Patient Education – Controlling the Environment

Allergies mean that the body’s immune system responds to a part of the environment, which we call an allergen. The symptoms of allergies depend on a many factors including where the allergen enters the body, and that person’s immune system. Symptoms of allergies to pollens often show up in the head, ears, throat, and chest because they enter the body by breathing. In trying to protect itself from the allergen, the body produces a variety of chemicals, including histamine. Histamine and the other chemicals make cells produce more mucous, which gives us the watery eyes, runny nose, stuffy head that we associate with allergies.

The body’s response to irritants does not involve the immune system, and is restricted to the part of the body being irritated. When we scratch our skin it turns red, and is an example of irritation. Many things can irritate our bodies. Tobacco smoke and perfume irritate the cells that they come in contact with. These irritated cells produce more mucous just because they are irritated, not because the immune system is involved.

It should be stressed that few can comply with all these measures, and in a sense we recommend that you “choose your battles.” We suggest prudence in instituting these measures so that they don’t interfere with the patient’s lifestyle – for example, going to the ballpark with a mask on is no fun at all.

Odors: When cells produce mucous because of allergies, and then are irritated as well, they produce even more mucous. Reducing odors in the household environment of an allergic person can help to decrease allergy symptoms.

• Use the exhaust fan by the stove to reduce or eliminate cooking odors.
• Do not use air fresheners or cleaners.
• Do not let anyone in the house use perfume or items with a fragrance, including soaps.
• Do not light a fire in the fireplace.
• Do not use room deodorizers, mothballs, or bug sprays when the allergy patient is home. Store them away from the patient.
• Artificial Christmas trees and decorations are preferable to natural Christmas trees and wreaths.

Epidermal Allergies: Inhaled dander (epithelial scales or flakes of skin) from animal species other than humans can cause allergies. These most commonly come from dogs, cats, birds, cattle, horses, sheep, goats, and ducks. The hair and saliva of some of these animals may also be allergenic. Because the allergen is mostly on the soluble dander, short hair breeds or non-shedding dogs also cause allergies. The best advice is not to have pets of any of these species, certainly not to have them in the house.

House Dust: Dust is material from the inside the house, consisting of animal dander, indoor molds, plant particles, food particles, insect parts and waste, algae and human dander. The house dust mite is an insect-like creature that feeds off human dander and lives in mattresses, stuffed furniture, rugs, and pillows. It is an important source of indoor allergies. Mite colonies reach a peak in the months of September and October. See also “Dust Mite and Mold Avoidance” article.

Cleaning: Since most people spend a great deal of time in their bedroom, it is the most important room to clean. If you will carefully follow these instructions, you can eliminate much of the dust in your home. House dust comes from mattresses, pillow, box springs, overstuffed furniture, and such stuffed articles as toys and comforters that cannot be washed. Acaracides are substances that, when applied directly over the rug or carpet, eliminate the House Dust Mite for a period of up to 3-4 months. Acrosan (Benzyl benzoate) kills the mite. Allergy control solution (Tannic acid) denatures mite protein. However, there is conflicting evidence as to whether these substances are truly beneficial to allergic patients.

“Desensitizing” the Patient’s Room

• The patient should not be in the room during the cleaning because of exposure to allergens.
• Wash the room thoroughly – walls, woodwork, ceiling and floor (hard flooring is best).
• Wash the bed frame. Vacuum the bed and box springs.
• Cover the mattresses, box springs, and pillows with airtight, dustproof cover.
• Anyone sleeping in the room should use foam or Dacron (non-allergenic) pillows.
• Wash the bedding. Use fuzz-free cotton or Dacron sheets next to the patient’s body.
• Wash the few pieces of furniture left in the room (wood or metal is best).
• Empty, then wash the closets. Wash all clothing kept in the room.
• Do not use heavy rugs, drapes, upholstered furniture, and chenille spreads.
• Use curtains made from washable cotton, plastic or Plexiglas.
• Allow only wooden, plastic or non-allergenic (not fuzzy) toys which can be washed.
• Clean the room daily using a vacuum cleaner, damp cloth or oil mop, not a broom or duster.
• Store blankets, woolens, felt hats, or other dust catchers outside of the room.
• Keep the closet doors closed.
• Doors and windows in the room must fit tightly. Close the windows during major pollen seasons or during pollution alert.

“Desensitizing” the Rest of the House

• No smoking should be allowed anywhere in the home.
• No pets should be kept indoors. There should be no animals with fur or feathers in the home.
• Eliminate all houseplants (sources of dust and molds).
• Do not use room deodorizers, mothballs, or bug sprays.
• Clean the furnace or air conditioner regularly and provide covers for the air vents if needed.
• The allergic patient should not sit on overstuffed furniture or on the rug.
• The patient should not handle objects with dust, such as books, boxes or clothing that have been stored over a long period of time.
• The patient should avoid attics and closets. If exposure is unavoidable, wear a dust mask.
• Go over floors and furniture with a vacuum cleaner at frequently to keep the dust down.
• Use a damp or oiled cloth to dust.
• If home while someone is cleaning, the patient should wear an inexpensive dust mask (available at the pharmacy or home improvement store).
• Keep humidifier and air conditioners clean; replace or wash filters monthly during heavy use.
• Consumer Report is an excellent source for techniques to modify the home environment.

“Desensitizing” the Car

• Clean floor mats often to remove dust, pollens, and molds.
• Seal car leaks to prevent water accumulation of the floor.
• Frequently expose mats and underside padding to air and sun to avoid mold formation.
• Decontaminate mold areas with Lysol spray.
• Use Dacron or other synthetic pillows, not Kapok or feather.
• Travel only in an air-conditioned car if possible. Recirculate the air inside rather than taking in air from outside.
• Keep windows closed during pollen season.
• Have the car air conditioner serviced every 6 months, and change the filters.
• Run the air conditioning 2-3 minutes before entering the car, which dissipates most of the dust and mold accumulated inside the unit.

Pollens: Pollen grains come from seed bearing plants. They are the male part (sperm or male gamete) necessary to reproduce those plants. The female part (egg or female gamete) stays in the plant. Plants that are pollinated by the wind are important in allergies. Other plants usually do not cause problems because the pollen only travels by insects, not in the air. Pollens are responsible for allergies outside. The seasons are as follows:

• Late winter and spring symptoms are usually due to Tree pollens (Oak, Cypress, Cedar, etc.)
• Spring and summer symptoms are usually due to Grass pollens (Bermuda, Johnson, Bahia, etc.)
• Late summer and fall symptoms are usually due to Weed pollens (Ragweed, Dog Fennel, English Plantain, etc.)

Molds: Molds (fungi) are simple plants that are among the most successful creatures on earth. Two basic structural forms exist: the yeast form, and the hyphal form. Some hyphae specialize by reproducing through spores that disperse in water, air, or by insects or animals. Such spores are strong allergens, which when inhaled by an allergic patient may cause significant symptoms. Although complete eradication of molds is impossible, the use of dehumidifiers and fungicides can produce significant reduction in mold concentration. See also “Dust Mite and Mold Avoidance” article.

Humidifiers help maintain the humidity at 35-50%. Proper care is mandatory to prevent mold contamination of humidifiers. Relative humidity is high is South Florida, therefore we generally recommend dehumidifiers when the air conditioning unit fails to keep humidity below 50%.

Inside

• All bathrooms with shower stalls and/or bathtubs need functioning exhaust fans.
• The bathrooms should not be carpeted, especially in the children’s area.
• Bathrooms should be painted and not wallpapered.
• Any wall or carpeting which has been infested with mold should be replaced.
• Cleaning of carpets is best left to professionals.
• After working in soil or dirt, shoes and clothing should be washed or brushed clean.
• Throw away old furniture instead of having it reupholstered unless the stuffing can be completely sealed.
• If the family lives in a rural setting, a central air filter is desirable.
• Remove wicker baskets and dry flowers. A dehumidifier may be necessary for extremely humid areas such as waterfront homes. Keep humidity indoors from 35 – 50%.
• Avoid damp basements. Sometimes dehumidifiers or keeping lights on in storage areas of the house is necessary. Cool, damp places are conducive to mold growth.
• If necessary, check the house drainage to make sure the walls are kept as dry as possible.
• Filters for removing house dust are also effective in removing air-borne molds.

Outside

• Prune and trim large shrubs and trees to allow access for sunlight to reach the house and surrounding area.
• Correct any drainage or grading problems.
• Remove fallen leaves as well as grass clippings as promptly as possible.
• Avoid compost heaps, hay, and heavy ground vegetation.
• Avoid redwood bark chip mulch.
• Remove diseased plants whenever possible.
• Avoid granaries, decaying vegetation, cut grass, weeds, and dry leaves.
• Remember that high mold levels occur before storms and even in winter on windy days.

Fungicides

• Can be used either by direct application or by fumigation; repeat monthly as needed while the patient is out of the room.
• Phenolated disinfectants (Lysol for example) are inexpensive, and are effective in controlling mold growth.
• Benzalkonium chloride (Zephiran chloride, 1:10,000 aqueous dilution) is one of the cationic surface disinfectant types of fungicides.
• Again, there is conflicting evidence as to whether these products are truly beneficial to allergic patients, even though theoretically they could and should be helpful.
  Environmental Control Measures: In addition to standard environmental control guidelines, the following special devices can help reduce allergic and irritant exposure at home.

Air conditioning: The beneficial effect of air conditioning on allergic symptoms is recognized. For individual or central air conditioning units, proper regular maintenance and cleaning is necessary. Air duct cleaning regularly (as needed) is also important.

Air Filters: Reduce airborne particles. Filters must be changed or washed monthly.

HEPA Filters: (High Efficiency Particulate Air) One of the most efficient air cleaners available, removes up to 99.9% of particles greater than 0.3 microns in diameter. These are somewhat expensive, but can be helpful especially for cat dander. Since dust mite particles settle out of the air quickly, air filters in general are not very helpful if a person only has a problem with dust mites.

Electrostatic: Using the electrostatic precipitation method (charging particles that are then attracted and held to oppositely charged plates), these cleaners offer medium to high cleaning efficiency, removing 99% of particles greater than 5 microns. Two basic types are available.

Single stage electronic air cleaners require no modification to the air conditioning unit, are medium efficient, and washable. Two stage electrostatic precipitators have a higher initial expense, high efficiency for both large and small particles, and are washable.

Negative Ion Generators: This device produces negative ions (ozone) which disperse in the room. Studies as to the health effect are inconclusive. We do not recommend this type of filter.