Source: Manual of Ambulatory Pediatrics 2010
SOAP Note – Environmental Control for the Atopic Child
ENVIRONMENTAL CONTROL FOR THE ATOPIC CHILD
With mild or questionable atopy, aggressive environmental control may be disruptive to the family and home environment. The health care professional should select portions of environmental control applicable to the individual child since in many children, environmental control results in significant symptomatic improvement. When discussing environmental control, it is important to keep in mind that the removal of a family pet can cause a significant emotional upheaval for both the child and family.
However, since allergies develop with continued exposure to allergens, it is advisable to use as many preventive measures as possible. Innovative approaches may need to be devised to avoid disruptions in family life.
I. Indications for environmental control
A. Positive skin tests for environmental allergens
B. Pollen sensitivity
C. Clinical history of significant symptoms of allergy, including food sensitivity
II. Commonly encountered allergens in the home
A. Dust mites are the predominant indoor allergen. They thrive in mattresses, pillows, linens, carpets, stuffed animals, and upholstered furniture.
B. Animals: Cat, dog, guinea pig, hamster, gerbil
C. Plants, flowers
D. Jute, horse hair: Carpet padding
E. Kapok: Pillows, upholstery, stuffed animals
F. Feathers, down: Pillows, upholstery
G. Wool: Blankets, clothing
H. House dust: In addition to containing the allergen, dust contains bacteria, mites, kapok, dander, horse hair.
I. Cosmetics: Talcum powder, perfumes
J. Molds: Found in bathroom, shower stall, tile grout, basement, garage, attic, books, wallpaper, foam rubber pillows
K. Smoke: Cigarettes, wood stoves
III. General measures for the home
A. Damp dust daily.
B. Use vacuum cleaner with an effective filtration system (HEPA). Do not vacuum when child is in room.
C. Steam cleaning of carpeting should be done routinely. Dust mites have sticky feet and vacuuming does not remove them from carpeting.
D. Use air conditioner rather than fan. Air conditioning allows house to be closed to decrease exposure to outdoor allergens. It also lowers humidity.
E. Hot air ducts and returns should be covered with filters or cheesecloth. Vacuum ducts weekly.
F. Replace air conditioner and furnace filters regularly.
G. Shades and cotton curtains are preferable to venetian blinds and draperies.
H. Avoid wool rugs and blankets.
I. Paint walls or use washable wallpaper.
J. Kitchen, bathroom, and laundry should be adequately ventilated. Clean tile, grout, under sink, and behind toilet frequently.
K. Keep windows closed during pollen season.
L. Keep humidity below 50%. Dust mites thrive at 50% or above.
M. Use hot water (130F) laundering to kill mites. They cannot be washed away.
N. Pet
1. The recommendation to remove a family pet may be very difficult to implement, but it is a sound prophylactic measure even in the absence of a positive skin test because sensitivity frequently develops in an atopic child.
2. If giving up the family pet is a problem, try to keep the animal outside as much as possible and restricted to one area in the house.
3. Cat or dog should be shampooed 1–2 times a week.
4. If pet dies, advise parents not to replace it. (Snakes are acceptable for an atopic child.)
O. Do not give child chores such as dusting or mowing the lawn.
P. Plants may harbor mold. They should be removed.
Q. Discourage smoking and use of a wood stove or fireplace.
R. Keep child out of attic and cellar.
S. Consider a HEPA air cleaner if symptoms remain severe when other environmental control measures are taken. Dust and dust mites settle quickly so even HEPA filters are not completely effective for them. They are most effective for airborne particulate material.
T. Cleaning products
1. Chlorine bleach for bathrooms, cellars, other damp areas
2. Ammonia for general cleaning
3. Club soda as a spot remover
4. Vinegar to remove mold
5. Baking soda for carpets and refrigerator
IV. Environmental control for child’s room
A. Remove everything from room and closet except large pieces of furniture. Carpeting and/or scatter rugs should be removed also.
B. Vacuum mattress and box spring, and cover with plastic. Zipper of plastic case can be covered with adhesive tape. Wipe covers with damp cloth weekly.
C. Wash walls, woodwork, ceiling, floor, and windows.
D. Paint walls or cover with washable wallpaper. Do not use wall hangings; paint murals on walls instead.
E. Install washable, synthetic window shades.
F. Dust and wax furniture; damp dust drawers.
G. Seal off forced hot air ducts and returns. Use an electric heater if necessary.
H. Carefully screen all items returned to room. Do not replace carpet or rugs.
I. Use Dacron pillows. Wash weekly. Replace yearly.
J. Use cotton or Dacron blankets, bedspreads, sheets, and curtains. Do not use mattress pads or quilts.
K. Use wood or plastic chairs and tables. Avoid stuffed or wicker furniture.
L. Do not use venetian blinds or louvered doors.
M. Lamps should have plastic shades.
N. Return clothes to closet and drawers. Do not store woolens, flannels, or unnecessary items of clothing.
O. Books, stuffed animals, sports equipment, old shoes, and “collections” are dust and mold collectors and should not be in the room in which the child sleeps.
P. To maintain dust-free room:
1. Keep door closed to minimize dust entering room.
2. Damp dust and damp mop daily.
3. Clean room thoroughly, vacuum mattress and box spring, wash all bedding and curtains weekly.
V. School
A. Child should not sit near blackboard or handle erasers.
B. Caged pets such as hamsters or gerbils should not be in school room.
C. Concrete slab floors covered with carpeting may harbor molds.
D. Molds may grow on plants or dried arrangements.
E. Outdoor gym class may be a problem during pollen season.