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Asthma, airborne allergens and air quality: an inflammatory problem

Asthma is a chronic condition that affects around 5.4 million people in the UK, including 1.1 million children. There are many allergens that can cause issues for those suffering with asthma, including animal dander, dust mites, indoor/outdoor moulds, tree pollen and grass pollen.

Airborne Allergy Action is a community interest company set up to raise awareness of the benefits of avoiding these allergens to reduce the symptoms of asthma.

The company’s Director, Catherine Sutton, spoke to us about her own experience with her son, Edward, who has suffered from severe allergies and asthma from a young age. She also explained what needs to be done to raise awareness about the links between asthma, airborne allergens and air quality.

How did you first become aware of the issues surrounding airborne allergies and air quality?

When my son Edward was little, he couldn’t stop coughing. He would get very poorly, had to have an inhaler and antibiotics. When he was about five, I noticed that he was sneezing in a very allergic way – blood tests showed that he was allergic to house dust mite allergen (the waste from house dust mites which live in bedding and furnishings), grass pollen, moulds and cat and dog dander to varying degrees. His house dust mite sensitivity was the highest possible level so he was very much a ‘canary in the coalmine’.

What changes did you make to help Edward?

I took Allergy UK’s advice and began to systematically avoid the things Edward was allergic to reduce his exposure to them. A 2016 study had shown that anti-dust mite bedding can reduce hospitalisations for asthma in dust mite allergic children: when I changed his bedding, his symptoms improved. An alternative is to wash bedding regularly at 60 degrees celsius to remove house dust mite allergen.

Also in accordance with this advice, I updated the HEPA filter in my vacuum cleaner. I hadn’t realised but a HEPA (high efficiency particulate air) filter, has over 99.97% filtration, and coupled with a sealed bag meant that Edward would not come into contact with the dust any longer.

I also started removing surface dust regularly with a damp cloth. As time went by I got rid of all the cushions and changed the sofas to leather. Vacuuming the curtains helped too. I kept Edward away from the dusty loft and the bunk bed, both of which seemed to aggravate him. All these changes made a drastic difference to his symptoms. As time went and he grew bigger his reactions to non allergic substances like chemicals, perfumes and outdoor air pollution also improved by themselves.

What about when Edward was outside of your home?

To avoid asthma attacks and allergic rhinitis (nasal irritation), I started to bring anti-dust mite bedding and my HEPA vacuum on holiday with us if we’re going to be away for more than a few days in the UK, and that really helped. Alternatively, some hotels did have the right type of vacuum cleaner that would not resuspend particles into the air.

A bigger problem was at school. When Edward started secondary school, the cough returned very forcefully. I immediately went to the school and asked if they could change the vacuum used on his block to one with a HEPA filter and sealed bag. The school complied and his symptoms improved quickly and dramatically– and that was just by changing one vacuum cleaner. 

People also don’t necessarily realise the small number of specific things that cause inhaled allergies. For example, many schools have planted silver birch trees on their grounds despite many children having a very high sensitivity to that pollen in April time. In Denmark, there are silver birch-free areas for this very reason. Indoor mould, arising from flooding, can also be associated with severe asthma.

How important do you think it is for people to make improvements to their indoor air quality even if they don’t suffer from allergies?

I think it is very important to be aware of the problems associated with indoor and outdoor air quality because these issues are not always obvious but can still be badly affecting your health. If you’re waking up coughing and sneezing, it may well be that you are being affected by house dust mite allergen which is, in fact, the number one trigger for asthma worldwide. I didn’t know that I had a dust mite allergy until Edward was diagnosed but following the changes I made, I could feel the difference to my health too. Make sure you open the windows whilst vacuuming and to ventilate. Opening the windows quickly to purge the house can make a big difference and it won’t make the whole house cold. You can also invest in air quality monitors to keep track of air quality inside your home or use HEPA air purifiers.

What can be done to raise awareness of the links between asthma, airborne allergens and air quality?

There are lots of groups doing great work. However awareness and action needs to come from the top. As a minimum, national and global asthma and other respiratory disease guidelines need to replicate the recommendations of the Royal College of Paediatrics report into Indoor Air Quality and Child Health which undertook a systematic review of the evidence. Allergen avoidance for asthma and allergic rhinitis was recommended in this report.

Uncontrolled asthma is a major risk factor for anaphylaxis, but the links between asthma and inhaled allergies are still widely unknown. Airborne allergies are very misunderstood and unknown, especially when compared to food allergies even though they are a major factor for asthma and other respiratory illnesses. The Working Party who undertook this review have now produced some resources for schools and parents about improving indoor air quality, too.

A great example of effective action is the Alameda County Study in California, where more than one million children suffer from asthma. This project which began in 2001 focused on the home, the place where children spend a lot of their time. A team of cleaners who specialised in asthma trigger remediation would visit the homes of children suffering from asthma and give their home a deep clean, removing mould, providing anti-dust mite bedding and even carrying out minor repairs. They also offered low income families HEPA filter vacuums and medics helped families to understand asthma medication, too.

Families reported fewer and less aggressive symptoms, and a data review in 2012 showed that health care costs for children in the programme were cut in half in the 12 months after they took part. Alameda County officials believe they might be able to save up to $16 million a year in paediatric hospitalisation costs through such projects.

So I think awareness is the key. Once there is awareness about how poor air quality can be and what are the components of poor air quality, including inhaled allergens, you can start to

tackle it.

Download 2020: Our Air in Review, to read more interviews and discover findings from our latest research.