factors are present, ensure that these patients are given specific, practical information about how to reduce their exposure to arthropod and other allergens.

Although most studies investigate asthma (because it is common and can be measured objectively), sensitivity to indoor allergens is also very common among patients with other allergic conditions such as chronic rhinitis and atopic dermatitis. Because the important cause of inflammation that is common for all of these diseases is exposure to allergens, avoidance of the exposure should be the primary anti-inflammatory treatment. Developing realistic avoidance protocols for routine use is a challenge that must not take second place to pharmaceutical treatment.

Research Agenda Item: Conduct detailed studies of physical factors, such as sources and emission rates, that influence the levels of exposure to arthropod and other indoor allergens. These studies should include the effects of (a) protocols for reducing exposure and (b) devices advertised as reducing indoor allergen concentrations. More specifically, test the effectiveness of allergen avoidance protocols on the management of allergic asthma and other allergic diseases using protocols that have been demonstrated to reduce exposure by 90 percent or more. Such protocols should be tested under field conditions and should encompass the socioeconomic, cultural, ethnic, and geographic diversity of these problems in the United States.

The more important question now is the effectiveness of avoidance measures for reducing the development of disease (i.e., sensitization). Specific measures include the use of polished wooden floors and no upholstered furniture in bedrooms and possibly in schoolrooms, keeping pillows and mattresses covered, and using bedding that can be washed regularly in hot water. Other measures, which require further evaluation, include air filtration, chemical treatment of carpets, and dehumidification.

Research Agenda Item: Develop allergen-free products to help reduce the incidence of allergic disease in the general public. The initial objective of this initiative, which should be carried out by the industrial/business sector, would be to provide an aesthetically appealing bedroom with reduced allergen exposure for children under the age of five.

There is considerable evidence that allergen avoidance is an effective means of reducing allergy symptoms. Practical measures to control exposure to mite and other allergens in the house can reduce both the symptoms



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