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Environmental Control for Indoor Allergens

Environmental Control for Indoor Allergens

House dust contains a variety of allergens such as insect parts, animal dander, and dust mites. Furthermore, mold may also be present in homes. It is important to eliminate as much allergen as possible from the home in order to derive maximum benefit from your treatment.

House Dust Mite is probably the most important allergen in most homes. Controlling house dust mite exposure will decrease symptoms in allergic patients and may decrease the risk of developing dust mite allergy in patients not yet sensitized. Dust mites are tiny microscopic creatures that thrive in warm, moist climates. Upholstery (particularly the bed) is the ideal habitat for dust mites because they need the protection of the padding and a food supply (shed human skin) to survive. They cannot thrive on non-porous surfaces or in cool dry climates.

There are simple things you can do to minimize dust mite exposure:

  • You should concentrate on the bedroom (particularly the bed) because this is where you spend most of your time. In fact, when you are sleeping, you are breathing with your mouth and nose inches from a whole army of dust mites. The bedroom should be clutter free.
  • Dusting should be done frequently with a damp cloth.
  • The humidity in the bedroom should be kept below 50%. In Central Oklahoma this generally requires only air condition, but may require a de-humidifier. Humidifiers encourage dust mite and mold growth and should be avoided.
  • The mattress, box spring and pillow should be encased in dust mite proof encasements. All items on the bed should be washed in hot water (140 degrees) every one to two weeks. Stuffed animals should be removed from the bed.
  • Upholstered furniture and wall to wall carpet contain dust mites and should be avoided if possible, but these are not nearly as important as the bed.
  • Air filters, expensive vacuum cleaners, and duct cleaning help only minimally. When vacuuming, a HEPA filter or double bag should be used to minimize dust mites being stirred up and released into the air.

Cockroaches are now recognized as important indoor allergens. Other insects such as lady bugs, spiders, and crickets have recently been implicated. Keep the home clean and dry and fix any leaks or drips. It may be necessary to have an exterminator treat the home periodically.

Animal dander, generally from cats and dogs (but sometimes from gerbils, hamster, guinea pigs, mice, etc.) is a very important source of allergen in dust. Contrary to popular belief, animal hair is not the problem. Rather, it is a protein in the urine, saliva and dander of animal that provokes allergy. There are no “nonallergenic” furred pets. Some individual animals produce more allergen than others but there are no “safe” breeds.

  • The best thing you can do if you are allergic is to eliminate the pet.
  • Keeping the animal outside is only a partial solution because people who handle the animals outside will bring the allergen in on their clothes.
  • If you cannot eliminate the pet, try to keep the pet in non-upholstered areas and never let the pet in the bedroom. A HEPA filter in the bedroom may provide some protection.
  • Bathing the animals weekly may decrease the amount of allergen they produce.
  • After the animal has been removed, it can take as long as a year for allergen levels in the home to drop significantly, so a good thorough cleaning of the home is necessary after eliminating the animal.

Recently some information has come to light which suggests that if you are not already allergic it may actually be helpful to have cats or dogs in the home. However, if you are already pet allergic having the pets around will only worsen your allergic symptoms.

Indoor Mold can also cause significant allergic respiratory symptoms. Homes with high humidity and/or leaks have a high likelihood of having significant indoor molds. Once these issues have been fixed, it is generally easy to eliminate molds, but if you continue to have problems with water leaks or high humidity, you will have a hard time cleaning up your mold. Use a cleaning solution containing 5% bleach and a small amount of detergent to clean up moldy areas. Performing house dust control measures will help as well.

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American College of Allergy, Asthma, and Immunology (ACAAI) Guidance on Risk of Allergic Reactions to the Pfizer-BioNTech COVID-19 Vaccine

Allergic reactions to vaccines, in general, are rare with the incidence of anaphylaxis estimated at 1.31 in 1 million doses given. With the emergency use authorization of the Pfizer-BioNTech COVID-19 vaccine by the FDA on December 11, 2020, the ACAAI COVID-19 Vaccine Task Force recommends the following guidance for physicians and other providers related to risk of an allergic reaction on vaccination. These recommendations are based on best knowledge to date but could change at any time, pending new information and further guidance from the FDA or CDC. 
 
1. The Pfizer-BioNTech COVID-19 vaccine should be administered in a health care setting where anaphylaxis can be treated. All individuals must be observed for at least 20-30 minutes after injection to monitor for any adverse reaction. All anaphylactic reactions should be managed immediately with IM epinephrine as the first line treatment.
 
2. The Pfizer-BioNTech COVID-19 vaccine should not be administered to individuals with a known history of a severe allergic reaction to polyethylene glycol as it is a component of this vaccine known to cause anaphylaxis.
 
3. Data related to risk in individuals with a history of allergic reactions to previous vaccinations and/or mast cell activation syndrome/idiopathic anaphylaxis is very limited and evolving. A clinical decision to administer the Pfizer-BioNTech COVID-19 vaccine should be undertaken by the physician or other provider administering the vaccine using their professional judgment and in consultation with the patient, balancing the benefits and risks associated with taking the vaccine.
 
4. Individuals with common allergies to medications, foods, inhalants, insects and latex are no more likely than the general public to have an allergic reaction to the Pfizer-BioNTech COVID-19 vaccine. Those patients should be informed of the benefits of the vaccine versus its risks.
 
5. The Pfizer-BioNTech COVID-19 vaccine is not a live vaccine and can be administered to immunocompromised patients. Physicians and other providers should inform such immunocompromised patients of the possibility of a diminished immune response to the vaccine.
 
6. Anyone with questions related to the risk of an allergic reaction to the Pfizer-BioNTech COVID-19 vaccine should contact their local board-certified allergist/immunologist.
 
 
References
 
McNeil MM, Weintraub ES, Duffy J, et al. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol. 2016;137(3):868-878.
 
Dreskin et al. International Consensus (ICON): allergic reactions to vaccines
World Allergy Organization Journal (2016) 9:32.
 
Wylon, K., Dölle, S. & Worm, M. Polyethylene glycol as a cause of anaphylaxis. Allergy Asthma Clin Immunol 12, 67 (2016).

Stone CA, Liu Y, et al. Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized.  J Allergy Clin Immunol Pract. 2019; 7(5): 1533–1540.

The post American College of Allergy, Asthma, and Immunology (ACAAI) Guidance on Risk of Allergic Reactions to the Pfizer-BioNTech COVID-19 Vaccine appeared first on Oklahoma Allergy and Asthma Clinic.

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