Housing interventions and control of asthma-related indoor biologic agents: a review of the evidence.

Subject matter experts systematically reviewed evidence on the effectiveness of housing interventions that affect health outcomes, primarily asthma, associated with exposure to moisture, mold, and allergens. Three of the 11 interventions reviewed had sufficient evidence for implementation: multifaceted, in-home, tailored interventions for reducing asthma morbidity; integrated pest management to reduce cockroach allergen; and combined elimination of moisture intrusion and leaks and removal of moldy items to reduce mold and respiratory symptoms. Four interventions needed more field evaluation, 1 needed formative research, and 3 either had no evidence of effectiveness or were ineffective. The 3 interventions with sufficient evidence all applied multiple, integrated strategies. This evidence review shows that selected interventions that improve housing conditions will reduce morbidity from asthma and respiratory allergies.

[1]  R. Garfinkel,et al.  Deteriorated housing contributes to high cockroach allergen levels in inner-city households. , 2002, Environmental health perspectives.

[2]  D. Zeldin,et al.  Environmental and occupational disorders Abatement of cockroach allergens ( Bla g 1 and Bla g 2 ) in low-income , urban housing : Month 12 continuation results , 2003 .

[3]  A. Woodcock,et al.  Distribution, aerodynamic characteristics, and removal of the major cat allergen Fel d 1 in British homes. , 1998, Thorax.

[4]  Comparative Study of Integrated Pest Management and Baiting for German Cockroach Management in Public Housing , 2006 .

[5]  T. Platts-Mills,et al.  Chemical treatment of carpets to reduce allergen: comparison of the effects of tannic acid and other treatments on proteins derived from dust mites and cats. , 1995, The Journal of allergy and clinical immunology.

[6]  J. Caravanos,et al.  A multihazard, multistrategy approach to home remediation: results of a pilot study. , 2005, Environmental research.

[7]  W. Phipatanakul,et al.  Mouse allergen. I. The prevalence of mouse allergen in inner-city homes. The National Cooperative Inner-City Asthma Study. , 2000, The Journal of allergy and clinical immunology.

[8]  Sherry L Dixon,et al.  An evaluation of one-time professional cleaning in homes with lead-based paint hazards. , 2003, Applied occupational and environmental hygiene.

[9]  George D Thurston,et al.  The role of air pollution in asthma and other pediatric morbidities. , 2005, The Journal of allergy and clinical immunology.

[10]  D. Strachan,et al.  Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. , 2003, The New England journal of medicine.

[11]  D. Zeldin,et al.  National Prevalence and Exposure Risk for Cockroach Allergen in U.S. Households , 2005, Environmental health perspectives.

[12]  Asa Bradman,et al.  Housing interventions and control of health-related chemical agents: a review of the evidence. , 2010, Journal of public health management and practice : JPHMP.

[13]  D. Brugge,et al.  A community-based participatory research study of multifaceted in-home environmental interventions for pediatric asthmatics in public housing. , 2006, Social science & medicine.

[14]  D. Zeldin,et al.  Exposure to multiple indoor allergens in US homes and its relationship to asthma. , 2008, The Journal of allergy and clinical immunology.

[15]  C. Rand,et al.  Home environmental intervention in inner-city asthma: a randomized controlled clinical trial. , 2005, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[16]  A. Custovic,et al.  Reduction in humidity as a method of controlling mites and mite allergens: the use of mechanical ventilation in British domestic dwellings , 1996, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[17]  P. Kinney,et al.  Distribution and determinants of mouse allergen exposure in low-income New York City apartments. , 2003, Environmental health perspectives.

[18]  R. Einarsson,et al.  Vacuum cleaning decreases the levels of mite allergens in house dust , 1993, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[19]  R. Wood Air filtration devices in the control of indoor allergens , 2002, Current allergy and asthma reports.

[20]  B. Paigen,et al.  Distribution of airborne mouse allergen in a major mouse breeding facility. , 1994, The Journal of allergy and clinical immunology.

[21]  M. Colloff,et al.  The use ofdomestic steam cleaning for the control of house dust mites , 1995 .

[22]  A. Custovic,et al.  Clinical effects of air filters in homes of asthmatic adults sensitized and exposed to pet allergens , 2003, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[23]  J. Warner,et al.  The effect of high‐efficiency and standard vacuum‐cleaners on mite, cat and dog allergen levels and clinical progress , 2000, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[24]  M. V. Van Natta,et al.  A placebo-controlled trial of a HEPA air cleaner in the treatment of cat allergy. , 1998, American journal of respiratory and critical care medicine.

[25]  A. Sheikh,et al.  Mono and multifaceted inhalant and/or food allergen reduction interventions for preventing asthma in children at high risk of developing asthma. , 2009, The Cochrane database of systematic reviews.

[26]  S. Leeder,et al.  Prevention of asthma during the first 5 years of life: a randomized controlled trial. , 2006, The Journal of allergy and clinical immunology.

[27]  G. O'Connor,et al.  Results of a home-based environmental intervention among urban children with asthma. , 2004, The New England journal of medicine.

[28]  P. Gøtzsche,et al.  House dust mite control measures in the management of asthma: meta-analysis , 1998, BMJ.

[29]  K. Berhane,et al.  Cockroach counts and house dust allergen concentrations after professional cockroach control and cleaning. , 2003, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[30]  S. London,et al.  Dustborne Alternaria alternata antigens in US homes: results from the National Survey of Lead and Allergens in Housing. , 2005, The Journal of allergy and clinical immunology.

[31]  W. Morgan,et al.  A multifaceted, home based, environmental intervention modestly reduced asthma morbidity in children with atopic asthma , 2005 .

[32]  P. Gergen,et al.  The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. , 1997, The New England journal of medicine.

[33]  M. Chapman,et al.  Airborne cat allergen (Fel d I). Environmental control with the cat in situ. , 1991, The American review of respiratory disease.

[34]  L G Arlian,et al.  Reducing relative humidity is a practical way to control dust mites and their allergens in homes in temperate climates. , 2001, The Journal of allergy and clinical immunology.

[35]  Stephen Margolis,et al.  A systematic review of housing interventions and health: introduction, methods, and summary findings. , 2010, Journal of public health management and practice : JPHMP.

[36]  A. Woodcock,et al.  High‐efficiency vacuum cleaners increase personal mite allergen exposure, but only slightly , 2006, Allergy.

[37]  Wade Watson,et al.  The Canadian asthma primary prevention study: outcomes at 2 years of age. , 2004, The Journal of allergy and clinical immunology.

[38]  T. Lasserson,et al.  Pet allergen control measures for allergic asthma in children and adults. , 2001, The Cochrane database of systematic reviews.

[39]  Patricia Dolan Mullen,et al.  Developing an Evidence-Based Guide to Community Preventive Services—Methods , 2000 .

[40]  F. Perera,et al.  An Intervention to Reduce Residential Insecticide Exposure during Pregnancy among an Inner-City Cohort , 2006, Environmental health perspectives.

[41]  G. Marks,et al.  Effectiveness of an intervention to reduce house dust mite allergen levels in children's beds , 2003, Allergy.

[42]  C. V. van Schayck,et al.  Clinical effectiveness of a mite allergen-impermeable bed-covering system in asthmatic mite-sensitive patients. , 2004, The Journal of allergy and clinical immunology.

[43]  J. W. Roberts,et al.  Reducing Dust, Lead, Dust Mites, Bacteria, and Fungi in Carpets by Vacuuming , 1999, Archives of environmental contamination and toxicology.

[44]  A. Custovic,et al.  Risk levels for mite allergens. Are they meaningful? , 1998, Allergy.

[45]  R. Gerth van Wijk,et al.  Evaluation of impermeable covers for bedding in patients with allergic rhinitis. , 2003, The New England journal of medicine.

[46]  D. Zeldin,et al.  Abatement of cockroach allergen (Bla g 1) in low-income, urban housing: A randomized controlled trial. , 2003, The Journal of allergy and clinical immunology.

[47]  R Niven,et al.  Attempting to control mite allergens with mechanical ventilation and dehumidification in British houses. , 1999, The Journal of allergy and clinical immunology.

[48]  M. V. Van Natta,et al.  House dust mite and cockroach exposure are strong risk factors for positive allergy skin test responses in the Childhood Asthma Management Program. , 2001, The Journal of allergy and clinical immunology.

[49]  T. Blakely,et al.  Effect of insulating existing houses on health inequality: cluster randomised study in the community , 2007, BMJ : British Medical Journal.

[50]  M. Schluchter,et al.  Reduction in Asthma Morbidity in Children as a Result of Home Remediation Aimed at Moisture Sources , 2006, Environmental health perspectives.

[51]  J. Crane,et al.  A pilot study of the effect of mechanical ventilation and heat exchange on house‐dust mites and Der p 1 in New Zealand homes , 1998, Allergy.

[52]  D M Miller,et al.  Cost and efficacy comparison of integrated pest management strategies with monthly spray insecticide applications for German cockroach (Dictyoptera: Blattellidae) control in public housing. , 2004, Journal of economic entomology.

[53]  R. Mellins,et al.  Cockroach allergen levels and associations with cockroach-specific IgE. , 2008, The Journal of allergy and clinical immunology.

[54]  D. Postma,et al.  Clinical evaluation of the effect of anti-allergic mattress covers in patients with moderate to severe asthma and house dust mite allergy: a randomised double blind placebo controlled study , 2002, Thorax.

[55]  T. Platts-Mills,et al.  House dust mite avoidance for children with asthma in homes of low-income families. , 1999, The Journal of allergy and clinical immunology.

[56]  R. Dahl,et al.  House‐dust mite exposure reduction in specially designed, mechanically ventilated “healthy” homes , 1994, Allergy.

[57]  A. Custovic,et al.  The effect of air filtration on airborne dog allergen , 1999, Allergy.

[58]  A. Dubois,et al.  Clinical effects of air cleaners in homes of asthmatic children sensitized to pet allergens. , 1999, The Journal of allergy and clinical immunology.

[59]  H. Burge,et al.  Effects of physical interventions on house dust mite allergen levels in carpet, bed, and upholstery dust in low-income, urban homes. , 2001, Environmental health perspectives.

[60]  G. Hédelin,et al.  Prevalence of symptoms, sensitization to rats, and airborne exposure to major rat allergen (Rat n 1) and to endotoxin in rat‐exposed workers: a cross‐sectional study , 2002, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[61]  R. Dahl,et al.  Clinical efficacy of reduction in house‐dust mite exposure in specially designed, mechanically ventilated “healthy” homes , 1994, Allergy.

[62]  A. Woodcock,et al.  Early life environmental control: effect on symptoms, sensitization, and lung function at age 3 years. , 2004, American journal of respiratory and critical care medicine.

[63]  Chew,et al.  The effects of carpet fresheners and other additives on the behaviour of indoor allergen assays , 1999, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[64]  F. R. Stephen,et al.  Mechanical ventilation and high-efficiency vacuum cleaning: A combined strategy of mite and mite allergen reduction in the control of mite-sensitive asthma. , 2000, The Journal of allergy and clinical immunology.

[65]  Tuula Putus,et al.  Effects of moisture damage and renovation on microbial conditions and pupils' health in two schools--a longitudinal analysis of five years. , 2007, Journal of environmental monitoring : JEM.

[66]  Tiina Reponen,et al.  Mold and Endotoxin Levels in the Aftermath of Hurricane Katrina: A Pilot Project of Homes in New Orleans Undergoing Renovation , 2006, Environmental health perspectives.

[67]  J. Georgitis,et al.  A double-blind study of the effectiveness of a high-efficiency particulate air (HEPA) filter in the treatment of patients with perennial allergic rhinitis and asthma. , 1990, The Journal of allergy and clinical immunology.

[68]  E. Tovey,et al.  The vertical distribution of house dust mite allergen in carpet and the effect of dry vacuum cleaning. , 2007, International journal of hygiene and environmental health.

[69]  Patrick N Breysse,et al.  Environmental issues in managing asthma. , 2008, Respiratory care.

[70]  D. Zeldin,et al.  Cockroach allergen reduction by cockroach control alone in low-income urban homes: a randomized control trial. , 2007, The Journal of allergy and clinical immunology.

[71]  H. Kromhout,et al.  Determinants of airborne rat and mouse urinary allergen exposure. , 1998, Scandinavian journal of work, environment & health.

[72]  Amanda J. Wheeler,et al.  Quality of indoor residential air and health , 2008, Canadian Medical Association Journal.

[73]  L. Arruda,et al.  Ecology and elimination of cockroaches and allergens in the home. , 2001, The Journal of allergy and clinical immunology.

[74]  Lin Song,et al.  The Seattle-King County Healthy Homes Project: a randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. , 2005, American journal of public health.

[75]  D. Zeldin,et al.  National prevalence and exposure risk for mouse allergen in US households. , 2004, The Journal of allergy and clinical immunology.

[76]  H. Burge,et al.  House dust mite allergen in US beds: results from the First National Survey of Lead and Allergens in Housing. , 2003, The Journal of allergy and clinical immunology.

[77]  T. Platts-Mills,et al.  Home intervention in the treatment of asthma among inner-city children. , 2001, The Journal of allergy and clinical immunology.

[78]  R. L. Miller,et al.  Breathing freely: the need for asthma research on gene-environment interactions. , 1999, American journal of public health.

[79]  E. Mutius Gene-environment interactions in asthma , 2009 .

[80]  E. K. Adams,et al.  Does a multifaceted environmental intervention alter the impact of asthma on inner-city children? , 2006, Journal of the National Medical Association.

[81]  B. Israel,et al.  Evaluation of Community Action Against Asthma: A Community Health Worker Intervention to Improve Children's Asthma-Related Health by Reducing Household Environmental Triggers for Asthma , 2008, Health education & behavior : the official publication of the Society for Public Health Education.

[82]  W. Phipatanakul,et al.  Effect of environmental intervention on mouse allergen levels in homes of inner-city Boston children with asthma. , 2004, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[83]  J. Knottnerus,et al.  The PREVASC study: the clinical effect of a multifaceted educational intervention to prevent childhood asthma , 2005, European Respiratory Journal.

[84]  F. Dunstan,et al.  Effects on patients with asthma of eradicating visible indoor mould: a randomised controlled trial , 2007, Thorax.

[85]  N. Smeeton,et al.  A randomized controlled trial of mite allergen‐impermeable bed covers in adult mite‐sensitized asthmatics , 2003, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.