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Allergen avoidance in the treatment of asthma and allergic rhinitis

Thomas A E Platts-Mills, MD, PhD
Section Editor
Bruce S Bochner, MD
Deputy Editor
Anna M Feldweg, MD


Immediate hypersensitivity to inhaled allergens is very common among children and young adults with asthma and rhinitis. Sensitization to one or more of the major indoor allergens (such as dust mite, cat, dog, or cockroach) combined with significant accumulation of relevant allergens in the house has been consistently found to be the strongest risk factor for asthma in population, case control, and prospective studies [1-5].

This topic reviews measures for reducing exposure to indoor allergens. Approaches for minimizing exposure to nonallergic triggers and reducing a patient's sensitivity to allergens are presented separately. (See "Trigger control to enhance asthma management" and "Subcutaneous immunotherapy for allergic disease: Indications and efficacy".)


Evidence for a causal relationship between allergen exposure and asthma comes from bronchoprovocation experiments demonstrating that these allergens can induce bronchospasm, eosinophilic airway inflammation, and prolonged increases in bronchial hyper-reactivity [6,7]. Perhaps more significantly, moving some asthmatic children or adults from their homes to a different low-allergen residential setting results in major improvements in clinical symptoms and bronchial hyper-reactivity [1,8-10]. This background provides a powerful rationale for recommending that allergic patients should reduce allergen exposure in their houses as part of the management of asthma and allergic rhinitis [11].

There are major differences in the dominant allergens based on climate, housekeeping practices, and pet ownership. In particular, there are now well-defined geographic areas where dust mite, cockroach, or pet dander is the strongest contributor to asthma risk. It is also possible that certain indoor allergens, such as dust mite, are more important in the pathogenesis of allergic airway disease than others, and this is an area of active investigation [12-15]. (See "Risk factors for asthma".)

Specific monoclonal antibody-based assays have been developed to monitor allergen levels during controlled trials and to test the specific measures recommended to control exposure to dust mite, cat, dog, and cockroach antigens [16-18]. These techniques have facilitated detailed studies of specific allergens and have helped to define effective control measures, although the exquisite specificity of these measurements may mean that some forms of the specific allergen (eg, some isoforms of Der p 1) may escape detection [19].

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Literature review current through: Nov 2017. | This topic last updated: Aug 29, 2017.
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