Callahan KA, Eggleston PA, Rand CS, Kanchanaraksa S, Swart LJ, Wood RA. Ann Allergy Asthma Immunol. 2003;90:302–307
Purpose of the Study.
To compare the knowledge and practice of environmental control measures in families of children with asthma who were treated by either an allergist or a pediatrician.
The subjects were 114 asthmatic children (age range: 6–17 years; mean age: 11.2 years) with positive skin test results for house dust mites. The children were recruited from 4 pediatric practices in the Baltimore metropolitan area.
A cross-sectional study using secondary analyses of data from a clinical trial of parents and their children with asthma was performed. In the initial visit, skin testing was performed and the parent answered baseline questions related to the child’s health history. A baseline home environment evaluation consisted of 35 questions addressing the family’s cleaning habits, knowledge of environmental control measures, and self-reported changes in the home to reduce the child’s exposure to indoor allergens. A home inspection evaluated the home characteristics, as well as evidence of dust mite environmental controls (eg, mattress encasement, pillow encasement, removal of wall-to-wall carpeting, and removal of stuffed animals). Dust samples were collected and analyzed for indoor allergens with standard methods. The children were divided into 2 groups, according to whether they had been treated by an allergist. The study then determined whether the 2 groups had ever been advised to make changes in their homes to reduce dust mite exposure (knowledge) and whether they had made any changes in their homes to reduce dust mite exposure (practice).
The study families were predominately white (50%) or African American (35%). All of the children demonstrated positive skin test results for dust mite allergen, 61% (n = 69) had been examined and skin-tested by an allergist before enrolling in the study, and 4% were currently receiving immunotherapy. Fifty-six of the 69 families (81%) that had visited an allergist reported receiving advice regarding general indoor environmental control, compared with 22 families (49%) that had not visited an allergist (P < .0001). With respect to specific dust mite recommendations, families that had been evaluated by an allergist had significantly more dust mite knowledge (70% vs 18%, P < .0001). Families that had visited an allergist demonstrated a significantly greater frequency of knowledge regarding the need for mattress encasement (61% vs 13%, P < .001) and pillow encasement (51% vs 11%, P < .0001), compared with the non-allergist-treated group. Families that had visited an allergist demonstrated somewhat greater implementation of dust mite control recommendations, compared with families that had visited a pediatrician (68% vs 56%, P = .063%). The use of mattress and pillow encasements was significantly greater (38% vs 11%, P = .001, and 36% vs 16%, P = 009, respectively) in the allergist-treated group than in the pediatrician-treated group. To evaluate adherence, comparisons of each family’s knowledge of specific recommendations with the changes made in the household were made. Of the families that had visited an allergist, 70% had knowledge of dust mite control measures and 60% of those families made at least 1 of the 4 observable changes in their households to reduce dust mite allergen exposure. Of the families that had visited a pediatrician, 18% had knowledge of dust mite control recommendations and 63% of those families made changes in their households.
Parents of dust mite-sensitive, asthmatic children who visited an allergist were more aware of dust mite allergen control recommendations and made more indoor environmental changes. Allergists are able to perform specific tests to determine allergies and can offer directed education regarding environmental control measures.
This study emphasizes the importance of identifying allergy triggers. Without knowledge of specific allergy triggers, guidelines for environmental controls can only be vague. When given specific advice, patients appeared to be equally motivated, regardless of which physician provided the environmental control advice. However, a limitation of the study, as the authors noted, was that the subjects in the study were predominantly middle-class children; patients in lower socioeconomic groups might have different outcomes. In addition, depending on the type of insurance (if any), patients might not have easy accessibility to an allergist.