Effective Environmental Control Methods: What Works and What Doesn’t

In 1929 Storm Van Leuven published his results on treatment of asthma using a “climate chamber.” His design of a room included maintaining low dust levels and a supply of clean air. This experiment was based on the observation that many asthmatics improved when they spent time in the high altitude clinics in Switzerland (1). It was also well known .50 years ago that patients with asthma improved when they were admitted to hospital. Indeed Rackemann included failure to improve in hospital as one of the characteristics of intrinsic asthma (2). Skin testing with house dust extracts was routine in allergy clinics as early as 1935. However, advice on avoidance of house dust was hampered because the nature of the house dust “atopen” was not known. In 1962, Spieksma saw live mites in house dust and she and her colleagues rapidly developed clear evidence that mites were a major source of allergens in dust (3). Research relevant to allergen avoidance as a treatment for asthma can now be separated into four areas of interest: i) Biology of dust mites, cockroaches and other living organisms that contribute to the allergen content of houses. ii) Immunochemistry of indoor allergens and the development of assays for allergens in dust. iii) Analysis of the reasons why patients with asthma improve when they are moved to sanatoria or hospital rooms. iv) Detailed studies on techniques for controlling allergens in inhabited houses.