40. doi:10.1067/mai.2001.113669
Cook KA, Modena BD, Simon RA. Improvement in asthma control using a minimally burdensome and proactive smartphone application. The Journal of Allergy and Clinical Immunology: In Practice. 2016 Jul 1;4(4):730-7. doi:10.1016/j.jaip.2016.03.005
Adkinson Jr NF, Eggleston PA, Eney D, Goldstein EO, Schuberth KC, Bacon JR, Hamilton RG, Weiss ME, Arshad H, Meinert CL, Tonascia J. A controlled trial of immunotherapy for asthma in allergic children. New England Journal of Medicine. 1997 Jan 30;336(5):324-32.
Ehnert B, Lau-Schadendorf S, Weber A, et al. Reducing domestic exposure to dust mite allergen reduces bronchial hyperactivity in sensitive children with asthma. J Allergy Clinical Immunol 1992;90:135-8.
Satyaraj E, Wedner HJ, Bousquet J. Keep the cat, change the care pathway: A transformational approach to managing Fel d 1, the major cat allergen. Allergy. 2019;74 Suppl 107(Suppl 107):5-17. doi:10.1111/all.14013
Crocker DD, Kinyota S, Dumitru GG, et al. Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a community guide systematic review. Am J Prev Med. 2011;41(2 Suppl 1):S5-S32. doi:10.1016/j.amepre.2011.05.012
Wood RA, Chapman MD, Adkinson NF Jr, Eggleston PA. The effect of cat removal on allergen content in household-dust samples. J Allergy Clin Immunol. 1989;83(4):730-734. doi:10.1016/0091-6749(89)90006-7
Strzelczyk Z, Roszkowski M, Feleszko W, Krauze A. Avoidance of allergens as an environmental method in the prevention of inhaled allergy symptoms. Allergol Immunopathol (Madr). 2020;48(6):745-752. doi:10.1016/j.aller.2019.06.011
Rabito FA, Carlson JC, He H, Werthmann D, Schal C. A single intervention for cockroach control reduces cockroach exposure and asthma morbidity in children. J Allergy Clin Immunol. 2017;140(2):565-570. doi:10.1016/j.jaci.2016.10.019
