Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma


Woodcock, A; Forster, L; Matthews, E; Martin, J; Letley, L; Vickers, M; Britton, J; Strachan, D; Howarth, P; Altmann, D; Frost, C; Custovic, A; Medical Research Council General Practice Research Framework, ; (2003) Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. The New England journal of medicine, 349 (3). pp. 225-36. ISSN 0028-4793 DOI: https://doi.org/10.1056/NEJMoa023175

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Abstract

: The effectiveness of avoidance of house-dust-mite allergen (Dermatophagoides pteronyssinus 1 [Der p1]) in the management of asthma is uncertain.<br/> : We conducted a double-blind, randomized, placebo-controlled study of allergen-impermeable bed covers involving 1122 adults with asthma. The primary outcomes were the mean morning peak expiratory flow rate over a four-week period during the run-in phase and at six months and the proportion of patients who discontinued inhaled corticosteroid therapy as part of a phased-reduction program during months 7 through 12. Der p1 was measured in mattress dust in a 10 percent random subsample of homes at entry and at 6 and 12 months.<br/> : The prevalence of sensitivity to dust-mite allergen was 65.4 percent in the group supplied with allergen-impermeable bed covers (active-intervention group) and 65.1 percent in the control group supplied with non-impermeable bed covers. The concentration of Der p1 in mattress dust was significantly lower in the active-intervention group at 6 months (geometric mean, 0.58 microg per gram vs. 1.71 microg per gram in the control group; P=0.01) but not at 12 months (1.05 microg per gram vs. 1.64 microg per gram; P=0.74). The mean morning peak expiratory flow rate improved significantly in both groups (from 410.7 to 419.1 liters per minute in the active-intervention group, P<0.001 for the change; and from 417.8 to 427.4 liters per minute in the control group, P<0.001 for the change). After adjustment for base-line differences (by analysis of covariance), there was no significant difference between the groups in the peak expiratory flow rate at six months (difference in means, active-intervention group vs. control group, -1.6 liters per minute [95 percent confidence interval, -5.9 to 2.7] among all patients [P=0.46] and -1.5 liters per minute [95 percent confidence interval, -6.9 to 3.9] among mite-sensitive patients [P=0.59]). There was no significant difference between the groups in the proportion in whom complete cessation of inhaled corticosteroid therapy was achieved (17.4 percent in the active-intervention group and 17.1 percent in the control group) or in the mean reduction in steroid dose, either among all patients or among mite-sensitive patients.<br/> : Allergen-impermeable covers, as a single intervention for the avoidance of exposure to dust-mite allergen, seem clinically ineffective in adults with asthma.<br/>

Item Type: Article
Keywords: inhaled steroids, controlled trial, occupational asthma, indoor, allergens, avoidance, children, encasement, reduction, mattress, Adrenal Cortex Hormones, administration & dosage, Adult, Allergens, Animal, Asthma, drug therapy, physiopathology, prevention & control, Bedding and Linens, Double-Blind Method, Environment, Controlled, Environmental Exposure, prevention & control, Female, Human, Male, Middle Age, Peak Expiratory Flow Rate, Pyroglyphidae, immunology, Support, Non-U.S. Gov't
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
PubMed ID: 12867606
Web of Science ID: 184165700006
URI: http://researchonline.lshtm.ac.uk/id/eprint/16111

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