Indoor Allergen Control Measures: A Practical Summary

By Peter B. Boggs, MD

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Background

Avoidance of household allergens in the treatment of asthma was first recorded in the 16th century by Italian physician Gorolamo Cardano, who was called to Scotland by John Hamilton, Archbishop of St. Andrews, to advise on the treatment of the Archbishop's intractable asthma. Cardano, after reflection, recommended that the Archbishop remove his feather bedding. A "miraculous" remission followed.¹¹ Sir John Floyer observed in 1698 that asthma could be provoked by "…the sweeping of dust, especially in bedrooms."¹²

The first modern attempts to treat asthma by environmental intervention took place in the 1920s in the form of dust-free rooms, climate chambers, and cleaning measures designed to reduce dust in bedrooms.^13-15 The sentinel studies investigating the effect of environmental intervention on reducing allergen levels and improving asthma and allergy symptoms were done in alpine sanatoria in Switzerland and Italy.^16,17 Although burdened by the absence of controls, these investigators increased awareness of the importance of household agents as causes of asthma and allergy symptoms, and invited heightened attention to the most basic of treatments of allergic asthma: allergen avoidance.

Since that time, a series of immunologic, clinical, and epidemiologic studies have demonstrated a strong association between exposure and sensitization to indoor allergens and the development and persistence of chronic asthma in many areas of the world^.6-9,18

The relative importance of indoor allergens varies between and within cultures: cats and dogs are the dominant indoor allergens in Scandanavia and in desert regions of the United States; roaches in the inner city in the United States; and house dust mites in coastal, humid areas.³

Threshold levels (in micrograms of allergen per gram of settled dust) for sensitization and exacerbation of asthma for each of the common indoor allergens are incomplete. What is known regarding these levels will be cited in the discussion of each.

Past studies of the effectiveness of remediation measures in asthma suffer from being focused on single allergens, and hence are not representative of the more common clinical condition of multiple allergen sensitization.

Caveat

Indoor allergen avoidance programs for asthma care are only effective in the management of allergic asthma. The implementation of allergen avoidance measures in the management of nonallergic asthma is misguided and futile. Thus, a correct diagnosis of asthma and a proper assessment of airborne allergen sensitization are prerequisites to any remediation program.

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