Whenever allergy causes a disease in the unified airway system extending from the nasal cavity to deep in the lungs, patients are concerned with the control or the elimination of the disease. The fore most step in control of the disease is the identification of the incriminating allergen. It can be identified with a good history or a simple skin prick test which is more reliable than a blood test. This is usually due to aeroallergen which is always a protein living substance such as dust mites, pollens, fungus or animal dander. It is never due to the commonly unsubstantiated beliefs about perfumes, diesel, smoke or cold items. These substance cause symptoms due to their irritant properties. Food substances rarely cause respiratory symptoms without the presence of concurrent skin or gastrointestinal symptoms.
The most common aeroallergen in more than 50% of cases is the dust mites.
These are always present indoors in closed or sequestered spaces. The outdoor dust in the open spaces never contains dust mites. A simple advice to eliminate dust mites is “to lower the standard of living to that of a lower class”. In short it requires the removal
of cuts in the false ceilings, smoother walls without any hangings, non upholstered curtains and sofa covers, simple furniture and no rugs, blankets and carpets. Infact, any items allowing dust to gather like soft toys should be removed if unable to wash on a regular basis. A daily wet mopping is far superior to vacuum cleaning. The bed sheets should be washed weekly in hot water, sun dried, dusted and then to be used. Lastly a word about AC. They are very good if well maintained and the filter is cleaned monthly but deleterious to the health if not done so.
The pollens are present strictly outdoors and their peak action is between 11 am and 5 pm when they are released into the atmosphere. A very simple way of dealing is to stay indoors during this time with all doors and windows closed. If the patient needs to go out or stay in the open, they should cover themselves well and have a bath on returning.
Fungal allergens are present both indoors and outside. They have a propensity for dampness which should be ameliorated at all costs. Hence there should be no wet walls leakages, collection of water in pots and proper disposal of garbage. A new well painted house is a simple solution.
The pest controller is the best remedy to the cockroach. This should not undermine the importance of cleanliness and proper disposal.
The most difficult aspect in the aeroallergen control is of pet animals.
Patients especially children and adolescent would prefer to get rid of the doctor rather than to remove the pet from the house. Hence, we need to have a detail session on pet management with the family. This includes regular washing and handling of the pet. The difficult part of the cat dander is that it is ubiquitous and it’s not necessary that there should be a cat at home. Its mere presence in the neighborhood is enough.
A strict environmental control is required for 40% control of the symptoms. The drugs will take care of the balance 50 to 60% control of the disease. There are many a patients who do take their medication regularly but not able to achieve symptom control. The most common reason would be either poor technique in the use of devices or/and improper or no environmental control of the allergens.