How much have you done? Did the cost discourage you?

According to a recently published article in Allergy and Asthma Proceedings Nov-Dec 2008, the cost to follow through with the allergist’s suggestions for environmental controls is about $1500 per household.

The article reviews several other studies looking at the relevance of various environmental triggers and the methods available to reduce them.

I’m sorry to say that many of the things we ask our patients and parents to do in their homes have not been verified in well controlled studies.

So let’s separate proven fact from opinion:

Dust mites are a common trigger for people with year round nasal allergy and / or asthma. What are the steps that have the most proven value for reducing dust mites?

Getting those specially meshed (dust mite proof) encasements tops the list. The author, Dr. Robert Bush reports there is at least one controlled study that supports the encasements. Other highlighted maneuvers include removing carpets, humidity control (don’t over humidify) and hot washing the bed coverings.

What about Frisky the cat?

Sorry feline lovers, the best thing you can do to improve upon your indoor environment if you have a cat (or dog or other pets...) is to remove it from the home (that’s a fact). Many allergists know this may be devastating to families and especially children so they tread lightly on this area of advisory. The next best things to pet removal are unfortunately far less effective, but believed to be worth doing.

These include: Restricting the cat (this goes for man’s best friend too) from the bedroom and family room area at all times (a major challenge for these vertical creatures); getting a hepa air filter device for the bedroom and family room (or whole house); cat washing twice weekly (could be dangerous); removing all carpets.

Got Mold?

The answer is yes, every home has some level of mold in it. These are microscopic fungi that thrive on moisture, warmth and organic surfaces. We know some people are hypersensitive to mold but studies on how much indoor mold is bad, or which indoor mold should be targeted are lacking. The most important things you can do are to remove any and all contaminated material (which may include dry wall that has been soaked by flooding or carpets that lay on concrete); control humidity levels by using a dehumidifier in the basement especially during the warm summer months. A Hepa filter may be helpful. Sorry, no well controlled studies validating any of these suggestions.

Cockroaches! We don’t have Cockroaches! (said a parent of one of my patients)

Yes you do (or did at some point, in most cases). Cockroaches do not have to be seen to cause problems. When they are exterminated they are not removed from the home, workplace or building. They are essentially poisoned; they die, then dry up and become part of the circulated dust particles. That’s right, even if your home is squeaky clean and has nary a cockroach you are likely exposed once you enter your workplace, school, grocery store or go to a restaurant. Contrary to popular belief cockroaches don’t limit themselves to housing projects and other inner city residences (although this tends to be where they are most problematic).

What do you do about the varmints if you suspect you have them?

Well in this case there are a handful of measures that have proven value. These include: removal of food and water sources; use of appropriate pesticides (asthma patients beware of fumes); removal of dead cockroaches, body parts and excretions (a major challenge considering ducts, floor boards, carpets etc.); wash all surfaces including floors, tables, countertops, walls etc. with detergent.

Bottom Line:

Dr. Bush concludes that environmental controls are more likely to be effective when they are comprehensive (multiple measures done addressing the specific targets). He states that more research needs to be conducted to further explore allergy avoidance.

Allergy avoidance is a good investment if you factor in the cost of allergy medications, follow-up doctor visits and sick visits for complications (sinusitis, cough, worsening asthma...). Some things you do by doctor’s order may be covered by your insurance (check with your carrier) or may be considered a tax write-off (check with your tax expert).