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I agree my information will be processed in accordance with the Nature and Springer Nature Limited Privacy Policy. Norbert Mülleneisen, Manfred Springob, … Jens Callegari. Although the importance of house dust as a source of allergens was recognized as early as the s, mites were not identified as the major source of house dust allergens until [ 6 , 7 ].

Microscopic detection of house dust mites rapidly led to the development of techniques for culturing them, allowing the preparation of house dust mite extracts for skin testing and for the detection of specific IgE antibodies [ 8 , 9 , 10 ].

This has demonstrated that sensitization to house dust mites is strongly associated with asthma development in many temperate zones worldwide [ 11 ].

The impact of these findings was dramatic, as this was the first well-defined year-round allergen [ 12 ]. Anti-dust mite measures have played and continue to play an important role in scientific discussions [ 13 ].

The first purification of a house dust mite allergen was achieved from a house dust mite culture medium and was initially designated F4Pl and later Der p1. This was used to develop a radioimmunoassay to measure the presence of Der p1 in dust samples [ 14 ].

Detailed studies on the source of the allergen initially focused on mite feces [ 15 ]. Evidence that particles from this become airborne provided important information about the form of exposure and the size of the particles [ 15 , 16 , 17 ]. This also showed that the percentage of particles entering the peripheral lung during resting breathing decreases with increasing size [ 18 , 19 ].

Conversely, house dust mite allergens in larger particles median 9. The allergens in these particles contribute to progressive inflammation of the airway mucosa in sensitized individuals [ 21 ].

The notion that allergen size and sensitization pattern may lead to differences in upper and lower airway involvement is an interesting but insufficiently studied hypothesis [ 22 ]. Thus, probably only a small number of mite fecal particles enter the respiratory tract, usually causing no noticeable symptoms or changes in lung function at the time of exposure [ 15 , 21 ].

Thus, airway inflammation and symptoms in mite allergic individuals are essentially due to chronic exposure to a small number of relatively large particles, in contrast to pollen inhalation, where sufficient allergens can be inhaled to cause massive immediate phase reactions [ 15 , 21 ].

Thus, nasal or bronchial provocation testing also represents an artificial special situation [ 13 , 15 ]. Thus, in inhalation allergies to house dust mites, late-phase allergic responses by effector cells such as eosinophils, T cells, and other inflammatory mechanisms apparently play a greater role than immediate IgE- and mast cell-mediated immediate-phase responses [ 23 , 24 , 25 ] and rarely lead to immediate respiratory symptoms at the time of exposure [ 26 ].

This could also explain the marked allergen-induced nasal and bronchial hyperreactivity [ 27 ] which is often more pronounced in mite-allergic patients than in pollen-allergic patients, but which can also be reversed, but only with sufficiently long mite abstinence after several months [ 28 , 29 , 30 ].

Therefore, mite abstinence must always be a long-term therapeutic measure. An intervention to prevent allergen exposure in an already allergic and symptomatic patient is called tertiary prevention, and some intervention studies have been successful in reducing clinical symptoms [ 31 , 32 ].

However, tertiary prevention for mite allergic patients is also quite critically viewed [ 33 , 34 ]. In principle, this also applies to primary care—i. However, since exposure periods of only one week and even with relatively low allergen concentrations are sufficient to trigger primary sensitization, measures with this goal seem almost hopeless in regions where house dust mites are generally present [ 39 , 40 ] especially since exposure can occur anywhere, including the home, school, public buildings, transportation, or the workplace [ 41 ].

Consequently, inhalant mite allergy reduction measures serve to control or minimize symptoms of allergic diseases, but they cannot prevent the initiation of sensitization.

The aim of the measures is to avoid contact with the allergens to a large extent, to minimize the number of mites to a large extent, and to create unfavorable living conditions for the remaining mite population [ 42 ].

Several Cochrane meta-analyses have highlighted some clinical efficacy of individual of the above-mentioned reduction measures [ 43 , 44 ]. The clinical efficacy of this measure has been extensively demonstrated for patients with mite allergic asthma.

Embedded in an overall concept to reduce house dust mite allergens, these individual measures, such as the use of encasing, have a significantly better effect. Measures to reduce mite exposure in the context of secondary and tertiary prevention are also recommended in the revised guideline on allergy prevention by the German allergological societies [ 42 ].

In addition to elaborate laboratory chemical detection methods, the detection of significant mite allergen exposure by the guanine method is possible for home use [ 45 , 46 ].

However, the tests for home use have been withdrawn from the German market in recent years. If required, test kits from foreign companies can be purchased e. These membranes are usually made of nonwoven or woven textile and provide a physical barrier to mite allergen-containing particles.

They are offered by various companies. An excerpt is shown in Table 1. In a recent study, 46 mite-allergic children with asthma were included and the efficacy of impermeable covers for mattresses and pillows versus mite-permeable placebo covers was investigated over the period of one year [ 48 ].

Use of the mite-impermeable covers resulted in significant mite allergen reduction in the mattresses as well as significantly reduced need for inhaled steroids compared to children in the placebo group.

In the case of allergic rhinitis, inconsistent study results were found [ 44 ], which may be due to the different quality of the encasings used.

For example, in a study of dust mite allergic patients with allergic rhinitis, there was a significant reduction in mite allergen concentration in the mattresses of the patients who received an encasement, but no improvement in the clinical parameters studied compared to the patients who received a mite-permeable placebo cover [ 50 ].

The encasing must be able to retain live mites, parts of dead mites, mite excrement and smaller particles to which mite allergens adhere. The pore size should be smaller than 0. Quality criterion: TÜV Nord tested validated and certified test method with real dust mite allergens. All bed components mattress, blanket, pillow must be completely enclosed by encasings.

A fitted cover for mattresses or toppers is not sufficient. Partner or sibling beds in the same room must also be completely enclosed with encasings. In principle, two types of textile are available as suitable encasing material: woven textile and nonwoven Fig. Nonwoven fabric is formed from fibers or filaments by mechanical, aero- or hydrodynamic processes.

The resulting textile has good filtration properties, but may have varying layer thicknesses and irregularities across the surface. Woven textile must be woven particularly tightly, creating a uniformly dense fabric.

The polyurethane coating of encasings, which was common in the past, is no longer necessary due to the use of modern fibers and techniques. Microscopic view of nonwoven fabric a , © Freudenberg and woven fabric b , © Allergiezentrum Wiesbaden.

A breathable textile high air and water vapor permeability has significant therapeutic benefits, especially for neurodermatitis sufferers and people who perspire heavily, as eczema and itching can be prevented.

All raw materials needed for production must be tested for harmful substances according to OEKO-TEX standards.

The manufacturer itself must be ISO certified to ensure the quality standards. There are encasings with OEKO-TEX Standard Class I, which are also suitable for babies. Encaisings have a proven safety and effectiveness.

Class I low risk registration for non-invasive medical devices, with claims for the treatment and prevention of dust mite allergy,. Proven safety: the allergen-tightness within the scope of the perennial application as well as the pollutant-free nature of the raw materials was tested, and.

Clinically proven efficacy: the recommendation for encasings is found in all dermatological and allergological guidelines including the current EDF Guideline, European Dermatology Forum. Furthermore, a quality management system is required in the manufacturing plants, at least according to ISO , and possibly also ISO Encasings are eligible for prescription and reimbursement if they have been approved as a medical device Class I according to MDR.

Manufacturers must be able to prove this by means of a declaration of conformity CE. This is the qualitative prerequisite for reimbursement by statutory health insurers as a medical device.

Synthetic fibers release moisture more quickly, thus drying faster and providing a poorer breeding ground for bacteria than natural fibers such as cotton. Since encasings should be washed as rarely as possible so as not to impair the impermeability of the material, this hygiene aspect plays an important role.

It is important to distinguish between the different types of encasings [ 51 ]. All other materials placed on the mattress should be suitable for regular washing [ 52 ].

Furthermore, special mite detergents can be used, with allergen eliminating effect. There are differences in the reimbursement of mite-allergen-proof covers on the part of the cost bearers. Table 2 shows an excerpt regarding the reimbursement by the statutory health insurance.

In private health insurance, there is no general stipulation on the reimbursement of encasings. Here, insured persons can take out individual insurance coverage tailored to their personal needs. The contractually agreed benefits are generally provided if the treatment is medically necessary.

Therefore, it is checked whether a mite allergy is present and whether a treatment to reduce the allergen exposure is necessary. The amount of the insurance benefits depends on the selected insurance coverage and will be checked individually.

We consider the use of encasings to be particularly useful in combination with allergen immunotherapy, especially in the initial phase of allergen immunotherapy.

A template from the Ärzteverband deutscher Allergologen AeDA can be used for the prescription of encasings. Acaricides are pesticides or biocides used to control mites. Generally, one can distinguish between mite sprays and mite washes.

The mite sprays are mostly based on neem oil, eucalyptus, geraniol and many more. The formerly contained benzyl benzoate is now only allowed in washing additives excerpt of acaricides on the market in Table 3.

Use as a mite reduction measure may be considered, although no controlled studies of efficacy and absolute population size reduction of individual acaricides are known.

House dust mites depend on relatively high ambient humidity for growth and reproduction, but can survive for extended periods in low-humidity environments [ 55 ]. This helps to explain why both dust mite exposure and mite-related respiratory symptoms can vary seasonally and argues for a possible role for humidity reduction measures in mite scarcity [ 56 , 57 ].

However, the results from controlled studies on the effect of dehumidification measures on mite abundance have been markedly inconsistent [ 58 , 59 , 60 ]. This is probably related to the fact that even short periods of increased humidity are sufficient for the survival and reproduction of dust mites.

In addition, house dust mites can be found in large numbers even in desert areas if they find high humidity locally, e. Technical options for cleaning indoor air of particulate solids include electrostatic cleaners, in which the charged particles adhere to plates in the device [ 64 ].

Alternatively, filters are used in which the particles are physically trapped in the filter. HEPA high efficiency particulate air filters consist of a large area of folded paper that allows air to pass through and filter out The criticism here is that the exhaust air can swirl out dust and thus possibly swirl up more allergens than the filter removes from the air [ 65 ].

The complexity of these various issues underscores the importance of patient education and involvement. There is evidence that HEPA filters can reduce respiratory symptoms in mite allergic patients, suggesting that they may be helpful as part of a multifaceted avoidance strategy [ 66 , 67 ].

Several studies have shown that in addition to mattresses, carpets and upholstery materials are important sources of dust mite allergens [ 68 , 69 ]. Shifting furniture, fluffing or moving pillows, curtains or bedding can release significant amounts of mite allergens into the air [ 15 ].

Vacuum cleaners can remove particulate matter such as mite allergens from carpets and upholstered furniture, but cannot reduce live mites to any significant extent because mites can cling to almost any surface with gripping tools on their feet [ 70 , 71 ].

Even with modern vacuum cleaners, it is therefore impossible to remove all dust mite allergens from a carpet or upholstered furniture.

Therefore, humidity control should be emphasized at this point as part of the strategy. Placing carpets in the sun to clean and dry, as has traditionally been done, seems to be most effective.

It should be remembered that vacuum cleaners can also stir up dust [ 72 ] which should be investigated in industry standard tests [ 73 ]. Suitable high-quality filters or extractors can filter out most of the allergen containing particles [ 74 ].

Steam cleaners provide little additional benefit in reducing mite allergens [ 75 , 76 ]. The design of a controlled study of mite allergen avoidance is complex and captures many parameters of daily life that are difficult to control including ventilation behavior, length of stay in rooms, cleaning behavior of mattresses, blankets, sheets, etc.

In addition, behavioral changes may occur simply due to participation in the study and improved access to information in both the control and intervention groups, which may, for example, render the additional effect of an encasing undetectable [ 50 ].

Also, in polysensitized patients, symptomatology may be maintained by allergens other than house dust mites, so that the effect of the tested exemption measure is not detectable [ 78 ], or patients with relatively well-controlled disease or minimal dust exposure are included [ 79 ].

Therefore, it is important to know the mite allergen exposure precisely before starting the intervention over a longer period of time and under different living conditions [ 31 , 32 , 35 , 74 , 80 ]. Despite all these difficulties, successful studies have been conducted, with the main intervention usually related to beds.

The studies presented below focused on controlled study designs, in addition to the use of physical barriers encasings , heat treatment to kill mites, additional use of tannic acid to denature mite allergens, and a complex design with measures to control exposure to animal dander, cockroaches, and dust mites [ 81 , 82 ].

Murray et al. included children with mite asthma and preceding asthma exacerbations with need for hospitalization in a controlled, effectively blinded study of mite abstinence [ 82 ].

The result was a significant decrease in exacerbations over the next year. Improved drug therapy options [ 85 ] and the modern allergen immunotherapy [ 36 , 86 ] contribute significantly to an improved morbidity and mortality of these diseases.

Only actual complete allergen exposure avoidance can prevent sensitization. For the development of tolerance, the exposure of the immune system to allergens is necessary. It can be assumed today that small allergen amounts tend to lead to sensitization, whereas higher allergen concentrations tend to induce tolerance.

In the U. birth cohort study URECA, exposure to house dust mite allergen in the first year of life was not associated with an increased risk of recurrent wheeze at 3 years of age [ 87 ]. In a subsample, the microbial content of house dust was additionally examined [ 87 ].

Here, microbial diversity correlated negatively with asthma risk at 6 years of age [ 88 ] and at Other studies found differences in the qualitative and quantitative allergen composition and microbial diversity of house dust from homes where children with and without asthma symptoms grew up [ 90 , 91 , 92 ].

In particular, the indoor microbiota in urban, poorer neighborhoods appeared to be associated with a risk of developing respiratory symptoms. Further studies are needed to clarify whether the childhood microbiome is altered by this and to better characterize protective and risk factors.

Interventions to reduce the exposure to dust mite allergens in the household are therefore currently not proven useful with the aim of primary prevention, but can be recommended for tertiary prevention of allergic diseases, as evidence of efficacy exists here. We therefore recommend a therapy trial of at least 6 weeks with mite control measures in the case of mild symptoms and additional allergen-specific immunotherapy if there is no improvement.

In the case of moderate to severe symptoms, allergen-specific immunotherapy should be administered at the same time as the above-mentioned control measures.

Frequency of sensitizations and allergies to house dust mites. Allergo J Int. Article Google Scholar. Biology of house dust mites and storage mites. Brehler R.

Clinic and diagnostics of house dust mite allergy. Mülleneisen N, Springob M, Salge S, Völkel A, Magnet F, Callegari J. Der lange Weg von den ersten Symptomen einer Milbenallergie zur Milben-AIT. Vrtala S. Allergene von Hausstaub- und Vorratsmilben. Spieksma FTM, Dieges PH. The history of the finding of the house dust mite.

J Allergy Clin Immunol. Vannier WE, Campbell DH. A starch block electrophoresis study of aqueous house dust extracts. J Allergy. Miyamoto T, Oshima S, Ishizaki T, Sato SH. Allergenic identity between the common floor mite Dermatophagoides farinae Hughes, and house dust as a causative antigen in bronchial asthma.

Article CAS Google Scholar. Smith JM, Disney ME, Williams JD, Goels ZA. Clinical significance of skin reactions to mite extracts in children with asthma. Br Med J. Wide L, Bennich H, Johansson SG. Diagnosis of allergy by an in-vitro test for allergen antibodies. International Workshop report.

Dust mite allergens and asthma: a worldwide problem. Bull World Health Organ. Google Scholar. Platts-Mills TAE. Weck ALd. Dust mite allergens and asthma—A worldwide problem. Platts-Mills TA, Chapman MD. Dust mites: immunology, allergic disease, and environmental control. Chapman MD, Platts-Mills TA.

Purification and characterization of the major allergen from Dermatophagoides pteronyssinus-antigen P1. J Immunol.

Tovey ER, Chapman MD, Wells CW, Platts-Mills TA. The distribution of dust mite allergen in the houses of patients with asthma. Am Rev Respir Dis. CAS Google Scholar. Busse WW, Reed CE, Hoehne JH.

Where is the allergic reaction in ragweed asthma? This is discussed in more detail separately. See "Patient education: Anaphylaxis treatment and prevention of recurrences Beyond the Basics ". The best treatment for an anaphylactic reaction is epinephrine, which is available in a device that can be used to inject yourself or someone else.

If you or your child has a severe food allergy, you will need to carry an autoinjector with you at all times. The use of epinephrine autoinjectors is also discussed separately. See "Patient education: Using an epinephrine autoinjector Beyond the Basics ". Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available.

Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition.

These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Food allergy The Basics Patient education: Allergy skin testing The Basics Patient education: Peanut, tree nut, and seed allergy The Basics.

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon. Patient education: Food allergy symptoms and diagnosis Beyond the Basics Patient education: Using an epinephrine autoinjector Beyond the Basics.

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings.

These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

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Font Size Small Normal Large. Patient education: Food allergen avoidance Beyond the Basics. Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. Eating, touching, and inhaling allergens What about cooked or baked products?

Author: Scott H Sicherer, MD, FAAAAI Section Editor: Robert A Wood, MD Deputy Editor: Elizabeth TePas, MD, MS Contributor Disclosures. All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: Jan This topic last updated: Jan 11, FOOD ALLERGY OVERVIEW People with food allergies can have serious or even life-threatening reactions after consuming certain foods. LIVING WITH FOOD ALLERGIES Adults and caregivers of children with food allergies must learn to carefully read food labels, prepare meals at home, and talk to others about their condition.

FOOD ALLERGENS IN NON-FOOD ITEMS Non-food items, such as medications, cosmetics, vaccines, and craft supplies, may contain ingredients normally found in foods.

PERSONAL CONTACT AND FOOD ALLERGIES Saliva and other bodily fluids can potentially expose an allergic person to food allergens. FOOD ALLERGY TREATMENT PLAN Because it is not always possible to avoid food allergens, it is important to develop a plan for dealing with this type of emergency before it happens.

Patient education: Food allergy The Basics Patient education: Allergy skin testing The Basics Patient education: Peanut, tree nut, and seed allergy The Basics Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed.

Patient education: Food allergy symptoms and diagnosis Beyond the Basics Patient education: Using an epinephrine autoinjector Beyond the Basics Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings.

It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances.

Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient.

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Topic Feedback. Avoiding food allergens when dining out.

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Marks GB, Tovey ER, Green W, Shearer M, Salome CM, Woolcock AJ. House dust mite allergen avoidance: a randomized controlled trial of surface chemical treatment and encasement of bedding.

Woodcock A, Forster L, Matthews E, Martin J, Letley L, Vickers M, Britton J, Strachan D, Howarth P, Altmann D, Frost C, Custovic A. Medical Research Council General Practice Research Framework. Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma.

Jennings S, Prescott SL. Early dietary exposures and feeding practices: role in pathogenesis and prevention of allergic disease? Postgrad Med J ;— Gøtzsche PC, Johansen HK, Schmidt LM, Burr ML. House dust mite control measures for asthma. Cochrane Database Syst Rev CD Liao EC, Lee MF, Tsaii JJ.

The tropmyosin specific IgE and its roles of cross-reactivity between shrimp and dust mites. Clin Transl Allergy ;1:P Wang J, Calatroni A, Visness CM, Sampson HA. When covering crib mattresses and children's mattresses and pillows, only tight-fitting, commercial covers intended for this purpose should be used.

Homemade covers for example, plastic sheeting fastened with duct tape should not be used in children's beds, as these can come apart, and children can become trapped or suffocate. Tightly-woven fabrics with a pore size of 6 microns or less are very effective at controlling the passage of mite as well as cat allergens.

Fabrics with a pore size greater than 2 microns still permit airflow [ 3,4 ]. Mites can be eliminated by washing sheets and blankets weekly in warm water with detergent or by drying them in an electric dryer on the hot setting table 2.

Exposure can be further reduced by vacuuming with a vacuum cleaner equipped with a high-efficiency particulate air HEPA filter, dusting regularly, and not sleeping on upholstered furniture eg, couches. However, studies have yet to show that physical or chemical cleaning methods reduce mite levels to a degree that improves symptoms [ 5 ].

Indoor humidity levels should be kept below 50 percent. Inexpensive humidity monitors can be purchased at most hardware stores. Humidifiers make the problem worse and are not recommended. When possible, the amount of clutter, carpet, upholstered furniture, and drapes should be minimized, and horizontal blinds should be eliminated in the rooms where the person spends the most time bedroom, study, television room.

Washable vinyl, roller-type shades are optimal. For children, the number of stuffed toys in the bedroom should be minimized. Animal dander — Animal dander is made up of the dead skin cells or scales like dandruff that are constantly shed by animals. Any breed of dog or cat is capable of being allergenic, although the levels given off by individual animals may vary to some degree.

Accordingly, short-haired cats are not necessarily less allergenic than long-haired animals, and furless cats have allergen levels similar to furred cats.

Other animals, such as rodents, birds, and ferrets, can also trigger symptoms in an allergic individual. Pets without feathers or fur, such as reptiles, turtles, and fish, rarely cause allergy, although deposits of fish food that build up under the covers of fish tanks are an excellent source of food for dust mite colonies.

If a person is found to be allergic to a pet, the most effective option is to remove the pet from the home. Limiting an animal to a certain area in the house is not effective, because allergens are carried on clothing or spread in the air.

Once a pet has left a home, careful cleaning or removal of carpets, sofas, curtains, and bedding must follow. This is particularly true for cat allergens because they are "sticky" and adhere to a variety of indoor surfaces.

Even after a cat has been removed from a home and it has been thoroughly cleaned, it can take months for the level of cat allergen to drop.

For this reason, it may take months for the person's symptoms to fully reflect the absence of the pet. If it is not possible to remove the animal, measures can be taken to decrease exposure to the animal dander table 3 , although none of these methods are as effective as removing the animal.

Vacuum cleaners with a HEPA filter are effective in reducing cat and dog allergen levels in the home and can reduce symptoms [ 5 ]. See 'Air filters' below. Rodents — Mice and rats have proteins in their urine that can cause allergies.

This applies to rodents that live in a laboratory setting, as well as rodents that live in the wild. To reduce rodent allergen levels significantly, a combination of pest control methods, in addition to pesticides eg, poison baits , are usually necessary.

This includes keeping food and trash in covered containers, cleaning food scraps from the floor and countertops, and sealing cracks in the walls, doors, and floors. Cockroaches — Cockroach droppings contain allergens that can trigger asthma and allergic rhinitis in sensitive individuals.

Cockroaches thrive in warm, moist environments with easily accessible food and water. Unfortunately, efforts to control cockroach populations in infested areas are often less than successful.

Still, certain measures are recommended:. Asian ladybugs — Asian ladybugs were previously imported to the United States as a biologic means of controlling aphids. It was anticipated that the insects would not survive the cold of winter.

However, they adapted by moving inside houses when temperatures drop in the early fall. Allergies to Asian ladybugs have been increasingly reported as a source of seasonal indoor respiratory symptoms, particularly chronic cough, rhinitis, and asthma.

Most cases have been reported in rural areas of the central, midwestern, and southern United States. The insects can also bite and cause local reactions. Asian ladybugs enter homes through external cracks and crevices and then infest spaces within walls.

They secrete a brown liquid that may stain walls and produce an unpleasant smell. Treating the exterior of the house with a chemical pyrethroids before cold weather arrives can prevent swarming of the ladybugs inside the home. Pyrethroids are similar to pyrethrins, which are derived from marigold flowers.

Pyrethrins are broken down by the sun and do not significantly affect groundwater quality. Indoor molds — Mold spores can trigger symptoms of allergic rhinitis in allergic patients. Mold thrives in damp environments.

Areas, such as air conditioning vents, water traps, refrigerator drip trays, shower stalls, leaky sinks, and damp basements, are particularly vulnerable to mold growth if not cleaned regularly. Most of the mold spores enter the home from the outside air. However, under certain circumstances, mold growth in the home can be significant and worsen allergy symptoms.

To reduce the growth of mold in the home, it is necessary to remove existing mold and also to reduce humidity to prevent future growth of mold. Humidity can be reduced by removing sources of standing water and persistent dampness. Removing house plants, fixing leaky plumbing, correcting sinks and showers that do not drain completely, removing bathroom carpeting that is exposed to steam and moisture, using exhaust fans in the bathroom when bathing, and dehumidifying damp areas to levels below 50 percent are a few steps that can help to reduce or prevent growth of indoor mold.

Indoor garbage pails should be regularly disinfected, and an electric dehumidifier should be used to remove moisture from wet or humid basements. Old books, newspapers, and clothing should be discarded or donated rather than stored.

Water-damaged carpets and wall or ceiling boards should be thrown out because it is difficult or impossible to eliminate mold in this situation, even with thorough cleaning.

Mold thrives on soap film that covers tiles, sinks, and grout. Sinks, tubs, and other surfaces with visible mold growth should be cleaned at least every four weeks with dilute bleach 1 ounce [30 mL] bleach diluted in 1 quart [1 liter] of water.

Even then, it may take months after pet removal before allergen levels are reduced. The effectiveness of some measures such as washing animals frequently and using HEPA air filters remains uncertain. Dogs, guinea pigs, mice and rabbits are not as allergenic as cats and are more easily kept outside, but can still cause annoying and occasionally serious problems.

Horse allergy is very serious and even animal hair on clothes may be sufficient to trigger asthma. Great care must be taken to shower and change clothes before returning to a home of a person allergic to horses.

Birds may occasionally cause allergic symptoms. This is a different problem to pigeon fancier's lung which is a serious condition and requires complete avoidance. Mould in the home can show as mould, mildew or a musty smell.

It is commonly found in bathrooms, refrigerators and in places with little air circulation such as walk-in and built-in wardrobes, and in bedrooms with ensuite bathrooms. In Australia and New Zealand the height of the grass pollen season usually occurs between late September and December, and the major amount of pollen in the air usually occurs between 6am and noon.

Depending on the weather patterns, there may be an increase of pollen in the early hours of the morning. Although pollen is known to be blown long distances on windy days, most pollen is deposited within a short distance of its source. The highest pollen counts occur on calm, hot, sunny days in late October, November and December, although in Queensland the season is different, and January is a particularly high pollen count month.

Pollen allergy in tropical areas mainly occurs during the dry season. However, higher pollen counts are also associated with thunderstorms. When pollen granules come into contact with water, starch granules are released that are small enough to be breathed into the airways, triggering allergic rhinitis hay fever and asthma in some people.

Seek advice from your doctor or pharmacist about medications or treatments that will relieve your symptoms.

Information about pollen counts in Australia is available at www. ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice.

The content of ASCIA resources is not influenced by any commercial organisations. Skip to main content. Contact Us Locate a Specialist Sitemap. Home Patients Allergy treatments Allergen minimisation.

Allergen Minimisation ASCIA PCC Allergen minimisation House dust mites are common allergens in Australia and New Zealand House dust mites are the most common allergen source in humid areas such as coastal cities and towns.

House dust mite minimisation The first room to tackle is the bedroom and in particular the bedding, where we spend the greatest number of consecutive hours. This will kill dust mites and wash away the allergen they produce.

If you cannot wash in hot water, use a commercial product containing tea tree or eucalyptus oils, formulated to kill dust mites in cold water. If washing normally, hot tumble drying of washed items for ten minutes after they are dry, will kill dust mites.

Dry cleaning is not as effective as it will kill house dust mites but won't remove the allergen they produce. Cover mattress, pillow and quilt with dust mite resistant covers. Some health funds may provide a rebate for the purchase of these items. The covers must be washed every two months.

If covers are not available, wash blankets and non-encased washable doonas every three months in hot water. Remove sheepskins or woolen underlays from the bed and bedroom. Remove all soft toys from the bed and bedroom. Replace them with wooden or plastic toys which can be washed.

If keeping soft toys, wash them in eucalyptus oil weekly or place in the freezer overnight. Freezing soft toys overnight kills mites but does not remove the allergen. The following advice can apply to bedrooms as well as other rooms in the house: If possible, consider replacing carpets with hard floors such as wood, tiles, linoleum, concrete, where practical and affordable.

Carpets can contain large amounts of house dust mite and animal allergens which cannot be completely removed by vacuuming. Damp dust or use electrostatic cloths to clean hard surfaces including hard floors weekly. Vacuum carpets weekly, note that vacuuming increases the amount of house dust mite allergen in the air for up to 20 minutes.

Where possible, ask someone else to do the vacuuming and wait 20 minutes before re-entering the room. High efficiency particulate air HEPA filter vacuum cleaners may remove more allergen than other vacuum cleaners, however, they still temporarily increase the amount of dust mite allergen in the air.

Reduce humidity — Where possible, have a dry and well ventilated house, and adequate floor and wall insulation. Avoid using evaporative coolers water cooled air conditioners and unflued gas heaters, as these both release water into the air and can increase indoor dust mite and mould levels.

Thus, people who are very sensitive should avoid situations in which aerosolized food could be inhaled for example, being in close proximity to boiling or steaming milk or shellfish or frying fish or eggs.

Although peanut protein does not easily become airborne from peanut butter, it may from peanut flour or "dusty" roasted peanuts.

Similarly, touching an allergenic food and then touching your eyes, nose, or mouth can cause an allergic reaction. What about cooked or baked products? Tolerance is typically determined through a controlled "food challenge," in which the person is fed increasing amounts of a baked food in a supervised clinical setting.

LIVING WITH FOOD ALLERGIES. Adults and caregivers of children with food allergies must learn to carefully read food labels, prepare meals at home, and talk to others about their condition. Managing allergies in school — If your child has a food allergy, you will need to provide the school with their medications and a copy of their food allergy action plan.

Speak with the school nurse about the school's policies on managing allergies, for example, whether they have any rules about eating in the classroom or separating children with allergies at lunch time.

Food labeling — Laws regarding food labeling vary by country. People with food allergies must consider not only a food's ingredients, but also any potential cross-contact also called "cross-contamination" that can occur as the food is prepared.

It is also important to know that ingredients may change over time, and you should check labels each time you purchase a product, even if it's something you have had before. In the United States, the Food Allergen Labeling and Consumer Protection Act mandates that nutritional labels on food packages clearly identify nine specified food allergy sources milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, sesame, wheat, and soy , although other foods may still appear under multiple names.

Additionally, for tree nuts, crustacean shellfish, and fish, the specific type eg, walnut or cashew, shrimp or lobster, tuna or salmon, etc must be labeled. This law applies to all packaged foods manufactured in the United States and also to foods that are imported for sale in the United States.

However, the law does not apply to packaged fresh meat, poultry, or egg products. Updates to this law are available online from the Center for Food Safety and Applied Nutrition, a branch of the US Food and Drug Administration FDA; www. Potential allergens other than the "top nine" listed above may still be listed on food labels with unclear names for example, garlic may be listed as a spice, natural flavor, or even an artificial flavor.

If the label is unclear, call the manufacturer to clarify the ingredients. The Food Allergy Safety, Treatment, Education, and Research FASTER Act of declared sesame as the ninth major food allergen recognized by the United States. This change resulted in the requirement to declare sesame on labels as of January 1, Products on store shelves labelled prior to that date will not include this declaration.

Thus, some caution is needed during this transition period. In addition, it is important to understand that "substitute" foods, which are used to remove fats or other components of a food, may not remove the allergenic proteins.

As an example, some egg substitutes which are lower in cholesterol still contain egg white proteins. Advisory labeling — A manufacturer may use certain phrases when a particular allergen is not an intended ingredient but the ingredient may come in contact with the food during the manufacturing process.

As an example, a blueberry muffin may not intentionally contain nuts but may be made in a bakery where banana nut muffins are made. Manufacturers may use phrases such as "may contain," "processed in a facility with," "manufactured on shared equipment with," and others.

There are no laws regarding when this type of label should be used. Although manufacturers use a variety of label terms in their voluntary advisory warnings, these do not necessarily reflect the level of risk.

As an example, a muffin that says that it "may contain nuts" is no more or less likely to contain nuts than a muffin that says "processed in a facility with nuts. Advisory labeling may help to reduce the risk of an allergic reaction but may also significantly reduce the food choices available to people with food allergies.

Most allergists recommend avoiding foods that have an advisory label because it is impossible to know the actual risk. Serious allergic reactions have occurred as a result of cross-contact. Ask your allergy specialist if this is a concern for you. Alcoholic beverages — Alcoholic beverages may contain allergens.

Labeling laws do not currently apply to these beverages. People with food allergies are advised to call the manufacturer if there are questions about the ingredients.

Preparing meals at home — Some families avoid bringing food allergens into the home if one person is allergic. Other families keep the food in the house but are careful to avoid cross-contact. Avoiding cross-contact requires thoroughly cleaning utensils, cookware, glassware, storage containers, and other food preparation materials used with a food allergen before the item is used to prepare or serve "safe" meals.

See 'Cleaning' below. All members of the family, including children, must be careful if allergenic foods are brought into the house. As an example, if a child uses a single knife to prepare a peanut butter and jelly sandwich, they could introduce peanut allergen into otherwise safe jelly and subsequently cause a reaction in a peanut-allergic sibling who eats the jelly.

Other tips for preparing meals at home include preparing the safe meal first, keeping food containers covered to prevent spills, and designating specific containers of food for the allergic person only. Cleaning — Washing food storage containers and dishes in a dishwasher or hand washing with hot water and liquid dish soap is generally adequate to remove food allergens.

Tabletops and other surfaces may be cleaned with a household cleaner or commercial wipe. Bar or liquid soap, but not alcohol-based antibacterial hand gel, can remove peanut allergen from adults' hands. Studies of other non-peanut food allergens have not been performed, although these cleaning methods are probably adequate for other allergens as well.

Traveling and eating out — Dining out can be challenging for people with food allergies. The table includes tips to ensure that the risk of contact with a food allergen is minimized table 1.

Nuts are sometimes served on airplanes, increasing the risk of an allergic reaction. In addition, other travelers bring their own food on board.

If you are traveling with a young child who has a food allergy, clean the tray tables and inspect the seating area for foods that your child might find and eat. Some airlines provide additional accommodations when requested in advance eg, a flight where peanuts are not served.

FOOD ALLERGENS IN NON-FOOD ITEMS. Non-food items, such as medications, cosmetics, vaccines, and craft supplies, may contain ingredients normally found in foods. Labeling laws do not apply to these products. If there are questions about a product's ingredients, it is often helpful to call the manufacturer.

Vaccines — Gelatin, egg, and other potential allergens may be used in the production of certain vaccines:. People with egg allergies can be given the egg-based influenza vaccine safely.

Medications — Nonprescription and prescription medications in tablet, capsule, and inhaler form can contain food allergens. Always talk to your doctor or pharmacist to make sure you understand what is in your medications. One example is lactose, a sugar derived from milk.

Although lactose used in medications is unlikely to contain milk proteins, some experts recommend that people who are highly allergic to milk avoid using products that contain lactose for example, they can use metered dose inhalers rather than dry powder inhalers that contain lactose.

Cosmetics and crafts — Cosmetics may contain a variety of food-derived ingredients, including milk, nut oils, wheat, and soy. Craft items, such as modeling dough, may contain wheat. Egg white is sometimes used to smooth finger paints. If you have a question about a product's ingredients, call the manufacturer.

PERSONAL CONTACT AND FOOD ALLERGIES. Saliva and other bodily fluids can potentially expose an allergic person to food allergens. Kissing or sharing straws, glasses, or utensils are the most likely ways of spreading an allergen through saliva.

Based upon a study of peanut butter, waiting several hours after eating an allergenic food and then eating a nonallergenic food s seems to reduce the level of allergen in the saliva; this is a good way for a nonallergic person to minimize risk to a person with an allergy.

It is theoretically possible to have a food allergy reaction after other forms of contact, such as sexual intercourse or a blood transfusion. However, this type of reaction is uncommon. FOOD ALLERGY TREATMENT PLAN.

Because it is not always possible to avoid food allergens, it is important to develop a plan for dealing with this type of emergency before it happens. Serious allergic reactions are often unexpected, develop suddenly, and require immediate treatment.