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Wise et al.

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study group) or just standard medical care (second study group) during 3 consecutive grass pollen seasons. 1161 Interestingly, the authors found a significant improvement in ocular and nasal symptoms as well as RQLQ in the group provided with wraparound eyeglasses compared to the controls. Another approach is an active nasal filter by means of a membrane removing particles from the inhaled air. 1162 In a prospective, single-center, randomized, double-blind, placebo-controlled, crossover study performed in an ACC, 24 adult patients with grass-pollen induced SAR were randomly assigned to either a group that received this nasal filtering membrane or to a group that did not. 1162 Under repeated exposure in the ACC, patients with the membrane filter significantly improved in some of their nasal symptoms. However, the primary endpoint measuring maximum TNSS in this trial was not significant; thus, meaningful conclusions are difficult to draw from this study. 1162 The small sample size was a notable limitation. A real-world, single-center, double-blind, crossover trial of 65 patients by the same researchers, however, did find significant reductions in daily TNSS and maximum TNSS with nasal filters used in-season compared to placebo 1163 (Table IX.A.4). Avoidance of exposure to occupational inhalant allergens is feasible, in principle, in occupational allergic patients. 112 Several modalities of reducing workers’ exposure to occupational allergens such as “engineering controls” and “administrative controls” have been described in the literature. 1164 The former includes substitution of a hazardous chemical with a nonhazardous or less-hazardous alternative, isolation of the hazardous chemical, or efficient ventilation to reduce workers’ exposure. The latter includes workers’ education and personal protective equipment. A prospective controlled trial of 20 patients with confirmed diagnosis of occupational allergy demonstrated that cessation of the exposure of the causal allergen in the workplace led to a significant improvement of patients’ nasal symptom scores as well as disease-specific QOL. 1165 • Aggregate Grade of Evidence: B (Level 1b: 3 studies; Level 2b: 1 study; Table IX.A.4). • Benefit: Decreased allergen exposure with possible reduction in symptoms and need for allergy medication, along with improved QOL. • Harm: Financial and time costs of potentially ineffective intervention. • Cost: Low, but dependent on the EC strategy (ie, for occupational allergy ventilation measures and other “engineering controls” may be high). • Benefits-Harm Assessment: Equivocal. • Value Judgments: A limited number of studies show clinical effects of investigated EC measures. General EC recommendations are mainly based on expert opinions rather than evidence. • Policy Level: Option. • Intervention: Pollen and occupational allergen avoidance by EC strategies are an

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option for the treatment of AR; however, clinical efficacy has not been definitively demonstrated. More RCTs with larger samples are warranted to prospectively evaluate clinical efficacy.

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

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