Platts-Mills Thomas, Leung Donald Y M, Schatz Michael
Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, USA.
Am Fam Physician. 2007 Sep 1;76(5):675-80.
The National Asthma Education and Prevention Program Expert Panel guidelines for the management of asthma recommend that patients who require daily asthma medications have allergy testing for perennial indoor allergens and that, when triggers are found, exposure to allergens and pollutants be controlled through avoidance and abatement. For patients whose symptoms are not controlled adequately with these interventions and who are candidates for immunotherapy, the guidelines recommend referral to an allergist. However, the data supporting these recommendations are not consistent. Although there is evidence that simple allergen avoidance measures are ineffective, there is good evidence for the effectiveness of a comprehensive approach based on known sensitization. Thus, allergen avoidance may include removal of pets, use of high-efficiency particulate air filtration and vacuum cleaners, use of allergen-impermeable mattress and pillow covers, cockroach extermination, smoking cessation, and measures to control mold growth in the home. All allergen-specific treatment is dependent on defining sensitization. This can be achieved through serum assays of immunoglobulin E antibodies or skin tests with aeroallergens. Information on sensitization can be used to educate patients about the role of allergens in their symptoms, to provide avoidance advice, or to design immunotherapy.
国家哮喘教育与预防计划专家小组的哮喘管理指南建议，需要每日使用哮喘药物的患者应进行常年室内过敏原检测，并且一旦发现触发因素，应通过避免接触和减少暴露来控制对过敏原和污染物的接触。对于那些通过这些干预措施症状仍未得到充分控制且适合免疫治疗的患者，指南建议转诊给过敏症专科医生。然而，支持这些建议的数据并不一致。尽管有证据表明简单的过敏原回避措施无效，但也有充分证据表明基于已知致敏情况的综合方法是有效的。因此，过敏原回避措施可能包括送走宠物、使用高效空气微粒过滤器和真空吸尘器、使用防过敏原的床垫和枕套、消灭蟑螂、戒烟以及采取措施控制家中霉菌生长。所有针对特定过敏原的治疗都依赖于明确致敏情况。这可以通过检测血清免疫球蛋白E抗体或进行气传过敏原皮肤试验来实现。有关致敏情况的信息可用于教育患者了解过敏原在其症状中的作用、提供回避建议或设计免疫治疗方案。
