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The Role of Home Environments in Allergic Disease

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Abstract

Allergic diseases are surprisingly common, chronic health conditions. The primary location where the vast majority of people are exposed to allergens and other substances is in their home. This means it is important to understand home environments and how a home’s systems function and interact—and that how we occupy these spaces plays a crucial role in both environmental exposure and management of allergic disease. This review provides an overview of what is understood about home environmental exposure and its impact on our health, and proposes a systematic process for using a patient’s environmental history to develop individualized, manageable and cost-effective recommendations. Once occupant-related information has been gathered, a home environmental exposure assessment should be performed focused on identifying the relationships between any identified sources of contaminants and the housing systems, and conditions that may be contributing to exposure. The results and recommendations from this assessment can then be used to guide exposure-reduction efforts by patients and/or their caregivers in an effort to improve disease management. In this review, we’ll discuss three different types of home interventions—active, which must be routinely performed by the patient and/or caregiver, passive, which are interventions that work without routine, direct interaction from the homeowner, and behavioral changes in how the home environment is cleaned and maintained for long-term reduction of allergens. In this review, and others evaluated for this discussion, a significant number of home environmental assessment and intervention programs were shown to be cost effective, with the majority of programs showing a net positive return on investment. It is important to recognize that to be cost effective, the level and intensity of services offered through home visit programs need be stratified, based on the estimated health risks of the patient, in order to tailor the assessment and target the interventions to a patient's needs while maximizing cost effectiveness.

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Links to sample environmental history questionnaires

  1. Nation Environmental Education Foundation, Washington DC. https://www.neefusa.org/resource/asthma-environmental-history-form, https://www.neefusa.org/resource/pediatric-environmental-history

  2. National Healthy Home Training Center, Healthy Housing Solutions, Columbia, Maryland. http://healthyhousingsolutions.com/wp-content/uploads/2014/12/HHAPP_Ex_2_PEHA_Survey-Nov2013.pdf

  3. National Institute of Environmental Health Sciences, Research Triangle Park, NC. https://www.niehs.nih.gov/health/assets/docs_a_e/environmental_management_of_pediatric_asthma_guidelines_for_health_care_providers_508.pdf

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Acknowledgements

The work of the authors has been supported by the U.S. Dept. of Housing and Urban Development's Office of Lead Hazard Control and Healthy Homes.

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  1. Section of Toxicology and Environmental Health, Children’s Mercy Kansas City, Kansas City, USA

    Kevin Kennedy, Ryan Allenbrand & Eric Bowles

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Correspondence to Kevin Kennedy.

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Kennedy, K., Allenbrand, R. & Bowles, E. The Role of Home Environments in Allergic Disease. Clinic Rev Allerg Immunol 57, 364–390 (2019). https://doi.org/10.1007/s12016-018-8724-x

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