  Management
I
Advise patients not
to smoke and to avoid environmental
tobacco smoke. Smoking may worsen
both asthma and rhinitis, and impair
effectiveness of treatment.2
Allergen avoidance
Before considering trigger avoidance
strategies, confirm the diagnosis
and confirm that the particular
allergen is a significant trigger
for the individual by both allergy
testing and history.
Grass pollens
While
pollen avoidance measures such as
sealing the home against outside air
and the use of face masks or glasses
are sometimes advocated, these are
impractical in Australian
environments and generally
unacceptable to patients.
House dust mite
The
house dust mite is a very common
allergen source in humid areas of
Australia, and avoidance by allergic
individuals is intuitively
reasonable. However, there is no
definitive evidence from
well-designed studies to indicate
which strategies effectively reduce
allergen load or improve allergic
rhinitis and asthma.20,21 Measures
that have consistently been reported
effective in reducing mite exposure
include hot (>55 degrees C) washing
of all bedding and the use of
mite-proof cases for mattresses and
pillows.20
<Level II>
Patients
should be warned that house dust
mite avoidance measures can be
expensive and time consuming, and
may not be effective in individuals.
Pet allergens
For
patients with demonstrated allergy
to cats or other pets, allergic
symptoms are highly unlikely to be
adequately controlled while the pet
remains in the house. After removal
of a pet, thorough cleaning of walls
and floorings should be undertaken
to remove adherent allergens.
Allergic symptoms may not resolve
promptly despite these measures.
Recognise that psychosocial factors
will affect patients’ decisions
about existing pets.
Indoor and outdoor
moulds
There is insufficient
evidence to indicate effective
measures for avoiding exposure to
indoor and outdoor mould allergens,
or that avoidance attempts can
improve symptoms or allergy and
asthma.
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Practice
points |
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-
Don’t
recommend allergen
avoidance measures to
patients unless the
allergen is known be a
significant contributor
to symptoms, as
demonstrated by allergy
testing that has been
expertly performed and
interpreted.
-
Advise
patients with known pet
allergy not to acquire a
pet. If patients choose
to keep existing pets,
they should be kept
outside. Warn patients
that allergen exposure
and symptoms may persist
after removal, and that
frequent washing of pets
is ineffective and may
be harmful to pets.
-
High-efficiency
particulate air (HEPA)
filter vacuum cleaners
may remove more allergen
than other vacuum
cleaners, but there is
no evidence that they
are effective in
controlling allergic
rhinitis or asthma.
-
Acaracide sprays, home
dehumidifiers and air
cleaning devices are not
recommended in the
control of allergic
symptoms. For detailed
advice on allergen
avoidance, refer to the
Australasian Society of
Clinical Immunology and
Allergy (www.allergy.org.au)
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Consider nasal irrigation
Nasal irrigation is an effective technique for
managing allergic rhinitis in adults and children,
possibly due to enhanced ciliary function or removal
of inflammatory cytokines via mucus clearance.22
Various methods are suitable, including use of
pre-packaged nasal sprays and introduction of saline
solutions via rinse bottles. Suitable solutions
include commercially manufactured saline solutions
and home-made normal saline (4.5 g of common salt
added to 500 mL of boiled water; approximately 1
teaspoon per 600 mL/1 pint). There is limited
evidence to indicate whether solutions should be
hypertonic or isotonic, buffered or non-buffered,
sterile or non-sterile, or whether various additives
provide any advantage. There is insufficient
evidence to recommend that patients use steam or an
irritant decongestant (e.g. eucalyptus, menthol)
prior to saline irrigation.
When nasal irrigations are to be used frequently,
patients are more likely to adhere to simple and
convenient regimens than those requiring complex
procedures, regardless of theoretical advantages.22
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