Allergen avoidance

Provide the patient with a specific allergen avoidance plan and counsel all patients to avoid secondhand tobacco smoke. 

These agents are an excellent choice for perennial rhinitis and can be useful in seasonal rhinitis, especially if begun in advance of symptoms. Some authorities recommend nasal steroids as initial therapy over antihistamines because of their high degree of efficacy when used properly along with allergen avoidance. 

The therapy of respiratory allergy should be based on allergen avoidance, pharmacological treatment and, when indicated, IT [37]. SLIT represents a... 

The treatment of allergic rhinitis combines allergen avoidance (when possible), pharmacotherapy and immunotherapy. 

Advise the person on allergen avoidance and how best to achieve this (e.g. pollen count highest in the evening so advise closing of windows at night). Drug treatment is also usually necessary to help with symptoms. Assess the type and severity of the allergic rhinitis ... 

Some patients exhibit wheeze and breathlessness in the absence of an obvious allergen or atopy. They are considered to have intrinsic asthma and because of a lack of an identifiable allergen, allergen avoidance has no place in their management. 

Randomised controlled trials have tested whether specific interventions are effective in reducing allergen exposure and whether this reduction leads to a reduction in sensitisation or disease. The second approach is only valid if the first is proven. Unfortunately, despite a huge amount of research, there is no simple allergen avoidance intervention designed to be prescribed or evaluated [214(NC)]. 

There has been debate about the most effective approaches for allergen avoidance. For house dust mite avoidance, treatment of bedding [240( I b)] and laundry are effective. There is less certainty about replacement of fitted carpets with smooth flooring, and cleaning of hard surfaces, and even less about vacuuming, air filtration, ionisers, and air conditioning. Acaricides are unlikely to be useful [214(NC)]. 

Despite all that has been researched and written about allergen avoidance, the recent Cochrane Review found no significant clinical benefit on tertiary prevention of asthma and recommended larger and more rigorous trials with more careful monitoring of exposure and clinical outcomes [246(Ia)]. 

Zeiger RS, Heller S, Mellon MH, et al Effect of combined maternal and infant food-allergen avoidance on development of atopy in early infancy A randomized study. J Allergy Clin Immrmol 1989 84 72-89. 

Arshad SH, Matthews S, Gant C, Hide DW Effect of allergen avoidance on development of allergic disorders in infancy. Lancet 1992 339 1493-1497. 

Hide DW, Matthews S, Matthews L, et al Effect of allergen avoidance in infancy on allergic manifestations at age two years. J Allergy Clin Immunol 1994 93 842-846. 

Hide DW, Matthews S, Tariq S, Arshad SH Allergen avoidance in infancy and allergy at 4 years of age, Alleigy 1996 51 89-93,... 

Frederick JM, Gill LS, Warner JO, Colwell BM, Warner JA Allergen avoidance in the homes of atopic asthmatic parents during pregnancy. J Allergy Clin Immunol 1998 101(suppl) S26. 

Custovic A, Simpson A, Chapman MD, Woodcock A Allergen avoidance in the treatment of asthma and atopic disorders. Thorax 1998 53 63—72. 

In contrast, strategies aimed at secondary prevention can be based on the early manifestation of the IgE-mediated disease or even disease preceding IgE sensitisation, which usually occurs during infancy. Potential interventions include allergen avoidance measures to induce tolerance and early immunotherapy. Data have been provided that the early administration of pharmacotherapy in infants who have already developed atopic eczema can attenuate the allergic march into asthma (see Chapter 3, Early Immunological Influences). 

A large-scale trial of the widespread applicability of mite allergen avoid-... 

Zeiger RS, Heller S, Sampson HA Genetic and environmental factors affecting the development of atopy through age 4 in children of atopic parents A prospective randomized controlled study of food allergen avoidance. Pediatr Allergy Immunol 1992 3 110-127. (Ib)... 

Zeiger RS, Heller RS The development and prediction of atopy in high-risk children Follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. J Allergy Clin Immunol 1995 95 1179-1190. (Ib)... 

Piacentini GL, Martinati L, Mingoni S, Boner AL Influence of allergen avoidance on the eosinophil phase of airway inflammation in children with asthmatic asthma. J Allergy Clin Immunol 1996 97 1079-1084. (Ilb)... 

Grootendorst DC, Dahlen SE, Van Den Bos JW, Duiverman EJ, Veselic-Charvat M, Vrijlandt EJ, et al Benefits of high altitude allergen avoidance in atopic adolescents with moderate to severe asthma, over and above treatment with high dose inhaled steroids. Clin Exp Allergy 2001 31 400 408. (Ib)... 

Marks GB, Tovey ER, Green W, Shearer M, Salome CM, Woolcock AJ House dust mite allergen avoidance A randomized controlled trial of surface chemical treatment and encasement of bedding. Clin Exp Allergy 1994 24 1078-1083. (Ib)... 

Tan BB, Weald D, Strickland I, Friedmann PS Double-blind controlled trial of effect of housedust-mite allergen avoidance on atopic dermatitis. Lancet 1996 347 15—18. (Ib)... 

Allergic contact dermatitis can develop in the working environment. As a prerequisite for allergen avoidance at the workplace, the exact allergen must be identified by patch testing, but in many cases return to the workplace may be impossible. Examples of occupational contact allergens are nickel salts, potassium dichromate or paraphenylene diamine. 

Once the specific causes of the disease are identified, the most important aspect of treatment of occupational skin disease is to avoid contact. Dermatological treatment of acute disease is very similar to that of disease of non-occupational background. Skin protection (gloves, barrier cream, emollients and avoidance of irritative factors) is as important as allergen avoidance. Due to the legal implications of occupational skin disease, a thorough and detailed documentation of all medical investigations is important [30-36]. 

Effect of allergen avoidance in primary and secondary prevention, and in the treatment of allergic diseases (tertiary prevention). 

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