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]