Home Environmental triggers are suspected to significantly contribute to medical utilization by people with allergic diseases. The benefits of environmental assessment (EA) with remediation for such individuals remain to be clearly demonstrated. Since assessments often are expensive and require substantial resources, case management (CM) of patients for whom they are indicated also may be useful. To determine the effectiveness of CM combined with EA, the following study was performed.

Patients seen in a hospital based allergy clinic and who had a history of high ED and hospital utilization were referred for home assessment by pediatric allergists. CM that included asthma education, facilitation of clinic appointments, and assistance with criteria for EA was arranged. EA included inspection for water problems, evaluation of airborne spores, surface fungal identification, and dust analysis for allergens by enzyme immunoassay.

Of 27 pediatric subjects enrolled, 70% had asthma and 13% had rhinitis. In the year before EA and CM there were 47 ED visits, 22 hospitalizations and 279 clinic visits. In the year after the interventions there were 18 ED visits, 3 hospitalizations and 172 clinic visits. Dust antigen assessment revealed levels above 0.1 ug/gram in the following frequencies: Cladosporium-71%, Cat-63%, dog-47%, Penicillium-42%, Aspergillus-32%, Dust Mite-21%, Alternaria-21% and roach-16%. Of these same homes, 94% had airborne Aspergillus/Penicillium spore levels above 100/M³, 74% had Aspergillus/Penicillium levels above 1000 100/M³ and36% had airborne Stachybotrys spores above 100 100/M³.

Home environmental assessment and case management can reduce medical utilization for children suffering from rhinitis and asthma.