Environmental interventions
Certain interventions aiming at reduced allergen (pollen, molds, house dust mites, pets) or irritant (pollutants, tobacco smoke) exposure have long been incorporated into the guidelines [57]. There is substantial evidence that sensitization/exposure to molds correlates significantly with exacerbation of AR symptoms, even in children with non-allergic rhinitis [29, 88]. Mold and cockroach allergen reduction leading to subsequent symptom relief, can be achieved by combined interventions [89]. In general, control of indoor allergen exposure in allergic subjects, is effective when multifaceted and demanding approaches are followed [90]. With regards to house dust mite control, although previous meta-analyses showed minimal protective effects of interventions aiming at exposure reduction, recent data deriving from asthmatic patients indicate that certain actions, such as mite-impermeable bed encasings, may confer significant protection form disease morbidity [91]. It is plausible that early, prolonged and personalized interventions, tailored to individual sensitization and exposure status, can be clinically beneficial [92].
Exposure to AR-relevant outdoor pollens and molds can be reduced by limiting exposure and field activities during peak pollen days, however such recommendation is often unrealistic in the pediatric population and counters the goal of reinforcing daily activity in children [93].
Various epidemiological studies have shown that exposure to volatile organic compounds
from building materials and consumer products exacerbate rhinitis symptoms and although data on the effects on rhinitis of air pollution exposure per se are inconsistent [94, 95], their capacity to increase the allergenicity and immunogenicity of aeroallergens has been shown [96]. Heightened CO2 levels and global climate change have been strongly associated with increased prevalence of rhinitis symptoms, by increase in pollen levels both in volume and in time; policy adjustments have recently been addressed in order to decrease pollution and mitigate their effects on allergy-associated diseases [97]