on investigations of the probable costs and benefits of the various strategies for prevention and control. The cost analyses should include both direct and indirect costs (i.e., medical costs as well as lost work), and benefits should include a full assessment of the effects on improving the quality of life, as well as on reducing morbidity and mortality.

All of the committee's recommendations and research agenda items are presented below with brief introductions. The recommendations are presented first, followed by the research agenda.


Dust Mite, Cockroach, and Other Arthropoda

With most Americans spending the great majority of their time indoors—and much of that in their own homes—it is not surprising that the bulk of inhaled foreign protein is associated with indoor air. The evidence shows that a large proportion of asthmatics are allergic to indoor allergens and that several changes in the way we live indoors may have affected the levels of these allergens. These changes include increased mean temperatures, reduced ventilation (with consequent increased humidity), fitted carpets, and cool-wash detergents which have led to water temperatures for washing bedding that do not kill dust mites.

Once identified, reducing exposure to allergenic ''trigger factors" has been a standard part of the treatment of allergic disease for many years. Since approximately half of existing cases of asthma have been attributed to allergenic factors, it is reasonable to expect that asthmatics who require more than occasional treatment might also have allergies that induce their asthma.

Recommendation: Conduct appropriate allergy evaluations of asthmatics who require more than occasional treatment. Where allergic factors are present, ensure that these patients are given specific, practical information about how to reduce their exposure to arthropod and other allergens.

Skin Tests

Despite some relatively minor shortcomings, the value of skin testing has been well established over the past century. When correlated with an appropriate clinical history, skin prick tests often are a useful way of screening for the presence of allergic disease. Using appropriate positive and negative

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