Allergen Avoidance Strategies Research Articles

Mite allergen levels and fungal counts in children's bedding in four widely separated towns in Japan

We evaluated the relationships between children's housing, earthquake or tsunami damage affecting children, prevalence of allergic diseases, and levels of mite allergens and fungi on children's bedding after the Great East Japan Earthquake in four municipalities in Japan. We surveyed 464 children in Ishinomaki, 254 in Kami, 614 in Iwanuma, and 300 in Oiso whose parents or guardians had completed the International Study of Asthma and Allergies in Childhood questionnaire. We measured the levels of Dermatophagoides 1 allergens (Der 1) (Dermatophagoidespteronyssinus and Dermatophagoides farinae) on children's mattresses or futons and fungal counts (Aspergillus and yeast) between 2016 and 2018. Earthquake damage was significantly greater in Ishinomaki than in the other three municipalities. There were no differences in the prevalence of allergic disease among the four municipalities. Der 1 levels were significantly higher in Ishinomaki than in Iwanuma, but there were no differences among Oiso, Iwanuma, and Kami. Der 1 levels in children with asthma in Iwanuma and with allergic rhinitis in Kami were significantly higher than in those without these conditions. Total fungal counts and Aspergillus counts were highest in Kami and lowest in Oiso. Der 1 levels were significantly correlated with fungal counts in Kami and Iwanuma, but not in Ishinomaki or Oiso. Both Der 1 levels and total fungal counts in Ishinomaki were greater than those in other three municipalities. Housing and allergen-avoidance strategies varied among the four municipalities. Mite allergen and fungal levels in these Japanese municipalities might have been affected by the earthquake and tsunami, and these changes might have affected the prevalence of allergic diseases in children.

Pollen allergy and health behavior: patients trivializing their disease

Allergies are increasing in prevalence worldwide, with socioeconomic impacts and effects on quality of life. The aim of this study was to explore the health behavior and the utilization of different treatment options via questionnaires and to investigate for relationships of the above with socioeconomic factors. This cross-sectional survey was carried out among pollen allergic subjects in 2016, using questionnaires. A total of 679 allergics participated in the study (61.2% females). Their average age was 26.8 ± 8.8 years. Their symptom severity was 6.1 ± 1.9, measured on a 10-step scale and symptoms lasted for 9.0 ± 6.8 weeks during pollen season. Of all allergics, 9.1% were not aware of the causative agent of their allergy and 17.4% had never undergone allergy testing. Symptoms, especially in females, had strong impact on social life, everyday routines and sleep quality. Almost half of the participants treated their allergy without medical supervision, while only 32.3% sought medical support. Nevertheless, three quarters reported self-management of their allergies with oral antihistamines. Compared to males, females sought significantly more medical support, medications and allergen avoidance strategies. Knowledge about allergy increased the likelihood of treatment under supervision of a medical expert than no treatment, as well as symptom severity and interaction between female gender and symptom severity. The attitude of not considering allergy as a serious disease significantly reduced the likelihood of undergoing specific immunotherapy. This survey not only highlights the negative impact of pollen allergies on everyday life of allergics, but also that allergies are often neglected and untreated because of their trivialization by allergic subjects themselves.

The impact of pediatric atopic dermatitis on families: A review.

Atopic dermatitis (AD) is an extremely common childhood disease, with considerable impact on the quality of life of affected children and their families. While pruritus is the hallmark symptom of this disease, AD has been well-documented to impact patients beyond physical symptoms, resulting in behavior problems, mood disorders, and sleep disturbance. This literature review outlines how atopic dermatitis impacts the quality of life of families of children affected by AD. A total of 3436 articles were identified via an online search of the MEDLINE health literature database and were screened for relevance to quality of life impacts on families with children affected by AD. Caring for children affected by AD can be an extremely time-consuming task that can impair personal relationships, decrease psychosocial functioning, and cause sleep loss among family members of affected patients. Additionally, AD may result in work absence or decreased work productivity for caregivers. Special diets, irritant and allergen avoidance strategies, and alternative therapies are commonly used by patients to manage their disease and require large amounts of family involvement. Atopic dermatitis can greatly decrease quality of life of families of affected children in various domains, including sleep, finances, and relationships. Early intervention and psychotherapy may be needed in some patients to address these quality of life impairments.

How to manage food allergy in nursery or school.

The aim of this review is to describe effective management strategies in nursery or school based upon research findings. The prevalence of food allergy and number of emergency department visits for food-related anaphylaxis are increasing in children and adolescents. As there is currently no cure, the most effective strategy to decrease allergic reactions is food allergen avoidance. However, allergic reactions are inevitable in both food allergic children as well as in first-time reactors. Misconceptions exist on the safety of products with advisory labels and questions remain on whether school-wide bans decrease the risk of allergic reactions in school. Recent legislation has prompted schools to consider requiring unassigned epinephrine autoinjectors to better manage those who have allergic reactions in nursery or school. A collective effort is required to keep children with food allergies safe at school. Families, healthcare providers, and school personnel should be informed on food allergen avoidance strategies, symptoms consistent with allergic reactions and anaphylaxis, how to respond to allergic reactions, and the impact the diagnosis of food allergy may have on quality of life for affected children and their families.

Both children and adult patients with difficult-to-treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized.

BackgroundConcomitant allergic contact dermatitis (ACD) has been described as a possible cause of atopic dermatitis (AD) becoming difficult‐to‐treat. However, contact sensitization in this patient group has barely been studied.ObjectiveTo study the occurrence of ACD in a population of difficult‐to‐treat AD children and adults.MethodsClinical and patch test information of 48 patients with difficult‐to‐treat AD unresponsive to conventional outpatient treatments was gathered retrospectively. We studied prevalence and relevance of common allergens, performed dynamic patch test analysis and assessed occurrence of polysensitization.ResultsIn 48 patients with difficult‐to‐treat AD, 75% (n = 36/48) had a concomitant contact allergy, and 39% (n = 14/36) of these patients were polysensitized. ACD and polysensitization prevalences were equal amongst children and adults. The most frequent and relevant reactions were seen against wool alcohols, surfactants cocamidopropyl betaine and dimethylaminopropylamine, bichromate and fragrance mix I. Dynamic pattern analysis showed these reactions to be mostly allergic and not irritative of nature.ConclusionDifficult‐to‐treat AD patients frequently suffer from concomitant (multiple) contact allergies, and this may be a reason why the AD turns into a difficult‐to‐treat disease. Awareness of this phenomenon is necessary, as pragmatic implementation of allergen avoidance strategies may be helpful in getting disease control in this population.

266 Nickel coreactions and polysensitization to metals in adults

Allergic contact dermatitis to metals is a significant clinical and public health problem. Some patients may be sensitized to multiple metals, thereby complicating allergen avoidance strategies by patients and manufacturers. However, little is known about the frequency and predictors of polysensitization to metals. We sought to determine the frequency of ≥1 metal coreactions to nickel and metal polysensitization (positive reactions to ≥2 different metals). We performed a retrospective chart review of 484 adults (age ≥ 18, mean±sd: 46.7±14.6 years), who were patch-tested at the Northwestern Medicine patch-testing clinic from 2014-2017. Patients were patch-tested with the North American Contact Dermatitis Group (NACDG) standard series and supplemental metal series if indicated. Positive patch test reactions to ≥ 1 metal allergen were observed in 210 (43.3%) of patients, with nickel (19.1%), gold (11.8%) and palladium (11.1%) being most common. Among patients with positive reactions to nickel, 38.0%, 16.3% and 2.2% had positive reactions to 1, 2 or 3 additional metals, respectively. Overall, polysensitization to metals occurred in 13.9% of patients. In multivariable multinomial logistic regression models, polysensitization to metal allergens was associated with female sex (adjusted odds ratio [95% confidence interval]: 10.23 [2.38-43.98]) and polysensitization to non-metal allergens (2.07 [1.01-4.23]), inversely associated with older age (0.94 [0.92-0.97]), but not associated with non-white race/ethnicity (1.24 [0.62-2.48]) or birthplace outside the US (1.11 [0.48-2.55]). These results suggest that nickel-sensitized patients have high rates of metal co-reactions, and that polysensitization to metals is common. These results may help guide future strategies for allergen avoidance.

Consultation with registered dietitian to prevent accidental reactions to food: insight from an egg allergy influenza vaccination cohort.

Egg is an ubiquitous allergen found in many food products. Current food allergy guidelines recognize the importance of consultation with a registered dietitian to ensure nutritional adequacy. However, there is a lack of evidence on its impact on the implementation of allergen avoidance strategies. Taking advantage of a well-characterized cohort of influenza vaccination in egg-allergic children (n=397), we tested the hypothesis that real-life professional dietary advice was associated with a decrease in accidental reactions to egg in allergic children with retrospective questionnaires. Lack of consultation with a dietitian was associated with a 1.89-fold increase in the risk of accidental reactions to egg (confidence interval: 1.47-2.42). The only other independent variable that predicted reactions was having had a history of acute reaction to egg prior diagnosis (relative risk=2.02; confidence interval: 1.64-3.00). These findings support the usefulness of referral to a food allergy-specialized dietitian at time of diagnosis in order to prevent future accidental reactions to egg.

Skin Prick Test Reactivity to Aeroallergens in Allergic Rhinitis Children in Guangzhou, Southern China

This retrospective study reviewed skin prick test (SPT) positive results to various aeroallergens among 2136 children with allergic rhinitis (AR) in Guangzhou City, Southern China. Most (74.67%) of the 2136 children who underwent skin test showed positive reaction to 2-4 allergens. The allergen group with the highest positive incidence was Dermatophagoides pteronyssinus (der.p.) at 93.16%, followed by Dermatophagoides farinae (der.f.) at 86.23%, Tropical mites at 40.73%, Cat hair at 20.32% and Blattella germanica at 19.62%. Dust mites (der.p. & der.f) yielded strong positive reaction trend on AR children. The positive rate of der.p.,Cat hair and Blattella germanica was higher in school children group than preschool children group. Except for Blattella germanica, sensitization to every tested allergen varied in four season groups. These allergens should be given the highest priority when making the allergen avoidance strategies for AR children.

New approaches to the prevention of childhood atopic dermatitis

There has been a steep rise in the burden of atopic dermatitis (AD), and up to 20% of children in developed countries now suffer of the disease. At present, treatment at best achieves symptom control rather than cure, and there is a strong need to identify new methods of disease prevention. While earlier approaches focused on allergen avoidance strategies, there has been a clear shift towards attempts to induce tolerance and enhancement of skin barrier function, as skin barrier breakdown plays an important role in AD development. This article reviews the latest developments in the prevention of AD.

Allergic rhinitis: guide to diagnosis, allergen avoidance and treatment

AbstractAllergic rhinitis can lead to reduced quality of life and productivity at work and school and is a major risk factor for poor asthma control. Our Drug review discusses diagnosis, allergen avoidance strategies and the available drug treatments, followed by a review of the prescription data and sources of further information.

The strategies that peanut and nut‐allergic consumers employ to remain safe when travelling abroad

BackgroundAn understanding of the management strategies used by food allergic individuals is needed as a prerequisite to improving avoidance and enhancing quality of life. Travel abroad is a high risk time for severe and fatal food allergic reactions, but there is paucity of research concerning foreign travel. This study is the first to investigate the experiences of, and strategies used by peanut and tree nut allergic individuals when travelling abroad.MethodsThirty-two adults with a clinical history of reaction to peanuts or tree nuts consistent with IgE-mediated allergy participated in a qualitative interview study.ResultsTravel abroad was considered difficult with inherent risks for allergic individuals. Many participants recounted difficulties with airlines or restaurants. Inconsistency in managing allergen avoidance by airlines was a particular risk and a cause of frustration to participants. Individuals used a variety of strategies to remain safe including visiting familiar environments, limiting their activities, carrying allergy information cards in the host language, preparing their own food and staying close to medical facilities.ConclusionsParticipants used a variety of allergen avoidance strategies, which were mostly extensions or modifications of the strategies that they use when eating at home or eating-out in the UK. The extended strategies reflected their recognition of enhanced risk during travel abroad. Their risk assessments and actions were generally well informed and appropriate. A need for airline policy regarding allergy to be declared and adhered to is needed, as is more research to quantify the true risks of airborne allergens in the cabin. Recommendations arising from our study are presented.

Skin prick test reactivity to aeroallergens in Jordanian allergic rhinitis patients

Identification of the most common aeroallergens to which patients are sensitized in a specific area is important in the diagnosis and treatment of allergic rhinitis. The aim of this cross-sectional study was to investigate the pattern of skin prick test reactivity to various aeroallergens among allergic rhinitis patients attending outpatient clinics in Amman, Jordan. Skin prick test with 18 standardized allergen extracts was performed on 538 patients. Most allergic rhinitis patients in the study sample had polysensitization. Grasses mix (51.4% of patients), thistleweed (46.9%) and olive tree (45.3%) pollens were the most common allergens in this group of patients (all seasonal). Cat allergen was the most common perennial allergen (41.6%), followed by dust mite Dermatophagoides pteronyssinus (32.9%). These allergens should be given the highest priority when educating allergic rhinitis patients in Amman regarding allergen avoidance strategies.

Industrial Fungal Enzymes: An Occupational Allergen Perspective

Occupational exposure to high-molecular-weight allergens is a risk factor for the development and pathogenesis of IgE-mediated respiratory disease. In some occupational environments, workers are at an increased risk of exposure to fungal enzymes used in industrial production. Fungal enzymes have been associated with adverse health effects in the work place, in particular in baking occupations. Exposure-response relationships have been demonstrated, and atopic workers directly handling fungal enzymes are at an increased risk for IgE-mediated disease and occupational asthma. The utilization of new and emerging fungal enzymes in industrial production will present new occupational exposures. The production of antibody-based immunoassays is necessary for the assessment of occupational exposure and the development of threshold limit values. Allergen avoidance strategies including personal protective equipment, engineering controls, protein encapsulation, and reduction of airborne enzyme concentrations are required to mitigate occupational exposure to fungal enzymes.

Diagnosis, allergen avoidance and treatment of allergic rhinitis

AbstractAllergic rhinitis is common and increasing in prevalence, but it is often undertreated and its effect on quality of life often underestimated. Our Drug review discusses the available treatments as well as diagnosis and allergen avoidance strategies, followed by a review of the prescription data and sources of further information. Copyright © 2009 Wiley Interface Ltd

Human hair is a potential source of cat allergen contamination of ambient air

We have previously shown that airborne cat allergen levels are significantly lower in school classes using special school clothing or in classes with no pet owners. However, cat allergen is present and the levels are in fact two- to threefold higher on cat owners' than noncat owners' school clothing which is used, washed and stored at school only. This suggests that allergen is transferred to schools by routes other than clothing. To analyse levels of cat allergen (Fel d 1) in hair from cat owners and noncat owners among children and adults. Samples of unwashed hair (> or =1 day prior to sampling) from adults and children with (n = 22) or without (n = 22) cats at home were collected at a hairdresser. In addition, samples of newly washed hair (adults only, n = 11) were collected. The hair sample was extracted and analysed for Fel d 1 content with ELISA. The geometric mean levels were more than two orders of magnitude higher in unwashed hair from cat owners, compared with noncat owners (P < 0.0001) and more than 10-fold higher in newly washed hair from adults. The allergen contamination of unwashed hair among noncat owners appeared higher in children than in adults (P = 0.045). Hair may be an important source for transfer and deposition of cat allergen in schools and may explain why cat allergen is found in environments with strict allergen avoidance measures. Although it may be unrealistic to apply allergen avoidance strategies against this allergen source, it is important to be aware of it.

Allergen sensitization and bronchial hyper-responsiveness to adenosine monophosphate in asthmatic patients.

Indirect bronchoprovocation using adenosine monophosphate (AMP) is related to atopic phenotype expression. To evaluate the putative relationship between skin prick allergen sensitization and bronchial hyper-responsiveness to AMP in a retrospective cross-sectional database analysis. We retrospectively evaluated two groups of non-smoking asthmatics (forced expiratory volume in 1 s (FEV)1>/=60% predicted) who were reactive (responders) or unreactive (controls) to inhaled AMP. The main outcome measure was the difference in sensitization to individual allergens and the total atopic load according to the presence or absence of bronchial hyper-responsiveness. We initially identified 180 (44%) non-smoking asthmatics with PC20</=200 mg/mL, while 233 (56%) had PC20>/=1600 mg/mL. For those who had a skin prick test, the responders (n=151) and controls (n=151) were found to be matched for age, sex, inhaled corticosteroid dose and number of patients using inhaled corticosteroids. There were significant differences in the number of responders vs. controls in terms of sensitization to house dust mite (77% vs. 62%, P=0.004), aspergillus (19% vs. 9%, P=0.014), cat (61% vs. 48%, P=0.028), total atopic load (493 vs. 380 positive tests, P<0.001) and forced mid-expiratory flow (60% vs. 68% predicted, P<0.001). Sensitization to common aeroallergens increased the likelihood of bronchial inflammation as reflected by bronchial hyper-responsiveness to inhaled AMP, independently of both FEV1 or inhaled corticosteroid use. This in turn suggests an association between allergen exposure and AMP responsiveness in asthmatics. Further prospective long-term evaluation is indicated to assess whether allergen avoidance strategies can modify the airway response.

Clothing–Potentially a Significant Source of Endotoxin Exposure

Clothing–Potentially a Significant Source of Endotoxin Exposure

Maternal allergen immunization during pregnancy in a mouse model reduces adult allergy-related antibody responses in the offspring.

The immune status and allergen exposure of the mother may influence the immune response in the offspring after birth. This relationship may be important both for allergen avoidance strategies and, alternatively, for allergy prophylaxis by allergen exposure of the mother. The aim of the present study was to investigate the effect of allergen immunization of the mother during pregnancy and postpartum, in relation to the allergy-related immune response (IgE) and the non-allergy-related (IgG2a) response in the offspring. Pregnant NIH/OlaHsd females were immunized three times during pregnancy and one time postpartum with ovalbumin and the adjuvant Al(OH)3, and the offspring's ovalbumin-specific IgE, IgG1 and IgG2a responses were measured after challenge with the same allergen as young adults. Ovalbumin-specific IgE, IgG1 and IgG2a responses were also analysed in offspring of NIH/OlaHsd females immunized once at different times during pregnancy: about 3 days into pregnancy, mid-pregnancy (10 days into pregnancy) and about 4 days before giving birth (17 days into pregnancy). Allergen immunization of mother during pregnancy and postpartum significantly reduced the IgE response in the progenies, whereas the IgG2a response to the same allergen was increased. Allergen immunization of the mother 3 days into pregnancy resulted in a significantly lower IgE response in offspring compared with the response in offspring of non-immunized mothers and in offspring of mothers immunized 17 days into pregnancy. Maternal allergen immunization might favour selection for an allergen-specific Th1-dependent antibody response in the offspring. Our results indicate that IgE suppression is stronger after maternal allergen exposure during early pregnancy than after exposure in late pregnancy.

Avoidance of allergens and air pollutants in respiratory allergy

Avoidance of allergens and air pollutants in respiratory allergy

Do Asthmatics Benefit from House Dust Mite Allergen Avoidance Strategies?: Results of a Systematic Review of the Literature ♦ 22

We conducted a systematic review to determine if asthmatics who are sensitive to house dust mites (HDM) benefit from HDM allergen avoidance strategies. Using MEDLINE, a review of bibliographies, and references supplied by international experts in entomology and pediatric allergy, we identified 764 titles of English language articles, published between January, 1966 and July, 1997, which possibly included information about allergen avoidance strategies for HDM. Two investigators (MC, PE) independently reviewed the full bibliographic citation of each of the 764 candidate articles and identified 112 articles for further review. The full text of each of the 112 articles was read by two independent reviewers (MC, JZ) to identify randomized controlled trials which met the following criteria: presence of original data, intervention duration longer than eight weeks, washout period of at least four weeks for crossover trials, and a history of asthma with objective evidence of HDM sensitivity in the study population. Differences between the reviewers were resolved by consensus (MC, JZ, PE). 18 articles met the above inclusion criteria and included one or a combination of the following interventions: chemical control measures (13 articles), impermeable covers (9), aggressive cleaning (8), and/or humidity reduction (2). Studies also varied in their exclusion of study patients (i.e. severity of asthma, pet ownership, and/or tobacco exposure), as well as selection of outcome measurements, such as HDM allergen levels (12), HDM counts (5), house dust weight (3), subjective symptom scores (9), medication use (6), physician's assessment (1), lung function tests (12) and histamine/methacholine challenge tests (10). The 18 accepted articles differed in their conclusions regarding the benefit of HDM allergen avoidance measures. We conclude that the heterogeneity of interventions, exclusion criteria, and outcome measures prevents combining data among studies to calculate overall summary measures of intervention effectiveness. Furthermore, the studies suggesting a clinical benefit are qualitatively different from negative studies, since they tend to have more explicit protocols to monitor patient compliance, and tend to exclude patients on chronic steroids, patients with recent hospitalizations, and patients who own pets.