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Pham DL, Le KM, Truong DDK, Le HTT, Trinh THK. Environmental allergen reduction in asthma management: an overview. FRONTIERS IN ALLERGY 2023; 4:1229238. [PMID: 37868650 PMCID: PMC10587592 DOI: 10.3389/falgy.2023.1229238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Asthma is a prevalent non-communicable disease that affects both children and adults. Many patients with severe, uncontrolled asthma could not achieve total control despite using anti-asthmatic drugs. There is increasing evidence that allergy to environmental allergens, including both indoor and outdoor allergens, is associated with asthma symptoms and severe asthma. Frequently reported sensitized allergens were dust mites, cockroaches, grass pollens, molds, pets, and rodents in allergic asthma patients, although the patterns of widespread allergens differed from each country. Allergen avoidance is the cornerstone of asthma management, especially in sensitized subjects. This review summarizes environmental allergen avoidance and clarifies their effects on asthma control. Despite contrasting results about the impact of allergen exposure reduction on asthma control, several studies supported the beneficial effects of reducing asthma-related symptoms or risk of exacerbations as a nondrug therapy. Identifying environmental allergens is helpful for asthma patients, and further studies on clinically effective avoidance methods are required.
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Affiliation(s)
- Duy Le Pham
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kieu-Minh Le
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Diem D. K. Truong
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Huyen T. T. Le
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tu H. K. Trinh
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Landgraf-Rauf K, von Mutius E. Effective Ways to Prevent Allergic Diseases: Where Do We Stand? Handb Exp Pharmacol 2021; 268:437-448. [PMID: 34196812 DOI: 10.1007/164_2021_497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Since allergic diseases are of great public health relevance, effective primary prevention strategies are urgently needed. This chapter gives an overview of existing primary prevention programs on environmental exposures and dietary strategies based on epidemiological studies which have defined risk- and protective factors for the development of allergic diseases.The allergy protective effect mediated by growing up on a traditional farm environment is well studied. But the exact underlying mechanisms have still not been fully clarified and have not yet led to concrete prevention strategies. The beneficial effect of avoiding cigarette smoke exposure, indoor moisture and molds in pregnancy and childhood on the development of asthma is well documented. Whereas the avoidance of house dust mite exposure is not recommended to prevent eczema or allergy. Dietary supplementation with vitamins, pre- and probiotics in pregnant woman and their offspring is not harmful but evidence for the prevention of allergic diseases is still lacking. Fish oil consumption was shown to be asthma protective. The early introduction of peanuts and egg protein to prevent peanut and egg allergy in children with atopic dermatitis is promising. Further studies are needed to increase the overall evidence in allergy prevention. Most studies lack methodological standards such as randomization and blinding. More evidence is in demand on the potential beneficial impact of multifaceted interventional studies. The future of allergy prevention strategies might be based on individual risk assessment. Therefore, research in the immunological and molecular basis of allergic diseases needs to be promoted.
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Affiliation(s)
- Katja Landgraf-Rauf
- Department of Dermatology and Allergology, Cluster Allergy and Immunity, School of Medicine, Technical University of Munich, Munich, Germany
| | - Erika von Mutius
- Helmholtz Centre Munich - German Research Center for Environmental Health, Institute for Asthma and Allergy Prevention, Munich, Germany. .,Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Institute for Asthma and Allergy Prevention, Munich, Germany. .,Member of the German Center for Lung Research, Munich, Germany.
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3
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Conrad L, Perzanowski MS. The Role of Environmental Controls in Managing Asthma in Lower-Income Urban Communities. Clin Rev Allergy Immunol 2020; 57:391-402. [PMID: 30903438 DOI: 10.1007/s12016-019-08727-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Children living in lower-income urban communities are at much greater risk of developing asthma, going to the emergency department for an asthma attack and being hospitalized for asthma than children living in upper- and middle-income communities. For many asthmatic children living in urban communities, especially those with greater morbidity, the allergic pathway is important in the etiology of the disease. The stages of developing allergic disease can be divided into the onset of allergic sensitization, development of allergic disease and subsequent exacerbations, and it is useful to consider the relevance of interventions at each of these stages. Indoor allergens and environmental exposures are a major contributor to allergic disease, particularly among lower socioeconomic status, urban, minority communities. These exposures include allergens, environmental tobacco smoke, combustion by-products, and mold, all of which can play an important role in asthma progression as well as morbidity. These exposures are often not found in isolation and thus these concomitant exposures need to be considered when conducting environmental interventions. There have been numerous studies looking at both primary and tertiary prevention strategies and the impact on allergic sensitization and asthma with varied results. While the outcomes of these studies have been mixed, what has emerged is the need for tertiary interventions to be targeted to the individual and to reduce all relevant exposures to which an asthmatic child is exposed and sensitized. In addition, effective intervention strategies must also consider other social determinants of asthma morbidity impacting low socioeconomic, urban communities.
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Affiliation(s)
- Laura Conrad
- Division of Pulmonology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, 11th floor, New York, NY, 10032, USA.
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van Boven FE, de Jong NW, Braunstahl GJ, Gerth van Wijk R, Arends LR. A meta-analysis of baseline characteristics in trials on mite allergen avoidance in asthmatics: room for improvement. Clin Transl Allergy 2020; 10:2. [PMID: 31921410 PMCID: PMC6943957 DOI: 10.1186/s13601-019-0306-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence regarding the clinical effectiveness of mite allergen avoidance for the treatment of asthma is lacking. In previous meta-analyses on mite allergen control, the baseline data were not discussed in detail. This study updates and extends the existing Cochrane review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187), with a focus on baseline asthma outcomes and allergen exposures. METHODS We used the existing trials in the original Cochrane review and included newly published studies. The baseline data for the mite allergen load from the mattress, the standardized asthma symptom score (ASS), the forced expiratory volume in 1 s percentage of predicted (FEV1 %pred.), and the histamine provocative concentration causing a 20% drop in FEV1 (PC20) were extracted. First, the mean values of the outcomes were calculated. The influence of the mite allergen load was examined with a random-effect meta-regression using the Metafor package in R. RESULTS Forty-five trials were included; 39 trials reported strategies for concurrent bedroom interventions, and 6 trails reported strategies for air purification. The mite allergen load ranged from 0.44 to 24.83 μg/g dust, with a mean of 9.86 μg/g dust (95% CI 5.66 to 14.05 μg/g dust, I2 = 99.8%). All health outcomes showed considerable heterogeneity (standardized ASS mean: 0.13, 95% CI 0.08 to 0.18, I2 = 99.9%; FEV1 %pred. mean: 85.3%, 95% CI 80.5 to 90.1%, I2 = 95.8%; PC20 mean: 1.69 mg/mL, 95% CI 0.86 to 2.52 mg/mL, I2 = 95.6%). The covariate mite allergen load did not significantly influence health outcomes. DISCUSSION This meta-analysis shows that mite avoidance studies are characterized by the inclusion of patients with rather mild to moderate asthma and with varying and sometimes negligible levels of allergen exposure. Future studies should focus on patients with severe asthma and increased levels of allergen exposure.
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Affiliation(s)
- Frank E. van Boven
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Nicolette W. de Jong
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Sint Franciscus Vlietland Groep, P.O. Box 10900, 3004 BA Rotterdam, The Netherlands
- Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Lidia R. Arends
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Zhao Q, Yang C, Tang S, Zhao Y, Dou H, Chen Y, Lu Y, Tao L. Developing and Testing the Reliability and Validity of the Brief Haze Weather Health Protection Behavior Assessment Scale-Adolescent Version (BHWHPBAS-AV). Front Pediatr 2020; 8:498885. [PMID: 33072666 PMCID: PMC7536278 DOI: 10.3389/fped.2020.498885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To develop a Brief Haze Weather Health Protection Behavior Assessment Scale-Adolescent Version (BHWHPBAS-AV). Methods: Considering primary prevention, secondary prevention and tertiary prevention as a theoretical basis, researchers developed a Brief Haze Weather Health Protection Behavior Assessment Scale-Adolescent Version-I(BHWHPBAS-AV-I). After performing 6 reviews by related experts, and after conducting six adolescent tests for BHWHPBAS-AV-I, researchers developed an updated BHWHPBAS-AV-II. Out of the 20 districts in Baoding, two districts were randomly selected; moreover, two middle schools from these two districts were also randomly selected. Considering one class as a unit, researchers subsequently randomly selected 22 classes by using stratified sampling. In the end, 1,025 valid questionnaires were used as part of the study. At which point, researchers investigated the validity and reliability of the scale and obtained the final scale (BHWHPBAS-AV). Results: BHWHPBAS-AV Cronbach's α = 0.878, content validity = 0.948, and factor cumulative contribution rate = 54.058% using exploratory factor analysis. By confirmatory factor analysis, Chi square value (χ2) = 271.791, degrees of freedom (df) = 94, Chi square value/degrees of freedom (χ2/df) = 2.891, root-mean-square error of approximation (RMSEA) = 0.051, normed fit index (NFI) = 0.930, incremental fit index (IFI) = 0.953, goodness of fit index (GFI) = 0.955, Tueker-Lewis index (TLI) = 0.940, comparative fit index (CFI) = 0.953. BHWHPBAS-AV was composed of 16 items as well as 3 dimensions. Conclusions: A BHWHPBAS-AV scale that has an acceptable reliability and validity can be applied to assess adolescent haze weather health protection behavior, and can also help school teachers, as well as medical staff working in community health care institutions, to perform targeted behavioral interventions and deliver health education programs to adolescents.
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Affiliation(s)
- Qingchun Zhao
- Outpatient Department, Operating Room, Blood Transfusion Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Chun Yang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Shanshan Tang
- Outpatient Department, Operating Room, Blood Transfusion Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Yuejia Zhao
- Outpatient Department, Operating Room, Blood Transfusion Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Hongzhe Dou
- Outpatient Department, Operating Room, Blood Transfusion Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Yanhong Chen
- Outpatient Department, Operating Room, Blood Transfusion Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Yanrong Lu
- United Front Department, Hebei University, Baoding, China
| | - Lingwei Tao
- School of Public Health, Peking University, Beijing, China
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6
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Hawiger J, Zienkiewicz J. Decoding inflammation, its causes, genomic responses, and emerging countermeasures. Scand J Immunol 2019; 90:e12812. [PMID: 31378956 PMCID: PMC6883124 DOI: 10.1111/sji.12812] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/03/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022]
Abstract
Inflammation is the mechanism of diseases caused by microbial, autoimmune, allergic, metabolic and physical insults that produce distinct types of inflammatory responses. This aetiologic view of inflammation informs its classification based on a cause‐dependent mechanism as well as a cause‐directed therapy and prevention. The genomic era ushered in a new understanding of inflammation by highlighting the cell's nucleus as the centre of the inflammatory response. Exogenous or endogenous inflammatory insults evoke genomic responses in immune and non‐immune cells. These genomic responses depend on transcription factors, which switch on and off a myriad of inflammatory genes through their regulatory networks. We discuss the transcriptional paradigm of inflammation based on denying transcription factors’ access to the nucleus. We present two approaches that control proinflammatory signalling to the nucleus. The first approach constitutes a novel intracellular protein therapy with bioengineered physiologic suppressors of cytokine signalling. The second approach entails control of proinflammatory transcriptional cascades by targeting nuclear transport with a cell‐penetrating peptide that inhibits the expression of 23 out of the 26 mediators of inflammation along with the nine genes required for metabolic responses. We compare these emerging anti‐inflammatory countermeasures to current therapies. The transcriptional paradigm of inflammation offers nucleocentric strategies for microbial, autoimmune, metabolic, physical and other types of inflammation afflicting millions of people worldwide.
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Affiliation(s)
- Jacek Hawiger
- Immunotherapy Program at Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Veterans Affairs, Tennessee Valley Health Care System, Nashville, TN, USA.,Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jozef Zienkiewicz
- Immunotherapy Program at Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Veterans Affairs, Tennessee Valley Health Care System, Nashville, TN, USA
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7
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Abstract
Food allergy and allergic rhinitis are childhood diseases with special relevance to the pediatric otolaryngologist. Much of the diagnosis of food allergy can be made on history alone; strict avoidance is the mainstay treatment. Skin prick testing and serum-specific IgE testing play a stronger role in allergic rhinitis diagnosis. If pharmacotherapy fails, allergen immunotherapy is an option. Currently, there is intense investigation on diagnostic tests, novel treatments, and prevention strategies that could dramatically affect the way these diseases are identified and managed. This article summarizes the epidemiology, pathophysiology, diagnosis, and management of food allergy and allergic rhinitis.
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Affiliation(s)
- Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Outpatient Center, 6th Floor, 601 North Caroline Street, Baltimore, MD 21287-0910, USA
| | - Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Outpatient Center, 6th Floor, 601 North Caroline Street, Baltimore, MD 21287-0910, USA.
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8
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van Boven FE, Arends LR, Braunstahl G, van Wijk RG. A reintroduction of environmental mite allergen control strategies for asthma treatment and the debate on their effectiveness. Clin Exp Allergy 2019; 49:400-409. [PMID: 30659677 PMCID: PMC6850033 DOI: 10.1111/cea.13340] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 12/19/2022]
Abstract
Asthma affects three hundred million people worldwide. The effectiveness of house dust mite allergen control for asthma treatment is debatable. One aspect that has been little discussed in existing meta-analyses is the possible role of environmental strategies. Here, we reintroduce the previously defined strategies for mite allergen control and discuss their importance to the debate on clinical effectiveness. The strategy of concurrent bedroom interventions is related to the combined use of a priori defined interventions, while the strategy of exposure-based control relates to the treatment of relevant textiles after assessing exposure. The air purification strategy aims to purify the human breathing zone of airborne allergens. In Western European patient practice, the use of these strategies differs. A post hoc study of the dominant Cochrane review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187) appears to indicate that a majority of the underlying trials reported on the strategy of concurrent bedroom interventions, which were mainly executed in a minimal manner. Some trials have reported on the air purification strategy and may potentially alter the debate on effectiveness. No trial has reported on the strategy of exposure-based control. We therefore hypothesize that the absence of evidence for the effectiveness of mite allergen control for asthma treatment applies to the strategy of concurrent bedroom interventions. The evidence-based effectiveness of the exposure-based control strategy appears to be undetermined. The results of our post hoc reanalysis urge that future meta-analyses of mite allergen control should a priori define the environmental strategy under study. Future trials of mite allergen control are warranted to test the exposure-based strategy as well as the sparsely tested strategy of air purification.
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Affiliation(s)
- Frank E. van Boven
- Department of Internal MedicineSection of AllergologyErasmus Medical CenterRotterdamThe Netherland
| | - Lidia R. Arends
- Department of BiostatisticsErasmus Medical CenterRotterdamThe Netherlands
- Department of Psychology, Education & Child StudiesErasmus University RotterdamRotterdamThe Netherlands
| | - Gert‐Jan Braunstahl
- Department of PulmonologySint Franciscus Vlietland GroepRotterdamThe Netherlands
- Department of PulmonologyErasmus Medical CenterRotterdamThe Netherlands
| | - Roy Gerth van Wijk
- Department of Internal MedicineSection of AllergologyErasmus Medical CenterRotterdamThe Netherland
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9
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Jeon YH, Lee YJ, Sohn MH, Lee HR. Effects of Vacuuming Mattresses on Allergic Rhinitis Symptoms in Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:655-663. [PMID: 31332977 PMCID: PMC6658412 DOI: 10.4168/aair.2019.11.5.655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effects of daily vacuuming of mattresses on the concentration of house dust mite (HDM) allergens and on allergic rhinitis (AR) symptoms in children sensitized to HDM. METHODS Forty children between the ages of 6 and 12 years with mild persistent AR and sensitized only to HDM were enrolled and randomly allocated to 2 groups. Caregivers of children in the experimental group cleaned the children's rooms and vacuumed their mattresses daily for 2 weeks. Caregivers of children in the control group cleaned the children's rooms without vacuuming mattresses. Symptoms of AR were checked weekly and dust samples were collected from the mattresses before and after the study. RESULTS Demographics at the beginning of the study were not significantly different between the 2 groups. In the experimental group, symptoms of AR and dust weight were significantly decreased after 2 weeks (total symptoms of AR, P <0.001; sneezing, P < 0.001; rhinorrhea, P <0.001; nasal obstruction, P < 0.001; itching, P <0.001; and dust weight, P = 0.006). The concentrations of HDM allergens were not changed significantly (Der p1, P = 0.333; Der f1, P = 0.841). In the control group, there were no significant changes in symptoms of AR, dust weight, or the concentration of HDM allergens. CONCLUSIONS Our findings showed that daily vacuuming of mattresses reduced dust weight and symptoms of AR. However, the concentration of HDM allergens did not significantly decrease.
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Affiliation(s)
- You Hoon Jeon
- Department of Pediatrics, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea.,Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Hwaseong, Korea
| | - Yong Ju Lee
- Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Hwaseong, Korea.,Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.,Department of Medicine, Graduate School, Yonsei University, Seoul, Korea.
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Ran Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
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Salo PM, Zeldin DC. Mite-impermeable bedding casings and severe asthma exacerbations. J Pediatr 2018; 192:266-269. [PMID: 29246350 DOI: 10.1016/j.jpeds.2017.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Päivi M Salo
- National Institute of Health Research Triangle Park, North Carolina
| | - Darryl C Zeldin
- National Institute of Health Research Triangle Park, North Carolina
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11
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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; 140:565-570. [PMID: 28108117 DOI: 10.1016/j.jaci.2016.10.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/11/2016] [Accepted: 10/26/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Exposure to cockroaches is an important asthma trigger, particularly for children with asthma living in inner cities. Integrated pest management is the recommended approach to cockroach abatement; however, it is costly and difficult to implement. The impact of reducing cockroach exposure on asthma outcomes is not known. OBJECTIVE We sought to test the use of a single intervention, insecticidal bait, to reduce cockroach exposure in the home of children with asthma in New Orleans and to examine the impact of cockroach reduction on asthma outcomes. METHODS One hundred two children aged 5 to 17 years with moderate to severe asthma were enrolled in a 12-month randomized controlled trial testing the use of insecticidal bait on cockroach counts and asthma morbidity. Homes were visited 6 times and asthma symptoms were assessed every 2 months. RESULTS After adjustment, intervention homes had significantly fewer cockroaches than did control homes (mean change in cockroaches trapped, 13.14; 95% CI, 6.88-19.39; P < .01). Children in control homes had more asthma symptoms and unscheduled health care utilization in the previous 2 weeks (1.82, 95% CI, 0.14-3.50, P = .03; 1.17, 95% CI, 0.11-2.24, P = .03, respectively) and a higher proportion of children with FEV1 of less than 80% predicted (odds ratio, 5.74; 95% CI, 1.60-20.57; P = .01) compared with children living in intervention homes. CONCLUSIONS Previous research has demonstrated improvement in asthma health outcomes using multifaceted interventions. The strategic placement of insecticidal bait, which is inexpensive, has low toxicity, and is widely available, resulted in sustained cockroach elimination over 12 months and was associated with improved asthma outcomes. This single intervention may be an alternative to multifaceted interventions currently recommended to improve asthma morbidity.
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Affiliation(s)
- Felicia A Rabito
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, La.
| | - John C Carlson
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, La
| | - Hua He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, La
| | - Derek Werthmann
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, La
| | - Coby Schal
- Department of Entomology, North Carolina State University, Raleigh, NC
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12
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di Mauro G, Bernardini R, Barberi S, Capuano A, Correra A, de’ Angelis GL, Iacono ID, de Martino M, Ghiglioni D, Di Mauro D, Giovannini M, Landi M, Marseglia GL, Martelli A, Miniello VL, Peroni D, Sullo LRMG, Terracciano L, Vascone C, Verduci E, Verga MC, Chiappini E. Prevention of food and airway allergy: consensus of the Italian Society of Preventive and Social Paediatrics, the Italian Society of Paediatric Allergy and Immunology, and Italian Society of Pediatrics. World Allergy Organ J 2016; 9:28. [PMID: 27583103 PMCID: PMC4989298 DOI: 10.1186/s40413-016-0111-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/07/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Allergic sensitization in children and allergic diseases arising therefrom are increasing for decades. Several interventions, functional foods, pro- and prebiotics, vitamins are proposed for the prevention of allergies and they can't be uncritically adopted. OBJECTIVE This Consensus document was developed by the Italian Society of Preventive and Social Paediatrics and the Italian Society of Paediatric Allergy and Immunology. The aim is to provide updated recommendations regarding allergy prevention in children. METHODS The document has been issued by a multidisciplinary expert panel and it is intended to be mainly directed to primary care paediatricians. It includes 19 questions which have been preliminarily considered relevant by the panel. Relatively to each question, a literature search has been performed, according to the Italian National Guideline Program. Methodology, and a brief summary of the available literature data, has been provided. Many topics have been analyzed including the role of mother's diet restriction, use of breast/formula/hydrolyzed milk; timing of introduction of complementary foods, role (if any) of probiotics, prebiotics, vitamins, exposure to dust mites, animals and to tobacco smoke. RESULTS Some preventive interventions have a strong level of recommendation. (e.g., the dehumidifier to reduce exposure to mite allergens). With regard to other types of intervention, such as the use of partially and extensively hydrolyzed formulas, the document underlines the lack of evidence of effectiveness. No preventive effect of dietary supplementation with polyunsaturated fatty acids, vitamins or minerals has been demonstrated. There is no preventive effect of probiotics on asthma, rhinitis and allergic diseases. It has demonstrated a modest effect, but steady, in the prevention of atopic dermatitis. CONCLUSIONS The recommendations of the Consensus are based on a careful analysis of the evidence available. The lack of evidence of efficacy does not necessarily imply that some interventions may not be effective, but currently they can't be recommended.
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Affiliation(s)
- Giuseppe di Mauro
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Roberto Bernardini
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Salvatore Barberi
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Annalisa Capuano
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Antonio Correra
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Gian Luigi de’ Angelis
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Iride Dello Iacono
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Maurizio de Martino
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Daniele Ghiglioni
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Dora Di Mauro
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Marcello Giovannini
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Massimo Landi
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Gian Luigi Marseglia
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Alberto Martelli
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Vito Leonardo Miniello
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Diego Peroni
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Lucilla Ricottini Maria Giuseppa Sullo
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Luigi Terracciano
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Cristina Vascone
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Elvira Verduci
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Maria Carmen Verga
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
| | - Elena Chiappini
- Department of Sciences for Health Sciences, Anna Meyer Children’s University Hospital, University of Florence, Viale Pieraccini, 24, Florence, 50100 Italy
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Tsurikisawa N, Saito A, Oshikata C, Yasueda H, Akiyama K. Effective allergen avoidance for reducing exposure to house dust mite allergens and improving disease management in adult atopic asthmatics. J Asthma 2016; 53:843-53. [PMID: 27049597 DOI: 10.3109/02770903.2016.1155218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We investigated the best strategy for adult asthmatics to avoid exposure to Dermatophagoides group (Der-1) allergens. METHODS Adult atopic asthmatics (n = 111) followed a 32-item checklist for avoiding Der-1 allergen exposure. Twenty-five patients were excluded through incomplete sampling; 50 remaining patients encased their pillows/futons/mattresses in microfine-fiber covers, 13 used vacuum cleaners with dust-mite-collection nozzles, and 23 acted as non-intervention controls. During August-October 2010 and August-October 2011, dust samples were collected in Petri dishes placed in bedrooms for 2 weeks and from mattresses/futons by using adhesive tape on one morning. A Der-1 level decrease was defined as a mean 2011 Der-1 level of <1 as a ratio of the 2010 level on tape or Petri dish samples. We analyzed the associations between Der-1 level change (by ELISA) and % weekly variability in peak expiratory flow (PEF) or fraction of exhaled nitric oxide (FeNO) after intervention. RESULTS Der-1 levels decreased significantly in the covers group but not the vacuuming group. FeNO levels and PEF variability were unchanged in both groups. In patients whose Petri dish or tape samples showed decreased Der-1 levels, the % PEF variability was lower in 2011 than in 2010, but FeNO levels were unchanged. Three interventions (vacuuming all family members' mattress/futon surfaces at least weekly or after exposure of the futons to sunlight, and floor wiping before vacuuming), plus using covers, were the most effective management strategy in reducing Der-1 levels. CONCLUSIONS This environmental and bedding maintenance program may help manage adult atopic asthma.
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Affiliation(s)
- Naomi Tsurikisawa
- a Department of Allergy and Respirology , National Hospital Organization Sagamihara National Hospital , Kanagawa , Japan.,c Department of Respirology , National Hospital Organization Saitama Hospital , Saitama , Japan
| | - Akemi Saito
- b Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital , Kanagawa , Japan
| | - Chiyako Oshikata
- a Department of Allergy and Respirology , National Hospital Organization Sagamihara National Hospital , Kanagawa , Japan.,c Department of Respirology , National Hospital Organization Saitama Hospital , Saitama , Japan
| | - Hiroshi Yasueda
- b Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital , Kanagawa , Japan
| | - Kazuo Akiyama
- a Department of Allergy and Respirology , National Hospital Organization Sagamihara National Hospital , Kanagawa , Japan
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14
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Bremmer SF, Simpson EL. Dust mite avoidance for the primary prevention of atopic dermatitis: A systematic review and meta-analysis. Pediatr Allergy Immunol 2015; 26:646-54. [PMID: 26235650 PMCID: PMC10775895 DOI: 10.1111/pai.12452] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dust mite sensitization plays a controversial role in the development of atopic dermatitis. Despite a lack of evidence for its efficacy, dust mite avoidance is commonly recommended for the prevention and treatment of atopic dermatitis. We aimed to evaluate whether dust mite avoidance strategies reduce the risk of developing atopic dermatitis in high-risk infants compared to randomized controls. METHODS Studies were obtained by searching MEDLINE, PubMed, Scopus, The Cochrane Library, and The Global Resource of Eczema Trials databases. We included randomized, controlled trials of high-risk infants treated with a dust mite avoidance intervention and assessed for atopic dermatitis. Data were extracted independently by two reviewers using predefined criteria. RESULTS Seven randomized controlled trials met our inclusion criteria (total n = 3040). Studies were largely unblinded but otherwise of reasonable quality. Three trials utilizing a dust mite avoidance approach but not additional interventions were combined in a meta-analysis. Dust mite avoidance provided no benefit in the prevention of atopic dermatitis (relative risk (RR) = 1.08, 95% confidence interval (CI) = 0.78-1.49, I(2) = 73%). CONCLUSIONS Dust mite avoidance strategies alone or in combination with additional allergen avoidance modalities do not decrease the risk of developing atopic dermatitis and, given the current state of the evidence, should not be recommended for this purpose. The utility of dust mite avoidance for the treatment of atopic dermatitis or for the prevention and treatment of asthma or seasonal rhinoconjunctivitis are outside the scope of this review.
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Affiliation(s)
- Samuel F Bremmer
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
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15
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van Boven FE. Effectiveness of mite-impermeable covers: a hypothesis-generating meta-analysis. Clin Exp Allergy 2015; 44:1473-83. [PMID: 25048696 DOI: 10.1111/cea.12376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Asthma is a heterogeneous disease. The subject of mite allergen control has evolved into a debate dominated by a Cochrane review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187). A not well-discussed aspect of that study is the selection by those authors of a univariate meta-analysis including various interventions. This study extends the meta-analysis by Gøtzsche and Johansen and aims to generate hypotheses on the effectiveness of various bedding interventions, including the coverage of all bedding elements. Trials were selected based on environmental criteria. The interventions were classified according to the number of barriers used. Standardized mean differences yielded the mite load, three physiological outcomes and asthma symptom scores. The influence of covariates was examined with a mixed-effect model using the metafor package for meta-analysis in R. Twelve trials included 1187 observations. The interventions included one barrier or product (six trials), two barriers or partial control (four trials) and three barriers or integral control (two trials). The exposure data showed considerable heterogeneity (I(2) = 93%). The risk of bias significantly (P = 0.04) influenced the final load, the square root of the interaction between the baseline load and the type of intervention as well (95% CI: -0.66 to -0.07 μg/g; P = 0.02). Changes in load showed similar tendencies. Health outcomes showed moderate to considerable heterogeneity (physiological outcomes I(2) = 44-94%; symptom score I(2) = 93%). A meta-regression of bedding interventions indicates that integral control most significantly reduced mite load when the load was high at baseline. The number of trials was too small to allow an appropriate examination of health outcomes. Future studies are suggested to test the hypothesis that allergic patients benefit from integral control when the baseline mite load is high.
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Affiliation(s)
- F E van Boven
- Working Group on Allergen Avoidance, V&VN Lung Care Nurses, V&VN Dutch Nurses' Association, Utrecht, The Netherlands
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16
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Clarke D, Burke D, Gormally M, Byrne M. Dynamics of house dust mite transfer in modern clothing fabrics. Ann Allergy Asthma Immunol 2015; 114:335-40. [PMID: 25680836 DOI: 10.1016/j.anai.2014.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/23/2014] [Accepted: 12/30/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Clothing is largely presumed as being the mechanism by which house dust mites are distributed among locations in homes, yet little research to date has investigated the capacity with which various clothing fabric types serve as vectors for their accumulation and dispersal. Although previous research has indicated that car seats provide a habitat for mite populations, dynamics involved in the transfer of mites to clothing via car seat material is still unknown. OBJECTIVE To investigate the dynamics involved in the transfer of house dust mites from car seat material to modern clothing fabrics. METHODS A total of 480 samples of car seat material were seeded with mites and subjected to contact with plain woven cotton, denim, and fleece. Contact forces equivalent to the mass of a typical adult and child were administered for different durations of contact. RESULTS Mean transfer efficiencies of mites from car seat material to receiving clothing fabrics ranged from 7.2% to 19.1%. Fabric type, mite condition (live or dead), and the force applied all revealed a significant effect (P < .001 for each variable) on the transfer efficiency of house dust mites from seeded material to receiving fabrics, whereas duration of contact revealed no effect (P = .20). In particular, mean numbers of mites transferred to fleece (compared with denim and plain woven cotton) were greater for each treatment. CONCLUSION These findings indicate that clothing type can have important implications for the colonization of other biotopes by house dust mites, with potential for affecting an individuals' personal exposure to dust mite allergens.
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Affiliation(s)
- David Clarke
- School of Physics and Ryan Institute, National University of Ireland, Galway, Ireland; Applied Ecology Unit, School of Natural Sciences and Ryan Institute, National University of Ireland, Galway, Ireland.
| | - Daniel Burke
- School of Physics and Ryan Institute, National University of Ireland, Galway, Ireland; Applied Ecology Unit, School of Natural Sciences and Ryan Institute, National University of Ireland, Galway, Ireland
| | - Michael Gormally
- Applied Ecology Unit, School of Natural Sciences and Ryan Institute, National University of Ireland, Galway, Ireland
| | - Miriam Byrne
- School of Physics and Ryan Institute, National University of Ireland, Galway, Ireland
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Abstract
Allergic rhinitis is a common pediatric problem with significant comorbidities and potential complications. This article is an overview of the epidemiology, pathophysiology, and current therapeutic strategies. Allergic rhinitis management in a specific child is age dependent and influenced by the severity and frequency of the symptoms and the presence of any concurrent conditions. Current strategies permit symptomatic control and improved quality of life for most patients.
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