Environmental control and immunotherapy for allergic disease.

Treatment for allergic disease can help prevent recurrent sinusitis. Removal of carpeting and feather bedding and use of acaricides can significantly improve symptoms caused by house dust mites or animal dander. To kill mites, wash-water temperature must be at least 58 degrees C. Patients with severe allergy should use an air-filtering vacuum cleaner and an air cleaner with a HEPA filter. Humidity should be kept at under 50%. If other measures fail, pets may have to be removed. Subcutaneous immunotherapy is effective for patients with anaphylactic reactions to insect stings, allergic rhinitis, and allergic asthma. It is ineffective for food allergy or nonallergic rhinitis or asthma. In children, immunotherapy is reserved for generalized life-threatening airway reactions. Relative indications for immunotherapy include inability to avoid the allergen and poor results or significant side effects from pharmacologic treatment. Efficacy depends on dosage, duration of treatment, and allergen selection. Low initial doses are increased at a set rate until the dose induces appropriate antibody response without significant reactions. Patients should be much improved or symptom-free for 1 to 2 years before immunotherapy is discontinued. Pollen, house dust mite, cat, and some mold spore extracts reduce symptoms and sensitivity to nasal or bronchial provocation. When used appropriately, immunotherapy is safe and effective.