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What is an allergic reaction?
An allergic reaction occurs when the immune system reacts to a normally harmless substance by making a specific antibody to fight it. Each time the person encounters the offending allergen, it links up with the antibody to cause the release of histamine and other chemicals into the tissues. These substances cause the irritation and inflammation of allergic disease.
Allergies occur most commonly in people with a family history of allergic disease, although this is not always the case.
What are allergens?
Allergens are substances that trigger the immune system to promote an allergic reaction.
What are the symptoms caused by indoor allergens?
Indoor allergens most commonly affect the nose, chest, skin and eyes:
· Itchy skin, rashes, wheals
· Itchy, runny or congested nose, sneezing
· Irritable airways, coughing, tight chest, wheezing, shortness of breath
· Itching, watering, inflammation of both eyes
· Congested sinuses and headache
· Poor concentration
· Disturbed sleep
· Symptoms worse indoors, in bed or early morning
Unlike hay fever, symptoms can occur throughout the year although symptom severity may vary from day to day and is normally worse in winter. You may improve abroad in a hot or very cold but dry place.
What are the main causes of indoor allergies?
House Dust Mites
House dust mites present in all houses in the UK and are the most prevalent
of all allergens, causing allergic reactions in 85% of asthmatic children.
The warmth and humidity in modern UK homes is an ideal breeding environment
for them. They cannot survive in extremely dry or cold conditions. Like most
living creatures, they require warmth, food and water and, as they cannot
drink, they need to absorb moisture through their skin. Our beds provide the
ideal environment, with a supply of our shed skin cells (their food source),
water from our sweat, expired breath, and warmth. They also find skin cells
and other proteins to eat in carpets, upholstered furniture, fabrics and
furry toys. The allergen which triggers the immune system is mainly in the
mite droppings, which are very dry and fragment into fine particles. These
become airborne and are easily inhaled deep into our airways and lungs. The
particles settle quickly into the depths of our pillows, mattresses, duvets,
upholstery and carpets.
Mould Spores
Allergy to mould spores is quite common and is often overlooked. Moulds are
ubiquitous and present indoors for most of the year. Mould also prefer damp,
warmer environments so are particularly found in bathrooms, kitchens, on
refrigerator door seals, shower curtains and particularly in houses that
have obvious damp patches and black mould on window frames. Due to the high
level of humidity, they are also found in our beds. The water reservoirs of
dehumidifiers can be a breeding ground for moulds. Spores are sometimes
hidden underneath wallpaper and commonly present in the soil of houseplants.
Houses built in areas of underlying water, and in river valleys, are often
damp.
Symptoms from mould allergy may be better in hot, dry weather and become troublesome on damp, cloudy and misty days.
Animal Allergens
Animal allergens are the next most frequent cause of allergic reactions. The
allergen that triggers allergic responses to animals is found in their
saliva, skin and urine. When the animal grooms, the allergen coats the skin,
fur or feathers, and is spread by shed skin cells (dander) as well as by
licking. The particle size of the allergen is extremely small and therefore
easily airborne and breathed in, causing respiratory symptoms, itchy eyes,
sneezing and skin irritation. Cat allergen, particularly, may be found on
walls and ceilings many months, or even years, after the animal has left the
house. It can also be found on the clothes and shoe soles of people with a
cat, so is easily spread. Feathers are rarely a cause of allergy although
the dust in feather pillows can be a cause of symptoms, as can the mites
that grow in them.
Smaller domestic animals, such as guinea pigs and hamsters distribute allergen in the urine in the bedding. This allergen easily becomes airborne when the animal scurries around in its cage. It is not advisable to keep these pets in the bedrooms of allergic people. Parrots and other birds are another common cause of allergic reactions to their feathers. Any animals, insect or creature can be a cause of allergic reactions. Even fish are not always the solution, as there are many allergenic proteins in fish food granules, and moulds can flourish in the damp environment.
Identifying the Causal Allergen
Allergy sufferers are rarely offered allergen diagnosis or advice. Identifying the causal allergen is an important step in taking control of your allergy, allowing you to reduce exposure to those substances that trigger your symptoms.
You should be referred to an Allergy Specialist or GP with a special interest in allergies, for diagnosis. Your levels of specific IgE will be tested by either skin prick or blood testing. This, together with clinical history, symptoms and examination will enable the specialist to correctly diagnose your condition and plan your future management.
Skin prick testing is a painless procedure in which one drop of each allergen is placed on the skin (usually on the lower inner arm), pricked with a specially designed lancet and blotted. If you are allergic to that substance, a small wheal of approximately 3-6mm, surrounded by an inflamed area, will appear within 15 minutes. This will itch for a short time before fading.
Controlling Indoor Allergens
House dust mite allergens
Most efforts at controlling dust mites should be aimed at areas of the home where you spend most of your time and where dust mite load is greatest, i.e. bedrooms and living areas
· Use allergen-proof barrier covers on all mattresses, duvets and pillows. These should be breathable and should completely enclose the item. Buy products that have been tested to make sure that they prevent the escape of house dust mite allergen.
· If possible remove all carpeting in the bedroom. Vacuum hard floors regularly with a high-filtration vacuum cleaner (see below).
· Wash all bedding that is not encased in barrier cover (e.g. sheets, blankets) every week. Washing at 60 degrees or above will kill mites. House dust mite allergen dissolves in water so washing at lower temperatures will wash the allergen away temporarily, but the mites will survive and produce more allergen after a while.
· Remove all carpeting from concrete floors. Such floors trap moisture allowing dust mites and mould spores to thrive. Seal the floor with a vapour barrier, and then cover it with a washable surface such as vinyl or linoleum.
· Where carpets cannot be removed, vacuum regularly with a high-filtration vacuum cleaner. Use a high-temperature steam-cleaner to kill mites effectively. Products are available that can be sprayed on carpets to kill mites; these are effective but should be used with care if you suffer from respiratory symptoms, and should not be used in areas where children play on the carpet, or on soft toys or pillows.
· Use a high-filtration vacuum cleaner with filters capable of retaining a high proportion of the smallest particles (HEPA filter, S-class filter or similar). Details of suitable vacuum cleaners are available from Allergy UK.
· Use light washable cotton curtains, and wash them frequently. Reduce unnecessary soft furnishings.
· Damp-wipe all surfaces each week (pelmet tops, window sills, tops of cupboards and so forth).
· Vacuum all surfaces of upholstered furniture at least twice a week.
· Washable stuffed toys should be washed as frequently and at the same temperature as bedding. alternatively, If the toy cannot be washed at 60 degrees place it in a plastic bag in the freezer for at least 12 hours once a month and then wash at the recommended temperature.
· If necessary use a dehumidifier to keep indoor humidity under 50% (but over 30%)Reduce humidity by increasing ventilation. Use trickle-vents in double-glazing, or open windows. Use extract fans in bathrooms and kitchens.
·
Animal Allergens
If you have a proven allergy to your pets then the best advice is to remove them from your home. After your pets are removed you should do the following;
· Wash all bedding and draperies, even if your pet was not directly in contact with them.
· Vacuum all surfaces to remove pet hair; also wash all walls and floors.
· Carpet Cleaning Steam clean all carpets and upholstery. Run your heating or air conditioning system to help quickly dry these surfaces and prevent mite or mould growth.
Reducing animal allergens
· Animals should not be allowed in the living area and never in the bedroom.
· Do not obtain any new pets.
· Wash cats and dogs 1-2 times a week.
· Groom dogs regularly outside.
· Wash everything, including walls, if you have a cat.
· Wash all bedding and soft furnishings on which an animal has layed.
· Allergic children should not play on carpets where animals have been
· Horse riders should change their clothes before entering the house of allergic people as horse allergen sticks to clothes.
Mould Allergens
· Use a dehumidifier to keep indoor humidity at 50% or less. Empty and clean the reservoir regularly
· Avoid damp basements, compost piles, fallen leaves, cut grass, barns and wooded areas - or wear a face mask if these places or things are unavoidable.
· Tackle any damp areas on walls (due to blocked / leaking gutters etc). Pay particular attention to walls behind kitchen units and cupboards; the lack of ventilation often means that excess mould grows in these areas. Tackle condensation.
· Make sure that your tumble dryer is vented outside during use, or use a condenser-dryer. Try not to dry damp clothing indoors.
· When showering or cooking, keep internal doors closed to prevent damp air spreading through the house. Use extract fans and cooker hoods vented outside.
· Do not let food decay and clean and thoroughly dry problem areas such as refrigerator seals.
· Do not hang clothes in damp cupboards or pack clothes too tightly in wardrobes. Leave wardrobe doors ajar to ventilate the clothes
· Strip wallpaper from damp walls.
· Get rid of old foam pillows and mattresses.
· Keep houseplants to a minimum and change the soil regularly
· Do not use humidifiers.
· Avoid using paraffin heaters and bottled gas heaters - they generate large amounts of moisture
Other Considerations
· Allergic people may be likely to develop other allergies over time, so all allergy sufferers should follow these guidelines for allergen reduction.
· Cigarette smoke makes all allergic conditions worse because of the aggravation of already inflamed skin and membranes. Nobody should smoke in the house of an allergy sufferer.
· Inflammation & symptoms develop over a long time so benefit may not be immediate.
· Early exposure of babies to allergens and smoke is associated with later development of allergic disease.
· People with sensitive airways and skin should avoid all unnecessary chemicals, such as air fresheners and most commercial cleaning materials (contact Allergy UK for cleaning tips).
· Allergy test results should be interpreted by an allergy expert in conjunction with clinical history.
· Diagnosis by alternative methods is not recommended.
Recent evidence suggests that it is probably necessary to rigorously carry out several allergen avoidance measures in order to see an improvement in symptoms. Just doing one or two things half-heartedly may not make any difference.
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