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Living With Indoor Allergies

Posted Aug 24 2008 1:49pm
PAUL MONIZ: I'm Paul Moniz. Thank you for joining us on this webcast. Today we are discussing indoor allergens. Things like dust, mold, and even rotting insects that lurk under your bed and even on your bed sheets. Indoor allergens can indeed make your life miserable, but oftentimes sufferers attribute their symptoms to something else, never suspecting their own home may be the chief culprit.

Here to help us develop a battle plan against this indoor invasion, are two doctors who specialize in the field. Dr. Morris Nejat is the director of the Division of Pediatric Allergy and Clinical Immunology at Bellevue Hospital Center. He is also a clinical professor of pediatrics at NYU Medical Center. Dr. Nejat, thanks for joining us.

We also have Dr. Heidi Zafra, who is the head of Pediatric Allergy at St. Christopher's Hospital for Children in Philadelphia. She is also an assistant professor of pediatrics at the MCP Honneman School of Medicine. Dr. Zafra, let's begin with you. What are the most common causes of indoor allergies?

HEIDI ZAFRA, MD: Dust mites. Basically, the way I describe dust mites, they're microscopic organisms that live in your mattress and your pillows. When you shake your pillow and the dust flies, they're excrements from the dust mites, and that's what you inhale, and that's what irritates your nose and your lungs.

Also, there is indoor mold. There is pet dander. And, in cities, there is cockroach and mice. That's most of the indoor allergens.

PAUL MONIZ: Not a pretty mix, is it? What effect does that have on people?

HEIDI ZAFRA, MD: It can vary from mild symptoms such as nasal itching, chronic runny nose, chronic nasal congestion, eye itching, to more severe symptoms such as asthma, wheezing, coughing at night, shortness of breath.

PAUL MONIZ: Let's take these one by one, Dr. Nejat. Dust mites. What are they, how large are they, how much of a problem are they?

MORRIS NEJAT, MD: Dust mites are small microscopic organisms that, as Dr. Zafra mentioned, live off of, basically, shed human skin. You find them in high quantities in mattresses and boxsprings and pillows, in bedding and clothes, on carpets.

PAUL MONIZ: Those things are crawling around with you in bed, essentially?

MORRIS NEJAT, MD: Among other things, yeah. What happens is people who are genetically predisposed develop an allergy to the feces of the dust mites. What happens is, at night-time as you're sleeping, unbeknownst to you, you're breathing these fecal particles, causing allergic reaction in your nose, in your lungs, in your eyes. Causing allergy symptoms in people that are allergic to them.

PAUL MONIZ: How do you avoid dust mites?

MORRIS NEJAT, MD: Really, the big thing is, first of all, you want to make sure that you're allergic to dust mites. That would be accomplished by going to your allergist and having skin testing done, to really see are dust mites the problem?

Secondly what you want to do is, you want to get special covers to put on the mattress, the boxspring and the pillowcases. What this does is, it encases these things, to keep the dust mite feces inside the mattress, and keep you from breathing them in while you're sleeping. Then you would wash all the bedding in hot water, over 130 degrees Fahrenheit, once a week. What that'll do is, that will kill and denature the dust mites and their feces, so that they're no longer allergenic.

You would take all the clutter off the bed, like stuffed animals, the throw pillows, and things like that because all those are dust gatherers. You want to really try and make the bedroom a dust-mite free sanctuary, by decreasing the clutter in the whole bedroom as much as possible. I tell patients to picture a hospital room, where they have no rugs on the floors, they have nothing on the walls, they don't have upholstered furniture, and try and make your bedroom as much like a hospital room as possible.

PAUL MONIZ: Sounds almost institutional, though. People are certainly reluctant to do that, especially in their bedroom.

MORRIS NEJAT, MD: It depends on how bad their symptoms are. But numerous studies have been done where they've taken patients out of their homes, put them in a hospital room, put them there for six months. These patients that are allergic to dust mites did amazingly well, even without any change in the medications. Severely sick asthmatics were significantly better after six months in this dust-mite free environment.

PAUL MONIZ: We should point out, though, that not all people are allergic to dust mites. These covers that you spoke about is a booming, multi-million dollar business. They send out tapes, and they show the dust mites, and they magnify them by 100 times, and it looks like giant creatures are crawling on the beds, when in fact, obviously, they're microscopic, and a lot of people are not allergic to them.

What would you advise, if you're not having any symptoms, should you go out and buy these covers as a safety precaution?

MORRIS NEJAT, MD: Of course not. If you're not allergic person, you're not having problems, then I wouldn't. There are microscopic organisms everywhere, in our foods, on our bodies, in our clothes, in the water. You can make yourself nuts if you really worry about creatures. The problem is, in people that are allergic to dust mites, they have allergic reactions such as itchy eyes, itchy nose, sneezing, coughing, wheezing, and itchy skin. If you have these symptoms, and they're all year round and worse in the winter, it may be because of dust mite allergy.

PAUL MONIZ: There's a substance – is it "Acaricide?"

MORRIS NEJAT, MD: Acaricides. What that does is, this is something that you would put on your carpeting and maybe on upholstered furniture, to denature the dust mites and the feces that are there because you can't really encase those or wash those.

PAUL MONIZ: Can it be toxic?

MORRIS NEJAT, MD: No, it's not toxic. It's very safe to humans. The only problem is that (A) you often have to reapply, and (B) some of the newer acaricides that have come out now, they put perfume in it.

HEIDI ZAFRA, MD: It becomes an irritant, basically.

MORRIS NEJAT, MD: The perfumes that they're putting in to make it smell better have been shown to irritate some people's skin.

PAUL MONIZ: What about, Dr. Zafra, the humidity in someone's apartment? In Manhattan especially, and in many other cities, dry apartments are a major problem, because of the heat that rises from the bottom of the building. And so people are cracking their windows or opening them up, but it's still very dry. A lot of people buy humidifiers. Good idea, bad idea?

HEIDI ZAFRA, MD: I am not a big fan of humidifiers. You see, dust mites are moisture-loving insects. The more humid the environment, the more dust mites grow, and the more humid the environment, the more molds grow. I really discourage my patients from buying humidifiers. If they really want the room to be less dry, they lower the heat and open up the window a little bit. But I know that Dr. Nejat has a different opinion about that.

PAUL MONIZ: A different opinion? Well, that's what we want to hear.

MORRIS NEJAT, MD: I don't mind humidifiers, as long as they don't make it too humid. I tell patients to keep the humidity around 30%. That way you're not really promoting dust mite proliferation. At the same time you're making the apartment a little bit more comfortable. Because otherwise you have all the problems of dry air, bleeding noses, etc.

HEIDI ZAFRA, MD: The other thing, also, is the water in the humidifier must be thrown out and cleaned every day, because that water can also grow a lot of bacteria and mold, and that gets aerosolized as well.

PAUL MONIZ: So people that are leaving the humidifier there with standing water for 10 days and turning it on? Probably not a good idea.

What else can you tell us about roaches? Let's take the next topic here. How should people control them, and what do they do? How do they affect people's allergies?

MORRIS NEJAT, MD: Roaches have been described as a major inner city allergy and asthma problem only in the last decade. Really, in some areas, it's probably a bigger problem than dust mites are. The main thing is, you want to decrease the roach proliferation in your home.

PAUL MONIZ: Is it the roach droppings that you're concerned about?

MORRIS NEJAT, MD: No, it's actually the roaches themselves.

PAUL MONIZ: The roaches themselves?

HEIDI ZAFRA, MD: Insect parts.

MORRIS NEJAT, MD: They die, their bodies decompose, become part of the dust.

PAUL MONIZ: You often can't see them, because they're behind furniture or whatever.

MORRIS NEJAT, MD: Sure. And also, they might not even be in your apartment. They might be in the guy next door, but when the roaches die, it gets all mixed together with the dust in the whole building. But you want to decrease the roaches in your dwelling as much as possible, by not leaving food out, using Roach Motels, things like that.

HEIDI ZAFRA, MD: And no eating in the bedroom.

MORRIS NEJAT, MD: No eating in the bedroom.

PAUL MONIZ: That might be a little easier than telling people to get rid of their pets, which is the next topic. It is a major source of disagreements among families, when one person has an allergy and the others don't. What do you do, if you have a pet that you're allergic to? Can you still live with that pet and make peace with the rest of your family, or what?

HEIDI ZAFRA, MD: It depends on what the symptoms are. If it's just a runny nose, itchy eyes, it's just a quality of life issue. If you can live with the runny nose and the itchy eyes, fine. You can keep the pet, but leave the pet out of the bedroom, because when the pet dander's in the bedroom, you're miserable all day, all night long. You're exposed to the dander all day long.

But if you have asthma, especially if you have a child who has asthma and wheezes with the pet, the choice is really easy, the kid or the pet. Asthma is life-threatening, and you don't want to risk the child's life just to save the pet. I just really tell them to get rid of their pets. Move the pet to a friend's house, so that they have visiting rights, but it's best to remove the pet from the home.

PAUL MONIZ: What about when the pet has a shedding phase? What do you recommend? Does that cause more of a problem, or not necessarily?

MORRIS NEJAT, MD: What happens is, especially in cats, people are allergic to the saliva of the cat. What the cat does, it licks its pelt, that when it's shed, you're getting the saliva everywhere. Cat antigen, as opposed to dust mites, which is very heavy. Dust mites are very heavy antigens. Cat antigen is very light, so it aerosolizes very easily. You walk into a room and the room is filled with cat antigen.

I tell patients to put a HEPA filter in the bedroom to clean out as much of the cat antigen as possible out of the bedroom. I also recommend, if they do keep the cat, to wash the cat at least once a week, to help take off as much antigen as you can from the cat's skin.

Oftentimes patients will undergo allergy immunotherapy to their pet's antigens, to decrease their sensitivity so they can tolerate it. I've had probably a dozen instances where a marriage was in jeopardy because a boyfriend or girlfriend would want to get married, but somebody had a cat. The other partner was extremely allergic to the cat, and they couldn't live with the cat. It really became a choice of --

PAUL MONIZ: The other person couldn't live without the cat.


PAUL MONIZ: Or wouldn't live without the cat.

MORRIS NEJAT, MD: These patients are very, very, very good patients as far as compliance. Very compliant patients. They come in every week for allergy shots, and they've done very well, actually. Where, now, they can play with the cat; they've done very well on allergy immunotherapy.

PAUL MONIZ: You've been able to help. What about with mold, Dr. Zafra? What are we seeing with mold?

HEIDI ZAFRA, MD: There are two kinds of mold. There's indoor mold and there's outdoor mold. Indoor mold is in bathrooms. It's in basements, moist basements. It's around windowsills. It's around moist pipes. It's in potted plants. For indoor mold, basically, you want the room on the dry side. You must bleach your bathrooms at least once a week, because bleach kills mold. You have to keep the areas, which are moist, nice and dry. Wiping it out, making sure that the pipes aren't leaking.

If your carpet is set on concrete, maybe take out the carpet, because the back of the carpet will grow mold behind it. Basically remove anything that collects moisture, because that can be a culture for growing mold.

PAUL MONIZ: The HEPA filter, does that help with mold?

MORRIS NEJAT, MD: It can help. The best things are as Dr. Zafra discussed, but it can help take out some of the aerosolized mold out of the air.

PAUL MONIZ: People see these HEPA filters all the time in stores.

HEIDI ZAFRA, MD: They're $400.

PAUL MONIZ: They're confused about them. They're expensive, and they question the value. What is the value of a HEPA filter, as it pertains to these allergens?

HEIDI ZAFRA, MD: If money is an issue, the best thing, really, is to make your apartment, your room, nice and clean. That will save you a lot of money, save you the HEPA filter. If you can afford it, yes, it will add some additional benefit. But if you're cost cutting, you can't afford the HEPA filter, then keeping your room clean is just fine.

PAUL MONIZ: What symptoms might someone see if they're allergic to these? Sneezing? Let's go through them quickly. You walk into your apartment, what are the telltale signs? You walk into your apartment and suddenly you start sneezing, should you be concerned?

MORRIS NEJAT, MD: Sneezing, itchy nose, itchy throat.

PAUL MONIZ: What about runny nose?

MORRIS NEJAT, MD: Runny nose, runny eyes, coughing, wheezing, itchy skin. All those can be signs of indoor allergy.

PAUL MONIZ: Are there any other allergens that we haven't spoken about? These are the main ones that can cause problems inside people's home?

HEIDI ZAFRA, MD: Sometimes mice, if mice is a problem in some people's homes. Mice can cause problems, too.

PAUL MONIZ: But, really, it sounds like some of the solutions are fairly simple. Keep the place clean, and just avoid what you're allergic to. If you can't do that, get some shots and make peace at home.

MORRIS NEJAT, MD: It's easier said than done to clean. A lot of times patients will do it for like a week or two. Then they, because it's cumbersome. Then they're back in the office again saying, "I'm sick again."

PAUL MONIZ: Dr. Zafra, closing comments from you. What advice would you have for patients dealing with these indoor allergens?

HEIDI ZAFRA, MD: Basically making your environment nice and clean cuts down your symptoms and cuts down your need for medication. If you can't totally keep your environment clean, you can either have medication, or you can have immunotherapy. There are many options for people with a lot of allergies, especially those with severe allergies and asthma, to help their symptoms. But, really, good environmental control makes a big difference in their quality of life.

PAUL MONIZ: All right, some good advice. Thank you very much, Dr. Heidi Zafra. We appreciate your time. Dr. Morris Nejat, yours as well. We thank you for joining us on this webcast. Just like your Mom told you: Keep the place clean, and you'll feel better. I'm Paul Moniz.

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