Treatment with common household bleach containing hypochlorite destroys dust mites and denatures protein allergens. The purpose of this study was to determine if home use of hypochlorite products results in lowered exposure to bacteria, fungi, and protein allergens and improved quality of life (QOL) for asthmatic persons in the home. Asthmatic and nonasthmatic households containing at least three persons (between 2 and 17 years of age) were recruited. Households were supplied one of three sets of cleaning products (regular products, some containing hypochlorite; regular products plus three additional products with dilute hypochlorite; control, no products). Participants were supplied with cleaning instructions and asthma education. The control group was instructed to clean as usual. Participants completed general health and QOL questionnaires. Asthmatic participants completed an additional asthma QOL questionnaire. Families participated in the study for 8 weeks and completed the full set of questions every 2 weeks. Homes were visited at the beginning of the study and twice thereafter at monthly intervals. Samples evaluated were surface bacteria, viable and nonviable airborne spores, and dust antigen content. Reductions in surface bacteria, airborne fungal spores, and dust antigen levels were achieved. Significant improvement in general health parameters was seen for the asthmatic product groups over the control group. Significant improvement in general QOL and asthma-specific QOL was seen in the asthmatic group. Emphasis on cleaning and cleaning education combined with hypochlorite-based cleaning supplies resulted in significantly improved QOL for families with asthmatic children.

No abstract

Effective management of allergic diseases relies on the ability to make an accurate diagnosis. Although clinicians rely on experience obtained over many years of practice, such experience is anecdotal and unique to the individual using it. The result is a tendency for patients with similar clinical presentations to receive different diagnoses and treatment, depending on which provider they happened to see. The probability that a patient has a particular diagnosis can be determined using a combination of diagnostic tests. To make the best use of tests, it is important to understand their performance characteristics in terms of reproducibility and likelihood ratios. A test that is reproducible but that does not predict the presence of a disease is not helpful, nor is an accurate test that is not reproducible. To improve the reproducibility of diagnostic tests, it is important that proficiency testing be instituted for both skin and in vitro tests so that the coefficient of variance can be determined. This has already been done for the latter and needs to be done for skin tests as well. With use of a combination of history and appropriate diagnostic tests, the probability that a particular diagnosis is present can be increased or decreased sufficiently either to confirm it or to rule it out. As proficiency testing of allergy tests becomes more common and the use of tests becomes more consistent, we believe that patients with allergic diseases will benefit.

By applying the principles of evidence-based medicine to define likelihood ratios for each criterion, it should be possible to define the probability of asthma and to identify the best treatment. Future research should permit accurate correlations to be drawn between the underlying pathophysiology and the clinical condition commonly known as asthma.

Allergists often suspect home environmental conditions are contributors to allergic disease. Case management can be an effective tool in managing asthmatic patients. To describe the impact of home environmental assessments and case management on the medical care utilization of patients with allergic disease the following studies were conducted. This study was designed to retrospectively examine health care utilization of pediatric patients that had a home environmental assessment recommended by a pediatric allergist as part of a comprehensive case management program. Subjects were chosen from pediatric patients who received home assessment after referral for case management by pediatric allergy specialists in a hospital-based clinic as indicated by high emergency room (ER) and hospital utilization. Case management included education, clinic visits, environmental assessment, and a single person responsible for following the subject's care. Home assessment included airborne spore collections, surface collections, and dust collection for evaluation of antigens. There were 25 subjects. Seventy-two percent were asthmatic and 12% were diagnosed with allergic rhinitis. In the year before entering the study these subjects experienced 47 ER visits, 22 hospitalizations, and 279 clinic visits. In the subsequent year they underwent 18 ER visits, 3 hospitalizations, and 172 clinic visits. Penicillium/Aspergillus levels were above 100 spores/m(3) of air in 94% of homes and above 1000 spores/m(3) in 74% of homes. Thirty-six percent of homes had Stachybotrys above 100 spores/m(3). Home environmental assessment and case management may reduce medical care utilization for children suffering from allergic rhinitis and asthma.