Mercedes Amado

The impact of home cleaning on quality of life for homes with asthmatic children

Treatment with common household bleach containing hypochlorite destroys dust mites and denatures protein allergens. The purpose of this study was to determine if home use of hypochlorite products results in lowered exposure to bacteria, fungi, and protein allergens and improved quality of life (QOL) for asthmatic persons in the home. Asthmatic and nonasthmatic households containing at least three persons (between 2 and 17 years of age) were recruited. Households were supplied one of three sets of cleaning products (regular products, some containing hypochlorite; regular products plus three additional products with dilute hypochlorite; control, no products). Participants were supplied with cleaning instructions and asthma education. The control group was instructed to clean as usual. Participants completed general health and QOL questionnaires. Asthmatic participants completed an additional asthma QOL questionnaire. Families participated in the study for 8 weeks and completed the full set of questions every 2 weeks. Homes were visited at the beginning of the study and twice thereafter at monthly intervals. Samples evaluated were surface bacteria, viable and nonviable airborne spores, and dust antigen content. Reductions in surface bacteria, airborne fungal spores, and dust antigen levels were achieved. Significant improvement in general health parameters was seen for the asthmatic product groups over the control group. Significant improvement in general QOL and asthma-specific QOL was seen in the asthmatic group. Emphasis on cleaning and cleaning education combined with hypochlorite-based cleaning supplies resulted in significantly improved QOL for families with asthmatic children.

Reduced clinic, emergency room, and hospital utilization after home environmental assessment and case management.

Allergists often suspect home environmental conditions are contributors to allergic disease. Case management can be an effective tool in managing asthmatic patients. To describe the impact of home environmental assessments and case management on the medical care utilization of patients with allergic disease the following studies were conducted. This study was designed to retrospectively examine health care utilization of pediatric patients that had a home environmental assessment recommended by a pediatric allergist as part of a comprehensive case management program. Subjects were chosen from pediatric patients who received home assessment after referral for case management by pediatric allergy specialists in a hospital-based clinic as indicated by high emergency room (ER) and hospital utilization. Case management included education, clinic visits, environmental assessment, and a single person responsible for following the subjects care. Home assessment included airborne spore collections, surface collections, and dust collection for evaluation of antigens. There were 25 subjects. Seventy-two percent were asthmatic and 12% were diagnosed with allergic rhinitis. In the year before entering the study these subjects experienced 47 ER visits, 22 hospitalizations, and 279 clinic visits. In the subsequent year they underwent 18 ER visits, 3 hospitalizations, and 172 clinic visits. Penicillium/Aspergillus levels were above 100 spores/m(3) of air in 94% of homes and above 1000 spores/m(3) in 74% of homes. Thirty-six percent of homes had Stachybotrys above 100 spores/m(3). Home environmental assessment and case management may reduce medical care utilization for children suffering from allergic rhinitis and asthma.

Diagnosing asthma in young children.

Purpose of reviewAsthma is defined by the 1997 National Asthma Education and Prevention Program guideline as a chronic inflammatory disorder of the airways which leads to an increase in bronchial hyperresponsiveness to a variety of stimuli or triggers. Since it is difficult to determine whether an individual patient has the above pathophysiology, particularly in young children, it is essential that clinically useful criteria be identified that can serve as proxies for the presence of asthma. Recent findingsThere are three reasons for making a diagnosis: to identify the most effective treatment to alleviate symptoms and prevent mortality; to educate the parent or primary caregiver to manage symptoms and avoid triggers; and to estimate the prognosis. A diagnostic test is a procedure which gives a rapid, convenient and inexpensive indication of whether a patient has a certain disease. The likelihood ratio incorporates both the sensitivity and specificity of the test and provides a direct estimate of how much a test result will change the odds of having a disease. SummaryBy applying the principles of evidence-based medicine to define likelihood ratios for each criterion, it should be possible to define the probability of asthma and to identify the best treatment. Future research should permit accurate correlations to be drawn between the underlying pathophysiology and the clinical condition commonly known as asthma.

They Tell Me I'm Allergic to Ragweed

ticing allergists will tell you, the positive predictive value of skin prick testing or IgE levels for determining which of the asymptomatic group will develop symptoms in any subsequent season was not very good (14–27%). A few things that the current authors could not control complicated the study. Pollen levels and individual exposures fluctuate from year to year, and symptoms in any one individual are likely to correlate with this varying exposure. As the researchers mentioned, the 2003 birch pollen season was unusually light, but exposure levels should have been adequate. The other variable that is not only uncontrollable but also difficult to quantify or even recognize is individual memory and bias. Eight subjects realized that they had prior symptoms only after the first season started, and 1 subject denied having symptoms despite symptom indications listed in the daily diary. There are probably some very unique and clever methods whereby these and additional uncontrolled variables can be managed by the investigator, but they are either completely impractical or have not been thought of yet. Nonetheless, the current authors have made very creditable efforts toward handling or at least becoming aware of these confounding parameters. The results of this study are bolstered by the time investigators spent to collect symptoms promptly in season and not by longterm recall. Also, the use of 4 methods to evaluate the atopic status including late phase and conjunctiva testing provides additional confidence in the results. A word of praise should also go to the subjects who volunteered for this inconvenient and often uncomfortable testing. TakThe patient who is skin test positive, or increasingly in current practice, IgE positive to a known and prevalent aeroallergen, but exhibits no symptoms, has always been a conundrum in the practice of allergy. With the increased accessibility to IgE testing, allergists often see persons with positive specific IgE results and are asked to interpret the clinical significance of these tests. In the current era of evidence-based medicine, it is important to have scientific data to support clinical recommendations. The article by Bodtger et al. [1] in this issue of International Archives of Allergy and Immunology begins to provide some systematic information on this topic. The authors followed 52 skin test-positive subjects (birch and/or grass) who had rhinitis symptoms and 52 similarly skin test-positive subjects who had no rhinitis symptoms. The subjects were followed during 2 successive birch/grass pollen seasons. The authors observed that nearly 10% of the subjects asymptomatic before the first season became symptomatic before the end of the study. None of a control group of 39 skin test-negative subjects became symptomatic during the study. Also, some of the subjects who had reported previous symptoms lost symptoms during the time of the study. The most comforting thing about these results is that the old, reliable skin test had a good ability to tell that a person will not develop allergic symptoms (negative predictive value 95–100%). Also, when the skin prick and specific IgE data were examined, those who lost symptoms had smaller skin tests and lower IgE values, and those who acquired symptoms had larger skin tests and higher IgE values. Unfortunately, as most pracPublished online: February 2, 2011