Advertisement

Non-pharmacologic Aspects of Management: “Asthma and Allergic and Immunologic Diseases During Pregnancy – A Guide to Management”

  • David Lawrence Brauer
  • Katharine Margaret WoessnerEmail author
Chapter

Abstract

Pregnancy represents a unique physiologic state that makes management of allergic disease challenging, particularly when considering use of pharmacologic therapies in the context of risk for possible teratogenicity and poor maternal-fetal outcomes. Non-pharmacologic approaches to management of atopic disorders in pregnancy need to be a key part of any allergic disease state management plan. Allergic rhinitis, asthma, and atopic dermatitis represent the three main allergic diseases that can be expected to be encountered during pregnancy. The avoidance of known irritants and allergens is a cornerstone of allergic rhinitis and allergic asthma therapeutic strategy, and non-pharmacologic interventions for atopic dermatitis are critical components of standard management. In some instances, adequate relief may be achieved solely with non-pharmacologic interventions, and in many cases, the need for pharmacologic therapy can be reduced by concurrent use of non-pharmacologic approaches. This chapter focuses on effective avoidance strategies and other non-pharmacologic approaches to the management of common allergic disease in the pregnant patient, allowing for better outcomes while at the same time limiting exposure to unnecessary medical therapy.

Keywords

Pregnancy Allergy Non-pharmacologic management Allergic rhinitis Asthma Atopic dermatitis 

References

  1. 1.
    Bolz M, Körber S, Reimer T, Buchmann J, Schober H, Briese V. The treatment of illnesses arising in pregnancy. Dtsch Arztebl Int. 2017;114:616–26.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Pali-Schöll I, Namazy J, Jensen-Jarolim E. Allergic diseases and asthma in pregnancy, a secondary publication. World Allergy Organ J. 2017;10:10.CrossRefGoogle Scholar
  3. 3.
    Namazy JA, Schatz M. The treatment of allergic respiratory disease during pregnancy. J Investig Allergol Clin Immunol. 2016;26(1):1–7. San Diego.CrossRefGoogle Scholar
  4. 4.
    Namazy JA, Schatz M. Pharmacotherapy options to treat asthma during pregnancy. Expert Opin Pharmacother. 2015;16(12):1783–91.CrossRefGoogle Scholar
  5. 5.
    Weidinger S, Novak N. Atopic dermatitis. Lancet. 2015;387:1109–22. Kiel, Germany.CrossRefGoogle Scholar
  6. 6.
    Babalola O, Strober BE. Treatment of atopic dermatitis in pregnancy. Dermatol Ther. 2013;26:293–301.CrossRefGoogle Scholar
  7. 7.
    Baldacci S, Maio S, Cerrai S, Sarno G, Baïz N, Simoni M, Annesi-Maesano I, Viegi G, on behalf of the HEALS Study. Allergy and asthma: effect of the exposure to particulate matter and biological allergens. Respir Med. 2015;109:1089–104.CrossRefGoogle Scholar
  8. 8.
    Shirai T, Matsui T, Suzuki K, Chida K. Effect of pet removal on pet allergic asthma. Chest. 2005;127:1565–71.CrossRefGoogle Scholar
  9. 9.
    Hodson T, Custovic A, Simpson A, et al. Washing the dog reduces dog allergen levels, but the dog needs to be washed twice a week. J Allergy Clin Immunol. 1999;103:581–5.CrossRefGoogle Scholar
  10. 10.
    Portnoy J, Kennedy K, Sublett J. Environmental assessment and exposure control: a practice parameter-furry animals. Ann Allergy Asthma Immunol. 2012;108:223.e1–223.e15.CrossRefGoogle Scholar
  11. 11.
    Ahluwalia S, Matsui E. Indoor environmental interventions for furry pet allergens, pest allergens, and mold: looking to the future. J Allergy Clin Immunol Pract. 2018;6(1):9–19.CrossRefGoogle Scholar
  12. 12.
    Phipatanakul W, Matsui E, Portnoy J, Williams PB, Barnes C, Kennedy K, et al. Environmental assessment and exposure reduction of rodents: a practice parameter. Ann Allergy Asthma Immunol. 2012;109:375–87.CrossRefGoogle Scholar
  13. 13.
    Pongracic JA, Visness CM, Gruchalla RS, Evans R III, Mitchell HE. Effect of mouse allergen and rodent environment intervention on asthma in inner-city children. Ann Allergy Asthma Immunol. 2008;101:35–40.CrossRefGoogle Scholar
  14. 14.
    DiMango E, Serebrisky D, Naurla S, Shim C, Keating C, Sheares B, et al. Individualized household allergen intervention lowers allergen level but not asthma medication use: a randomized controlled trial. J Allergy Clin Immunol Pract. 2016;4:671–9.CrossRefGoogle Scholar
  15. 15.
    Matsui EC, Perzanowski M, Peng RD, Wise RA, Balcer-Whaley S, Newman M, et al. Effect of an integrated pest management intervention on asthma symptoms among mouse-sensitized children and adolescents with asthma: a randomized control trial. JAMA. 2017;317:1027–36.CrossRefGoogle Scholar
  16. 16.
    Phipatanakul W, Cronin B, Wood RA, Eggleston PA, Shih MC, Song L, et al. Effect of environmental intervention on mouse allergen levels in homes of inner-city Boston children with asthma. Ann Allergy Asthma Immunol. 2004;92:420–5.CrossRefGoogle Scholar
  17. 17.
    Eggleston PA, Butz A, Rand C, Curtin-Brosnan J, Kanchanaraksa S, Swartz L, et al. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial. Ann Allergy Asthma Immunol. 2005;95:518–24.CrossRefGoogle Scholar
  18. 18.
    Eggelston PA, Wood RA, Rand C, Nixon WJ, Chen PH, Lukk P. Removal of cockroach allergen from inner-city homes. J Allergy Clin Immunol. 1999;104:842–6.CrossRefGoogle Scholar
  19. 19.
    Morgan WJ, Crain EF, Gruchalla RS, O’Connor GT, Kattan M, Evans R III, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. 2004;132:1068–80.CrossRefGoogle Scholar
  20. 20.
    Portnoy J, Chew GI, Phipatankul W, Williams PB, Grimes C, Kennedy K, et al. Environmental assessment and exposure reduction of cockroaches: a practice parameter. J Allergy Clin Immunol. 2013;132:802–8.CrossRefGoogle Scholar
  21. 21.
    Arbes SJ Jr, Sever M, Mehta J, Gore JC, Schal C, Vaughn B, et al. Abatement of cockroach allergens (Bla g 1 and Bla g 2) in low-income, urban housing: month 12 continuation results. J Allergy Clin Immunol. 2004;113:109–14.CrossRefGoogle Scholar
  22. 22.
    Rabito FA, Carlson JC, He H, Wethmann D, Schal C. A single intervention for cockroach control reduces cockroach exposure and asthma morbidity in children. J Allergy Clin Immunol. 2017;140:565–70.CrossRefGoogle Scholar
  23. 23.
    Konradsen JR, Fujisawa T, Van Hage M, Hedlin G, Hilger C, Kleine-Tebbe J, Matsui EC, Roberts G, Ronmark E, Platts-Mills TAE. Allergy to furry animals: new insights, diagnostic approaches, and challenges. J Allergy Clin Immunol. 2014;135(3):616–25.CrossRefGoogle Scholar
  24. 24.
    Sánchez J, Díez S, Cardona R. Pet avoidance in allergy cases: is it possible to implement it? Biomédica. 2015;35:357–62.PubMedGoogle Scholar
  25. 25.
    Mendell MJ, Mirer AG, Cheung K, Tong M, Douwes J. Respiratory and allergic health effects of dampness, mold and dampness-related agents: a review of the eoidemiologic evidence. Environ Health Perspect. 2011;119:748–56.CrossRefGoogle Scholar
  26. 26.
    Medicine, Institute of. Damp indoor spaces and health. Washington, DC: National Academy of Sciences, Board on Health Promotion and Disease Prevention, National Academies Press; 2004.Google Scholar
  27. 27.
    Fisk WJ, Lei-Gomez Q, Mendell MJ. Meta-analysis of the association of respiratory health effects with dampness and mold in homes. Indoor Air. 2007;17:284–96.CrossRefGoogle Scholar
  28. 28.
    Chao HJ, Milton DK, Schwartz J, Burge HA. Dustborne fungi in large office buildings. Mycopathologia. 2002;154:93–106.CrossRefGoogle Scholar
  29. 29.
    Kercsmar CM, Dearborn DG, Schluchter M, Xue L, Kirchner HL, Sobolewski K, et al. Reduction in asthma morbidity in children as a result of home remediation aimed at moister sources. Environ Health Perspect. 2006;114:1574–800.CrossRefGoogle Scholar
  30. 30.
    Burr ML, Matthews IP, Arthur RA, Watson HL, Gregory CJ, Dunstan FD, et al. Effects on patients with asthma of eradicating visible indoor mould: a randomized controlled trial. Thorax. 2007;62:767–72.CrossRefGoogle Scholar
  31. 31.
    Mitchell H, Cohn RD, Wildfire J, Thornton E, Kennedy S, El-Dahr JM, et al. Implementation of evidence-based asthma interventions in post-Katrina New Orleans: the Head-Off Environmental Asthma in Louisiana study. Environ Health Perspect. 2012;120:1607–12.CrossRefGoogle Scholar
  32. 32.
    Pongracic JA, O’Connor GT, Muilenberg ML, Vaughn B, Gold DR, Kattan M, et al. Differential effects of outdoor versus indoor fungal spores on asthma morbidity in inner-city children. J Allergy Clin Immunol. 2010;126:593–9.CrossRefGoogle Scholar
  33. 33.
    Gent JF, Kezik JM, Hill ME, Tsai E, Li DW, Leaderer BP. Household mold and dust allergens: exposure, sensitization and childhood asthma morbidity. Environ Res. 2012;118:86–93.CrossRefGoogle Scholar
  34. 34.
    Wilson JM, Platts-Mills T. Home environmental interventions for House Dust Mite. J Allergy Clin Immunol: Pract. 2018;6(1):1–7.CrossRefGoogle Scholar
  35. 35.
    Choi SY, Lee IY, Sohn JH, Lee YM, Shin YS, Yong TS, et al. Optimal conditions for the removal of house dust mite, dog dander, and pollen allergens using mechanical laundry. Ann Allergy Asthma Immunol. 2008;100:583–8.CrossRefGoogle Scholar
  36. 36.
    Miller JD. Difference in mite survival in blankets washed in top-loading vs. front-loading washing machines. J Allergy Clin Immunol. 2017;139:Ab119.CrossRefGoogle Scholar
  37. 37.
    Mason K, Riley G, Siebers R, Crane J, Fitzharris P. Hot tumble drying and mite survival in duvets. J Allergy Clin Immunol. 1999;104:499–500.CrossRefGoogle Scholar
  38. 38.
    Arlian LG, Neal JS, Morgan MS, Vyszenski-Moher DL, Rapp CM, Alexander AK. Reducing relative humidity is a practical way to control dust mites and their allergens in homes in temperate climates. J Allergy Clin Immunol. 2001;107:99–104.CrossRefGoogle Scholar
  39. 39.
    Arlian LG, Neal JS, Vyszenski-Moher DL. Reducing relative humidity to control the house dust mite Dermatophagoides farinae. J Allergy Clin Immunol. 1999;104:852–6.CrossRefGoogle Scholar
  40. 40.
    Singh M, Jaiswal N. Dehumidifiers for chronic asthma. Cochrane Database Syst Rev. 2013;6:CD003563.Google Scholar
  41. 41.
    Gore RB, Durrell B, Bishop S, Curbishley I, Woodcock A, Custovic A. High-efficiency vacuum cleaners increase personal mite allergic exposure, but only slightly. Allergy. 2006;61:119–23.CrossRefGoogle Scholar
  42. 42.
    Agency, California Environmental Protection. Air Resources Board. Fact sheet: beware of ozone-generating indoor “Air Purifiers”. [Online] March 2006. [Cited: March 8, 2018].Google Scholar
  43. 43.
    Wood RA, Johnson EF, Van Natta ML, Chen PH, Eggleston PA. A placebo-controlled trial of a HEPA air cleaner in the treatment of cat allergy. Am J Respir Crit Care Med. 1998;158:115–20.CrossRefGoogle Scholar
  44. 44.
    Sulser C, Schulz G, Wagner P, Sommergeld C, Keil T, Reich A, et al. An use of HEPA cleaners in homes of asthmatic children and adolescents sensitized to cat and dog allergens decrease bronchial hyperresponsiveness and allergen contents in solid dust? Int Arch Allergy Immunol. 2009;14B:23–30.CrossRefGoogle Scholar
  45. 45.
    Francis H, Fletcher G, Anthony C, Pickering C, Oldham L, Hadley E, et al. Clinical effects of air filters in homes of asthmatic adults sensitized and exposed to pet allergens. Clin Exp Allergy. 2003;33:101–5.CrossRefGoogle Scholar
  46. 46.
    Reisman RE, Mauriello PM, Davis GB, et al. A double-blind study of the effectiveness of a high-efficiency particulate air (HEPA) filter in the treatment of patients with perennial allergic rhinitis and asthma. J Allergy Clin Immunol. 1990;85:1050–7.CrossRefGoogle Scholar
  47. 47.
    Stillerman A, Nachtsheim C, Li W, et al. Efficacy of a novel air filtration pillow for avoidance of perennial allergens in symptomatic adults. Ann Allergy Asthma Immunol. 2010;104:440–9.CrossRefGoogle Scholar
  48. 48.
    Metzger WJ, Turner E, Patterson R. The safety of immunotherapy during pregnancy. J Allergy Clin Immunol. 1978;61:268–72.CrossRefGoogle Scholar
  49. 49.
    Shaikh WA. A retrospective study on the safety of immunotherapy in pregnancy. Clin Exp Allergy. 1993;23:857–60.CrossRefGoogle Scholar
  50. 50.
    Oykham R, Kim HL, Ellis AK. Allergen immunotherapy in pregnancy. Allergy Asthma Clin Immunol. 2015;11:31. 1–5.CrossRefGoogle Scholar
  51. 51.
    Shaikh WA, Shaikh SW. A prospective study on the safety of sublingual immunotherapy in pregnancy. Allergy. 2012;67:741–3.CrossRefGoogle Scholar
  52. 52.
    Grarup PA, Janner JH, Ulrik CS. Passive smoking is associated with poor asthma control during pregnancy: a prospective study of 500 pregnancies. PLoS One. 2014;9(11):e112435.CrossRefGoogle Scholar
  53. 53.
    Thacher JD, Gruzieva O, Pershagen G, Neuman A, Wickman M, Kull I, et al. Pre- and postnatal exposure to parental smoking and allergic disease through adelescence. Pediatrics. 2014;134(3):28–34.CrossRefGoogle Scholar
  54. 54.
    Zairina E, Stewart K, Abramson MJ, George J. The effectiveness of non-pharmacological healthcare interventions for asthma management during pregnancy: as systematic review. BMC Pulm Med. 2014;14:1–8. 46.CrossRefGoogle Scholar
  55. 55.
    Macêdo TMF, Freitas DA, Chaves GSS, Holloway EA, Mendonça KMPP. Breathing exercises for children with asthma. Cochrane Database Syst Rev. 2016;(4). Art. No.: CD011017.Google Scholar
  56. 56.
    Ly NP, Litonjua A, Gold DR, Celedón JC. Gut microbiota, probiotics, and vitamin D: interrelated exposures influencing allergy, asthma, and obesity? J Allergy Clin Immunol. 2011;127(5):1087–94.CrossRefGoogle Scholar
  57. 57.
    Mennini M, Dahdah L, Artesani MC, Fiocchi A, Martelli A. Probiotics in asthma and allergy prevention. Front Pediatr. 2017;5:165.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • David Lawrence Brauer
    • 1
  • Katharine Margaret Woessner
    • 2
    Email author
  1. 1.Allergy/ImmunologyScripps Clinic/Green HospitalLa JollaUSA
  2. 2.Division of Allergy, Asthma and ImmunologyScripps ClinicSan DiegoUSA

Personalised recommendations