ALERGENI V STANOVANJU

V LEŽIŠČU NAJVIŠJA KONCENTRACIJE ALERGENOV PRŠICE

Raziskava vodena v VELIKI BRITANJI je pokazala da je 30% prebivalstva senzibilna na Dermatophagoides Pteronyssinus. Študija opravljena na evropski ravni pa dokazuje le 20.3% senzibilnost.

Allergy to indoor allergens is important for atopic disease, particularly asthma. In a UK study, it was found that 30% of the population was sensitized to D. pteronyssinus, and in a large European survey, a median prevalence of 20.3% for sensitization to D. pteronyssinus was found.

Izvleček iz : Lovic M, Gaarder PI, Mehl R. The house-dust mites: its biology and role in allergy. A synopsis. Allergy 1998; 53 (Suppl 48): 121-135.

Najvišja koncentracija alergenov pršice se nahaja v ležišču. Pacienti preživijo vsako noč 6-8 ur v stiku z blazino, vzmetnico in odejo, taka izpostavljenost alergenom je nedopustljiva in jo je potrebno rešiti . Z alergeni živali (psi, mačke) pridemo v stik v dnevnih prostorih našega stanovanja, to moramo upoštevati ko gradimo obrambno strategijo. V stik s temi alergeni pridemo tudi na javnih mestih (kinematografi, avtobusi), celo v bolnišnicah. Prisotnost alergenov ščurkov v šolah in velikih stavbah lahko postane problematično.

· The highest concentration of mite allergens is found in beds; patients spend 6-8 hours every night in close contact with their mattress, pillow, and bedding, so the reduction of exposure in the bedroom is critical · Most exposure to pet allergens probably occurs in living areas other than the bedroom, and this must be taken into account when planning avoidance strategies· In public areas for example, cinemas and public transport mite allergen levels are low, but exposure to airborne pet allergens can be substantial even in hospital outpatient areas · Exposure to cockroach allergens may be important in schools and some high rise blocks of flats.

Izvleček iz : Lovic M, Gaarder PI, Mehl R. The house-dust mites: its biology and role in allergy. A synopsis. Allergy 1998; 53 (Suppl 48): 121-135.

Prah iz vzmetnic vsebuje tudi do 100 X večjo vsebnost pršic, kakor prah iz talnih površin. Zaradi tega vzroka predstavlja ležišče idealni prostor za pršico.

The first studies of house-dust mites in dwellings were exclusively concerned with the occurrence of mites in dust samples from floor dust, predominantly house-dust mites (Dermatophagoides spp.) which constitute 70% of the mites found. The mean concentration was 61 mites/5 g of dust. It was later documented that mattress dust held concentrations of house-dust mites 100-fold higher than corresponding floor dust. Therefore, the bed was considered the biologically most important habitat of house-dust mites. This view is supported by the observation of higher concentrations of mites from floor dust just beneath the bed than 1 m away, just as the concentration of mites is higher in dust samples from the floor in bedrooms than from the floor in living rooms.

Izvleček iz : Korsgaard J. Epidemiology of house-dust mites. Allergy 1998; 53 (Suppl 48): 36-40.

Sakaguchi et al., so v raziskavi, (Sakaguchi M, Inouye S, Yasueda H, Shida T. Concentration of airborne mite allergens during sleep. Allergy 1992; 47: 55-7) izmerili nivo alergenov (Skupine 1 in Skupine 2) v zraku spalnice 10X več kakor v dnevnih prostorih.

It is likely that most exposure to mite allergens occurs overnight in bed. Sakaguchi et al. reported that airborne levels of Group 1 and Group 2 mite allergens in bed were approximately 10 times as high as those during everyday life in the living room.

Izvleček iz : Custovic A, Chapman M. Risk levels for mite allergens. Are they meaningful? Allergy 1998; 53 (Suppl 48): 71-76.Abundance of dust mite in "different" habitats, based on published studies

Izvleček iz : Colloff MJ. Distribution and abundance of dust mites within homes. Allergy 1998; 53 (Suppl 48): 24-27.

Odstranitev alergenov pršice iz stanovanjskega okolja

Spalnica

Izpostavljenost alergenom pršice v postelji je mnogo večje, kakor bilo kje drugje v stanovanju. Najbolj učinkovita metoda znižanja nivoja alergenov je obleči vzmetnice, blazine in odeje v primerne prevleke, obenem pa prati posteljno perilo tedensko na primerni temperaturi. S tem postopkom zmanjšamo izpostavljenost alergenom pršice od 100 do 1000 X.

House dust mite allergen exposure is much greater in bedding than elsewhere in the home. The most effective method to reduce mite allergen levels in bedding is to install impervious covers over the mattress, pillow and comforter and to wash sheets, pillow cases, blankets, and mattress pads at least weekly. By doing so, mite allergen exposure can be reduced 100 to 1000-fold within a month.

Izvleček iz : Ad Hoc Working group on Environmental Allergens and Asthma. Environmental allergen avoidance in allergic asthma. J Allergy Clin Immunol 1999; 103: 203-5.

Edini učinkoviti način zmanjšanja nivoja alergenov v blazinah, vzmetnicah in odejah je uporaba odgovarjajočih prevlek. Nekoč so te prevleke bile iz plastike in niso nudile odgovarjajočega udobja. Dan danes obstajajo prevleke, ki omogočajo transpiracijo obenem pa so nepropustne za alergene. Z uporabo takih prevlek znižamo nivo alergenov za več kot 100 X. Posteljno perilo mora biti pralno na 55°C: na ta način odstranimo alergene in pršice. Pranje pri nižji temperaturi (30°C) zmanjša koncentracijo alergenov toda pršica preživi. Prevleke ob zamenjavi perila pobrišemo z vlažno krpo. Nakup novih vzmetnic izboljša stanje le za 3 tedne, dokler se pršica ponovno ne naseli. Preproge v sobi odstranimo, zavese redno operemo.

The single most effective measure is to cover the mattress, pillows, and duvet with covers that are impermeable to mite allergens. These covers used to be made of plastic and were uncomfortable to sleep on. Now fabrics permeable to water vapour (either microporous or polyurethane coated) but also both impermeable to mite allergens and comfortable to sleep on are available. Allergen concentrations decrease by up to 100-fold after such covers are introduced. All exposed bedding should be washed at 55°C. This kills mites and removes allergen; although the "cold" cycle (30°C) of laundry washing dramatically reduces allergen concentrations, most mites survive it. The covers should be wiped down at each change of bedding.Buying a new mattress produces only a temporary benefit as reinfestation may occur within a few months from other reservoirs, such as carpets. Ideally, bedroom carpets should be replaced with sealed wooden or vinyl flooring, and the curtains should be hot washed regularly or replaced with wipeable blinds. In this way exposure to mite allergens in the bedroom at night can be virtually abolished. Substantial clinical benefit of effective mite avoidance has been shown in mite sensitised asthmatic patients and in patients with eczema or perennial rhinitis.

Izvleček iz : Woodcock A, Custovic A. Avoiding exposure to indoor allergens. BMJ 1998; 316: 1075-1078.

V stanovanju v katerem imamo itison je nivo alergenov višji. Prvi od treh prehodov z sesalcem na tlaku z preprogami odstrani le 35 % pršič odstranjenih z tremi prehodi, pri lesenem tlaku je ta procent bistiveno večji saj presega 80 %.

Within the home, mite concentrations are higher in rooms with floors that have carpets, perhaps because of the protective properties of the carpet. The first of three consecutive vacuum cleanings of a carpeted floor can remove only 35% of the total number of mites removed after three cleanings, whereas the corresponding figure for solid floors is 80%.

Izvleček iz : Lovic M, Gaarder PI, Mehl R. The house-dust mites: its biology and role in allergy. A synopsis. Allergy 1998; 53 (Suppl 48): 121-135.

Blazine iz sintetičnih materialov

V zadnjem desetletju je prodaja sintetičnih blazin narasla, predvsem zaradi prepričanja o anti-alergičnosti le teh. Novejše raziskav dokazujejo ravno nasprotno. Kemp et al. so izvedli primerjavo med 9 pari blazin ( ena z perjem druga z poliestrom), katere je uporabil posamezni pacient 6 mesecev , na koncu opazovanega obdobja so izvedli meritve in odkrili da je nivo Der p 1 pri poliesterskih blazinah 8 X večji. Ta ugotovitev je postavila pod vprašaj nasvete o uporabi anti-alergičnih blazin pri astmatičnih pacientih.

Over the last decade, sales of pillows using synthetic fillings have increased enormously based on the concepts that they are non-allergenic (as opposed to feather pillows). Recent data suggest that this is a myth, and the converse is true. Kemp et al. have recently compared nine pairs of pillows (one feather and one polyester) which had been used on a same adult bed for more than 6 months, and found an approximately eightfold higher level of total recovered Der p 1 in polyester than feather filled pillows. This finding challenged the wisdom of advising asthmatic patients to avoid using the feather pillows and to replace them with synthetic ones.

Izvleček iz : Custovic A, Woodcock A. Feather or syntehetic? That is the question. Clinical and Experimental Allergy 1999; 29: 144-7

Zakaj je koncentracija Der p 1 v sintetičnih blazinah tako visoka je še negotova . Analiza uporabljenega tekstila za prevleke posameznih blazin je odkrila, da se za prevleke iz perja uporablja bolj fino tkano blago (ugotovitev ni objavljena).

This study has demonstrated that synthetic pillows accumulate Der p 1 more rapidly than feather pillows, and that pillow Der p 1 accumulation is governed by the Der p 1 concentration at the site they are placed in. The study has also reconfirmed our previous findings of a greater Der p 1 content of synthetic pillows when compared with feather pillows, which has recently been confirmed in tile UK. The reason for the greater Der p 1 accumulation on synthetic pillows is uncertain. Synthetic pillows either preferentially retain allergen or support greater house dust mite infestation. In regard to the latter, electron microscopy showed that the weave of the encasement on synthetic pillows is considerably more open than that of the feather pillow encasement material (unpublished observations).

Izvleček iz : Rains N, Siebers R, Crane J, Fitzharris P. House dust mite allergen (Der p 1) accumulation on new synthetic and feather pillows. Clinical and Experimental Allergy 1999; 29: 182-185.

Pacienti in preventiva

Upoštevanje navodil o uporabi prevlek in ostalih preventivnih ukrepov pri pacientih ni zadovoljiva. Farmakološki terapiji pacienti še sledijo, ampak preventivnih ukrepov ne izvajajo. Brez izobraževanja se pacienti ne bodo držali priporočil .Z normalno klinično edukacijo, je Korsgaard ugotovil da je le 17% pacientov namestilo prevleke. Huss et al. je prišel do enakih rezultatov, poleg tega je ugotovil da z upoštevanjem navodil poveča na 27% in celo na 39% z programom izobraževanja temelječim na računalniku. Sistematično klinično izobrazevanje motiviranih pacientov lahko dvigne ta odstotek na 48%.

Although environmental allergen avoidance is included in both the Unites States and international treatment guidelines, adherence by physicians and patients to these recommendations needs improvement. Patients often report that they are adherent, but home inspection shows much less adherence than patient self-reports. Without formal educational programs no patient had installed mattress covers. With the usual clinic-based educational efforts, Korsgaard found that only 17% had installed a mattress cover. Huss et al found similar figures but also found that the adherence could be increased to 27% with repetitive clinic-based education and to 39% with a computer-based educational program. Adherence to allergen avoidance advice is generally not as good as with medication. For example, in a clinical trial that achieved better than 95% adherence to medication regimens, no more than 48% of families had installed mattress covers. Thus with specific clinic-based education, between 17% and 27% of patients will adhere to recommendations for environmental avoidance, whereas more intensive clinic-based education in highly motivated patients may increase adherence to 48%.

Izvleček iz: Ad Hoc Working group on Environmental Allergens and Asthma. Environmental allergen avoidance in allergic asthma. J Allergy Clin Immunol 1999; 103: 203-5.