What 2011 allergen avoidance

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What 2011 allergen avoidance

  1. 1. WHAT YOU SHOULD HAVE READ BUT….2011 <ul><li>allergen avoidance </li></ul>University of Verona, Italy Attilio Boner
  2. 2. Efficacy of a novel air filtration pillow for avoidance of perennial allergens in symptomatic adults Stillerman Ann Allergy Asthma Immunol 2010;104:440 PureZone system diagram depicting the clean air breathing zone ( a ), which is created by pressurizing room air ( b ); removing allergens through high-efficiency particulate air filtration ( c ); conveying the clean airflow toward the breathing zone through an upper chamber in the pillowcase over the existing pillow, which is encapsulated in a lower chamber dust mite barrier ( d ); and providing clean airflow to the breathing zone through the top pillowcase surface ( e ). A B C D E
  3. 3. Efficacy of a novel air filtration pillow for avoidance of perennial allergens in symptomatic adults Stillerman Ann Allergy Asthma Immunol 2010;104:440 <ul><li>35 dults with perennial allergic rhinoconjunctivitis (dog, cat, or dust mite sensitivity) randomized to PureZone. </li></ul>Mean change from baseline in Total Symptom Scores on waking. a P < .05
  4. 4. Effects of HEPA Air Cleaners on Unscheduled Asthma Visits and Asthma Symptoms for Children Exposed to Secondhand Tobacco Smoke. Lanphear J Ped 2011;127:93
  5. 5. Effects of HEPA Air Cleaners on Unscheduled Asthma Visits and Asthma Symptoms for Children Exposed to Secondhand Tobacco Smoke. Lanphear J Ped 2011;127:93 <ul><li>225 asthmatic children (6-12 years) exposed to ≥5 cigarettes per day. </li></ul><ul><li>Active or inactive HEPA air cleaners. </li></ul><ul><li>Follow-up 12 mo. </li></ul>% reduction in unscheduled asthma visits during 1 yrs follow-up -18% HEPA Air Cleaners p=0.04 0 -10 – -15 – -20 –
  6. 6. Effects of HEPA Air Cleaners on Unscheduled Asthma Visits and Asthma Symptoms for Children Exposed to Secondhand Tobacco Smoke. Lanphear J Ped 2011;127:93 % reduction of particles of >0.3 μ m -25% 0 -10 – -15 – -20 – -25 – -30 – HEPA Air Cleaners <ul><li>225 asthmatic children (6-12 years) exposed to ≥5 cigarettes per day. </li></ul><ul><li>Active or inactive HEPA air cleaners. </li></ul><ul><li>Follow-up 12 mo. </li></ul>
  7. 7. Effects of HEPA Air Cleaners on Unscheduled Asthma Visits and Asthma Symptoms for Children Exposed to Secondhand Tobacco Smoke. Lanphear J Ped 2011;127:93 % reduction of particles of >0.3 μ m -25% 0 -10 – -15 – -20 – -25 – -30 – HEPA Air Cleaners <ul><li>225 asthmatic children (6-12 years) exposed to ≥5 cigarettes per day. </li></ul><ul><li>Active or inactive HEPA air cleaners. </li></ul><ul><li>Follow-up 12 mo. </li></ul>There were no significant differences in parent-reported asthma symptoms, exhaled nitric-oxide levels, air nicotine levels, or cotinine levels according to group assignment.
  8. 8. Eight-year outcomes of the Childhood Asthma Prevention Study Toelle JACI 2010;126:388 <ul><li>HDM avoidance and dietary fatty acid modification increasing the ratio of ω-3 to ω-6 fatty acids in plasma. </li></ul><ul><li>450 children. </li></ul>% children with HDM allergy at age 7 years 33.2% Intervention Controls 37.9% 40 – 35 – 30 – 25 – 20 – 15 – 10 – 0 5 – 0 0 ns
  9. 9. Eight-year outcomes of the Childhood Asthma Prevention Study Toelle JACI 2010;126:388 <ul><li>HDM avoidance and dietary fatty acid modification increasing the ratio of ω-3 to ω-6 fatty acids in plasma. </li></ul><ul><li>450 children. </li></ul>% children with HDM allergy at age 7 years 33.2% Intervention Controls 37.9% 40 – 35 – 30 – 25 – 20 – 15 – 10 – 0 5 – 0 0 ns But among children who were atopic at 8 years of age, the active HDM avoidance intervention was associated with significant absolute risk reduction of 10.6% (95% CI, 0.1% to 21.0%) in poor asthma control compared with those in the control group.
  10. 10. Major mite allergen Der f 1 concentration is reduced in buildings with improved energy performance Spertini Allergy 2010;65:623 <ul><li>Der f 1, Der p 1, Fel d 1 and Bla g 2 from mattress and carpet dust samples. </li></ul><ul><li>5 buildings designed for low energy use (LEB) and in control buildings (CB). </li></ul>Der f 1 Der p 1
  11. 11. Major mite allergen Der f 1 concentration is reduced in buildings with improved energy performance Spertini Allergy 2010;65:623 <ul><li>Der f 1, Der p 1, Fel d 1 and Bla g 2 from mattress and carpet dust samples. </li></ul><ul><li>5 buildings designed for low energy use (LEB) and in control buildings (CB). </li></ul>Mite allergens are significantly less abundant in LEB than in CB groups. Der f 1 Der p 1
  12. 12. Major mite allergen Der f 1 concentration is reduced in buildings with improved energy performance Spertini Allergy 2010;65:623 Fel d 1 Bla g 2 <ul><li>Der f 1, Der p 1, Fel d 1 and Bla g 2 from mattress and carpet dust samples. </li></ul><ul><li>5 buildings designed for low energy use (LEB) and in control buildings (CB). </li></ul>
  13. 13. Major mite allergen Der f 1 concentration is reduced in buildings with improved energy performance Spertini Allergy 2010;65:623 <ul><li>Der f 1, Der p 1, Fel d 1 and Bla g 2 from mattress and carpet dust samples. </li></ul><ul><li>5 buildings designed for low energy use (LEB) and in control buildings (CB). </li></ul>(A) Dry temperature p<0.01 p=0.01 (B) relative humidity
  14. 14. Major mite allergen Der f 1 concentration is reduced in buildings with improved energy performance Spertini Allergy 2010;65:623 In the 1970s, attempts to decrease energy losses by occluding most of a building’s openings led to impaired ventilation and increased humidity, conditions that favoured mite growth. However, novel concepts in building construction including high performance mechanical ventilation systems with heat recovery have largely modified the strategies of energy savings, allowing a reduction in annual consumption of <42 kWh/m 2 floor area for heating and hot water in optimal conditions. (Minergie® label,http://www.minergie.ch/)
  15. 15. Effects of latex avoidance on latex sensitization, atopy and allergic diseases in patients with spina bifida Blumchen Allergy 2010;65:1585 <ul><li>120 children with spina bifida </li></ul><ul><li>O perated on under latex-free conditions (‘current group’) </li></ul><ul><li>Compared to a ‘historic’ (not latex-free operated group) </li></ul>% children developing latex sensitization 5% CURRENT HISTORIC 60 – 50 – 40 – 30 – 20 – 10 – 0 55% GROUP p<0.001
  16. 16. Effects of latex avoidance on latex sensitization, atopy and allergic diseases in patients with spina bifida Blumchen Allergy 2010;65:1585 <ul><li>120 children with spina bifida </li></ul><ul><li>O perated on under latex-free conditions (‘current group’) </li></ul><ul><li>Compared to a ‘historic’ (not latex-free operated group) </li></ul>% children developing latex allergy 0.08% CURRENT HISTORIC 40 – 30 – 20 – 10 – 0 37% p<0.001 GROUP
  17. 17. Effects of latex avoidance on latex sensitization, atopy and allergic diseases in patients with spina bifida Blumchen Allergy 2010;65:1585 <ul><li>120 children with spina bifida </li></ul><ul><li>O perated on under latex-free conditions (‘current group’) </li></ul><ul><li>Compared to a ‘historic’ (not latex-free operated group) </li></ul>% children developing latex allergy 0.08% CURRENT HISTORIC 40 – 30 – 20 – 10 – 0 37% p<0.001 GROUP Latex avoidance in children with spina bifida prevents latex sensitization and latex allergy
  18. 18. Compliance education
  19. 19. Comprehensive environmental management of asthma and pediatric preventive care Roy Pediatr Allergy Immunol 2011;22:277 <ul><li>Indoor environmental triggers can increase asthma morbidity. </li></ul><ul><li>National guidelines recommend comprehensive use of environmental control practices (ECPs) as a component of asthma management. </li></ul><ul><li>1,921 children with asthma. </li></ul><ul><li>Comprehensive use was defined as using at least 5 of 8 ECPs: (i) air filter, (ii) dehumidifier, (iii) mattress cover, (iv) pillow cover, (v) pet avoidance, (vi) smoke avoidance, (vii) removing carpets, and (viii) washing sheets in hot water. </li></ul>
  20. 20. Comprehensive environmental management of asthma and pediatric preventive care Roy Pediatr Allergy Immunol 2011;22:277 ECP Environmental control practices
  21. 21. Comprehensive environmental management of asthma and pediatric preventive care Roy Pediatr Allergy Immunol 2011;22:277 ECP Environmental control practices Comprehensive use of ECPs was associated with having received physician advice
  22. 22. Comprehensive environmental management of asthma and pediatric preventive care Roy Pediatr Allergy Immunol 2011;22:277 ECP Environmental control practices Only a minority of parents implement comprehensive ECPs
  23. 23. Comprehensive environmental management of asthma and pediatric preventive care Roy Pediatr Allergy Immunol 2011;22:277 Odds of comprehensive environmental management according to number of routine asthma visits in prior year
  24. 24. Take home

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