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Wise et al.

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• Harm: Emotional distress caused by removal of household pets. Financial and time costs of potentially ineffective intervention. • Cost: Low to moderate. • Benefits-Harm Assessment: Equivocal. • Value Judgments: While several studies have demonstrated an association between EC and reductions in environmental antigens, only a single, multimodality RCT has demonstrated clinical improvement in nasal symptoms among patients with Fel d 1 sensitivity. The secondary prevention and treatment of asthma in sensitized individuals must also be considered. • Policy Level: Option. • Intervention: Pet avoidance and EC strategies, particularly multimodality EC among patients with diagnosed Fel d 1 sensitivity, are an option for the treatment of AR related to pets. IX.A.4. Other (pollen, occupational)— For patients with pollen allergy, avoidance measures aim to minimize allergen exposure during the respective pollen season. 101 However, pollination is a global natural phenomenon which periodically occurs, making it nearly impossible for patients to thoroughly avoid exposure. There are some practical methods to minimize patients’ exposure via EC measures. However, there is a paucity of clinical trials evaluating the clinical efficacy of therapeutic strategies. Most of the recommended strategies are based on expert consensus and clinical experience. 1155 concentration). 1156 Patients can get further information about the current pollen count in their respective region through internet sources (ie, the European Aeroallergen Network [EAN] database [https://ean.polleninfo.eu/Ean/]; Foundation German Pollen Information Service [http://www.pollenstiftung.de/]; American Academy of Allergy Asthma and Immunology [AAAAI] [http://www.aaaai.org/global/nab-pollen-counts]). This information may be used, for example, in avoidance of extensive outdoor exercise during peak pollen levels or timing of preventive medication. 1157,1158 Although expert opinion endorses these strategies, there is no evidence to support their clinical efficacy. One potential EC strategy is limiting residential exposure during periods of high pollination (ie, vacationing in geographical regions with a reduced intensity of local pollen In addition, patients may open their home windows when the pollen counts are low or keep windows closed and use air conditioning during times of high pollination. Special dust and pollen filters may be used in cars to reduce the pollen concentration within the car. Furthermore, pollen-allergic patients may be educated on removal of clothing and washing their hair before entering their bedrooms during pollen season as pollen grains stick to both hair and clothing. Again, expert opinion endorses these strategies, but there is no evidence to support their clinical efficacy. 1159,1160 Another EC strategy utilizes physical barriers to minimize mucosal exposure to airborne allergens. In a prospective trial, 70 patients with SAR caused by grass pollen were randomized to receive wrap-around eyeglasses in addition to standard medical care (first

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Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.