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Allergen Management in Children with Type 2-High Asthma
Madeleine Gray-Ffrench1, Ricardo M Fernandes2,3, Ian P Sinha4,5
1University of Birmingham, Faculty of Medicine, Birmingham, UK.
Insights
Children exposed to allergens like dust mites and pollen face higher asthma risks. Reducing exposure to indoor and outdoor allergens may help manage childhood asthma, though evidence for single treatments is limited.
Area of Science:
- Pediatric Allergy and Immunology
- Environmental Health and Asthma
- Respiratory Medicine
Background:
- Childhood asthma is linked to indoor and outdoor allergen exposure, with sensitization predicting disease severity.
- Aeroallergen exposure significantly impacts asthma outcomes, interacting with social determinants of health.
- Type 2-high asthma in children is a growing concern influenced by environmental factors.
Purpose of the Study:
- To review factors of aeroallergen exposure in type 2-high childhood asthma.
- To examine the role of indoor and outdoor allergens in asthma exacerbations and severity.
- To assess evidence for allergen avoidance and treatment strategies.
Main Methods:
- Literature review focusing on indoor aeroallergens (mites, pets, cockroaches, molds, rodents) and outdoor aeroallergens (pollens, molds).
- Analysis of the interplay between aeroallergens, climate change, social determinants, and asthma outcomes.
- Examination of the impact of reduced aeroallergen exposure during the COVID-19 pandemic on asthma exacerbations.
Main Results:
- Sensitization to aeroallergens is a key predictor of childhood asthma morbidity.
- Limited evidence supports the clinical benefit of single-strategy allergen avoidance or treatment.
- Reduced outdoor aeroallergen exposure during COVID-19 coincided with fewer asthma exacerbations.
Conclusions:
- Aeroallergen exposure is a critical factor in childhood asthma development and exacerbation.
- Comprehensive strategies considering environmental and social factors are needed for effective asthma management.
- Further research is required to validate allergen avoidance and treatment efficacy in pediatric asthma.
Abstract:
Children exposed to various indoor and outdoor allergens are placed at an increased risk of developing asthma in later life, with sensitization in these individuals being a strong predictor of disease morbidity. In addition, aeroallergen exposure influences asthma outcomes through an interplay with adverse determinants of health. The goal of this review is to provide an introductory overview of factors related to aeroallergen exposure in type 2-high childhood asthma. These include the relevance of exposure in asthma exacerbations and severity, and the evidence-base for avoidance and treatment for sensitization to these allergens. This review will focus on both indoor aeroallergens (house dust mite, pet, cockroach, mold, and rodent) and outdoor aeroallergens (pollens and molds). Treatment of aeroallergen sensitization in children with asthma includes avoidance and removal measures, although there is limited evidence of clinical benefit especially with single-strategy approaches. We will also address the interplay of aeroallergens and climate change, adverse social determinants, and the current COVID-19 pandemic, when we have seen a dramatic reduction in asthma exacerbations and emergency department visits among children. While there are many factors that are hypothesized to contribute to this reduction, among them is a reduced exposure to outdoor seasonal aeroallergens.
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