Individualized household allergen intervention lowers allergen level but not asthma medication use: a randomized controlled trial
Open accessAbstract
Background Environmental exposures to indoor allergens are major contributors to asthma symptoms, particularly in inner cities. The effectiveness of household allergen reduction as an adjunct to National Asthma Education Prevention Program guideline-based pharmacologic therapy in asthma has not been prospectively studied.Objective To study the effect of individualized allergen reduction on ability to reduce asthma pharmacologic therapy over 40 weeks.Methods We performed a randomized controlled trial to determine the effect of multifaceted indoor allergen avoidance measures on the ability to reduce asthma controller therapy in adults and children residing in New York City who were both sensitized and exposed to at least 1 indoor allergen. Asthma treatment and control were optimized in all subjects before randomization.Results A total of 125 subjects were randomized to receive individualized household allergen reduction and 122 received a sham intervention. Subjects in the intervention group significantly reduced all measured allergen levels (cat, dog, dust mite allergens in the bedroom, cockroach and mouse allergens in the kitchen and bedroom); those in the control group reduced only dust mite and mouse allergens in the bedroom and cockroach allergen in the kitchen. Participants in the intervention arm reduced National Asthma Education Prevention Program-based therapy from step 4.4 at randomization to 3.50 postintervention (range, 0-6); participants in the control arm reduced medication from step 4.4 to 3.4 (P = .76). There were no differences in other measured asthma outcomes.Conclusions Targeted allergen avoidance measures do not allow for reduction in asthma pharmacologic therapy compared with usual care in patients already receiving optimal controller therapy.
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In that 2016 trial, despite modest reductions in multiple indoor allergens in the intervention group, there were no statistically significant differences in allergen levels between intervention and control groups for most exposures by the end of the study.
“Although the intervention group achieved modest reductions in multiple indoor allergens, there were no statistically significant differences in allergen levels between the intervention and control groups for most exposures by the end of the study.”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [53]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredOne possible explanation for the lack of benefit on treatment step is that allergen levels were lowered in both groups and did not differ significantly between them.
“One possible explanation for the lack of benefit on treatment step is that allergen levels were lowered in both groups and were not significantly different between groups (53).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [53]
The Results report that allergen levels fell in both groups, though all measured allergens declined significantly only in the intervention group; asthma treatment step did not differ significantly between groups. The Discussion says allergen reductions in the control group made the intervention’s effect on treatment harder to assess. Neither passage establishes the claim’s specific assertion that allergen levels were not significantly different between groups. (LLM, conf=0.83)
Experimental — accuracy not yet measuredAlthough allergen reduction may improve the indoor environment, its inconsistent effect on controller medication treatment step, especially in well-managed patients, and the lack of sustained reductions in several studies limit definitive conclusions about long-term benefits.
“Although allergen reduction may contribute to a healthier indoor environment, its inconsistent impact on controller medication treatment step, particularly in well-managed patients, combined with the lack of sustained reductions in several studies, limits definitive conclusions about long-term benefits (53).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [53]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredModest reductions in allergen levels may not produce clinical benefits.
“Additionally, modest lowering of allergen levels may not translate to clinical benefits (53).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [53]
The Abstract Results and Discussion report reduced household allergen levels without an additional reduction in asthma medication use or improvement in other measured asthma outcomes. The paper does not characterize the allergen reductions as modest, so it supports the clinical point but not that description of their magnitude. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn that 2016 trial, no significant differences were found in other asthma-related health outcomes.
“Additionally, no significant differences were observed in other asthma-related health outcomes (53).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [53]
In that 2016 trial, the control group showed reductions only in dust mite and mouse allergens in the bedroom and cockroach allergen in the kitchen.
“The control group showed reductions only in dust mite and mouse allergens in the bedroom and cockroach allergen in the kitchen (53).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [53]
The 2016 allergen reduction study was a randomized controlled trial.
“This randomized controlled trial involving 247 participants (adults and children) in New York City who were both sensitized and exposed to at least one indoor allergen, examined whether individualized household allergen reduction could allow for a reduction in asthma pharmacologic therapy when added to standard guideline-based treatment (53).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [53]
The 2016 study concluded that targeted allergen avoidance measures do not significantly reduce asthma medication use compared with usual care in patients already receiving optimal controller therapy.
“This study concluded that targeted allergen avoidance measures do not provide a significant benefit in reducing asthma medication use compared to usual care for patients already receiving optimal controller therapy (53).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [53]
In that 2016 trial, the intervention group significantly reduced exposure to cat, dog, and dust mite allergens in the bedroom, and to cockroach and mouse allergens in the kitchen and bedroom.
“The intervention group significantly reduced exposure to allergens, including cat, dog, and dust mite allergens in the bedroom, as well as cockroach and mouse allergens in the kitchen and bedroom (53).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [53]
A 2016 study of individualized household allergen reduction found no significant effect on reducing asthma medication use.
“However, a 2016 study examining individualized household allergen reduction found no significant impact on reducing asthma medication use (53).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [53]
In that 2016 trial, there was no significant difference between intervention and control groups in reducing asthma pharmacologic therapy (intervention reduced NAEPP-based therapy from step 4.4 to 3.50, control from 4.4 to 3.4; p=0.76).
“Participants in the intervention group reduced their NAEPP-based therapy from step 4.4 to 3.50, while the control group reduced therapy from step 4.4 to 3.4 (p=0.76) (53).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [53]
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Lung Effects of Household Air Pollution
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Couillard, S., Jackson, D. J., Wechsler, M. E., & Pavord, I. D. (2021) · CHEST Journal · doi:10.1016/j.chest.2021.07.008 · Cited by 43 · see citing works
Update on indoor allergens and their impact on pediatric asthma
Maciag, M. C., & Phipatanakul, W. (2022) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2022.02.009 · Cited by 38 · see citing works
Bedroom Allergen Exposure Beyond House Dust Mites
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Louisias, M., & Phipatanakul, W. (2017) · Current Allergy and Asthma Reports · doi:10.1007/s11882-017-0734-x · Cited by 37 · see citing works
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Environmental allergen reduction in asthma management: an overview
Pham, D. L., Le, K., Truong, D. D. K., Le, H. T. T., & Trinh, H. K. T. (2023) · Frontiers in Allergy · doi:10.3389/falgy.2023.1229238 · Cited by 29 · see citing works
Indoor Environmental Interventions and their Effect on Asthma Outcomes
Kader, R., Kennedy, K., & Portnoy, J. M. (2018) · Current Allergy and Asthma Reports · doi:10.1007/s11882-018-0774-x · Cited by 27 · see citing works
Care transition interventions for children with asthma in the emergency department
Martin, M. A., Press, V. G., Nyenhuis, S. M., Krishnan, J. A., Erwin, K., Mosnaim, G. S., Margellos-Anast, H., Paik, S. M., Ignoffo, S., & McDermott, M. (2016) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2016.10.012 · Cited by 26 · see citing works
“Home environmental remediation remains a difficult to address component of care transitions and recent evidence call into question the overall efficacy of this intervention.(56) Environmental remediation frequently requires actions and partnerships with agencies outside of the health care system and oneway to achieve…”
BackgroundButz, A. M., Bollinger, M. E., Ogborn, J., Morphew, T. L., Mudd, S. S., Kub, J. E., Bellin, M. H., Lewis-Land, C. J., DePriest, K. N., & Tsoukleris, M. G. (2019) · Pediatric Pulmonology · doi:10.1002/ppul.24239 · Cited by 24 · see citing works
“For example, significant reduction in allergen levels (cat, dog, dust mite, cockroach, mouse) was noted in sensitized and exposed innercity adults and children with asthma and who were assigned to an intensive home based EC intervention including provision of vacuums and HEPA air-purifiers, encouraging reduction of SH…”
Effectiveness of Indoor Allergen Reduction in Management of Asthma
Leas, B. F., D’Anci, K. E., Apter, A. J., Bryant-Stephens, T. C., Schoelles, K. M., & Umscheid, C. A. (2017) · doi:10.23970/ahrqepccer201 · Cited by 21 · see citing works
Indoor environmental exposures and their relationship to allergic diseases
Grant, T., Wood, R. A., & Chapman, M. (2023) · Journal of Allergy and Clinical Immunology: In Practice · doi:10.1016/j.jaip.2023.08.034 · Cited by 18 · see citing works
Franklin, J. M., Grunwell, J. R., Bruce, A. C., Smith, R. C., & Fitzpatrick, A. M. (2017) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2017.04.008 · Cited by 20 · see citing works
Kaviany, P., Brigham, E. P., Collaco, J. M., Rice, J. L., Woo, H., Wood, M., Koehler, K., Wu, T. D., Eakin, M. N., Koehler, K. A., et al. (2021) · Journal of Asthma · doi:10.1080/02770903.2021.1893745 · Cited by 19 · see citing works
“Notably, there is variability between study findings: some studies demonstrate benefit of air purifier containing interventions on asthma morbidity (11,21,23) and others do not (19,20).”
BackgroundAdvances in environmental and occupational disorders in 2016
Sheehan, W. J., Gaffin, J. M., Peden, D. B., Bush, R. K., & Phipatanakul, W. (2017) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2017.09.032 · Cited by 20 · see citing works
van Boven, F. E., de Jong, N. W., Braunstahl, G., van Wijk, R. G., & Arends, L. R. (2020) · Clinical and Translational Allergy · doi:10.1186/s13601-019-0306-3 · Cited by 17 · see citing works
Housing Insecurity and Asthma Outcomes
Gabbay, J. M., Abrams, E. M., Nyenhuis, S. M., & Wu, A. C. (2023) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2023.10.031 · Cited by 16 · see citing works
Grant, T. L., McCormack, M. C., Peng, R. D., Keet, C. A., Rule, A. M., Davis, M. F., Newman, M., Balcer-Whaley, S., & Matsui, E. C. (2023) · Journal of Asthma · doi:10.1080/02770903.2022.2083634 · Cited by 14 · see citing works
“allergen intervention did not lower controller medication more than sham interventions (15); both groups experienced a reduction in treatment step, but this reduction was not significantly different between groups.”
BackgroundResultInfluentialInner-City Asthma in Childhood
Coleman, A. T., Teach, S. J., & Sheehan, W. J. (2019) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2018.12.008 · Cited by 14 · see citing works
Tschudy, M. M., Sharfstein, J., Matsui, E. C., Barnes, C. S., Chacker, S., Codina, R., Cohn, J. R., Sandel, M. T., & Wedner, H. J. (2017) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2016.12.975 · Cited by 12 · see citing works
“For example, in a recent randomized controlled trial, changes in indoor allergen exposure were quite modest and similar between the control and intervention groups, highlighting the fact that morework is needed to optimize home environmental interventions.(37) There is a need to develop and evaluate novel approaches t…”
BackgroundReducing Environmental Allergic Triggers: Policy Issues
Abramson, S. L. (2018) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2017.10.027 · Cited by 11 · see citing works
Ahmed, A. G., Sadreameli, S. C., Curtin-Brosnan, J., Grant, T. L., Phipatanakul, W., Perzanowski, M. S., Balcer-Whaley, S. L., Peng, R. D., Newman, M. G., Cunningham, A., et al. (2019) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2019.08.044 · Cited by 10 · see citing works
Self-citationA multi-city study of indoor air quality in green vs non-green low-income housing
Rabito, F. A., Werthmann, D., Straubing, R., Adamkiewicz, G., Reponen, T. A., Ashley, P. J., & Chew, G. L. (2023) · Environmental Research · doi:10.1016/j.envres.2023.117576 · Cited by 9 · see citing works
The Role of Home Environments in Allergic Disease
Kennedy, K., Allenbrand, R., & Bowles, E. (2019) · Clinical Reviews in Allergy & Immunology · doi:10.1007/s12016-018-8724-x · Cited by 9 · see citing works
“None reported DiMango, 2016 [62] Study looked at how reducing environmental allergens affects use of asthma meds over 40 week period; multifaceted approach for half of subjects; each subj. exposed to at least one indoor allergen Mattress encasements; HEPA air purifiers provided Targeted education…”
BackgroundSeth, D., Saini, S., & Poowuttikul, P. (2021) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2021.07.002 · Cited by 8 · see citing works
Environmental Interventions for Asthma
Banzon, T. M., & Phipatanakul, W. (2022) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0042-1749453 · Cited by 8 · see citing works
Environmental Exposures Impact Pediatric Asthma Within the School Environment
Mortelliti, C. L., Banzon, T. M., Vieira, C. L. Z., & Phipatanakul, W. (2022) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2022.05.005 · Cited by 8 · see citing works
Hogaard, N. V., Sigsgaard, T., Agertoft, L., Halken, S., & Rubak, S. (2025) · Respiratory Medicine · doi:10.1016/j.rmed.2025.108299 · Cited by 7 · see citing works
The Journal of Allergy and Clinical Immunology: In Practice — 2016 Year in Review
Schatz, M. X., Sicherer, S. H., & Zeiger, R. S. (2017) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2016.12.002 · Cited by 7 · see citing works
The Role of Environmental Controls in Managing Asthma in Lower-Income Urban Communities
Conrad, L. A., & Perzanowski, M. S. (2019) · Clinical Reviews in Allergy & Immunology · doi:10.1007/s12016-019-08727-y · Cited by 7 · see citing works
Self-citationCluster analysis of indoor environmental factors associated with symptoms of mite allergy
Virot, E., Godet, J., Khayath, N., Ott, M., Dazy, A., & Frederic de, B. L. A. Y. (2019) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2019.05.020 · Cited by 7 · see citing works
Seth, D., Saini, S., & Poowuttikul, P. (2019) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2019.06.012 · Cited by 6 · see citing works
Indoor Allergen Interventions in Homes and Schools for Managing Asthma
Beheshti, R., Phipatanakul, W., DiMango, E., & Grant, T. L. (2025) · The Journal of Allergy and Clinical Immunology: In Practice · doi:10.1016/j.jaip.2025.04.027 · Cited by 6 · see citing works
Self-citationThe Impact of the Indoor Environment on Childhood Asthma
Conroy, E. R., Phipatanakul, W., & Banzon, T. M. (2025) · Current Allergy and Asthma Reports · doi:10.1007/s11882-025-01193-x · Cited by 6 · see citing works
Public health and veterinary importance
Schal, C., & DeVries, Z. C. (2021) · CSIRO Publishing eBooks · doi:10.1071/9781486312078.bk07899_ch02 · Cited by 5 · see citing works
Place des interventions non médicamenteuses dans l’asthme
Bousso, A., Chenivesse, C., & Barnig, C. (2019) · La Presse Médicale · doi:10.1016/j.lpm.2019.02.019 · Cited by 5 · see citing works
Minimizing Indoor Allergen Exposure: What Works?
Beheshti, R., Grant, T. L., & Wood, R. A. (2024) · Current Allergy and Asthma Reports · doi:10.1007/s11882-024-01185-3 · Cited by 5 · see citing works
“As with mice, cockroach allergen exposure can be reduced using IPM, including the use of pesticides, timey waste disposal, and home repairs [79–82].”
Sobczak, M., Kowal, K., & Pawliczak, R. (2025) · International Forum of Allergy & Rhinology · doi:10.1002/alr.23565 · Cited by 3 · see citing works
Primary and Secondary Environmental Control Measures for Allergic Diseases
Cosme‐Blanco, W., Arce-Ayala, Y. M., Malinow, I. K., & Nazario, S. (2018) · Springer eBooks · doi:10.1007/978-3-319-58726-4_36-1 · Cited by 3 · see citing works
Eggleston, P. A. (2016) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2016.04.017 · Cited by 3 · see citing works
Effective pest control alone reduces mouse allergens in low-income housing
Sarker, S., Yu, J., Pan, X., Hamilton, R. G., Cooper, R., & Wang, C. (2025) · Journal of Allergy and Clinical Immunology Global · doi:10.1016/j.jacig.2025.100539 · Cited by 2 · see citing works
Understanding the Updates in the Asthma Guidelines
Lee, D. L., & Baptist, A. P. (2022) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0042-1745747 · Cited by 2 · see citing works
A New Approach to Environmental Control Trials
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Uncontrolled and severe asthma: predictive factors and comparison of control assessment tools
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“Allergen exposure continues to be a recognised contributor to uncontrolled asthma, with recent reviews confirming that targeted avoidance improves outcomes in sensitised patients (25).”
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Environmental Assessment and Control
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Non-drug treatments and rehabilitation of patients with bronchial asthma
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“Many studies have shown a direct link between a significant reduction in allergens of cockroaches, mites [26, 27], mice [28, 29], fungi [30] and the clinical picture of the disease and control of bronchial asthma, but the type of allergen is important, exposure, seasonality, which must be taken into account when carry…”
Comparative analysis identifies significant peptides related to asthma mechanism.
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Primary and Secondary Environmental Control Measures for Allergic Diseases
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Does improved indoor air quality lead to better asthma control?
Pandya, A., & Portnoy, J. M. (2023) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2022.11.022
- Authors
- DiMango, E., Serebrisky, D., Narula, S., Shim, C., Keating, C., Sheares, B., Perzanowski, M., Miller, R., DiMango, A., Andrews, H., Merle, D., Liu, X., Calatroni, A., & Kattan, M.
- Affiliations
- Columbia University Irving Medical Center (US)
- Jacobi Medical Center (US)
- Columbia University (US)
- Rho (United States) (US)
- Corresponding author
- DiMango, Emily
- ORCID
- Venue
- The Journal of Allergy and Clinical Immunology: In Practice
- Publisher
- Elsevier BV
- Published
- 2016-07
- Volume
- 4
- Issue
- 4
- Pages
- 671-679.e4
- ISSN
- 2213-2198 (ISSN-L)
- PMC
- PMC5295498
- OpenAlex
- W2310152440
- Cited by
- 72
- References
- 45
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 2 · 2023: 8 · 2022: 8 · 2021: 6 · 2020: 5 · 2019: 12 · 2018: 8 · 2017: 14 · 2016: 2
- FWCI
- 9.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Allergy and Clinical Immunology In Practice (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Environmental Health Sciences (P30ES009089)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- indoor allergens, allergen avoidance, asthma control, house dust mite allergens, cockroach allergens, mouse allergen, controller therapy, inner-city asthma, New York City
- MeSH terms
- Adolescent, Adult, Aged, Allergens, Animals, Asthma, Cats, Child, Cockroaches, Dogs, Environmental Exposure, Female, Forced Expiratory Volume, Housing, Humans, Male, Middle Aged, New York City, Urban Population, Anti-Asthmatic Agents, Pyroglyphidae, Mice, Young Adult
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