Dietary measures - allergen avoidance

After an allergic affliction (expressed as rhino-conjunctivitis, rhinitis, asthma or eczema) has been diagnosed, and treatment of the more serious symptoms initiated, avoidance of causal allergens may be discussed with the patient and other members of his or her household. The therapeutic success of different sanitation measures depends on the individual clinical relevance of those allergens avoided, as well as on the efficacy of the measures actually taken (Kniest 1990). Anamnestic results and laboratory data (such as Phadiatop results) collected to arrive at the diagnosis of ‘allergic disease’ do not usually provide a complete basis for an effective avoidance plan. In this chapter we will try to show a structured way to arrive at effective sanitation procedures

Allergen avoidance in the dwelling environment

No abstract

Medical impact of arthropod allergens

In the European Union and the USA allergens of arthropods comprise a rising health problem. Atopic diseases resulting from insect or mite exposure cost several hundreds of millions British pounds per European country per year. This article is devoted to major sources of inhalant arthropod allergens, the cause of their rising abundance and resulting morbidity, and possibilities for effective management. For this review, literature was collected from the time period 1900-present. Arthropod allergens are involved in three different atopic diseases: allergic asthma, allergic rhinitis and atopic eczema. About 40% of the human population has a hereditary predisposition to develop atopic allergies. The atopic diseases show a rising trend in both prevalence and severity. Nowadays, 2-27% (Scandinavia) to 80% (the Netherlands, United Kingdom) of atopic patients are sensitized to one or more allergens derived from arthropods. In the United States up to 70% of asthmatics have a cockroach allergy. Major arthropods producing relevant allergens include house dust mites, storage mites and cockroaches. Arthropod allergen exposure indoors has increased due to changes in building construction, household management and facility management. Pesticides may be used to diminish pest populations producing inhalant allergens, but diminishing medical symptoms or preventing sensitization is only possible when the remaining allergens are removed by cleaning. The prevention of atopic disease demands avoidance in both the domestic and the occupational domain. Responsibility for the prevention and management of arthropod derived disease in the domestic environment is shared between the householder and owner of the dwelling. Health professionals have an advising and therapeutic role. In the occupational domain, architect, facility manager, work manager and employee share responsibility for prevention and care. In the domestic and occupational domains different multidisciplinary Task Groups should be formed to solve the problem of arthropod allergens. Pest exterminators have a (public) health task in both domains

Clinical improvement after unusual avoidance measures in the home of an atopic dermatitis patient

A 27-year-old female office clerk with widespread atopic dermatitis (AD) since infancy appeared to be highly sensitized and exposed to molds, storage mites, and chicken feathers and moderately sensitized to house-dust mites and grass and birch pollens. Hardly any textiles were present in her home; that is, only 28 m2, which is less than 25% of the Dutch national average. The causal relationship between eczema and molds plus storage mites in this case of AD was strengthened by the positive effect of an unusual, multidisciplinary home-sanitation program involving cleaning of mineral surfaces and ventilation improvement. This home-sanitation program led to a gradual drop of total IgE and clinical symptom scores to 21% and 13%, respectively, of the original values

Clinical improvement after unusual avoidance measures in the home of an atopic dermatitis patient

A 27-year-old female office clerk with widespread atopic dermatitis (AD) since infancy appeared to be highly sensitized and exposed to molds, storage mites, and chicken feathers and moderately sensitized to house-dust mites and grass and birch pollens. Hardly any textiles were present in her home; that is, only 28 m2, which is less than 25% of the Dutch national average. The causal relationship between eczema and molds plus storage mites in this case of AD was strengthened by the positive effect of an unusual, multidisciplinary home-sanitation program involving cleaning of mineral surfaces and ventilation improvement. This home-sanitation program led to a gradual drop of total IgE and clinical symptom scores to 21% and 13%, respectively, of the original values

The abundance of house dust mites (Pyroglyphidae) in different home textiles in Europe, in relation to outdoor climates, heating and ventilation

In Europe, house dust mites of the family Pyroglyphidae are abundant producers of allergens in dwellings. Their prevalence in dwellings as well as their distribution among different types of home textiles vary in different localities in Europe. The main limiting factor for mite population growth is water activity. Water activity is closely related to relative humidity in the mite niche. Relative humidity in the mite niche is influenced by outdoor temperature and absolute air humidity, heating and ventilation. The mean January outdoor air temperature was determined. Based on outdoor temperatures and absolute air humidities, the length of heating season and length of mite population growth season for different home textiles were defined. These variables were validated with published data on mite abundance in mattresses and on floors in climatically distinct areas in Finland, Denmark, United Kingdom, The Netherlands, France, Switzerland, Italy and Poland. Length of mite population growth season - abbreviated to mite season - can be shortened by effective ventilation. Therefore, minimal required ventilation rates, to keep the relative humidity in the mite niche below the hygienic moisture limit for mite population growth, in European countries, were collected. No significant correlation was demonstrated between length of heating season and mite numbers in any of the home textiles. Between mean January outdoor air temperature and mite numbers in mattresses; and between length of mite season and mite numbers in mattresses, significant correlations were seen (Spearman rank correlation test, p <0.05). On floors, none of the climatic variables showed a significant correlation with mite numbers. Minimal required ventilation rates were found in Denmark and the Netherlands, only. In contrast to length of heating season, mean January outdoor air temperature and length of mite season in mattresses can predict the overall abundance of house dust mites in mattresses in a climatic area. To predict the overall mite burden on floors, the influence of outdoor climate should be examined in combination with soil and constructional factors. To shorten the length of the mite population growth season minimal required ventilation rates have to be known

Allergen avoidance in the dwelling environment

No abstract

Daily Practice Experience of Baricitinib Treatment for Patients with Difficult-to-Treat Atopic Dermatitis: Results from the BioDay Registry

Clinical trials have shown that baricitinib, an oral selective Janus kinase 1/2 inhibitor, is effective for the treatment of moderate-to-severe atopic dermatitis. However, daily practice data are limited. Therefore, this multicentre prospective study evaluated the effectiveness and safety of 16-weeks' treatment with baricitinib in adult patients with moderate-to-severe atopic dermatitis in daily practice. A total of 51 patients from the BioDay registry treated with baricitinib were included and evaluated at baseline and after 4, 8 and 16 weeks of treatment. Effectiveness was assessed using clinician- and patient-reported outcome measurements. Adverse events and laboratory assessments were evaluated at every visit. At week 16, the probability (95% confidence interval) of achieving Eczema Area and Severity Index ≤ 7 and numerical rating scale pruritus ≤ 4 was 29.4% (13.1-53.5) and 20.5% (8.8-40.9), respectively. No significant difference in effectiveness was found between dupilumab non-responders and responders. Twenty-two (43.2%) patients discontinued baricitinib treatment due to ineffectiveness, adverse events or both (31.4%, 9.8% and 2.0%, respectively). Most frequently reported adverse events were nausea (n = 6, 11.8%), urinary tract infection (n = 5, 9.8%) and herpes simplex infection (n = 4, 7.8%). In conclusion, baricitinib can be an effective treatment option for moderate-to-severe atopic dermatitis, including patients with non-responsiveness on dupilumab. However, effectiveness of baricitinib is heterogeneous, which is reflected by the high discontinuation rate in this difficult-to-treat cohort