Download Environmental Control Handbook

Environmental Control
Handbook
ALLERGY PARTNERS
www.allergypartners.com
Allergy
Test Results Summary
Did
YouSkin
Know?
Your body is like a cup which allergens from the best way to treat your allergy is for you to do as
environment
flow into. Like a cup, your body can hold much as you canDate:
to avoid
the things that bother you
Name: ___________________________________________
_____________________
only so many allergens before it overflows. When or at least minimize your exposure to those things.
Yourcup
skinoverflows,
tests showed
that symptoms
you haveappear
a sensitivity to the substances checked below:
your
your allergy
The one part of your day that you can control
and you begin to sneeze, wheeze, sniffle, itch,
most
is the
timeheavily
you sleep.
If your
sleepspring,
time canfrom
be
Trees
pollinate
most
in the
early
� cough.
Tree Pollen
scratch and
as
allergy
free
as
possible,
your
“cup”
will
get
a
fresh
February through May.
The purpose of environmental control is to start the next day.
modify the things in your environment that you are
Therefore,
makingmost
your of
Grass
fromconcentrate
mid-springon
through
�in Grass
Pollenyour exposure
allergic to
order to decrease
time pollinates
bedroom
the
center
of
your
efforts.
theThe
summer.
and to keep your body’s “cup” from overflowing.
� Weed Pollen
� Molds/Mildew
� House Dust Mites
� Cat/Dog Dander
� Cockroach
� Other
Although some weeds pollinate in the spring and
summer, the most important ones pollinate heavily
from mid-August until there have been several hard
frosts.
Molds send out spores almost year-round. They
occur both outdoors and indoors.
These microscopic pests infest homes year-round.
They are the number one cause of year round allergies.
There is usually no significant difference in sensitivity
between breeds.
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
2
Your Home….
Resources
The majority of allergens which
can fill up your “cup” fall into 4
Mission Allergy major categories: house dust,
molds,
28 Hawleyville Road,
P.O. pollens,
Box 45 and pets. Irritants
such
as
tobacco smoke and air
Hawleyville, CT 06440
pollution
can exacerbate allergic
1-877-NOALLERGY
symptoms.
www.missionallergy.com
A Closer Look
Allergy Control Products
96 Danbury Road
Ridgefield, CT 06877
1-800-422-DUST
www.allergycontrol.com
(allergy control products such as HEPA cleaners
and dust mite encasings)
Now, take a look at what
specific things you can do to avoid
Achoo Allergy or control allergens in your
3872 Roswell Road,
Suite C-3
environment.
Atlanta, GA 30342
1-800-339-7123
Dust Mite
www.achooallergy.com
House Dust Mites - are microscopic, sightless, light-sensitive,
eight-legged insects.
Discount Stores
Department Stores
National Allergy Supply, Incorporated
1620-D Satellite Blvd.
Duluth, GA 30097
1-800-522-1448
www.nationalallergy.com
Dust mite’s
favorite food is
shed human
skin. They thrive
in warm, damp
homes and die
when the temperature falls
below 50 degrees or humidity
levels are less than 50%. Dust
mites can be found in carpeting,
mattresses, comforters, pillows,
box springs, upholstered furniture
and stuffed toys. A dead mite is
still an allergic mite as the mite's
excreta and body parts also trigger
allergic symptoms.
National Organizations
American Academy of Allergy & Immunology
611 East Wells Street
Milwaukee, WI 53202
1-800-822-2762
www.aaaai.org
American College of Allergy & Immunology
800 East Northwest Highway
Suite 1080
Palantine, Il 60067
www.acaai.org
These organizations are made up of 3,000 doctors dedicated to educating
physicians
and
healthcare
Recent
studies
show
that mite
providers in the field of allergy. They encourage research and maintain
skills
of
their
members
allergy is a major risk factorbyfor
sponsoring educational programs, scientific publications, and patient information.
emergency visits for treatment of
asthma.
3
Dust Mite Avoidance: Focus on the “Bedroom”
A Patient Guide to Immunotherapy
MATTRESS
ANDAND
BOXSPRING:
EncaseEncase
in dust mite
MATTRESS
BOXSPRING:
in dust
proofproof
encasements.
mite
encasements. Tape should be placed over
How Long Do I Stay on
zippers.
(continued)
local reactions. However they are much more
Immunotherapy?
serious. Systemic reactions are usually mild and
PILLOWS:
UseUse
dacron
or polyfill
in place
of feather,
PILLOWS:
dacron
or polyfill
in place
of feather,
Immunotherapy
is
generally
continued
for
3
to
5
respond rapidly to medications. Symptoms can
down or
or foam.
foam. Replace
Replace every
down
every 1-2 years. Encase in dust
years,
at
which
time
the
decision
to
stop
include increased allergy symptoms such as
mite
proofEncase
covers.in
1-2 years.
immunotherapy should be discussed with your sneezing, nasal congestion, or hives. Rarely, a
dust
mite proof
covers.
BLANKETS
COMFORTERS:
Wash
in relief
hot water
allergist.
SomeAND
people
may experience
lasting
serious systemic reaction, called anaphylaxis, can
every
weekallergy
or encase
in dust mite
encasements.
of their
symptoms
after proof
stopping
shots. occur. Symptoms of anaphylaxis include swelling in
Others
may find Wipe
that their
symptoms gradually return. the throat, wheezing or tightness in the chest,
WATERBED:
mattress
Therefore,
decision
to stop immunotherapy must nausea, dizziness, or other symptoms. In very rare
and
under the
edge
of mattress
be individualized.
instances, anaphylactic reactions can be fatal.
frequently
with warm soapy
water.
When Will I Start to Feel Better?
Because of possible reactions to immunotherapy,
Initial improvement
withKeep
immunotherapy may be
STUFFED
ANIMALS:
noted
as
soon
as
2
to
4
months
to a minimum. Choose 1-2 that after starting, but it
may washable
take longer. Symptomatic
improvement tends to
are
and
progressInthroughout
dryable.
addition, treatment. Maximum symptom
reliefinoccurs
approximately
2 years after starting.
place
a freezer
for
immunotherapy
does not provide
24Because
hours every
two
immediate relief of your allergy symptoms, you will
weeks.
need to continue your allergy medicines at least
LAUNDRY: Use
during the beginning of build up. Hopefully, as you
hot water wash in
continue
on immunotherapy, your need for
place
of cold-water
medications
control your symptoms should
wash for all tobed
gradually
decline.
linens
including
What Kind
of Reactions Can Occur?
mattress
pad every
most common shot reaction is a local reaction.
1 to The
2 weeks.
It appears as redness and swelling at the injection
WINDOW
COVERsite.
This can happen
immediately, several hours, or
INGS: Should be wash1-2 days after an injection. If you experience such
able or wipeable.
reactions, it is very important to notify your nurse
FURNACE
AND
AIR Your immunotherapy dose
before
your next
injection.
CONDITIONING
FILTER:
may need to be modified to prevent further local
Change
monthly.
reactions.
Systemic reactions are much less common than
it is absolutely mandatory that injections be given in
BLANKETS
ANDofCOMFORTERS:
Wash
in hot water
the presence
qualified medical
providers.
It is
every
week
or
encase
in
dust
mite
proof
encasenecessary to wait at least 30 minutes following
your
ments.
injection to ensure there is no significant reaction. If
you feel any Wipe
itching,mattress
swelling,and
tightness
the of
throat
WATERBED:
under inedge
or chest, you must immediately let the shot nurse
mattress frequently with warm soapy water.
know so that you can receive prompt care. If a
systemic reaction
begins
after you Choose
have left1-2
STUFFED
ANIMALS:
Keeptotooccur
a minimum.
the office,
return immediately
to In
theaddition,
office orplace
go toin a
that
are washable
and dryable.
the nearest
emergency
medical
facility.
freezer
for 24
hours every
two weeks.
What Can I Expect from
LAUNDRY:
Use hot water wash inplace of cold water
Immunotherapy?
wash
for
all
bedoflinens
mattress
every 1
In over 85%
cases,including
immunotherapy
canpad
provide
to
2
weeks.
substantial, long lasting improvement in allergy
symptoms. You should have fewer and less severe
WINDOW COVERINGS: Should be washable or
allergic reactions to those substances that currently
wipeable.
cause your allergies or asthma to flare. Also, you
should be AND
able AIRCONDITIONING
to control your symptoms
with
less
FURNACE
FILTER:
Change
medicine than you presently need. Allergy shots may
monthly.
not be a cure, but they are an excellent means of
controlling your allergy symptoms.
4
Recent studies show that dust mite allergy is a major risk factor
for emergency visits for treatment of asthma.
Skin Testing
VACUUM CLEANING: Should be done
one to two times weekly when patient
is not present. Wearing a mask may
help if patient must do vacuuming.
Skin Testing
LookVACUUM
for vacuum
cleaners with
CLEANING:
One to two times
Why
Skin
Testing?
HEPA
filters
or
high
filtration
bags. Wearing a
weekly when patient
is not present.
Special Instructions
become enlarged and/or red at times. It may take
several days or occasionally several weeks for the
sites to completely fade. For excessive itching, the
patient may take their antihistamines. Prolonged
swelling and/or soreness may be treated with ice
packs and/or anti-inflammatory medications (i.e.,
Ibuprofen, Motrin®, Advil®, etc.). The sites should be
kept clean by washing daily with soap and water.
On may
the next
you will
“Allergy Skin
mask
help page
if patient
mustfind
do the
vacuuming.
Test
which
we have
used
record the
DUSTING:
damp
method
Look Record”
for Use
vacuum
cleaners
withone
HEPAtofilters
results
of
the
skin
tests,
which
have
been
done. Skin
high
filtration
bags.
toortwo
times
per week.
tests are the most reliable form of allergy testing.
DUSTING:
Use may
damp
Other
blood tests
or method
may notone
havetobeen pertwo
times
per
week
formed depending on the individual patient. If these
About Your Positive Skin Tests
are needed now or at a later date, they will be disBEDROOM: Keep free of clutter,
Please refer to the next page for those tests
cussed with you by the doctor.
upholstered furniture, chenille bedwhich were found to be positive. The doctor or
What
SkinAvoid
Tests?
spreads,Are
andAllergy
knickknacks.
under
allergy nurse will discuss with you those considered
bed
storage.
Allergy skin tests are extracts of various most significant. A brief description follows. Please
substances which are known to cause allergies. We refer to the individual environmental control pages
BEDROOM CLOSET: Store only curhave chosen the extracts which are felt to give the for a discussion of ways to reduce exposure to those
rent articles. Place seasonal items in other
most reliable results in test interpretation. Many things to which you are allergic.
rooms.
things, which at one time were thought to have
caused
allergies, are
now
felt to be onlyAvoid
irritating to
VAPORIZERS
AND
HUMIDIFIERS:
certain
people but
not allergenic.
Wemite
have
elected CLOSET: Store only current articles. Place seasonal
since increased
humidity
promotes
and
BEDROOM
not
include these in our battery of tests.
moldtogrowth.
items in other rooms.
Extensive
testing
to food
allergens
is generally
not
CARPETING:
First
choice
is tile, wood,
or other
indicated.
We
routinely
test
to
only
a
handful
of
foods
hard floor covering. Throw rugs may be used.
With wall
VAPORIZERS
AND HUMIDIFIERS: Avoid since increased
which
for itover
95%be
of synthetic,
food allergy.
to wallaccount
carpeting,
should
short pile, with
humidity promotes mite and mold growth.
Allergy pad.
testsSteam
have been
These
are dry
the in
tests
synthetic
cleandone.
yearly.
Should
2-3 hours
placed
ordinarily
placed
on
the
back.
In
addition,
a growth.
after
cleaning,
as
increased
moisture
promotes
mite
CARPETING: First choice is tile, wood or other hard
floor covering and throw rugs may be used. With
group of “intradermal” tests may have been placed
wall
to
wall
carpeting,
it
should
be
synthetic,
short
pile,
with synthetic
pad. Steam clean yearly and
FANS
OF
ALL
TYPES:
Should
be
avoided
since
use
causes
dust
on your arm. In young children and infants, “scratch”
ensure
it
dries
within
2-3
hours
after
cleaning
as
increased
moisture
promotes
mite growth.
particles
to
become
airborne.
tests may be the only tests indicated. All skin tests
are HUMIDITY:
read by the Keep
nurse humidity
and/or the
doctor.
below
50%. Use air condi-
FANS
OF
ALL
TYPES:
Should be avoided since use causes dust particles to become airborne.
tioning Test
or supplement
with a dehumidifier.
Skin
Site Care
Skin test sites are usually not painful following the
HUMIDITY:
Keep humidity below 50%. Use air conditioning or supplement with a dehumidifier.
testing. Some of the individual sites might itch and
5
Pollen
Air Filters
Mold Allergens
Trees, Air
grasses,
pollinate atafter
different
filters and
may weeds
be recommended
other times
environmentalMolds
control
haveplants
beenwithout
completed
or measures
fungi are tiny
rootsand
Weed,
grass
and tree
pollen
are
prevalent
in
the
of the
the
year
depending
on
where
you
live.
Tree
pollen
patient still continues to have increased allergic
symptoms.
Air filters
are not the by
firstreleasing
line of treatment.
or stems
that reproduce
spores
Southeast
a year.
and January
is
typically 9-10
most months
prevelant
in theDecember
Spring, grasses
in the
into the air. Indoor molds grow in damp, musty
are
our
only
low
pollen
months.
It
is
difficult
to
avoid
There
areweeds
two types
of Fall.
motor-driven
air filters;
the HEPA
filterlike
and the
electronic garages,
filter. Both bathtubs,
types come
Summer,
and
in the
Your Allergy
Partners
areas
basements,
pollen
unless
you
live ininunits
a local
plastic
bubble!
Thisand
isinnot
in portable
central
that
are installed
thethe
central
heating
unit.
The
HEPA
filter
is
the
most
efficient.
physician
is anor
expert
aerobiology
will
be
shower stalls, laundry rooms, refrigerators,
aim of to
environmental
Wepollens
want tocause
help problems
you lead
happy
discuss whatcontrol.
types of
and humidifiers.
Portable
should be placed several inches off thevaporizers,
floor if carpeting
is present. If placed directly on
asyour
normal
a lifeunits
as possible.
in
area.
the carpeting, the fan from the motor will cause dust to be airborne
and
consequently
cause more
Outdoor molds prefer warm,
moistirritation
and
to the airways.
Pollen
Avoidance
shady confines such as mulch piles, black soil
____ A
1. third
Keep
bedroom
closed
at all times
andcostly,
fallenreplaces
leaves. Some
moldsfurnace
repro-filtype
of filter windows
is called an
electrostatic
filter. This gardens
filter is less
the normal
during
pollen
season.
duce rapidly when it rains, while others release
ter and can be washed monthly.
____ 2. Use central or window air conditioning and
their spores during the dry periods that follow
Many
homefilters
health
companies
will allow a month's
rental
of portable units before purchase.
change
at supply
least once
a month.
rainy
weather.
____ 3. If air conditioning is not present, cut furnace
filter to fit bedroom window.
Mold Avoidance
____ 4. Shower and shampoo hair as soon as you are
____ 1. Avoid damp and dusty places, such as
finished working or playing outdoors.
attics, basements, garages and storeARE NOT
____ NOTE:
5. LeaveIONIZERS
pollen-contaminated
clothing out of
rooms.
bedroom.
RECOMMENDED
FOR ALLERGY
____ 2. Keep the basement and other damp
____
6. Avoid newly
grass.
PATIENTS
AND cut
HAVE
BEEN
household areas as dry as possible.
____ 7. Keep animals outdoors as they carry pollen
SHOWN TO INCREASE
on their coats during pollen season.
____ 3. In bathroom, check behind the toilet,
ASTHMA
____
8. WearSYMPTOMS.
a pollen mask when necessary to work
under sink, on shower curtain and
in heavily pollinated areas.
walls for mold growth, clean with mold
inhibitor such as X-14 or diluted
bleach.
____ 4. Check closets, old shoes, boots,
sneakers, etc. for mildew.
____ 5. Check stored foods for spoilage and
mold growth.
____ 6. Check pan under refrigerator for
possible mold growth.
6
____ 7. Avoid use of vaporizers and humidifiers, as they can encourage mold
growth .
____ 8. Houseplants and dried flower arrangements should be kept to a minimum and out of the bedroom
Whatcompletely.
is Immunotherapy?
triggers determined, an allergy vaccine will be made
Potting soil may breed molds.
Immunotherapy, or “allergy shots”, is a form of specifically for you based on your individual allergies.
____
9. Water
houseatplants
when patient
will be away
for require
several hours.
treatment
aimed
decreasing
your sensitivity
to from
Youarea
may
1, 2, or 3 vials of vaccines
substances
in
the
environment
called
allergens.
depending
on
the
number
type of allergens that
____ 10. When cleaning carpeting, use steam cleaning, but make sure it dries in 2-3and
hours.
These
areand
identified
by allergy
testing. should
trigger
____
8. allergens
Houseplants
dried flower
arrangements
be your
kept symptoms.
to a minimum and out of the bedroom
What
istrigger
Immunotherapy?
determined,
an will
allergy
vaccine
made
____
11. can
Use
artificial
Christmas
natural
trees
manyvaccine
mold
spores.
They
your
allergy
symptoms
when
you carrytriggers
Your
series
start
with will
verybe small
completely.
Potting
soiltrees,
may as
breed
molds.
Immunotherapy,
or
“allergy
shots”,
is
a
form
of
specifically
for
you
based
on
your
individual
allergies.
are12.
exposed
to them.outdoors.
Immunotherapy works as a quantities of allergen. Over time, you will receive
____
firewood
____
9.Store
Water
houseatplants
whenand
patient
willprevent
be away
foramounts.
several hours.
treatment
aimed
decreasing
your
sensitivity
to from
Youarea
may
require
1,
or 3 vials
vaccines
vaccination
against
allergens
helps
increasing
The2,highest
dose of
of vaccine
substances
in
the
environment
called
allergens.
depending
on
the
number
and
type
of
allergens
that
____
13.
Check
crawl
spaces
for
standing
water.
allergy
Immunotherapy
hassteam
been cleaning,
shown but
maymake
be upsure
to 10,000
concentration of your
____
10. symptoms.
When cleaning
carpeting, use
it driestimes
in 2-3the
hours.
These
allergens
are
identified
by
allergy
testing.
trigger
your
symptoms.
to 14.
prevent
the
development
of from
new house
allergies.
In first dose.
____
compost
piles away
areas.
____
11.Store
Use trigger
artificialyour
Christmas
trees,
as natural
trees
manyvaccine
mold spores.
They
can
allergy
symptoms
you carry
Your
series ofwill
start with very
small
children,
it can prevent
the
progression
ofwhen
allergic
There
are two phases
immunotherapy:
a build____
15.
Avoid
piles
of
dried
grass,
weeds
and
fallen
leaves.
are
exposed
to
them.
Immunotherapy
works
as
a
quantities
of
allergen.
Over
time,
you
will
receive
diseases
fromfirewood
allergic rhinitis
(hay fever) to asthma. up phase and a maintenance phase.
____
12. Store
outdoors.
vaccination against
allergens
and helpsrelief
prevent
increasing Phase:
amounts. You
Thereceive
highestinjections
dose ofonce
vaccine
Immunotherapy
can
lead
to caves.
long-lasting
of Build-up
or
____
16.
Avoid
deep
woods
and
____
13. Check
crawl Immunotherapy
spaces for standing
water.shown may be up to 10,000 times the concentration of your
allergy
symptoms.
has
been
allergy symptoms even after treatment is stopped.
twice a week with increasing amounts of allergen. At
____
17.
Check
exterior
of home
for
plants
growing
closefirst
to dose.
to
prevent
development
of from
new
allergies.
____
14.
Store the
compost
away
house
Immunotherapy
haspiles
been
shown
to
beareas.
veryIn first
you will receive shots from a green topped
the
home.
children,initthe
cantreatment
prevent the
progression
ofallergic
allergic bottle,
There
are two
phases
of increasing
immunotherapy:
a buildeffective
of
allergic
rhinitis,
starting
at 0.05
cc and
up to 0.5
cc.
____
15. Avoid
piles
of dried
grass,
weeds
and
fallen
leaves.
diseases
from
allergic
rhinitis
(hay
fever)
to
asthma.
up
phase
and
a
maintenance
phase.
conjunctivitis,
allergic
asthma,
and insect sting You will then progress through more concentrated
____
18. Vent clothes
dryers
to the outdoors.
Immunotherapy
can
leadsymptoms
to caves.
long-lasting
relief
Build-up
Phase:
You receive
once
____
16. Avoid
deepallergy
woods
and
allergy.
If your
are not
wellof vaccine
bottles
– blue, gold,
red. Theinjections
red topped
vialor
____allergy
19. Airsymptoms
conditioning
will
help
keep humidity
lower and
even
after
treatment
is
stopped.
twice
a
week
with
increasing
amounts
of
allergen.
At
controlled
avoidance
and close
is the
____
17.prevent
Checkwith
exterior
of home formeasures
plants growing
to most concentrated/strongest and will contain
mold
growth.
Immunotherapy
has
been
shown
to
be
very
first
you
will
receive
shots
from
a
green
topped
medications,
your allergist may use this customized your maintenance dose. It typically takes 6-8 months
the home.
effective
the
treatment
of
allergic
allergic
bottle, starting
at 0.05
cc andto
increasing
up to
0.5 cc.
____
20. Change
and/or
clean
filter
on
conditioning
series
of in
injections
to
reduce
andairrhinitis,
control
your (shorter
for insect
venoms)
reach the
highest
conjunctivitis,
allergic
asthma,
and
insect
sting
____
18.
Vent
clothes
dryers
to
the
outdoors.
You
will
then
progress
through
more
concentrated
frequently.
symptoms.
concentration.
allergy.
If your
allergy symptomsWork?
are not well Maintenance
vaccine
bottles –Phase:
blue, gold,The
red.typical
The red
How
Does
Immunotherapy
toptopped
dose vial
is
____
19.
Air
conditioning
will
help
keep
humidity
lower
and
____controlled
21. Keep home
humidity
betweenmeasures
30-40%, never
above
with
avoidance
and
is
the
most
concentrated/strongest
and
will
contain
By giving
small
doses
of
highly
refined
substances
0.5
cc
of
allergen
vaccine
from
the
red
topped
vial
prevent
mold
growth.
50%. Anyour
additional
dehumidifier
maycustomized
be beneficial.
allergist
may use this
your
dose. It typically
takes 6-8
months
tomedications,
which you are
allergic,
immunotherapy
stimulates and
is maintenance
called ‘Maintenance’.
Not all people,
however,
____
20.
Change
and/or
clean
filter
on
air
conditioning
series
of
injections
to
reduce
and
control
your
(shorter
for
insect
venoms)
to
reach
the
highest
____
22.
Kitchen
and
bathroom
exhaust
fans
can
help
remove
your immune system to become tolerant to these progress to this dose. Therefore, your ‘Maintenance’
frequently.
symptoms.
concentration.
water
vapors.
allergens. This tolerance protects you on further dose may be different. Once you are at maintenance,
How
Does
Work?
Maintenance
top dose is
____
21.Use
Keep
home
humidity
between
30-40%,
never
above
exposure
to
theImmunotherapy
same
substance
and
can
help
the
interval betweenPhase:
shots mayThe
be typical
increased.
____
23.
mold
retardant
paints
in areas
where
humidity
By
giving
small
doses
of
highly
refined
substances
0.5
cc
of
allergen
vaccine
from
the
red
topped
vial
50%.
Angrowth
additional
may
be beneficial.
decrease
or
even
eliminate
your
symptoms.
Vaccines lose potency with time:
When
and
mold
havedehumidifier
beenallergy
a problem.
to
which
you
are
allergic,
immunotherapy
stimulates
and
is
called
‘Maintenance’.
Not
all
people,
however,
Our 22.
initial
goal is
to bathroom
reduce your
allergy
symptoms.
you receive a new bottle of extract for maintenance
____
Kitchen
and
exhaust
fans
can
help remove
system
tostrength
become
tolerant
to these
progress
this dose.
Therefore,
your more
‘Maintenance’
Asyour
youimmune
build
up
on
the
of
your
shots,
we
therapy,
theto new
vial may
be slightly
potent
waterThis
vapors.
allergens.
tolerance
protects
you
on
further
dose
may
be
different.
Once
you
are
at
maintenance,
hope to reduce the medications needed to control than your old vial. We, therefore, will reduce
your
exposure
theretardant
same substance
and can
helphumidity
the interval
between
may
be increased.
____
23.
Use to
mold
paints in areas
where
your
symptoms.
dose
slightly with
a newshots
vial to
insure
safety. You will
decrease
or
even
eliminate
symptoms. then
Vaccines
lose
potency
with time:
and
mold
growth
have your
beenallergy
a problem.
What’s
Involved
in Immunotherapy?
need to go
through
a ‘mini build-up’
every When
one
Our
initial
goal
is
to
reduce
your
allergy
symptoms.
you
receive
a
new
bottle
of
extract
for
maintenance
After you have been tested and your allergy to two weeks to return to your maintenance dose.
As you build up on the strength of your shots, we therapy, the new vial may be slightly more potent
hope to reduce the medications needed to control than your old vial. We, therefore, will reduce your
your symptoms.
dose slightly with a new vial to insure safety.4/5/11
You10:07:17
will AM
What’s Involved in Immunotherapy?
then need to go through a ‘mini build-up’ every one
After you have been tested and your allergy 7 to two weeks to return to your maintenance dose.
mold
moldavoidance
avoidance
A Patient Guide to Immunotherapy
Cladosporium
Cladosporium
Alternaria
Alternaria
Penicillium
Penicillium
Aspergillius
Aspergillius
Animal Allergens
Dogs and cats are the most frequent offenders, but any furry or feathered pet including gerbils, guinea
pigs, hamsters, rats, mice, rabbits and birds can trigger allergies. New studies have shown the most allergic part
of animals or birds is their saliva, followed by their urine, mucus, feces, dander, hair, and feathers.
Animal Avoidance
____ 1. If you don't have household pets, do not acquire one.
____ 2. If you already have a pet, it is preferable that it lives outdoors in a house of its own.
____ 3. Keep pets out of bedroom at all times.
____ 4. Washing the pet twice weekly can decrease allergens.
____ 5. HEPA filters can reduce significant amounts of
animal allergen.
____ 6. Fur-bearing animals should not be carried in the car.
The close, confined area may aggravate allergy
symptoms.
____ 7. Vacuum carpets once per week, or remove carpet if
practical.
____ 8. After direct contact with an animal, it is best to
change clothing and wash hands thoroughly.
____ 9. When moving to a new home, inquire if pets were
present in the past. Studies show that animal antigen continues to remain for months, even after
cleaning.
____ 10. If pets are outdoors during the allergy season, many
pollen antigens are trapped in their coat and will be
carried indoors.
____ 11. After pet removal - thoroughly clean carpeting,
upholstered furniture, bedding, walls, window
coverings, furnace filter and vacuum cleaner.
____12. There is no evidence that certain breeds of dogs or
cats are less allergenic than others.
8
Tobacco
Smoke
Tobacco Smoke
Tobacco smoke often goes unrecognized as an important
aggravating factor in allergic disease. Exposure to tobacco smoke in
homes presents the greatest problem. Tobacco smoke acts as a
respiratory irritant resulting in a worsening of the allergy patient's
condition. Studies indicate that in almost every case of elimination of
smoke in the home, clinical improvement followed.
Tobacco
Tobacco Avoidance
Avoidance
____ 1. No smoking rules indoors
____ 2. No smoking rules in cars
____ 3. Avoid smoking areas in public
Eliminating tobacco
smoke
from the
allergic
Eliminating
tobacco
smoke
from
the
patient’s
environment
should be the
#1 step of
allergic
patient’s
environment
should
be
thethe
#1enironmental
step of thecontrol.
environmental control.
Studies show that children of smoking parents have
60% more upper respiratory infections than children of
nonsmoking parents.
Non-Specific Irritants
Non-Specific Irritants
Nonspecific irritants such as odors and fumes may adversely affect the allergic patient causing an
increase in the allergic symptoms. The effect on the respiratory system is one of irritation.
Avoidance
Avoidance
____ 1.
Avoid heavily scented cosmetics, perfumes, moth balls, insect sprays, tobacco smoke, soap
powders, chalk dust, fertilizer, fresh newspaper, smoke, paints, polishes, household chemicals,
ammonia, chlorine water, gasoline fumes, formaldehyde and natural gas.
____ 2.
Wood burning stoves and fireplaces should be well vented and should be kept burning rather than
allowed to smolder. Pollution measurements from a smoldering fire are greater than a steady
burning fire.
____ 3.
Avoid wood burning stoves and fireplaces when respiratory symptoms are increased.
9
Air Purifiers
One of the first recommendations made by allergists to help control allergy or asthma
symptoms is to reduce indoor air pollutants at the source. Unfortunately, complete
avoidance is not possible but there are some options to improve the air you breathe.
Contaminants found inside our homes and workplaces, such as dust mites, mold spores,
pollen, pet dander and volatile organic compounds (VOCs also known as toxic gases), can
exasperate allergy or asthma symptoms. Air purifiers are recommended in conjunction
with other environmental control measures as an effective means to reduce or control
allergy and asthma symptoms resulting from these contaminants.
In the past, there have only been four types of air cleaning technologies available to
remove these pollutants. These options are somewhat effective in eliminating individual, targeted contaminants
but limited in their ability to remove all contaminants. The reason is that most filters bring pollutants into the filter
using airflow. However, only 10% of airborne pollution—large particles such as smoke—can be moved with airflow. The
remaining 90% of air pollution—the toxic gases, fine particles, and microorganisms—are NOT moved by airflow. There
has been recent development in the technology of air purifiers which has allowed all types of pollutants to be captured
by a single air purifier utilizing an organic, water based filtration system. This new technology is changing the way our
patients handle the need to reduce indoor air pollutants that worsen their allergy and asthma symptoms.
In cooperation with your allergist, the below chart will help you determine the best air filtration technology to meet
your air cleaning needs.
Air Purifiers
Particle Size Removed
VOCs
Allergens
Bacteria
Odors
Viruses & Germs
No Limit
Yes
Yes
Yes
Yes
Yes
HEPA
Down to .3
None
Yes
Some
Some
Some
CARBON
None
Some
None
None
Some
None
IONIC*
Down to .1
None
Yes
Some
Some
Some
UV
None
None
None
Some
None
Some
MULTI-STAGE
Down to .1
Some
Yes
Some
Some
Some
O2
BioHygienic
*Note:
are
recommended
for patients
allergyand
patients
andshown
havetobeen
shown
tosymptoms.
increase asthma symptoms.
*Note:Ionizers
Ionizers are
notnot
recommended
for allergy
have been
increase
asthma
10
The Patient’s Guide to Immunotherapy
What is Immunotherapy?
Immunotherapy, or “allergy shots”, is a form of
treatment aimed at decreasing your sensitivity to
substances in the environment called allergens.
These allergens are identified by allergy testing.
They can trigger your allergy symptoms when you
are exposed to them. Immunotherapy works as
a vaccination against allergens and helps prevent
allergy symptoms. Immunotherapy has been shown
to prevent the development of new allergies. In
children, it can prevent the progression of allergic
diseases from allergic rhinitis (hay fever) to asthma.
Immunotherapy can lead to long-lasting relief of
allergy symptoms even after treatment is stopped.
Immunotherapy has been shown to be very
effective in the treatment of allergic rhinitis, allergic
conjunctivitis, allergic asthma, and insect sting allergy.
If your allergy symptoms are not well controlled with
avoidance measures and medications, your allergist
may use this customized series of injections to reduce
and control your symptoms.
How Does Immunotherapy Work?
By giving small doses of highly refined substances to
which you are allergic, immunotherapy stimulates
your immune system to become tolerant to these
allergens. This tolerance protects you on further
exposure to the same substance and can help
decrease or even eliminate your allergy symptoms.
Our initial goal is to reduce your allergy symptoms. As
you build up on the strength of your shots, we hope
to reduce the medications needed to control you
symptoms.
What’s Involved in Immunotherapy?
After you have been tested and your allergy triggers
determined, an allergy vaccine will be made
specifically for you based on your individual allergies.
You may require 1, 2, or 3 vials of vaccines depending
on the number and type of allergens that trigger your
symptoms.
Your vaccine series will start with very small quantities
of allergen. Over time, you will receive increasing
amounts. The highest dose of vaccine may be up to
10,000 times the concentration of your first dose.
There are two phases of immunotherapy: a build-up
phase and a maintenance phase.
Build-up Phase: You receive injections once
or twice a week with increasing amounts of allergen.
At first you will receive shots from a green topped
bottle, starting at 0.05 cc and increasing up to 0.5 cc.
You will then progress through more concentrated
vaccine bottles - Blue, gold, red. The red topped vial
is the most concentrated/strongest and will contain
your maintenance dose. It typically takes 6-8 months
(shorter for insect venoms) to reach the highest
concentration.
Maintenance Phase: The typical top dose is
0.5cc of allergen vaccine from the red topped vial
and is called ‘Maintenance’. Not all people, however,
progress to this dose. Therefore, your ‘Maintenance’
dose may be different. Once you are at maintenance,
the intervals between shots may be increased.
Vaccines lose potency with time: When you receive
a new bottle of extract for maintenance therapy, the
new vial may be slightly more potent than your old
vial. We, therefore, will reduce your dose slightly with
a new vial to insure safety. You will then need to go
through a ‘mini build-up’ every one to two weeks to
return to your maintenance dose.
11
The Patient’s Guide to Immunotherapy continued
How Long Do I Stay on
Immunotherapy?
Immunotherapy is generally continued for 3 to 5 years,
at which time the decision to stop immunotherapy
should be discussed with your allergist. Some people
may experience lasting relief of their allergy symptoms
after stopping shots. Others may find that their
symptoms gradually return. Therefore, the decision
to stop immunotherapy must be individualized.
When Will I Start to Feel Better?
Initial improvement with immunotherapy may be
noted as soon as 2 to 4 months after starting, but it
may take longer. Symptomatic improvement tends to
progress throughout treatment. Maximum symptom
relief occurs approximately 2 years after starting.
Because immunotherapy does not provide immediate
relief of your allergy symptoms, you will need to
continue your allergy medicines at least during the
beginning of build up. Hopefully, as you continue on
immunotherapy, your need for medications to control
your symptoms should gradually decline.
What Kind of Reactions Can Occur?
The most common shot reaction is a local reaction.
It appears as redness and swelling at the injection
site. This can happen immediately, several hours, or
1-2 days after an injection. If you experience such
reactions, it is very important to notify your nurse
before your next injection. Your immunotherapy dose
may need to be modified to prevent further local
reactions. Systemic reactions are much less common
than local reactions. However they are much more
serious. Systemic reactions are usually mild and
respond rapidly to medications. Symptoms can
include increased allergy symptoms such as sneezing,
nasal congestion, or hives. Rarely, a serious systemic
reaction, called anaphylaxis, can occur. Symptoms of
anaphylaxis include swelling in the throat, wheezing
or tightness in the chest, nausea, dizziness, or other
symptoms. In very rare instances, anaphylactic
reactions can be fatal. Because of possible reactions
to immunotherapy, it is absolutely mandatory that
injections be given in the presence of qualified
medical providers. It is necessary to wait at least 30
minutes following your injection to ensure there is no
significant reaction. If you feel any itching, swelling,
tightness in the throat or chest, you must immediately
let the shot nurse know so that you can receive
prompt care. If a systemic reaction begins to occur
after you have left the office, return immediately to
the office or go to the nearest emergency medical
facility.
What Can I Expect from
Immunotherapy?
In over 85% of cases, immunotherapy can provide
substantial, long lasting improvement in allergy
symptoms. You should have fewer and less severe
allergic reactions to those substances that currently
cause your allergies or asthma to flare. Also, you
should be able to control your symptoms with less
medicine than you presently need. Allergy shots may
not be a cure, but they are an excellent means of
controlling your allergy symptoms.
12
Skin Testing
Special
SpecialInstructions
Instructions
VACUUM
CLEANING: One to two times
Skin
Testing
weekly when patient is not present. Wearing a
Why
Skin
Testing?
mask may
help
if patient must do vacuuming.
Look
cleaners
with
HEPA
filters Skin
On for
the vacuum
next page
you will
find
the “Allergy
or high
filtration
bags.we have used to record the
Test
Record”
which
results of the skin tests, which have been done. Skin
DUSTING: Use damp method one to
tests are the most reliable form of allergy testing.
two times per week
Other blood tests may or may not have been performed
dependingKeep
on the
individual
patient. If these
BEDROOM:
free
of clutter,
are
needed
now
or
at
a
later
date,
they
upholstered furniture, chenille bed-will be discussed
youknickknacks.
by the doctor.Avoid under
spreads,with
and
bed storage.
What
Are Allergy Skin Tests?
Allergy
skinCLOSET:
tests are
extracts
of various
BEDROOM
Store
only cursubstances
which
are
known
to
cause
allergies.
We
rent articles. Place seasonal items in other
have
chosen
the
extracts
which
are
felt
to
give
the
rooms.
most reliable results in test interpretation. Many
VAPORIZERS
AND time
HUMIDIFIERS:
Avoidto have
things,
which at one
were thought
since
increased
humidity
promotes
mite
and
caused allergies, are now felt to be only irritating
to
mold
growth.
certain people but not allergenic. We have elected
not CARPETING:
to include these
in choice
our battery
of wood,
tests. or other
First
is tile,
become enlarged and/or red at times. It may take
several days or occasionally several weeks for the
sites to completely fade. For excessive itching, the
patient may take their antihistamines. Prolonged
swelling and/or soreness may be treated with ice
packs and/or anti-inflammatory medications (i.e.,
Ibuprofen, Motrin®, Advil®, etc.). The sites should be
kept clean by washing daily with soap and water.
About Your Positive Skin Tests
Please refer to the next page for those tests
which were found to be positive. The doctor or
allergy nurse will discuss with you those considered
most significant. A brief description follows. Please
refer to the individual environmental control pages
for a discussion of ways to reduce exposure to those
things to which you are allergic.
Extensive
testing Throw
to foodrugs
allergens
is used.
generally
hard
floor covering.
may be
Withnot
wall
indicated.
We routinely
test tobeonly
a handful
of foods
to wall carpeting,
it should
synthetic,
short
pile, with
which
account
for overclean
95%yearly.
of foodShould
allergy.dry in 2-3 hours
synthetic
pad. Steam
after
cleaning,
as
increased
moisture
promotes
mite growth.
Allergy tests have been done. These
are the tests
placed
ordinarily
on Should
the back.
addition,
a use causes dust
FANS
OF ALLplaced
TYPES:
be In
avoided
since
group
of
“intradermal”
tests
may
have
been
placed
particles to become airborne.
on your arm. In young children and infants, “scratch”
HUMIDITY:
Keep
below 50%.
Usetests
air conditests
may be the
onlyhumidity
tests indicated.
All skin
tioning
with a dehumidifier.
are
readorbysupplement
the nurse and/or
the doctor.
Skin Test Site Care
Skin test sites are usually not painful following the
testing. Some of the individual sites might itch and
13
Allergy
SkinTest
Test
Results
Summary
Allergy Skin
Results
Summary
Name: ___________________________________________ Date: _____________________
Your skin tests showed that you have a sensitivity to the substances checked below:
� Tree Pollen
� Grass Pollen
� Weed Pollen
� Molds/Mildew
� House Dust Mites
� Cat/Dog Dander
� Cockroach
� Other
Trees pollinate most heavily in the early spring, from
February through May.
Grass pollinates from mid-spring through most of
the summer.
Although some weeds pollinate in the spring and
summer, the most important ones pollinate heavily
from mid-August until there have been several hard
frosts.
Molds send out spores almost year-round. They
occur both outdoors and indoors.
These microscopic pests infest homes year-round.
They are the number one cause of year round allergies.
There is usually no significant difference in sensitivity
between breeds.
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
14
National Allergy Organizations
The following organizations are made up of 3,000 allergists dedicated to educating
physicians and health-care providers in the field of allergy. They encourage research
and maintain skills of their members by sponsoring educational programs. Scientific
publications, and patientNational
information. Allergy Organizations
The following
organizations are made
up of 3,000
doctors
dedicated
to educating
American Academy
of Allergy,
American
College
of Allergy
& Immunology
physicians
and
healthcare
providers
in
the
field
of
allergy.
They
encourage
reAsthma & Immunology
800 East Northwest Highway
search
and
maintain
skills
of
their
members
by
sponsoring
educational
programs,
611 East Wells Street
Suite 1080
Milwaukee, WIscientific
53202 publications, and patient information.
Palantine, IL 60067
800-822-2762
www.acaai.org
American Academy of Allergy, Asthma & Immunology
www.aaaai.org
611 East Wells Street
Milwaukee, WI 53202
Air Purification
1-800-822-2762
AirStar, LLC www.aaaai.org
1978 Hendersonville Rd., Ste. 130
Asheville, NCAmerican
28803 College of Allergy & Immunology
800 East Northwest Highway
Customer Service: 877-689-6247
Suite 1080
O2airpurifier.com
Palantine, IL 60067
www.acaai.org
Receive a discount
on your order with
code: AllergyPartnersPatients2015
Allergy Resources
Allergy Bedding/Encasements
Allergy Resources
Allergy Guardian
7422 Carmel Executive Park
Allergy Bedding/Encasements
Suite 310-B
Allergy Guardian
NC 28226 310-B
7422 Carmel Charlotte,
Executive ParkSuite
Charlotte, NCCustomer
28622 Service:
800.631.3549
Customer Service:
allergyguardian.com
800-631-3549
www.allergyguardian.com
15
www.allergypartners.com