Skip to main content

Advertisement

Log in

A New Model for Environmental Assessment and Exposure Reduction

  • Pediatric Allergy and Immunology (JM Portnoy and CE Ciaccio, Section Editors)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Environmental assessment and exposure reduction are a set of diagnostic and treatment techniques that work in tandem with the traditional medical approach by reducing a patient’s exposure to adverse environmental conditions as part of medical care. Assessment involves identifying the specific exposures to which a patient is sensitive and locating the corresponding contaminants in the patient’s environment. This provides a more complete diagnostic evaluation of a patient’s problem than could be obtained merely by examining the patient alone. Exposure reduction involves reducing the identified triggers to levels that are below thresholds that are associated with increased risk of sensitization and disease morbidity. Assessment of an environment for contaminants focuses on a chain of factors that include contaminant sources such as cockroaches, rodents, dust mites and fungi that excrete contaminants into an environment, facilitative factors such as moisture, food, water and shelter that help sources to thrive, and reservoirs where contaminants can accumulate prior to subsequent transport to occupants. By using this model to guide environmental assessments and their corresponding interventions, the root cause of health problems can be addressed, leading to improved quality of life for patients and reduced need for chronic medications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Schatz M, Zeiger RS. Ineffectiveness of telephone-based environmental control intervention to improve asthma outcomes. J Allergy Clin Immunol. 2010;126(4):873–5. Epub 2010/10/06.

    Article  PubMed  Google Scholar 

  2. •• Schatz M, Zeiger RS. Telephone-based environmental control interventions in asthmatic patients: what are patients willing to do? Ann Allergy Asthma Immunol. 2012;In press. This study and the earlier one (reference 1) determined what patients are actually willing to do about environmental control. This is important because if patients are not willing to modify their enviornment, the interventions described in this review will not be effective.

  3. •• Portnoy J, Kennedy K, Sublett J. Environmental assessment and exposure control: a practice parameter-furry animals. Ann Allergy Asthma Immunol. 2012;108(4):223 e1–e15. Epub 2012/04/04. This is the first in a series of practice parameters that address the issue of environmental assessment and source reduction. The basics of the new model are described and practical, evidence-based recommendations are provided..

    Article  Google Scholar 

  4. Lewis RD, Breysse PN, Lees PS, Diener-West M, Hamilton RG, Eggleston P. Factors affecting the retention of dust mite allergen on carpet. Am Ind Hyg Assoc J. 1998;59(9):606–13. Epub 1998/10/21.

    Article  PubMed  CAS  Google Scholar 

  5. Ciaccio CE, Portnoy JM. Strategies for primary prevention of atopy in children. Curr Allergy Asthma Rep. 2008;8(6):493–9. Epub 2008/10/23.

    Article  PubMed  Google Scholar 

  6. Arshad SH, Bateman B, Matthews SM. Primary prevention of asthma and atopy during childhood by allergen avoidance in infancy: a randomised controlled study. Thorax. 2003;58(6):489–93. Epub 2003/05/31.

    Article  PubMed  CAS  Google Scholar 

  7. • Wegienka G, Johnson CC, Havstad S, Ownby DR, Zoratti EM. Indoor pet exposure and the outcomes of total IgE and sensitization at age 18 years. J Allergy Clin Immunol. 2010;126(2):274–9. 9, 9 e1-5. Epub 2010/06/29. This article demonstrated that indoor exposure to pet allergens has an important impact on sensitization 18 years later.

    Article  PubMed  Google Scholar 

  8. Arruda LK, Vailes LD, Ferriani VP, Santos AB, Pomes A, Chapman MD. Cockroach allergens and asthma. J Allergy Clin Immunol. 2001;107(3):419–28. Epub 2001/03/10.

    Article  PubMed  CAS  Google Scholar 

  9. Prevention strategies for asthma--secondary prevention. CMAJ. 2005;173(6 Suppl):S25-7. Epub 2005/09/15.

  10. Sheikh A, Hurwitz B, Nurmatov U, van Schayck CP. House dust mite avoidance measures for perennial allergic rhinitis. Cochrane Database Syst Rev. 2010;7:CD001563. Epub 2010/07/09.

    PubMed  Google Scholar 

  11. •• Sheehan WJ, Rangsithienchai PA, Wood RA, Rivard D, Chinratanapisit S, Perzanowski MS, et al. Pest and allergen exposure and abatement in inner-city asthma: a work group report of the American Academy of Allergy, Asthma & Immunology Indoor Allergy/Air Pollution Committee. J Allergy Clin Immunol. 2010;125(3):575–81. Epub 2010/03/17. This report reviews the data demonstrating that IPM is effective and which interventions are necessary to result in improved health.

    Article  PubMed  Google Scholar 

  12. Arbes Jr SJ, Sever M, Mehta J, Gore JC, Schal C, Vaughn B, et al. Abatement of cockroach allergens (Bla g 1 and Bla g 2) in low-income, urban housing: month 12 continuation results. J Allergy Clin Immunol. 2004;113(1):109–14. Epub 2004/01/10.

    Article  PubMed  Google Scholar 

  13. WHO guidelines for indoor air quality :dampness and mould. Copenhagen, Denmark: World Health Organization; 2009.

  14. Avner DB, Perzanowski MS, Platts-Mills TA, Woodfolk JA. Evaluation of different techniques for washing cats: quantitation of allergen removed from the cat and the effect on airborne Fel d 1. J Allergy Clin Immunol. 1997;100(3):307–12. Epub 1997/10/06.

    Article  PubMed  CAS  Google Scholar 

  15. Hodson T, Custovic A, Simpson A, Chapman M, Woodcock A, Green R. Washing the dog reduces dog allergen levels, but the dog needs to be washed twice a week. J Allergy Clin Immunol. 1999;103(4):581–5. Epub 1999/04/13.

    Article  PubMed  CAS  Google Scholar 

  16. Matsui E, Kagey-Sobotka A, Chichester K, Eggleston PA. Allergic potency of recombinant Fel d 1 is reduced by low concentrations of chlorine bleach. J Allergy Clin Immunol. 2003;111(2):396–401. Epub 2003/02/18.

    Article  PubMed  CAS  Google Scholar 

  17. Sever ML, Arbes Jr SJ, Gore JC, Santangelo RG, Vaughn B, Mitchell H, et al. Cockroach allergen reduction by cockroach control alone in low-income urban homes: a randomized control trial. J Allergy Clin Immunol. 2007;120(4):849–55. Epub 2007/09/11.

    Article  PubMed  Google Scholar 

  18. Curtin-Brosnan J, Saams J, Breysse P, diette G, Bradley H, Matsui E. Relationship between Cat and Mouse Allergen Levels in the Homes of Inner City Children with Asthma. J Allergy Clin Immunol. 2009:S64.

  19. Dodds W, Frantz S, Story K. The Professional’s Guide to Managing Poisoning by Anticoagulant Rodenticides. New York: Chempa Products Div., Lipha Chemicals, Inc; 1986.

    Google Scholar 

  20. Arlian LG, Vyszenski-Moher DL, Morgan MS. Mite and mite allergen removal during machine washing of laundry. J Allergy Clin Immunol. 2003;111(6):1269–73. Epub 2003/06/06.

    Article  PubMed  Google Scholar 

  21. Barnes CS, Kennedy K, Johnson L, Forrest E, Gard L, Pacheco F, et al. Use of dilute sodium hypochlorite spray and home cleaning to reduce indoor allergen levels and improve asthma health parameters. Ann Allergy Asthma Immunol. 2008;101(5):551–2. Epub 2008/12/06.

    Article  PubMed  Google Scholar 

  22. • Sublett JL, Seltzer J, Burkhead R, Williams PB, Wedner HJ, Phipatanakul W. Air filters and air cleaners: rostrum by the American Academy of Allergy, Asthma & Immunology Indoor Allergen Committee. J Allergy Clin Immunol. 2010;125(1):32–8. Epub 2009/11/17. The definitive review of evidence for the use of air filtration.

    Article  PubMed  Google Scholar 

  23. Johnson L, Ciaccio C, Barnes CS, Kennedy K, Forrest E, Gard LC, et al. Low-cost interventions improve indoor air quality and children's health. Allergy Asthma Proc. 2009;30(4):377–85. Epub 2009/09/24.

    Article  PubMed  Google Scholar 

  24. Morgan WJ, Crain EF, Gruchalla RS, O'Connor GT, Kattan M, Evans 3rd R, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. 2004;351(11):1068–80. Epub 2004/09/10.

    Article  PubMed  CAS  Google Scholar 

  25. Eggleston PA, Butz A, Rand C, Curtin-Brosnan J, Kanchanaraksa S, Swartz L, et al. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial. Ann Allergy Asthma Immunol. 2005;95(6):518–24. Epub 2006/01/13.

    Article  PubMed  Google Scholar 

  26. Gergen PJ, Mortimer KM, Eggleston PA, Rosenstreich D, Mitchell H, Ownby D, et al. Results of the National Cooperative Inner-City Asthma Study (NCICAS) environmental intervention to reduce cockroach allergen exposure in inner-city homes. J Allergy Clin Immunol. 1999;103(3 Pt 1):501–6. Epub 1999/03/09.

    Article  PubMed  CAS  Google Scholar 

  27. Krieger J, Jacobs DE, Ashley PJ, Baeder A, Chew GL, Dearborn D, et al. Housing interventions and control of asthma-related indoor biologic agents: a review of the evidence. J Public Health Manag Pract. 2010;16(5 Suppl):S11–20. Epub 2010/08/21.

    PubMed  Google Scholar 

  28. Pongracic JA, Visness CM, Gruchalla RS, Evans 3rd R, Mitchell HE. Effect of mouse allergen and rodent environmental intervention on asthma in inner-city children. Ann Allergy Asthma Immunol. 2008;101(1):35–41. Epub 2008/08/07.

    Article  PubMed  Google Scholar 

  29. Juliusson S, Jakobinudottir S, Runarsdottir V, Blondal T, Gislason D. Environmental control (EC) can effectively reduce cat allergen (Fel d 1) in house dust samples without removal of the cat [abstract]. J Allergy Clin Immunol. 1997;99:S388.

    Google Scholar 

  30. Wu F, Takaro TK. Childhood asthma and environmental interventions. Environ Health Perspect. 2007;115(6):971–5. Epub 2007/06/26.

    Article  PubMed  Google Scholar 

  31. Salo PM, Arbes Jr SJ, Crockett PW, Thorne PS, Cohn RD, Zeldin DC. Exposure to multiple indoor allergens in US homes and its relationship to asthma. J Allergy Clin Immunol. 2008;121(3):678–84. e2. Epub 2008/02/08.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

Dr. Portnoy has served as a consultant for, received honoraria from, and had travel/accommodations expenses covered/reimbursed by Thermofisher.

Drs. Ciaccio and Kennedy reported no potential conflicts of interest relevant to this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christina E. Ciaccio.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ciaccio, C.E., Kennedy, K. & Portnoy, J.M. A New Model for Environmental Assessment and Exposure Reduction. Curr Allergy Asthma Rep 12, 650–655 (2012). https://doi.org/10.1007/s11882-012-0297-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-012-0297-9

Keywords

Navigation