Feather or synthetic? That is the question

Neck abscess due to goose feathers leaked from a down comforter: case report, review of literature, and recommendations for parents

We present a 10-month-old baby girl who developed a neck abscess from the penetration of neck skin by 2 goose feathers that leaked from a down comforter. We review the risks of down and feather bedding and discuss consumer recommendations for parents and pediatricians.

Feather bedding and childhood asthma associated with house dust mite sensitisation: a randomised controlled trial

INTRODUCTION

Observational studies report inverse associations between the use of feather upper bedding (pillow and/or quilt) and asthma symptoms but there is no randomised controlled trial (RCT) evidence assessing the role of feather upper bedding as a secondary prevention measure.

OBJECTIVE

To determine whether, among children not using feather upper bedding, a new feather pillow and feather quilt reduces asthma severity among house dust mite (HDM) sensitised children with asthma over a 1-year period compared with standard dust mite avoidance advice, and giving children a new mite-occlusive mattress cover.

DESIGN

RCT.

SETTING

The Calvary Hospital in the Australian Capital Territory and the Children's Hospital at Westmead, Sydney, New South Wales.

PATIENTS

197 children with HDM sensitisation and moderate to severe asthma. Intervention New upper bedding duck feather pillow and quilt and a mite-occlusive mattress cover (feather) versus standard care and a mite-occlusive mattress cover (standard).

MAIN OUTCOME MEASURES

The proportion of children reporting four or more episodes of wheeze in the past year; an episode of speech-limiting wheeze; or one or more episodes of sleep disturbance caused by wheezing; and spirometry with challenge testing. Statistical analysis included multiple logistic and linear regression.

RESULTS

No differences between groups were found for primary end points--frequent wheeze (OR 1.51, 95% CI 0.83 to 2.76, p=0.17), speech-limiting wheeze (OR 0.70, 95% CI 0.32 to 1.48, p=0.35), sleep disturbed because of wheezing (OR 1.17, 95% CI 0.64 to 2.13, p=0.61) or for any secondary end points. Secondary analyses indicated the intervention reduced the risk of sleep being disturbed because of wheezing and severe wheeze to a greater extent for children who slept supine.

CONCLUSION

No differences in respiratory symptoms or lung function were observed 1 year after children with moderate-severe asthma and HDM sensitisation were given a mite-occlusive mattress cover and then received either feather upper bedding (pillow and quilt) or standard bedding care.

New insights in allergen avoidance measures for mite and pet sensitized patients. A critical appraisal

It is widely acknowledged that avoidance of allergens such as those derived from foods, drugs, latex and stinging insects results in a complete disappearance of symptoms. By contrast, although it has been clearly shown that allergens are an important risk factor for the development of respiratory symptoms and that several avoidance measures reduce allergen levels, whether this gives clinical improvement in symptoms is debatable. Many reasons could be invoked to justify this evident discrepancy. Apart from the intrinsic methodological aspects (e.g. single or combined interventions measure, population studied, severity of respiratory symptoms, outcomes, evaluated parameters, etc.), it is important to outline that a successful approach requires that the avoided allergen is the only and real factor responsible for symptoms, the patient's education and the use of a comprehensive protocol to reduce allergen exposure. Other important factors include the involvement of the patient, the relevance of other allergens/non-specific agents, and exposure to sensitizing agents also outside patient's home. It is likely that the clinical phase of allergic airway disease and the degree of bronchial (and also nasal) remodelling, in each individual, represent relevant factors for the clinical outcome of allergen avoidance procedures. Since the management of respiratory allergy is a complex strategy (including drugs, allergen avoidance, immunological and educational interventions), it is difficult in real life to distinguish the efficacy of a single intervention in comparison to the others. A combined strategy is likely to produce better clinical results.

A prospective association between cocoon use in infancy and childhood asthma

There is increasing evidence for a role for bedding items in the development of asthma. The use of some forms of synthetic bedding, such as foam mattresses and pillows, is associated with a significantly increased risk of childhood wheeze. Our aim was to examine prospectively whether the use of synthetic cocoon/baby nests in infancy is associated with the subsequent development of wheeze in childhood. Data collected in 1988 as part of the Tasmanian Infant Health Survey were linked to the cross-sectional Childhood Asthma Survey conducted in 1995 in Tasmania, Australia. We were able to match 863 records out of the 1111 in the 1988 survey. Information including parental, child-care, and the infant's sleeping environment was collected at home interview in 1988 when the infant was 1 month of age. Data including sleep environment and asthma symptoms were available for each child at age 7 years. A generalised linear model was used to calculate the adjusted relative risk (RR) estimates for symptoms of wheeze and infant cocoon use. For children who were placed in a cocoon in infancy, there was an increased risk of recent wheeze (adjusted RR = 4.33 [95% CI 2.08, 9.02]) and night wheeze (adjusted RR = 3.35 [95% CI 1.52, 7.39]) at age 7 years. In view of the increasing prevalence of childhood asthma, the identification of potentially modifiable environmental factors which might operate in infancy is of importance. The present findings implicate infant bedding choice as a significant factor and further studies on the infant sleeping environment are indicated.

The bedding environment, sleep position, and frequent wheeze in childhood

OBJECTIVE

Synthetic quilt use has been associated with increased childhood wheeze in previous studies. Our aim was to examine whether the adverse effect of synthetic quilt use on frequent wheeze differed by usual sleep position.

DESIGN, SETTING, AND PARTICIPANTS

A population-based cross-sectional study of 6378 (92% of those eligible) 7-year-olds in Tasmania, Australia, was conducted in 1995. Exercise-challenge lung function was obtained on a subset of 414 children from randomly selected schools.

EXPOSURE MEASURES

Child bedding including pillow and overbedding composition and usual sleep position by parental questionnaire.

OUTCOME MEASURES

Frequent wheeze (>12 wheeze episodes over the past year), using the International Study of Asthma and Allergies in Childhood parental questionnaire, and baseline and postexercise forced expiratory volume in 1 second lung-function measures.

RESULTS

Frequent wheeze (n = 117) was positively associated with synthetic quilts, synthetic pillows, electric blankets, and sleeping in a bottom bunk bed but did not vary by sleep position. In a nested case-control analysis, the association between synthetic quilt use and frequent wheeze differed by sleep position. Among children who slept supine, synthetic (versus feather) quilt use was associated with frequent wheeze (adjusted odds ratio: 2.37 [1.08, 5.23]). However, among nonsupine sleepers, overlying synthetic quilt use was not associated with frequent wheeze (adjusted odds ratio: 1.06 [0.60, 1.88]). This difference in quilt effect by sleep position was highly significant. Similarly, synthetic quilt use was associated with lower postexercise forced expiratory volume in 1 second measures among supine but not nonsupine sleeping children.

CONCLUSION

An increasing focus on the bedding environment immediately adjacent to the nose and mouth is required for respiratory disorders provoked by bedding, such as child asthma characterized by frequent wheeze.

Synthetic bedding and wheeze in childhood

BACKGROUND

The reasons for the increase in childhood asthma over time are unclear. The indoor environment is of particular concern. An adverse role for synthetic bedding on asthma development in childhood has been suggested by cross-sectional studies that have found an association between synthetic pillow use and childhood wheeze. Prospective data on infant bedding have not been available.

METHODS

Bedding data at 1 month of age were available from an infant survey for children who were participating in a 1995 follow-up study (N = 863; 78% traced). The 1995 follow-up was embedded in a larger cross-sectional survey involving 6,378 seven year olds in Tasmania (N = 92% of eligible). Outcome measures included respiratory symptoms as defined in the International Study of Asthma and Allergies in Childhood protocol. Frequent wheeze was defined as more than 12 wheeze episodes over the past year compared with no wheeze.

RESULTS

Synthetic pillow use at 1 month of age was associated with frequent wheeze at age 7 (adjusted relative risk [aRR] = 2.5; 95% confidence interval [CI] = 1.2-5.5) independent of childhood exposure. Current synthetic pillow and quilt use was strongly associated with frequent wheeze (aRR = 5.2; CI = 1.3-20.6). Substantial trends were evident for an association of increasing number of synthetic bedding items with frequent wheeze and with increasing wheeze frequency. Among children with asthma, the age of onset of asthma occurred earlier if synthetic bedding was used in infancy.

CONCLUSIONS

In this cohort, synthetic bedding was strongly and consistently associated with frequent childhood wheeze. The association did not appear to be attributable to bedding choice as part of an asthma management strategy.

Environmental controls in the management of allergic asthma

Environmental allergen control is one of the four primary goals of good asthma management. The American Academy of Allergy, Asthma, and Immunology has published a position statement [78] that endorses the National Asthma Education and Prevention Program management guidelines [23] and recommends that every patient with persistent asthma be evaluated for environmental allergen sensitivity. Patients who have sensitivities should receive practical advice on allergen avoidance. An accumulating body of knowledge indicates that such measures, when strictly applied for a sufficient period of time, can indeed reduce asthma symptoms, need for medication, and airway hyperresponsiveness. Ongoing prospective trials in large numbers of patients are being conducted and should enhance the ability to make proper recommendations to patients.

The use of a feather quilt, childhood asthma and allergic rhinitis: a prospective cohort study

BACKGROUND

Feather bedding has long been considered as a potential source of allergen exposure and thus a potential risk factor for allergic diseases. However, recent cross-sectional studies have reported a higher risk of allergic diseases among users of synthetic bedding compared with feather-bedding users.

OBJECTIVE

To explore associations between early life exposure to feather bedding and the risk of developing asthma allergic rhinitis in childhood.

METHODS

We assessed the association between early life exposure to feather quilts and the risk of bronchial obstruction during the first 2 years of life and asthma and allergic rhinitis in a prospective 4-year cohort study of 2531 Norwegian children.

RESULTS

At the age of 6 months, 24% of the children had a quilt with feathers, decreasing to 20% at the age of 2 years. The adjusted odds ratio for bronchial obstruction 0 to 2 years by exposure to a feather quilt at the age of 6 months was 0.59, 95% confidence interval 0.41 to 0.86, for asthma at the age of 4 years 0.38, 0.23 to 0.64 and for allergic rhinitis at the age of 4 years 0.73, 0.43 to 1.18.

CONCLUSION

The use of a feather quilt in early life does not seem to increase the risk of asthma and allergic rhinitis later in childhood.

Feather bedding and house dust mite sensitization and airway disease in childhood

Feather bedding has been inversely associated with child wheeze and also with house dust mite (HDM) allergen levels. We conducted a cross-sectional analysis of the childhood component of a birth cohort study. Our aim was to examine the relation between feather bedding and HDM sensitization and airway disease. A total of 498 children (84% of eligible) residing in Northern Tasmania in 1997 who were eligible for the Tasmanian Infant Health Survey at birth in 1988 or 1989 participated. Outcome measures included atopic sensitization to Dermatophagoides farinae or Dermatophagoides pteronyssinus allergens, spirometric lung function, and child respiratory symptoms using questions from the ISAAC study. HDM sensitization was strongly associated with frequent wheeze (more than 12 episodes of wheeze compared with no wheeze in the past year) (rate ratio [RR], 19.61; confidence interval [CI], 6.94-55.56) but only weakly associated with asthma ever (RR, 1.65; CI, 1.30-2.09). Feather quilt use was associated with reduced HDM sensitization (adjusted RR [ARR], 0.60; CI, 0.45-0.80) and also reduced frequent wheeze episodes over the past year (ARR, 0.24; CI, 0.07-0.86). The reduction in wheeze was more evident among HDM-sensitized children. These findings are consistent with the possible mechanisms for feather bedding of a reduction in initial HDM sensitization and an improvement in respiratory symptoms among HDM-sensitized children. However, prospective studies are required to fully exclude selection bias.

The association between synthetic bedding and adverse respiratory outcomes among skin-prick test positive and skin-prick test negative children

BACKGROUND

Synthetic bedding has been associated with increased child wheeze and also higher allergen levels in several studies. We aimed to examine whether the association between synthetic bedding and adverse respiratory outcomes was more evident among skin-prick test (SPT) positive children.

METHODS

A cross-sectional survey involving a population sample of 758 (81% of eligible) school children aged 8-10 years from randomly selected schools in the Australian Capital Territory in 1999. Parental questionnaires for ISAAC respiratory symptoms and child bedding were obtained. SPT results of 10 common allergens were available on 722 of the subjects (77% of those eligible). Synthetic pillow or quilt use was termed synthetic upper bedding.

RESULTS

Synthetic quilt use was associated with asthma (Adjusted Odds Ratio 1.67 (1.05, 2.65)), recent wheeze (AOR 1.63 (1.03, 2.59)) and allergic rhinoconjunctivitis (AOR 2.11 (1.33, 3.34)) among SPT-positive children. However, these associations were not apparent for SPT-negative children. Similarly, increasing synthetic upper bedding use was associated with more than 12 episodes of wheeze among SPT-positive children (AOR 1.69 (1.08, 2.64), P=0.02, per category) but not SPT-negative children (AOR 0.77 (0.26, 2.21), P=0.6, per category).

CONCLUSION

The apparent association between synthetic upper bedding and adverse respiratory outcomes was evident among SPT-positive but not SPT-negative children. Prospective intervention studies that aim to examine the effect of upper bedding composition on child asthma among SPT-positive children are required.

The role of intervention in established allergy: avoidance of indoor allergens in the treatment of chronic allergic disease

Avoidance of exposure to indoor allergens is an important element in the treatment of allergic disease. The results of several studies provide strong evidence in support of a role for allergen avoidance; however, strategies that optimize allergen reduction in houses have not been determined. Complex issues regarding the efficacy of physical and chemical measures that target house dust mite, pet, and cockroach allergens in the home are discussed. The greatest challenge is to educate allergic patients so that they can play an important role in controlling their own disease.

Urbanization and childhood asthma: an African perspective

The increasing prevalence of childhood asthma in the developed world is a cause for concern. Much research is currently being conducted in an attempt to identify possible reasons for this occurrence. A so-called Western lifestyle has been the factor most commonly cited to explain this worrying increase in asthma prevalence. In essence, this implies a way of life where children are exposed from early infancy to a wide range of foods, infections, indoor and outdoor allergens, and irritants and to the effects of motor vehicle pollution. Until fairly recently, children in many African countries lived mainly in rural areas and were not exposed to the effects of a Western lifestyle. Early studies in a limited number of African countries showed a very low rural prevalence of childhood asthma, especially where children lived according to a traditional lifestyle. These same studies showed that asthma was not uncommon in urbanized African children. There has been an increasing tendency over the past 20 years for those in rural communities to move to the large urban centers. More recent childhood asthma prevalence studies, especially those from Kenya and Ghana, have confirmed the urban-rural differences but have shown a much narrower gap. In part this may be the result of exposure of rural children to agricultural pesticides and irritants as well as of an increasing tendency to adopt a more Westernized lifestyle such as the use of beds with mattresses, pillows, and blankets. These circumstances on the African continent provide a natural laboratory in the quest for factors that influence the development of asthma in susceptible children. Once more fully elucidated, it is possible that much valuable information will be available to combat the relentless increase in childhood asthma both here as well as in the developed world.