Allergic Rhinitis and its Impact on Asthma - ARIA

ALLERGIC RHINITIS AND ITS IMPACT ON ASTHMA GUIDELINES ● 2010 – V. 9/8/2010
<strong>and</strong> heating/ventilation/air-conditioning alterations). The control group received only home cleaning
information. After 1 year the remediation group had a significant decrease in symptom days after
remodelling, whereas these parameters in the control group did not change. The remediation group
had a lower rate of acute care vis<strong>its</strong> compared with control group, but the difference was not
significant (10.0% vs 28.1%).In a second r<strong>and</strong>omised, cross-over trial (119) centrally installed
ultraviolet (UV) irradiation un<strong>its</strong> were investigated among 19 asthmatic children sensitized to
moulds. The authors reported improvement in asthma symptom scores, the number of days with
asthma symptoms, total asthma medication use in children provided with UV irradiation un<strong>its</strong>
versus placebo, but this trial had methodological limitations <strong>and</strong> it was not clear if the difference
between the groups was clinically important.
Harms
There were no definite adverse effects of these interventions but there is burden <strong>and</strong> cost.
Conclusions <strong>and</strong> research needs
Any net clinical benefit from methods aimed at reducing exposure to household moulds is very
uncertain. Trials had methodological limitations, results were inconsistent, <strong>and</strong> there is some
uncertainty about the directness of multiple interventions used in the study by Kercsmar <strong>and</strong>
colleagues (118).
Well designed <strong>and</strong> rigorously executed r<strong>and</strong>omised trials of methods aimed at reducing exposure to
household moulds that measure <strong>and</strong> properly report (74, 75) patient-important outcomes are needed.
If done, they are likely to have an important impact on this recommendation.
Recommendation
In patients allergic to indoor moulds, we suggest avoiding exposure to these allergens at home
(conditional recommendation | very low quality evidence).
Underlying values <strong>and</strong> preferences: This recommendation places a relatively high value on
possible reduction in the symptoms of rhinitis <strong>and</strong> asthma, <strong>and</strong> a relatively low value on the burden
<strong>and</strong> cost of interventions aimed at reducing exposure to household moulds.
Question 9
Should patients allergic to animal d<strong>and</strong>er avoid exposure to these
allergens at home?
Summary of findings
We did not identify any systematic review directly addressing the question of pet allergen control
measures in patients with allergic rhinitis. However, one recent systematic review reported 2 studies
that investigated the clinical efficacy of air filtration un<strong>its</strong> <strong>and</strong> concomitant environmental
interventions in the homes of people with pet-allergic asthma who had pets (120). Authors’ last
literature search in September 2006 did not reveal any new trials since the original review was
published in 2001.
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