This webinar was recorded on May 25, 2023

Asthma can be managed by using medication, but also by living in an environment that is free from allergy & asthma triggers. This webinar will help you learn how to make your house or apartment allergy & asthma friendly.


  • Dr. Sharmilee Nyenhuis
  • Dameka Edwards-Hart


• Download the presentation

Transcript: While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.

Hello everyone. Thanks for joining us. We are just waiting for a few more people to join us. We know that computers can be slow so we will give it another 10 and 15 seconds and I thank you in advance for holding. Hello everyone. Thank you for joining us today. We are just waiting a few more minutes for some people to join us. It can take a few seconds for your computer to connect, so thank you in advance for holding. Good afternoon everyone. Thank you for joining us today. We have a few housekeeping items before we start today’s program. I am in education specialist and a certified asthma educator. All participants will be on mute for today’s webinar and we will record the webinar and posted on her website in a few days and you can find our recorded webinars on our website at allergy asthma, scroll to the bottom of the page to find webinars and any upcoming webinars. The webinar will be about one hour and will leave time for questions. We will take those questions at the end of the webinar but you can put your questions and the Q&A TAB at any time. The Q&A boxes at the bottom of your screen a little bit on the left side there appeared we have someone monitoring the chat if you have any questions or need any help. We will get to his many questions as we can fully conclude today’s webinar. We do not offer CEU’s for this webinar however you will get a certificate of attendance a few days after the webinar you will receive an email from Zoom, and it will have resources from the webinar and a link to the certificate of attendance. We will now begin today’s webinar. Asthma can be managed by using medication but it is also very important important that the living environment is allergy and asthma friendly. This webinar will help you learn how to make your house or apartment allergy and asthma friendly. Allergy and asthma networks is a grassroots organization that was started over 35 years ago by a mom who knew that other mothers like her needed resources and support. Our mission is to end the needless death and suffering due to allergies, asthma, and related conditions throughout reach, education, advocacy, and research. Today it is my pleasure to introduce our speakers, Dr. Sharmilee Nyenhuis — sorry, pardon my speech. I have long COVID and I am a little slow today. Dr. Sharmilee Nyenhuis is an associate professor in the Department of pediatrics and medicine. She is associate chair of diversity, equity, inclusion in the Department of pediatrics at the University of Chicago. She is also an allergist immunologist and implementation scientist committed to addressing disparities in unique and minority populations with asthma and allergic diseases. Her research portfolio aims to examine the association of a real-time indoor and outdoor air quality and asthma outcomes. Tests and implement interventions that address diet weight loss and physical activity and — populations. And examine the impact of climate change in medically underserved populations. Her overall goals are to expand the knowledge of lifestyle behavior change in asthma, to improve the lives of minority ized population. Dameka Edwards-Hart is a proud Chicago Southsider born and raised in Inglewood and serves as a supervisor of community health workers in special programs for the liaison and care program under the University of Chicago medicines urban health initiative you HI. She joined the team in 2017 2017 is a community health worker with a proven record helping pediatric patients and their families overcome health disparities relating to asthma. She is a true veteran and the public health field and begin her career as a community health worker eight years ago at the University in Chicago. During that time she received extensive asthma and community health worker training at the Sinai urban health Institute and through this training she has gained the necessary knowledge needed to make her a well-rounded health educator and the role of a coming to help worker is more than just a job for her, she has made it one of her life’s missions to not only help the patient population at ECM but to overcome inequalities and social determinants of health, but she is also set a goal to prove how important this role is by recruiting, assisting, and training those entering this field behind her. I am so excited to hear this important information from both of you today because we know that a healthy environment is important to asthma control, so you make now begin your slides.

Dr. Nyenhuis: Great, thank you for inviting us to speak today, as Andrea said, this is such an important topic. So, you may realize and know that um allergies and asthma impact a large number of our population, so it can strike one out of five Americans and over 60 million people are impacted by allergies and asthma. The slide shows this is much higher than some of the other diseases that get a lot of attention such as diabetes as well as coronary heart disease and cancer, so pretty much all of these added together would give you you um know that 60 million people that are impacted by asthma and allergies. Well, why is this important? Is because over half of asthma is allergic asthma and in particular in school-aged children, more than 80% of asthma um that we see um the children are sensitized to at least one common um environmental allergen. Um also many people ask me you know can you develop allergies at any age and that is true so it is not something that you always get when you are younger and sticks with you from life. You can develop them at any age. We also know that allergies is a risk factor for developing asthma, so if you had allergies as a child you are at higher risk of developing asthma bent those people that do not have allergies. Also um allergies are associated with an increase in asthma symptoms, as well as its severity and um we edit is well-known that allergies can be a trigger for asthma flares. With this, the national guidelines recognize the importance of managing allergies in um in people with asthma. So, what is in allergen itself? So in allergen is any substance that can cause the immune system to overreact and often also known as an allergic trigger, that this could be a whole host of different allergens, and in allergen for one person does not mean that that is going to be in allergen for another person but some examples include pollens like grass pollen, tree pollen, weed pollen um but also can include medications as well as um foods um shown here and other things like um poison ivy and others, of these are just some examples. So, how do these allergens because disease or specifically allergies you know and asthma um or contribute to asthma? Is these allergens are often can be inhaled and um that ends up going into the air way can lead to inflammation. So here is just a little bit more about a diagram showing that you know that allergens are often become um aerosolized or so small that we can inhale them and when we inhale or brief — brieath them this inhalant allergy, like mold and other ones we would discuss. Once these um individuals or once people take these allergens into their airwaves um then this can lead to inflammation of the airway and obstruction of the airway or blockage of the airway and this occurs really only want the airways are sensitized to those allergens and that can be through an allergic response but also due to an irritant response. If somebody um does not have any um if they’re not if they are not sensitive to these allergens, either not allergic or again not impacted you know does not cause an irritant reaction, then you will not see any inflammation or obstruction of the airwaves. So I’m at some of the different types of inhalant allergens, and today we will mainly focus on the indoor inhalant allergens, these can include um animals and so we will start their first and these are the furry animals we love to have in our home and part of our families. Some times and these can be cats dogs and bacon also be rabbits guinea pigs, hamsters um and the allergens from cats and dogs typically come from their for our skin which is often known as their dander and also can be to a lesser extent the saliva of these animals. So these particles that carry cats and dog allergens can be small and then these can become airborne or go into the air with you know little disturbance in camp remain airborne for many hours so the main allergens from cats and dogs first of all for cap it is called — or dog –. These are produced by the animals um and there is it is very difficult to say that they are not produced unless they are genetically modified so some people say, o h, you know, they are in allergen free dog or allergen free cap. Less typically that has been genetically modified and they will all produce some amounts of these different proteins that I mentioned which can be these major allergens. Some animals can produce more and some can produce less. That is why some people can tolerate certain types of animals whereas other people cannot tolerate them. So what is an important feature of the particles that carry that dog and cat allergens is that they can be easily transferred on clothing um from homes with pets to homes and other buildings without pets, so we have seen that both cap and dog allergen is ubiquitous in public buildings or even schools because of this passive transfer that happens. So um you know and and one of the national algae studies, cat and dog allergens were detected in virtually all homes and levels that were considered to be high in that was found in almost half of the homestay found. Allergen concentrations are typically much higher for pets. Homes with pets have much higher levels than homes without but we do see pet allergen levels in those that don’t have pets because these proteins the allergens are proteins from the cat and dog trouble large and small and can easily be transferred. So, some of the other um indoor inhalant allergens, we think of these as may be the less desirable in the home, and these could be um pests such as mice and cockroaches. Now, mouse allergens primarily come from mouse urine and dander and cockroach mostly comes from fecal pellets or dried carcasses. Although Nelson cockroach allergens are found everywhere, rural, suburban, urban areas, we definitely see levels tend to be higher in urban environments. In this slide just demonstrates that where they looked at different concentrations of cockroach allergens in different housing, different dwellings, and here we have detached dwellings, kind of like a single-family home and they found that um compared to detached single-family homes, a high price apartment at 70 times more likely to have high levels of cockroach allergen um and this was also found in duplexes, triplex is, and bow rise apartments, so compared to a single-family home, those types of drawings more likely have much higher that having cockroach allergen. One thing that I tell my patients is that you may be keeping a very um clean home yourself but you don’t know what the other neighbors are doing um which could potentially be attracting those these pests into um the building itself. Additionally um it was found that the number of units in the building was um correlated with higher levels of the more units that were in a building um the more likely there was to be um higher cockroach allergen levels. Further um, when the house was built um has an impact, so definitely if the home was built before 1940 um that appears also to be um a high risk factor for um hi cockroach allergens. And then further too, as I mentioned earlier, urban populations, so if the population you know where someone is living is greater than one million, there is three times more likely to have high um cockroach allergen, so I always find this very interesting that um that it does that it is very dependent on um the on multiple different factors regarding um the home. So, another type of indoor inhalant allergen is mold, and mold can grow in outdoor and indoor environments. So um so it is important to note that it is not just an indoor thing or outdoor thing. Molds can be found in all regions and climates of the United States, and levels of outdoor mode can vary by season and geographic regions. Living here in Chicago I often tell people you know that molds can be present from you know the first thaw usually until the first frost for the outdoor ones, but again, if there is mold in the home, that can impact people all year-round. So, I also wanted to point out that in addition to these allergens, there are definitely irritants that can be found in the home. In these include first-hand secondhand and thirdhand smoke and also other smoke from fires, campfires, barbecue pits, also pollution and ozone can also be an irritant or trigger for asthma, and then those things that we use in our house a lot and may be don’t necessarily think of as triggers but can be, things with strong smells or sprays, so candles, incense, air fresheners, and then also thinking about cleaning supplies such as detergent or um other disinfectants. Those can also be a trigger. In these typically are not considered allergens and these can’t be tested to. We cannot do allergy testing to these things but this is something that commonly we see in the home and can um um be a trigger for asthma symptoms and exacerbations. So, how do we evaluate um the inhalant allergens? So they they are in the national guidelines. There is information on who should be evaluated. And essentially, they indicate that all patients that have asthma should be asked first of all about exposures to the inhalant allergens, especially indoor allergens. These can be mice, cockroaches, mold, dust and pets and again um they indicate that everyone should be asked about it. And this is really high-quality evidence. So, who really should be evaluated? Um and the recommendations they say that it should apply to anyone who has persistent asthma, meaning they are taking a daily medication for asthma or having symptoms two or more times per week or nighttime symptoms two or more times per month, but it is also worth recognizing that in the guidelines they say that for at least those patients that have persistent asthma, so this really indicates that these recommendations could also apply for individuals with what we call intermittent asthma as well. Typically we will um use the patient history to help guide us to help determine what you know potential allergen exposures may be worsening their asthma, but it is really essential to use testing, so there are two different kinds of testing. There is allergy skin testing which typically you have to go to an allergist or ENT doctor to have done or there is also allergy blood testing that can be done by a primary care doctor, pulmonologist, and allergist as well that can be used to help reliably determine what somebody is allergic to and um help guide management. It is really again important. There have been studies showing that using the medical history alone does not is not good enough and again, it really requires a testing, so it is, I really caution people to you know as some people, oh, do you have a cat or dog?And they should say yeah, you should remove the cat or dog from the home without doing testing. So, again um the was doing the allergen testing, we, there are multiple factors we have to consider, so um there are, we always consider um first of all, what geographic area are you living in because there are um in different parts of the country there are different kinds of tree pollen, grass pollen, weed pollen um and um so it is just really important that um the testing is potentially done based on the geographic region. So here in Chicago, we are testing to um pollens present in Florida or in California. Um we are testing what is here primarily in the Midwest area. Another consideration is where the individual lives or if they are living in an urban, suburban , or rural setting, because as I mentioned earlier, mouse and cockroach allergens are often found and can be found in all the settings but often they are very they are much higher in urban settings, so again doing testing to mouse and cockroach might be especially important in more urban settings. There are also other individual circumstances so um considering again um what that somebody has, so if somebody has a pet rabbit or guinea pig and they are concerned that that might be triggering um their symptoms um then it is reasonable to include those testing but that is not something I would do for everyone. And then find also considering work exposures, so um you may want to if somebody works in a lab with rats or other animals that um we typically don’t test for um but is having more symptoms again, potentially at their workplace, it is definitely reasonable to include and consider doing testing for those specific allergens. So, how do we control um some of these inhalant allergens? And, again, I typically tell my patients that um you know the first three things that we do in allergy once we find out somebody is allergic to something is avoidance, avoidance, and avoidance, so we really try to avoid it but it can be difficult in many cases. So um one of the, again, focusing on the national asthma guideline recommendations and this is um um based on um um some of the new updates um from 2020 is that again, um in patients with asthma at any level of severity whether intermittent, mild, moderate, severe, we should be reducing um exposure to the allergens that somebody is allergic to and exposed to. Now, they do specifically recommend, recommend though that in people that do not have allergies so if you um evaluate them and they are not allergic to anything, um then we don’t the recommendation is not to to do to remove again, remove the cat or dog or reduce dust exposure, so that would not necessarily be part of the routine as management. Again, if they’re not allergic or they don’t have symptoms related to that exposure. So um so that is something to consider. Um, and then here are some of the other highlights of the NA EPP recommendations regarding some of the specifics regarding inhalant allergens. And um at this time I am just going to go ahead um have Dameka talk about this because of her expertise in this area on making recommendations on how to manage um um exposures to um to reducing exposures to different allergens. Sorry.

Tori: Thank you, Dr. Nyenhuis. Often when we think about pets they are considered part of the family so it is very hard to just expect someone to get rid of the animal, but there are ways that weekend you know possibly keep someone that has asthma in that are allergic to the animal while trying to keep them safe also. So some of the things we like recommend to patients is keep the pet out of the bedroom. So we know that kiddos love their animals too, but it is not safe to have the animal in the area in which the child sleeps because we do not want them breathing air with pet dander, so again, the fire they shed, saliva and things like that, so it is important to make sure that the pet is kept away from the child, well the patient sleeping area. Um another thing we recommend is keeping the pet off the furniture and we recommend like you know using a HEPA filter vacuum cleaner if possible to kind of clean off the for if the animal is one that is used two jumping on the furniture. And also, washing the pet frequently, so even if that includes taking them to the groomers often or taking them at home. And another thing we recommend is you always wash your hands after you touch the pet that way you know if there is that excess for — I’m sorry, yeah, fur on your hands are not rubbing it across your face or putting it on your body when you’re done playing with the pet. Next slide, please. So this kind of um backs up what I was saying so um we recommend um all homes have if possible, a HEPA filter um and that we we are reducing the amount of time that we are spending with the animals, especially when it comes to that close contact, so you know, of course we we you know, we don’t want to keep the pet sheltered in a spot like a cage or whatever but if there is a room where the person with the allergies does not often frequent if we can have the pet in that area when the person that is allergic is around. Next slide. And this is slide just talking about ways to reduce the exposure to pets, so no one likes to have pets, and of course um as mentioned earlier, sometimes when you are living in close proximity to your neighbor specifically apartments the chances that no matter how clean you keep your spot, the chance if your neighbor has these pets, they may come to your apartment too so some of the things we can do to remediate the exposure is making sure we are keeping food and clothing and containers are kept away in a refrigerator or things like that making sure that we are minimizing things that are wet. So for example, you know like if there is a wet rag that you may have, excuse me, in your kitchen, making sure we put that away or that it is completely dry when you know as opposed to just leaving it out while it is wet. Making sure that we are ceiling any cracks or holes we observe and we know this can be tricky sometimes when it comes to renters so you can absolutely talk to your landlord in this regard to assist in filling some of those cracks and holes, and of course you can always reach out to your physician if you need assistance with like getting a letter drafted or anything like that. So of course there are pesticides but we are not really , but is not really at the top of artist to recommend because we know that a lot of them contain a lot of toxins, so if possible if that is the route you know that you need to take of course if you need to outsource to a pest control company, making sure that they are using more green products to reduce the amount of toxins that they will use know spray in your home. We always make sure that you are cleaning up any spills and tried to eat in one vocation. The reason why this is important because if you can possibly contain them into one area, they are more easy to control as opposed to different parts of your home or apartment. And also making sure that you are taking out your trash frequently and it is very important to if possible, have a trashcan that has a lid on the closes tightly so that those pests are not climbing into your garbage can. Um, and so the bottom says, individuals with asthma who have a sensitization or symptoms related to exposure of pests, the expert panel conditionally recommends the use of integrated pest management alone or as part of a multicomponent allergen-specific mitigation intervention. Next slide, please. Um, I think this, this we wanted to — new Dr. Nyenhuis: We wanted to show again that mouse allergen is widespread, both can be in the workplace as well as the home settings, and again, occur. err, we do see higher levels in urban areas as well as multifamily dwellings and um there is research to show that exposure to these um these allergens um specifically mouse and rat has been associated with worse outcomes um and those children that are allergic to it and definitely the um mitigation um incorporates all the things that Dameka mentioned on the last slide and definitely reductions in mouse allergen can also improve asthma symptoms. So now Dameka we’ll talk more about um management of house dust mites in the home.

Dameka: Yeah, so, dust mites is something we all encounter and um there are things that we can do to kind of reduce the amount of dust mites in our home. So for example, it is always recommended to use a um like a mattress cover or a pillowcase. We want to make sure that we are covering those um, we want to create like a barrier between our actual skin and the actual pillow or the mattress. Also making sure that we are washing our bedding frequency — frequently, so of course with everything medicine and research is always updated which is a good thing, so it used to be that Once upon a time it was recommended that you had the highest amount of heat possible when it comes to the water in your washing machine was washing her bedding to eliminate the amount of dust mites, but research now supports that it does not matter because you are killing the dust mites by drowning them, which is a good thing, so but we want to make sure that this is a weekly practice because believe it or not, over time, over a certain amount of years dust mites can make your mattress twice the size if we are not cleaning the bedding off and just allowing you know the dust to just collect up in our sleeping area. OK, so again comes that this is the first line of remediation you undertake. So make sure that we are using mattress and pillow covers and make sure we are washing betting often in washing also, washing the stuffed animals if possible, or even remove them altogether. Another thing is to make sure that we are controlling the humidity because of course the more humid it is in your sleeping area or in your home um the higher the chances are for more dust mites and making sure that we are removing carpet or using a HEPA filter vacuum cleaner so vacuum very often and same with cleaning your opposed threes, furniture — upholstery, furniture, casings on your furniture as well as your curtains. You want to make sure there are filters like in your intonation system and make sure you change that often too.

Dr. Nyenhuis: Great. Now, um just wanted to highlight as far as new guidelines, um they did talk about the management of house dust mites in particular bait indicated — and in particular they indicated it’s not enough to do the mattress and pillow coverings. That has been shown not to have that big of an impact but as part of a multipronged approach as Dameka mentioned, then it is recommended. So we have gone through um pets and pests and dust mites, that now um we, we will talk a little bit about how to manage um indoor molds itself. Now, with indoor molds, um we know that again similar to the dust mites, they thrive and very humid conditions, environments, and so the guidelines do recommend that individuals with asthma who are sensitive to indoor molds should take measures to really decrease that indoor humidity to less than 50%, so this could um include ventilating bathrooms and kitchen so turning that fan on when um you are in taking a bath or shower. Um, also, making sure we are repairing leaky faucets because that can contribute to the humidity and um as well as contribute to mold um accumulation. Also, you would definitely want to address any water condensation problems, so if you are seeing um any areas where there is a lot of that water buildup, especially often seen again, bathrooms and kitchens, but could occur in bedrooms, um you want to make sure that that is addressed. Um also, um, some people think about using humidifiers and vaporizers to increase the indoor humidity, but you have to be careful with that because sometimes there are filters in there or even if they do not have filters — the humidity fire fighters does humidifiers and vaporizers can just be putting mold into your there. Um so typically often we do not recommend the use of those things in the homes of patients with asthma. The CDC also has um great information that is really dedicated to mold and health and this includes different facts on molds, mold removal, as well as mold remediation.

Dameka: OK.

Dr. Nyenhuis: Go ahead, Dameka.

Dameka: Sorry.

Dr. Nyenhuis: I was going to introduce you again. [LAUGHTER]

Dameka: As mentioned earlier, irritants are different from allergens. Irritants are things that we cannot test for, so but they are not safe to be around when someone has um someone has asthma, so as mentioned earlier, we do not want to use um cleaning products or um fabric cleaners that have a lot of smells. We know we like the smell, but they are not 100 percent safe. Same with perfume and cologne. And the secondhand smoke is something that is around us a lot, right? But we pretty much know about the first and smoke and that is when someone is smoking themselves. Secondhand smoke as if I was smoking and you all were around but you would be exposed to that, but then the third hand smoke is the smoke caught in your curtains, couches, clothing the walls, cars, and that too can become an irritant for someone who has asthma and cause one to have an asthma exacerbation, so it is very important we minimize exposure to all of these and make sure that if there is a smoker that if they can reduce, prevent themselves from smoking in the home and smoke outside, but also use what is called a smoking jacket they can put over their clothing to reduce the amount of thirdhand smoke they will bring back and when they are done. Um, slide, please.

Dr. Nyenhuis: So, Dameka and I touched on this a little bit, but one of the things we find a lot in our work is a lot that our um patients do not own their home and they are tenants with asthma and it is sometimes hard to implement the changes we discussed if you are a tenant living with asthma, so because of this, we work with other partners including the Metropolitan tenants Association of Chicago in the Chicago asthma Consortium to develop an environmental checklist for tenants with asthma. Um, you can definitely go to this website, Chicago checklist to look at the whole document because I believe it is at least over 15 pages um but this is a really great resource I referred some of my patients to um if they are having, if there are concerns about um the home environment. Um, a company that also conducted two webinars, which, which goes into a bit more detail again, about the environment of checklist, which is focused on the principles of a healthy home, but we also incorporated um input from the Sinai urban health Institute as well as the Metropolitan tenants organization and legal aid Chicago which gives some information what to do, again, um as a tenant if you know, what are the channels um you should tried to do in order to help um make sure that you are living in a healthy environment. And then there was another video that we also created that um was that kind of did a virtual home walk-through so people knew, know what to look for, even when you are doing when you are looking for a new place to live or the things you should look for, even before you signed that police, that those — lease, so those are just some great resources we wanted to share in particular for tenants living with asthma and concerned about um some inhalant allergens exposures. So, in conclusion um, I think we reviewed all of these things but first of all inhalant allergens um can cause airways swelling and obstruction, that this is why it is so important to try to reduce one’s exposure to these, particularly if you have asthma and are allergic to those allergens. Also, indoor allergens can vary from pets, pests like cockroaches, mice, dust mites, mold, and also thinking about the irritants that Dameka talked about, those are very important to remember and those sometimes can be more ubiquitous in the home um then you know some of these other allergens. Also, there are you know outdoor allergens especially if you are keeping windows open in the home , those can come inside the home and does again can be like molds , but also pollen, trees, grasses, weeds, so those are defining the difference between the indoor/outdoor. The outdoor allergens can vary by season and geography, um so those are just some things to consider. So um, again, um some of the other things that um we should be doing, you know, in particular with providers is all persons with asthma should be asked about exposures to different inhalant allergens and asking and having a discussion about what is the potential effect on asthma, and really um we spend about 90% of our time indoors, and so it is really important again, to talk about those indoor allergens and utilizing allergy testing that could help along with the history to identify um what inhaled allergens somebody is allergic to. Also um definitely reducing exposure, we mentioned avoidance. It is one of the best treatments. Um, and, but, um, particularly in those sensitive um to those allergens come so again, we are not necessarily recommending reducing exposure if somebody is not sensitive to them. And then you know, as we discussed several times, is that allergen avoidance requires a multi-faceted or comprehensive approach, so unfortunately it is not just one thing, um it is often multiple things that need to be done in order to um reduce one’s exposure and have have it result in improvements in asthma systems as well as exacerbations. So, these are some of the additional resources as I mentioned. The expert panel report three, but also the 2020 focused updates to the asthma management guidelines. Again, the CDC, and I also include here the Chicago asthma Consortium tenant checklist as a resource. Um, and, um, again, we are definitely um open to answering any question so please put questions in the question box and I know that we will be happy to answer them. Thank you.

Andrea: thank you. Great information from behind the scenes what people need to do to control their asthma in addition to making sure they are on the right medication so some great comments in the chats that let’s look at a few of the questions we have in the first one is, do you have recommendations for allergy-friendly vacuums. We are not allowed to say brand names but maybe you could answer that in a different way to give them a little bit more information?

Dr. Nyenhuis: Dameka, do you want to take that, or I can?

Dameka: Sure. Just, it is, it is not, so come at the brand of vacuum cleaner is less important than the actual filters. You can purchase, so they have filters around the vacuum areas when you go to your local department store. The most important thing is to get a HEPA filter to put inside of a vacuum cleaner, so that is the most important.

Andrea: Thank you. We have another one and this is a really important question that people have asked. How can they completely get rid of mold indoors?

Dr. Nyenhuis: Yeah, so that can be a difficult question. I guess I can start. Dameka, if you want to add anything? If you identify mold, it would be something um, you know, you would have to potentially, it kind of depends on the extent of the mold. Um definitely, you know, if there is a little mold around the bathtub, that can often be — using cleaning agents. I will let Dameka talk about green cleaning agents so that does not trigger asthma, because bleach often triggers asthma, so I do not recommend that be used. If it is more extensive and involves walls and ceilings but then at that point you would probably want to get a contractor involved, because they may need to cut a portion of the wall or scene in order to remove that um. Now, I would just highlight because again, I am hearing from a lot of patients who are tenants with asthma, painting over it does not get rid of it, so I have heard stories of that you know where somebody has identified mold and they have just you know somebody comes in and paints over it, so that does not get rid of mold. Um, but, you know, again, as we were saying with everything, it is kind of a multifaceted approach. Um, Dameka, do you want to add to what I said?

Dameka: Sure, you mentioned green cleaning products. Believe it or not, one of the things that can assist with the mold and again, often times if there is an observation of mold and especially if your cell or your landlord tried to move it and it continues to grow back in the same area, then more often than not, you know, we should be contacting the contractor, as — to kind of see where the moisture source is, but you can use vinegar and water. So, if it is less aggressive, just you know, equal parts of vinegar and water them and then if it is more aggressive you want to use um feel on vinegar, so that can assist in getting rid of it, but again, I can’t stress it enough. If it continues to grow in the same area, you may want to contact a professional.

Andrea: Great. Thank you. Yes. We need to find the source of what’s causing it here at great information we have another question that says I understand dust mites are not present at high elevations, such as the Rocky Mountains. Is this correct?

Dr. Nyenhuis: Yes, so, as I mentioned earlier um you know the dust mites really do love um humidity, so in high altitudes, the humidity is much lower, so um that that is another option um in areas with low humidity that um typically they will have much lower levels. I would have to look. I don’t know 100% if there is like actually zero, but I think living at a high altitude definitely could potentially again have the lower dust mites, but you may still want to if you’re allergic to dust mites, you may still want to do some of those other um other management things that we discussed such as um the um hello and mattress cover and casings.

Andrea: Thank you. I can tag team on this a little bit because I do live in the Rocky Mountains and we do have some dust mites here, so it’s not that we don’t have any. We do have a drier climate, but a lot depends on what is used in the homes and a lot of people living in homes, we have a local professor doing studies on that and — dust mites in his microscope, so that has been the pretty fun. Our next question is — Sorry?

Dr. Nyenhuis: I said thank you.

Andrea: And there is great skiing if anyone wants to come out. [LAUGHTER] Another question I have someone says I have patients who are frequent marijuana users, so how can we advise them if they are smoking for recreational use to feel hig, since we knowh that smoking is an irritant and it is not good for them so is there any way to help people like that?

Dr. Nyenhuis: Dameka, do you have anything to add to that?

Dameka: Um so this is something we see in our population and you know, it is a bit tricky, especially if the person that is the marijuana user is the person with the allergy and or asthma so you know um and of course our first course of action is to offer assistance to help them quit, but if there isn’t, then we ask them if they could at least reduce the amount of times they are actually smoking so like if they smoke you know maybe three times a day, maybe we can you know push it down to two so it is all a matter of leading the patient — meeting the patient where they are at the moment and just kind of working with them without making them feel too overwhelmed because I am sure that you know they get it all the time from everywhere right? So biased is coming in and trying to assist where we can, we don’t want to push too much, but you know, I see that, in my years of experience that taking little steps can be a great improvement over time come so that is what I would recommend.

Andrea: Love that. Love that. That is an easy way to ease them down instead of saying you have to do it right now. Meet them where they are great information. We have someone who said I heard that keeping windows closed is the best thing that you can do. If either if you want to address that?

Dr. Nyenhuis: Yeah, so, it, again, I think it kind of depends on you know what you are allergic to come so again, it if you were to do allergy testing and that person had no outdoor allergens then um then you know, again, we would come at there is no evidence right now to show that keeping your windows you know closed would be effective. Um now, again, we talked a little bit about the indoor irritants but there are outdoor irritants to likely recently talked about like pollution, ozone and such, so I think it would be um you know that know to make sure that people know what is going on and what their air quality is like, so if the air quality outside is worse than inside, then yes, you would not want to be opening your windows, but again, in some homes that you know, in my experience, sometimes the indoor air quality is poor than the outdoor air quality was so it really kind of depends on what your environment is. You can use the air quality index, the HUI, and I see it on my phone — AQI, I see it on my phone in my Google speaker and things like that so that can be part of when you’re checking the temperature that you’re also checking the air quality and I can give you some impotency — to see see if it’s an OK day to open the windows, and also looking at pollen counts come so again, if you are allergic to trees or other grass pollens and such and those levels are high, I would keep the windows closed so um, so those are just some things to think about.

Andrea: OK. Thank you. We have another question. Someone asked do we need to wash the mattress bed cover or just the sheets?

Dr. Nyenhuis: Dameka, I would let you take that one.

Dameka: OK. Could you repeat the question?

Andrea: They were talking about washing bedding. They want to know if they need to wash the sheets and also the bed cover?

Dameka: Yes, so you can use, one of the things I burned in my training is you can use a steam cleaner to kind of um, so like when you are washing your bedding, um if you want to take that to your actual mattress then allow that to completely dry before you put the sheet and in the mattress cover back on, that is one of the things you can use to clean it.

Dr. Nyenhuis: Yeah. OK. And you could also definitely for the mattress cover itself you know, I probably would recommend doing it once a month. You might not have to do it as frequent as you might do the sheets.

Andrea: Called OK. Thank you. Someone else was asking about your comment about not having a wet towel in the kitchen, just wondering a little bit about that.

Dameka: So yes, pests love anything that is a water source or believe it or not, they were like sock the water out of that wet towel, so we do not want to give them access to anything, so food or water, so you want to make sure you know that the towel is not kept around wet, especially if you notice like may be droppings or you notice like this is where the pests frequent image you don’t want to keep anything that is wet around.

Andrea: Exactly. That is what I always tell people, keep it away from the food and water source, so thank you for that. Some one is asking how can we eradicate dust in the household. That is a never ending problem, isn’t it? But go ahead and answer the question whoever wants to. bSo believe it or not, we do not recommend light dusting, because what they do is they just sweep the dust from one area to another. To think that you want to do is what is called wet dusting, so that is to get like an old towel that you don’t use often and you want to clean the surface with moisture more so than dry dusting with a duster.

Andrea: Great. Yes. I grew up in the age of the feather duster. Those are a big no-no now. [LAUGHTER] Um, it sounds like I don’t know if we have a clinician today, but there are four or five questions a health care provider can ask about aspects of the home for someone that has asthma or respiratory issues to know if they need to be referred to a housing assistance program.

Dr. Nyenhuis: Um, OK, so just um , I guess, I guess maybe what I would um recommend is um as I introduced earlier, is these um in our tenants environmental checklist, there is the seven principles of a healthy home, and that can include like keeping things dry, keeping things clean um. There are multiple things on that, so I think kind of following those primary things as far as you know the, you know, looking at the major things in the home, um that can help one better understand what are the potential triggers. You know we talked about again pets, pests, dusts\ and mold — dust and mold. Those are some of the things, but again, looking at the kitchen about them are often the most because they have water sources there, those are um two big areas to um consider to make sure you do not have any leaks or um cracks or um you know that where pests can come in. Um, also in the bathroom looking for any source of mold, so you want to make sure that your fan is working properly, so um, again, you’re not having um water condensation um presenting um and I think those, I guess the other end in the last thing would begin no, particularly in the bedroom, looking at you know is there carpeting in the bedroom um again, if you are using the dust might end casings on the pillows and mattress. I don’t know, Dameka do you have anything else to add?

Dameka: No, I think you are spot on.

Andrea: OK. Do you have time for more questions? What if it is negative and out of the symptoms persist, what is the next step?

Dr. Nyenhuis: Yeah, so the allergen blood test is a very good test and can be helpful but allergy skin testing is more sensitive so it’s a little bit better of a test come so often it for some reason I did the blood test and it was negative but somebody still gave me a pretty strong history of you know exposures to let say cats or dogs, then I will often do the skin test. There are two types of tests, the allergy test, which often we use a device that is placed on the skin. , a hard roadshow bristle is put on the skin and does have allergens on them and if that is negative we still have a concern then there’s something cold entered dermal allergy test where there are needles that right underneath the skin and a small amount of those allergens are injected underneath the skin , so I guess it would say if the blood test was negative, I would definitely seek um specialty care from an allergist or somebody who does um allergy skin testing to provide that more definitive answer.

Andrea: OK. Thank you. Someone else is and this is a really tricky question. And the landlord is not willing to fix any issues with molds or pests. Any help that you can provide for the question.

Dameka: As mentioned earlier, for renters, there is a few resources, the Metropolitan tenets organization is one that we over Chicago refer our patients to and so they can provide assistance um all the way down to how to speak to your landlord about um these more indoor issues and um they will also have some um some residents communicating with their landlord through an app, where their communication with their landlord even though it is via text message will be sent to a cloud and they can see the landlord’s response and how to come up with ways to force them to fix any issues they may have.

Dr. Nyenhuis: I would just add to that. Again, this is a really great resource that was developed with the Metropolitan tenants organization um about you know what to do and it gives some advice on what to do. If you are having issues, I know throughout the document as we were doing this is the Metropolitan tenants organization said document, document the document, so you know you definitely want to document the first time you reach out to the landlord and what the response was in the second time the multiple times because that will provide a record of what you have done and what they have or have not done, so again, it is not, this is not necessarily creating a hostile relationship with the landlord and you definitely want people to work with their landlord to come up with a solution. In some situations, it can escalate if things are being done and may need to take legal action, and again in this um, and this webinar that we did, we actually included legal aid Chicago what are some other legal actions that need to be undertaken. This is very specific to Chicago but hopefully there are some um opportunities in other locations.

Andrea: Thank you. I know that it can be a little bit touchy dealing with landlords or other maintenance companies. And this will be our last question, and it says, can you use something else besides a bathmat in the tub since they are a source for mold.

Dr. Nyenhuis: Dameka?

Andrea: [INDISCERNIBLE] We all do. Yes, we are in good company paired so they are asking if there’s another option for about Matt since it can be a source for mold so is there something else they could use their tub? This is something that I get all the time. And so, one of the things that I would recommend um specifically like when coming out of the tub, you can place a towel down and just removed it to throw it in the drier to dry, once you come out of the tub but um that is all that I can think of.

Dr. Nyenhuis: Yeah, the only other thing that I could say is instead of using the bathmat sometimes there are some gripping strips to put into the tub, so if that is the concern which um you know lead to the mode, but also you know when you are, when you are, I guess another option would be you know if you’re using something in the tub um just making sure that you are um cleaning that somewhat frequently and again, like Dameka said, you can definitely use that one part water and one part vinegar, put that in a spray bottle and have that by the shower or bathtub to spray that um so that is another option um to help prevent accumulation of mold. But also, like Dameka said, for the bathmat’s they go outside of the shower or bath, definitely making sure that those are hung up to dry or putting them in the drier, of those don’t I can relate more. Mold often — it can often be put in the washing the scene so when you are washing your sheets once a week you can watch that.

Andrea: So lots of prevention ahead of time to try to prevent some of these things from happening.

Dr. Nyenhuis: Yes. Yes. Lots of prevention. As we said earlier, some of these things can be major triggers for exacerbation so again definitely talking to your doctor about your medications but also really thinking about what can be done in the home could have a large impact also on your asthma control.

Andrea: Thank you. And if you can go ahead and just advance the slide one slide? We will have a survey after this is over if you have ideas for a webinar or want to provide feedback. Often times when I go to the surveys at the end of the day, a lot of people are suggesting topics for webinars and we actually have these webinars on a website, allergy asthma We have been giving webinars for long enough that we’ve covered just about all the topics and you can search on there if there is a different topic that you would like, and if you go forward one more slide. Next month, we will have two webinars back to back and that is just how scheduling work sometimes, so long COVID, lasting lung problems, and we are lucky enough to have two speakers from the NIH who will be providing some information and research and things that are going on, and then on the 14th week will be knowing the difference, asthma or COPD but that particular webinar will be credentialed. Thank you Dr. Sharmilee Nyenhuis and Dameka for all your information. I know it is complex and that there is more information on your Chicago asthma Consortium because there can be a lot of things to look out for when you’re looking at the impairment trying to make a healthy home. So thank you again for joining us. This Andrea Jensen for the staff at the allergy and asthma network. Join us as we work every day to breathe better together. Thank you once again for joining us.

Dr. Nyenhuis: Thank you.