AAAAI & ACAAI GUIDELINES Bundle (free trial)

Management of Rhinitis Environmental Control Measures for Allergens ÎThe success of environmental control measures for rhinitis should be judged by clinical improvement, such as reduction in symptoms and medication scores, and not by a decrease in allergen concentration. Pollens > Patients with allergic rhinitis caused by pollens may be exposed to allergen from (1) nonpollen plant fragments, (2) allergenic bioaerosols without intact pollen grains, and (3) even high pollen concentrations of insect-pollinated plants.1 Fungi > Hydrophilic fungi, such as Fusarium and Phoma, are most abundant during rainy weather, whereas Alternaria and Cladosporium have elevated levels during dry, windy weather.1 > When involved in plant-disturbing activity, such as gardening and lawn mowing, facemasks can reduce exposure to fungi.1 > The first step in reduction of indoor fungal exposure consists of eliminating the source of moisture, such as water intrusion, cold surfaces, and elevated humidity.1 Dust mites and cockroaches > Dust mite exposure can be reduced through measures that kill the mites or degrade and/or prevent their fecal pellets from becoming airborne (eg, HEPA air filtration and vacuum cleaning with a HEPA filter, low humidity, hard surface flooring, hot water laundry, barrier protection on pillows and mattresses, and the use of acaricides).1 Animals > Confining a cat to an uncarpeted room (other than bedroom) with HEPA filtration may reduce by 90% airborne allergen dissemination to the remainder of the house.1 Irritants > Irritants reported to cause nasal symptoms include tobacco smoke, microbially derived volatile organic compounds from bacteria and fungi, formaldehyde, chlorine, and perfume.1 Management Decisions ÎManagement decisions must be individualized and guided by1 > Age > Frequency, severity, and spectrum of symptoms (eg, predominant congestion versus rhinorrhea) > Allergen exposure pattern > Comorbidities : > Response to previous treatment > Patient and family preferences > Compliance with therapy > Cost ÎTherapy decisions can be committed to a Rhinitis Action Plan developed jointly with the patient and family (refer to Figure 2). ÎPhysician should review the degree of symptom control and Quality of Life (QOL) at each office visit ÎConsider consultation with an allergist when any of the following are present: > Inadequately controlled symptoms > Reduced QOL or ability to function > Adverse reactions to medications > Desire to identify allergens > Need for environmental control education > Consideration of allergen immunotherapy > Presence of comorbid conditions (eg, asthma and chronic sinusitis) > Environmental control of cockroach allergen involves an integrated pest management with the combination of family education.1 > As a second step, dilute bleach solution with detergent denatures fungal allergens and may prevent regrowth with application to nonporous surfaces, whereas porous surfaces must be removed and/or replaced.1 FOR INTERNAL USE ONLY

• Cover