Skip to main content
Erschienen in: Current Allergy and Asthma Reports 6/2012

01.12.2012 | Pediatric Allergy and Immunology (JM Portnoy and CE Ciaccio, Section Editors)

A New Model for Environmental Assessment and Exposure Reduction

verfasst von: Christina E. Ciaccio, Kevin Kennedy, Jay M. Portnoy

Erschienen in: Current Allergy and Asthma Reports | Ausgabe 6/2012

Einloggen, um Zugang zu erhalten

Abstract

Environmental assessment and exposure reduction are a set of diagnostic and treatment techniques that work in tandem with the traditional medical approach by reducing a patient’s exposure to adverse environmental conditions as part of medical care. Assessment involves identifying the specific exposures to which a patient is sensitive and locating the corresponding contaminants in the patient’s environment. This provides a more complete diagnostic evaluation of a patient’s problem than could be obtained merely by examining the patient alone. Exposure reduction involves reducing the identified triggers to levels that are below thresholds that are associated with increased risk of sensitization and disease morbidity. Assessment of an environment for contaminants focuses on a chain of factors that include contaminant sources such as cockroaches, rodents, dust mites and fungi that excrete contaminants into an environment, facilitative factors such as moisture, food, water and shelter that help sources to thrive, and reservoirs where contaminants can accumulate prior to subsequent transport to occupants. By using this model to guide environmental assessments and their corresponding interventions, the root cause of health problems can be addressed, leading to improved quality of life for patients and reduced need for chronic medications.
Literatur
1.
Zurück zum Zitat Schatz M, Zeiger RS. Ineffectiveness of telephone-based environmental control intervention to improve asthma outcomes. J Allergy Clin Immunol. 2010;126(4):873–5. Epub 2010/10/06.PubMedCrossRef Schatz M, Zeiger RS. Ineffectiveness of telephone-based environmental control intervention to improve asthma outcomes. J Allergy Clin Immunol. 2010;126(4):873–5. Epub 2010/10/06.PubMedCrossRef
2.
Zurück zum Zitat •• Schatz M, Zeiger RS. Telephone-based environmental control interventions in asthmatic patients: what are patients willing to do? Ann Allergy Asthma Immunol. 2012;In press. This study and the earlier one (reference 1) determined what patients are actually willing to do about environmental control. This is important because if patients are not willing to modify their enviornment, the interventions described in this review will not be effective. •• Schatz M, Zeiger RS. Telephone-based environmental control interventions in asthmatic patients: what are patients willing to do? Ann Allergy Asthma Immunol. 2012;In press. This study and the earlier one (reference 1) determined what patients are actually willing to do about environmental control. This is important because if patients are not willing to modify their enviornment, the interventions described in this review will not be effective.
3.
Zurück zum Zitat •• Portnoy J, Kennedy K, Sublett J. Environmental assessment and exposure control: a practice parameter-furry animals. Ann Allergy Asthma Immunol. 2012;108(4):223 e1–e15. Epub 2012/04/04. This is the first in a series of practice parameters that address the issue of environmental assessment and source reduction. The basics of the new model are described and practical, evidence-based recommendations are provided..CrossRef •• Portnoy J, Kennedy K, Sublett J. Environmental assessment and exposure control: a practice parameter-furry animals. Ann Allergy Asthma Immunol. 2012;108(4):223 e1–e15. Epub 2012/04/04. This is the first in a series of practice parameters that address the issue of environmental assessment and source reduction. The basics of the new model are described and practical, evidence-based recommendations are provided..CrossRef
4.
Zurück zum Zitat Lewis RD, Breysse PN, Lees PS, Diener-West M, Hamilton RG, Eggleston P. Factors affecting the retention of dust mite allergen on carpet. Am Ind Hyg Assoc J. 1998;59(9):606–13. Epub 1998/10/21.PubMedCrossRef Lewis RD, Breysse PN, Lees PS, Diener-West M, Hamilton RG, Eggleston P. Factors affecting the retention of dust mite allergen on carpet. Am Ind Hyg Assoc J. 1998;59(9):606–13. Epub 1998/10/21.PubMedCrossRef
5.
Zurück zum Zitat Ciaccio CE, Portnoy JM. Strategies for primary prevention of atopy in children. Curr Allergy Asthma Rep. 2008;8(6):493–9. Epub 2008/10/23.PubMedCrossRef Ciaccio CE, Portnoy JM. Strategies for primary prevention of atopy in children. Curr Allergy Asthma Rep. 2008;8(6):493–9. Epub 2008/10/23.PubMedCrossRef
6.
Zurück zum Zitat Arshad SH, Bateman B, Matthews SM. Primary prevention of asthma and atopy during childhood by allergen avoidance in infancy: a randomised controlled study. Thorax. 2003;58(6):489–93. Epub 2003/05/31.PubMedCrossRef Arshad SH, Bateman B, Matthews SM. Primary prevention of asthma and atopy during childhood by allergen avoidance in infancy: a randomised controlled study. Thorax. 2003;58(6):489–93. Epub 2003/05/31.PubMedCrossRef
7.
Zurück zum Zitat • Wegienka G, Johnson CC, Havstad S, Ownby DR, Zoratti EM. Indoor pet exposure and the outcomes of total IgE and sensitization at age 18 years. J Allergy Clin Immunol. 2010;126(2):274–9. 9, 9 e1-5. Epub 2010/06/29. This article demonstrated that indoor exposure to pet allergens has an important impact on sensitization 18 years later.PubMedCrossRef • Wegienka G, Johnson CC, Havstad S, Ownby DR, Zoratti EM. Indoor pet exposure and the outcomes of total IgE and sensitization at age 18 years. J Allergy Clin Immunol. 2010;126(2):274–9. 9, 9 e1-5. Epub 2010/06/29. This article demonstrated that indoor exposure to pet allergens has an important impact on sensitization 18 years later.PubMedCrossRef
8.
Zurück zum Zitat Arruda LK, Vailes LD, Ferriani VP, Santos AB, Pomes A, Chapman MD. Cockroach allergens and asthma. J Allergy Clin Immunol. 2001;107(3):419–28. Epub 2001/03/10.PubMedCrossRef Arruda LK, Vailes LD, Ferriani VP, Santos AB, Pomes A, Chapman MD. Cockroach allergens and asthma. J Allergy Clin Immunol. 2001;107(3):419–28. Epub 2001/03/10.PubMedCrossRef
9.
Zurück zum Zitat Prevention strategies for asthma--secondary prevention. CMAJ. 2005;173(6 Suppl):S25-7. Epub 2005/09/15. Prevention strategies for asthma--secondary prevention. CMAJ. 2005;173(6 Suppl):S25-7. Epub 2005/09/15.
10.
Zurück zum Zitat Sheikh A, Hurwitz B, Nurmatov U, van Schayck CP. House dust mite avoidance measures for perennial allergic rhinitis. Cochrane Database Syst Rev. 2010;7:CD001563. Epub 2010/07/09.PubMed Sheikh A, Hurwitz B, Nurmatov U, van Schayck CP. House dust mite avoidance measures for perennial allergic rhinitis. Cochrane Database Syst Rev. 2010;7:CD001563. Epub 2010/07/09.PubMed
11.
Zurück zum Zitat •• Sheehan WJ, Rangsithienchai PA, Wood RA, Rivard D, Chinratanapisit S, Perzanowski MS, et al. Pest and allergen exposure and abatement in inner-city asthma: a work group report of the American Academy of Allergy, Asthma & Immunology Indoor Allergy/Air Pollution Committee. J Allergy Clin Immunol. 2010;125(3):575–81. Epub 2010/03/17. This report reviews the data demonstrating that IPM is effective and which interventions are necessary to result in improved health.PubMedCrossRef •• Sheehan WJ, Rangsithienchai PA, Wood RA, Rivard D, Chinratanapisit S, Perzanowski MS, et al. Pest and allergen exposure and abatement in inner-city asthma: a work group report of the American Academy of Allergy, Asthma & Immunology Indoor Allergy/Air Pollution Committee. J Allergy Clin Immunol. 2010;125(3):575–81. Epub 2010/03/17. This report reviews the data demonstrating that IPM is effective and which interventions are necessary to result in improved health.PubMedCrossRef
12.
Zurück zum Zitat Arbes Jr SJ, Sever M, Mehta J, Gore JC, Schal C, Vaughn B, et al. Abatement of cockroach allergens (Bla g 1 and Bla g 2) in low-income, urban housing: month 12 continuation results. J Allergy Clin Immunol. 2004;113(1):109–14. Epub 2004/01/10.PubMedCrossRef Arbes Jr SJ, Sever M, Mehta J, Gore JC, Schal C, Vaughn B, et al. Abatement of cockroach allergens (Bla g 1 and Bla g 2) in low-income, urban housing: month 12 continuation results. J Allergy Clin Immunol. 2004;113(1):109–14. Epub 2004/01/10.PubMedCrossRef
13.
Zurück zum Zitat WHO guidelines for indoor air quality :dampness and mould. Copenhagen, Denmark: World Health Organization; 2009. WHO guidelines for indoor air quality :dampness and mould. Copenhagen, Denmark: World Health Organization; 2009.
14.
Zurück zum Zitat Avner DB, Perzanowski MS, Platts-Mills TA, Woodfolk JA. Evaluation of different techniques for washing cats: quantitation of allergen removed from the cat and the effect on airborne Fel d 1. J Allergy Clin Immunol. 1997;100(3):307–12. Epub 1997/10/06.PubMedCrossRef Avner DB, Perzanowski MS, Platts-Mills TA, Woodfolk JA. Evaluation of different techniques for washing cats: quantitation of allergen removed from the cat and the effect on airborne Fel d 1. J Allergy Clin Immunol. 1997;100(3):307–12. Epub 1997/10/06.PubMedCrossRef
15.
Zurück zum Zitat Hodson T, Custovic A, Simpson A, Chapman M, Woodcock A, Green R. Washing the dog reduces dog allergen levels, but the dog needs to be washed twice a week. J Allergy Clin Immunol. 1999;103(4):581–5. Epub 1999/04/13.PubMedCrossRef Hodson T, Custovic A, Simpson A, Chapman M, Woodcock A, Green R. Washing the dog reduces dog allergen levels, but the dog needs to be washed twice a week. J Allergy Clin Immunol. 1999;103(4):581–5. Epub 1999/04/13.PubMedCrossRef
16.
Zurück zum Zitat Matsui E, Kagey-Sobotka A, Chichester K, Eggleston PA. Allergic potency of recombinant Fel d 1 is reduced by low concentrations of chlorine bleach. J Allergy Clin Immunol. 2003;111(2):396–401. Epub 2003/02/18.PubMedCrossRef Matsui E, Kagey-Sobotka A, Chichester K, Eggleston PA. Allergic potency of recombinant Fel d 1 is reduced by low concentrations of chlorine bleach. J Allergy Clin Immunol. 2003;111(2):396–401. Epub 2003/02/18.PubMedCrossRef
17.
Zurück zum Zitat Sever ML, Arbes Jr SJ, Gore JC, Santangelo RG, Vaughn B, Mitchell H, et al. Cockroach allergen reduction by cockroach control alone in low-income urban homes: a randomized control trial. J Allergy Clin Immunol. 2007;120(4):849–55. Epub 2007/09/11.PubMedCrossRef Sever ML, Arbes Jr SJ, Gore JC, Santangelo RG, Vaughn B, Mitchell H, et al. Cockroach allergen reduction by cockroach control alone in low-income urban homes: a randomized control trial. J Allergy Clin Immunol. 2007;120(4):849–55. Epub 2007/09/11.PubMedCrossRef
18.
Zurück zum Zitat Curtin-Brosnan J, Saams J, Breysse P, diette G, Bradley H, Matsui E. Relationship between Cat and Mouse Allergen Levels in the Homes of Inner City Children with Asthma. J Allergy Clin Immunol. 2009:S64. Curtin-Brosnan J, Saams J, Breysse P, diette G, Bradley H, Matsui E. Relationship between Cat and Mouse Allergen Levels in the Homes of Inner City Children with Asthma. J Allergy Clin Immunol. 2009:S64.
19.
Zurück zum Zitat Dodds W, Frantz S, Story K. The Professional’s Guide to Managing Poisoning by Anticoagulant Rodenticides. New York: Chempa Products Div., Lipha Chemicals, Inc; 1986. Dodds W, Frantz S, Story K. The Professional’s Guide to Managing Poisoning by Anticoagulant Rodenticides. New York: Chempa Products Div., Lipha Chemicals, Inc; 1986.
20.
Zurück zum Zitat Arlian LG, Vyszenski-Moher DL, Morgan MS. Mite and mite allergen removal during machine washing of laundry. J Allergy Clin Immunol. 2003;111(6):1269–73. Epub 2003/06/06.PubMedCrossRef Arlian LG, Vyszenski-Moher DL, Morgan MS. Mite and mite allergen removal during machine washing of laundry. J Allergy Clin Immunol. 2003;111(6):1269–73. Epub 2003/06/06.PubMedCrossRef
21.
Zurück zum Zitat Barnes CS, Kennedy K, Johnson L, Forrest E, Gard L, Pacheco F, et al. Use of dilute sodium hypochlorite spray and home cleaning to reduce indoor allergen levels and improve asthma health parameters. Ann Allergy Asthma Immunol. 2008;101(5):551–2. Epub 2008/12/06.PubMedCrossRef Barnes CS, Kennedy K, Johnson L, Forrest E, Gard L, Pacheco F, et al. Use of dilute sodium hypochlorite spray and home cleaning to reduce indoor allergen levels and improve asthma health parameters. Ann Allergy Asthma Immunol. 2008;101(5):551–2. Epub 2008/12/06.PubMedCrossRef
22.
Zurück zum Zitat • Sublett JL, Seltzer J, Burkhead R, Williams PB, Wedner HJ, Phipatanakul W. Air filters and air cleaners: rostrum by the American Academy of Allergy, Asthma & Immunology Indoor Allergen Committee. J Allergy Clin Immunol. 2010;125(1):32–8. Epub 2009/11/17. The definitive review of evidence for the use of air filtration.PubMedCrossRef • Sublett JL, Seltzer J, Burkhead R, Williams PB, Wedner HJ, Phipatanakul W. Air filters and air cleaners: rostrum by the American Academy of Allergy, Asthma & Immunology Indoor Allergen Committee. J Allergy Clin Immunol. 2010;125(1):32–8. Epub 2009/11/17. The definitive review of evidence for the use of air filtration.PubMedCrossRef
23.
Zurück zum Zitat Johnson L, Ciaccio C, Barnes CS, Kennedy K, Forrest E, Gard LC, et al. Low-cost interventions improve indoor air quality and children's health. Allergy Asthma Proc. 2009;30(4):377–85. Epub 2009/09/24.PubMedCrossRef Johnson L, Ciaccio C, Barnes CS, Kennedy K, Forrest E, Gard LC, et al. Low-cost interventions improve indoor air quality and children's health. Allergy Asthma Proc. 2009;30(4):377–85. Epub 2009/09/24.PubMedCrossRef
24.
Zurück zum Zitat Morgan WJ, Crain EF, Gruchalla RS, O'Connor GT, Kattan M, Evans 3rd R, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. 2004;351(11):1068–80. Epub 2004/09/10.PubMedCrossRef Morgan WJ, Crain EF, Gruchalla RS, O'Connor GT, Kattan M, Evans 3rd R, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. 2004;351(11):1068–80. Epub 2004/09/10.PubMedCrossRef
25.
Zurück zum Zitat Eggleston PA, Butz A, Rand C, Curtin-Brosnan J, Kanchanaraksa S, Swartz L, et al. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial. Ann Allergy Asthma Immunol. 2005;95(6):518–24. Epub 2006/01/13.PubMedCrossRef Eggleston PA, Butz A, Rand C, Curtin-Brosnan J, Kanchanaraksa S, Swartz L, et al. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial. Ann Allergy Asthma Immunol. 2005;95(6):518–24. Epub 2006/01/13.PubMedCrossRef
26.
Zurück zum Zitat Gergen PJ, Mortimer KM, Eggleston PA, Rosenstreich D, Mitchell H, Ownby D, et al. Results of the National Cooperative Inner-City Asthma Study (NCICAS) environmental intervention to reduce cockroach allergen exposure in inner-city homes. J Allergy Clin Immunol. 1999;103(3 Pt 1):501–6. Epub 1999/03/09.PubMedCrossRef Gergen PJ, Mortimer KM, Eggleston PA, Rosenstreich D, Mitchell H, Ownby D, et al. Results of the National Cooperative Inner-City Asthma Study (NCICAS) environmental intervention to reduce cockroach allergen exposure in inner-city homes. J Allergy Clin Immunol. 1999;103(3 Pt 1):501–6. Epub 1999/03/09.PubMedCrossRef
27.
Zurück zum Zitat Krieger J, Jacobs DE, Ashley PJ, Baeder A, Chew GL, Dearborn D, et al. Housing interventions and control of asthma-related indoor biologic agents: a review of the evidence. J Public Health Manag Pract. 2010;16(5 Suppl):S11–20. Epub 2010/08/21.PubMed Krieger J, Jacobs DE, Ashley PJ, Baeder A, Chew GL, Dearborn D, et al. Housing interventions and control of asthma-related indoor biologic agents: a review of the evidence. J Public Health Manag Pract. 2010;16(5 Suppl):S11–20. Epub 2010/08/21.PubMed
28.
Zurück zum Zitat Pongracic JA, Visness CM, Gruchalla RS, Evans 3rd R, Mitchell HE. Effect of mouse allergen and rodent environmental intervention on asthma in inner-city children. Ann Allergy Asthma Immunol. 2008;101(1):35–41. Epub 2008/08/07.PubMedCrossRef Pongracic JA, Visness CM, Gruchalla RS, Evans 3rd R, Mitchell HE. Effect of mouse allergen and rodent environmental intervention on asthma in inner-city children. Ann Allergy Asthma Immunol. 2008;101(1):35–41. Epub 2008/08/07.PubMedCrossRef
29.
Zurück zum Zitat Juliusson S, Jakobinudottir S, Runarsdottir V, Blondal T, Gislason D. Environmental control (EC) can effectively reduce cat allergen (Fel d 1) in house dust samples without removal of the cat [abstract]. J Allergy Clin Immunol. 1997;99:S388. Juliusson S, Jakobinudottir S, Runarsdottir V, Blondal T, Gislason D. Environmental control (EC) can effectively reduce cat allergen (Fel d 1) in house dust samples without removal of the cat [abstract]. J Allergy Clin Immunol. 1997;99:S388.
30.
Zurück zum Zitat Wu F, Takaro TK. Childhood asthma and environmental interventions. Environ Health Perspect. 2007;115(6):971–5. Epub 2007/06/26.PubMedCrossRef Wu F, Takaro TK. Childhood asthma and environmental interventions. Environ Health Perspect. 2007;115(6):971–5. Epub 2007/06/26.PubMedCrossRef
31.
Zurück zum Zitat Salo PM, Arbes Jr SJ, Crockett PW, Thorne PS, Cohn RD, Zeldin DC. Exposure to multiple indoor allergens in US homes and its relationship to asthma. J Allergy Clin Immunol. 2008;121(3):678–84. e2. Epub 2008/02/08.PubMedCrossRef Salo PM, Arbes Jr SJ, Crockett PW, Thorne PS, Cohn RD, Zeldin DC. Exposure to multiple indoor allergens in US homes and its relationship to asthma. J Allergy Clin Immunol. 2008;121(3):678–84. e2. Epub 2008/02/08.PubMedCrossRef
Metadaten
Titel
A New Model for Environmental Assessment and Exposure Reduction
verfasst von
Christina E. Ciaccio
Kevin Kennedy
Jay M. Portnoy
Publikationsdatum
01.12.2012
Verlag
Current Science Inc.
Erschienen in
Current Allergy and Asthma Reports / Ausgabe 6/2012
Print ISSN: 1529-7322
Elektronische ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-012-0297-9

Weitere Artikel der Ausgabe 6/2012

Current Allergy and Asthma Reports 6/2012 Zur Ausgabe

Pediatric Allergy and Immunology (JM Portnoy and CE Ciaccio, Section Editors)

Role of Viruses in the Development of Atopic Disease in Pediatric Patients

Betalaktam-Allergie: praxisnahes Vorgehen beim Delabeling

16.05.2024 Pädiatrische Allergologie Nachrichten

Die große Mehrheit der vermeintlichen Penicillinallergien sind keine. Da das „Etikett“ Betalaktam-Allergie oft schon in der Kindheit erworben wird, kann ein frühzeitiges Delabeling lebenslange Vorteile bringen. Ein Team von Pädiaterinnen und Pädiatern aus Kanada stellt vor, wie sie dabei vorgehen.

Eingreifen von Umstehenden rettet vor Erstickungstod

15.05.2024 Fremdkörperaspiration Nachrichten

Wer sich an einem Essensrest verschluckt und um Luft ringt, benötigt vor allem rasche Hilfe. Dass Umstehende nur in jedem zweiten Erstickungsnotfall bereit waren, diese zu leisten, ist das ernüchternde Ergebnis einer Beobachtungsstudie aus Japan. Doch es gibt auch eine gute Nachricht.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Update HNO

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.