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van Boven FE, Braunstahl GJ, Arends LR, van Maaren MS, Bramer WM, van Wijk RG, de Jong NW. House dust mite allergen avoidance strategies for the treatment of allergic asthma: A hypothesis-generating meta-analysis. World Allergy Organ J 2024; 17:100919. [PMID: 38966606 PMCID: PMC11223119 DOI: 10.1016/j.waojou.2024.100919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 07/06/2024] Open
Abstract
Background This study continues the review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187), aiming to systematically generate hypotheses on the effectiveness of (sub)strategies for house dust mite allergen avoidance in the treatment of allergic asthma. Methods We used the trials previously analysed by Gøtzsche and Johansen and searched recently published studies. Data on asthma symptom scores (ASS), ACQ, number of improved patients, AQLQ-scores, medication use, FEV1%, PC20, and FeNO levels were analysed. The effectiveness of strategies was assessed using Metafor in R. Results Thirty-five trials involving 2419 patients were included in the final study. The patient-reported outcome number of patients with improved condition following total bedroom control was RR = 3.39 (95% confidence interval: 1.04 to 11.04, P = 0.04). The mean differences in the ASS by nocturnal air purification was -0.7 (95% confidence interval: -1.08 to -0.32, P < 0.001). Other outcomes including partial bedroom control were non-significant or clinically not of importance. Conclusions Total bedroom control and nocturnal air purification of the breathing zone hypothetically provides clinical benefits in patients with house dust mite-induced allergic asthma. The number of patients with improvements in their condition respectively the asthma symptom score differences showed potential in small subgroups, consisting of single studies. Partial bedroom control is not recommended. Systematic Review Registration Prospero CRD42022323660.
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Affiliation(s)
- Frank E. van Boven
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, P.O. Box 10900, 3004 BA, Rotterdam, the Netherlands
- Department of Pulmonary Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Lidia R. Arends
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
- Department of Biostatistics & Epidemiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Maurits S. van Maaren
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Wichor M. Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Nicolette W. de Jong
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Cloutier MM, Baptist AP, Blake KV, Brooks EG, Bryant-Stephens T, DiMango E, Dixon AE, Elward KS, Hartert T, Krishnan JA, Lemanske RF, Ouellette DR, Pace WD, Schatz M, Skolnik NS, Stout JW, Teach SJ, Umscheid CA, Walsh CG. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol 2020; 146:1217-1270. [PMID: 33280709 PMCID: PMC7924476 DOI: 10.1016/j.jaci.2020.10.003] [Citation(s) in RCA: 403] [Impact Index Per Article: 100.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/22/2022]
Abstract
The 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group was coordinated and supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. It is designed to improve patient care and support informed decision making about asthma management in the clinical setting. This update addresses six priority topic areas as determined by the state of the science at the time of a needs assessment, and input from multiple stakeholders:A rigorous process was undertaken to develop these evidence-based guidelines. The Agency for Healthcare Research and Quality's (AHRQ) Evidence-Based Practice Centers conducted systematic reviews on these topics, which were used by the Expert Panel Working Group as a basis for developing recommendations and guidance. The Expert Panel used GRADE (Grading of Recommendations, Assessment, Development and Evaluation), an internationally accepted framework, in consultation with an experienced methodology team for determining the certainty of evidence and the direction and strength of recommendations based on the evidence. Practical implementation guidance for each recommendation incorporates findings from NHLBI-led patient, caregiver, and clinician focus groups. To assist clincians in implementing these recommendations into patient care, the new recommendations have been integrated into the existing Expert Panel Report-3 (EPR-3) asthma management step diagram format.
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Affiliation(s)
- Michelle M Cloutier
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Alan P Baptist
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Kathryn V Blake
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Edward G Brooks
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Tyra Bryant-Stephens
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Emily DiMango
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Anne E Dixon
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Kurtis S Elward
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Tina Hartert
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Jerry A Krishnan
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Robert F Lemanske
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Daniel R Ouellette
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Wilson D Pace
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Michael Schatz
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Neil S Skolnik
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - James W Stout
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Stephen J Teach
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Craig A Umscheid
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
| | - Colin G Walsh
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda
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Kennedy K, Allenbrand R, Bowles E. The Role of Home Environments in Allergic Disease. Clin Rev Allergy Immunol 2020; 57:364-390. [PMID: 30684120 DOI: 10.1007/s12016-018-8724-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Allergic diseases are surprisingly common, chronic health conditions. The primary location where the vast majority of people are exposed to allergens and other substances is in their home. This means it is important to understand home environments and how a home's systems function and interact-and that how we occupy these spaces plays a crucial role in both environmental exposure and management of allergic disease. This review provides an overview of what is understood about home environmental exposure and its impact on our health, and proposes a systematic process for using a patient's environmental history to develop individualized, manageable and cost-effective recommendations. Once occupant-related information has been gathered, a home environmental exposure assessment should be performed focused on identifying the relationships between any identified sources of contaminants and the housing systems, and conditions that may be contributing to exposure. The results and recommendations from this assessment can then be used to guide exposure-reduction efforts by patients and/or their caregivers in an effort to improve disease management. In this review, we'll discuss three different types of home interventions-active, which must be routinely performed by the patient and/or caregiver, passive, which are interventions that work without routine, direct interaction from the homeowner, and behavioral changes in how the home environment is cleaned and maintained for long-term reduction of allergens. In this review, and others evaluated for this discussion, a significant number of home environmental assessment and intervention programs were shown to be cost effective, with the majority of programs showing a net positive return on investment. It is important to recognize that to be cost effective, the level and intensity of services offered through home visit programs need be stratified, based on the estimated health risks of the patient, in order to tailor the assessment and target the interventions to a patient's needs while maximizing cost effectiveness.
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Affiliation(s)
- Kevin Kennedy
- Section of Toxicology and Environmental Health, Children's Mercy Kansas City, Kansas City, USA.
| | - Ryan Allenbrand
- Section of Toxicology and Environmental Health, Children's Mercy Kansas City, Kansas City, USA
| | - Eric Bowles
- Section of Toxicology and Environmental Health, Children's Mercy Kansas City, Kansas City, USA
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van Boven FE, de Jong NW, Braunstahl GJ, Gerth van Wijk R, Arends LR. A meta-analysis of baseline characteristics in trials on mite allergen avoidance in asthmatics: room for improvement. Clin Transl Allergy 2020; 10:2. [PMID: 31921410 PMCID: PMC6943957 DOI: 10.1186/s13601-019-0306-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence regarding the clinical effectiveness of mite allergen avoidance for the treatment of asthma is lacking. In previous meta-analyses on mite allergen control, the baseline data were not discussed in detail. This study updates and extends the existing Cochrane review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187), with a focus on baseline asthma outcomes and allergen exposures. METHODS We used the existing trials in the original Cochrane review and included newly published studies. The baseline data for the mite allergen load from the mattress, the standardized asthma symptom score (ASS), the forced expiratory volume in 1 s percentage of predicted (FEV1 %pred.), and the histamine provocative concentration causing a 20% drop in FEV1 (PC20) were extracted. First, the mean values of the outcomes were calculated. The influence of the mite allergen load was examined with a random-effect meta-regression using the Metafor package in R. RESULTS Forty-five trials were included; 39 trials reported strategies for concurrent bedroom interventions, and 6 trails reported strategies for air purification. The mite allergen load ranged from 0.44 to 24.83 μg/g dust, with a mean of 9.86 μg/g dust (95% CI 5.66 to 14.05 μg/g dust, I2 = 99.8%). All health outcomes showed considerable heterogeneity (standardized ASS mean: 0.13, 95% CI 0.08 to 0.18, I2 = 99.9%; FEV1 %pred. mean: 85.3%, 95% CI 80.5 to 90.1%, I2 = 95.8%; PC20 mean: 1.69 mg/mL, 95% CI 0.86 to 2.52 mg/mL, I2 = 95.6%). The covariate mite allergen load did not significantly influence health outcomes. DISCUSSION This meta-analysis shows that mite avoidance studies are characterized by the inclusion of patients with rather mild to moderate asthma and with varying and sometimes negligible levels of allergen exposure. Future studies should focus on patients with severe asthma and increased levels of allergen exposure.
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Affiliation(s)
- Frank E. van Boven
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Nicolette W. de Jong
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Sint Franciscus Vlietland Groep, P.O. Box 10900, 3004 BA Rotterdam, The Netherlands
- Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Lidia R. Arends
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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House-Dust Mite Immunotherapy in Asthma: Uncertainties and Therapeutic Strategies. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-00236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Custovic A, Murray CS, Simpson A. Dust-mite inducing asthma: what advice can be given to patients? Expert Rev Respir Med 2019; 13:929-936. [PMID: 31369320 DOI: 10.1080/17476348.2019.1651647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: Amongst allergic asthmatics, high allergen exposure increases asthma severity. However, there is no consensus on the role of mite allergen avoidance in the management of asthma, and various guidelines differ in their recommendations. Areas covered: Several systematic reviews/meta-analyses on mite avoidance in the management of asthma have been published, and their findings have been used for a call to provide a recommendation in British guidelines that dust-mite control measures should not be recommended. However, there are several problems with such analysis (such as combining studies in adults and children), and we question whether these are appropriate tools to evaluate available evidence about mite allergen avoidance, and whether it is correct to rely disproportionately on the results of meta-analyses/systematic reviews to inform clinical practice in this area. Recent evidence in children suggests that mite-impermeable bed encasings reduce emergency hospital attendance with severe asthma exacerbations. Expert opinion: The practical questions include how to achieve a sufficient real-life reduction allergen exposure, and how to identify patients who will benefit from effective intervention. The intervention should start early in the natural history of asthma, and consideration for choosing patients should include using the titre of allergen-specific IgE antibodies or the size of skin test wheal as an indicator.
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Affiliation(s)
- Adnan Custovic
- National Heart and Lund Institute, Imperial College London , London , UK
| | - Clare S Murray
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
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Leas BF, D'Anci KE, Apter AJ, Bryant-Stephens T, Lynch MP, Kaczmarek JL, Umscheid CA. Effectiveness of indoor allergen reduction in asthma management: A systematic review. J Allergy Clin Immunol 2018; 141:1854-1869. [DOI: 10.1016/j.jaci.2018.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/16/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
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Le Cann P, Paulus H, Glorennec P, Le Bot B, Frain S, Gangneux JP. Home Environmental Interventions for the Prevention or Control of Allergic and Respiratory Diseases: What Really Works. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:66-79. [PMID: 27665387 DOI: 10.1016/j.jaip.2016.07.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 06/17/2016] [Accepted: 07/08/2016] [Indexed: 12/29/2022]
Abstract
Home health care workers interventions have been implemented in western countries to improve health status of patients with respiratory diseases especially asthma and allergic illnesses. Twenty-six controlled studies dealing with prevention and control of these diseases through home environmental interventions were reviewed. After a comprehensive description of the characteristics of these studies, the effectiveness of each intervention was then evaluated in terms of participants' compliance with the intervention program, improvement of quality of the indoor environment, and finally improvement of health outcomes, in detailed tables. Limitations and biases of the studies are also discussed. Overall, this review aims at giving a toolbox for home health care workers to target the most appropriate measures to improve health status of the patient depending on his and/or her environment and disease. Only a case-by-case approach with achievable measures will warrant the efficacy of home interventions. This review will also provide to the research community a tool to better identify targets to focus in future evaluation studies of home health care workers action.
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Affiliation(s)
- Pierre Le Cann
- Environmental and Occupational Health Department, EHESP School of Public Health, Rennes, France; Inserm UMR 1085-IRSET, Rennes, France.
| | - Hélène Paulus
- ESITC, Engineering School of Construction Works, Cachan, France
| | - Philippe Glorennec
- Environmental and Occupational Health Department, EHESP School of Public Health, Rennes, France; Inserm UMR 1085-IRSET, Rennes, France
| | - Barbara Le Bot
- Environmental and Occupational Health Department, EHESP School of Public Health, Rennes, France; Inserm UMR 1085-IRSET, Rennes, France
| | - Sophie Frain
- Captair Bretagne Association, Dinan Hospital, Dinan, France
| | - Jean Pierre Gangneux
- Inserm UMR 1085-IRSET, Rennes, France; Parasitology-Mycology Laboratory, Rennes Teaching Hospital/University Rennes 1, Rennes, France
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Tsurikisawa N, Saito A, Oshikata C, Yasueda H, Akiyama K. Effective allergen avoidance for reducing exposure to house dust mite allergens and improving disease management in adult atopic asthmatics. J Asthma 2016; 53:843-53. [PMID: 27049597 DOI: 10.3109/02770903.2016.1155218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We investigated the best strategy for adult asthmatics to avoid exposure to Dermatophagoides group (Der-1) allergens. METHODS Adult atopic asthmatics (n = 111) followed a 32-item checklist for avoiding Der-1 allergen exposure. Twenty-five patients were excluded through incomplete sampling; 50 remaining patients encased their pillows/futons/mattresses in microfine-fiber covers, 13 used vacuum cleaners with dust-mite-collection nozzles, and 23 acted as non-intervention controls. During August-October 2010 and August-October 2011, dust samples were collected in Petri dishes placed in bedrooms for 2 weeks and from mattresses/futons by using adhesive tape on one morning. A Der-1 level decrease was defined as a mean 2011 Der-1 level of <1 as a ratio of the 2010 level on tape or Petri dish samples. We analyzed the associations between Der-1 level change (by ELISA) and % weekly variability in peak expiratory flow (PEF) or fraction of exhaled nitric oxide (FeNO) after intervention. RESULTS Der-1 levels decreased significantly in the covers group but not the vacuuming group. FeNO levels and PEF variability were unchanged in both groups. In patients whose Petri dish or tape samples showed decreased Der-1 levels, the % PEF variability was lower in 2011 than in 2010, but FeNO levels were unchanged. Three interventions (vacuuming all family members' mattress/futon surfaces at least weekly or after exposure of the futons to sunlight, and floor wiping before vacuuming), plus using covers, were the most effective management strategy in reducing Der-1 levels. CONCLUSIONS This environmental and bedding maintenance program may help manage adult atopic asthma.
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Affiliation(s)
- Naomi Tsurikisawa
- a Department of Allergy and Respirology , National Hospital Organization Sagamihara National Hospital , Kanagawa , Japan.,c Department of Respirology , National Hospital Organization Saitama Hospital , Saitama , Japan
| | - Akemi Saito
- b Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital , Kanagawa , Japan
| | - Chiyako Oshikata
- a Department of Allergy and Respirology , National Hospital Organization Sagamihara National Hospital , Kanagawa , Japan.,c Department of Respirology , National Hospital Organization Saitama Hospital , Saitama , Japan
| | - Hiroshi Yasueda
- b Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital , Kanagawa , Japan
| | - Kazuo Akiyama
- a Department of Allergy and Respirology , National Hospital Organization Sagamihara National Hospital , Kanagawa , Japan
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van Boven FE. Effectiveness of mite-impermeable covers: a hypothesis-generating meta-analysis. Clin Exp Allergy 2015; 44:1473-83. [PMID: 25048696 DOI: 10.1111/cea.12376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Asthma is a heterogeneous disease. The subject of mite allergen control has evolved into a debate dominated by a Cochrane review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187). A not well-discussed aspect of that study is the selection by those authors of a univariate meta-analysis including various interventions. This study extends the meta-analysis by Gøtzsche and Johansen and aims to generate hypotheses on the effectiveness of various bedding interventions, including the coverage of all bedding elements. Trials were selected based on environmental criteria. The interventions were classified according to the number of barriers used. Standardized mean differences yielded the mite load, three physiological outcomes and asthma symptom scores. The influence of covariates was examined with a mixed-effect model using the metafor package for meta-analysis in R. Twelve trials included 1187 observations. The interventions included one barrier or product (six trials), two barriers or partial control (four trials) and three barriers or integral control (two trials). The exposure data showed considerable heterogeneity (I(2) = 93%). The risk of bias significantly (P = 0.04) influenced the final load, the square root of the interaction between the baseline load and the type of intervention as well (95% CI: -0.66 to -0.07 μg/g; P = 0.02). Changes in load showed similar tendencies. Health outcomes showed moderate to considerable heterogeneity (physiological outcomes I(2) = 44-94%; symptom score I(2) = 93%). A meta-regression of bedding interventions indicates that integral control most significantly reduced mite load when the load was high at baseline. The number of trials was too small to allow an appropriate examination of health outcomes. Future studies are suggested to test the hypothesis that allergic patients benefit from integral control when the baseline mite load is high.
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Affiliation(s)
- F E van Boven
- Working Group on Allergen Avoidance, V&VN Lung Care Nurses, V&VN Dutch Nurses' Association, Utrecht, The Netherlands
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13
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Huiyan W, Yuhe G, Juan W, Junyan Z, Shan W, Xiaojun Z, Ailin T. The Importance of Allergen Avoidance in High Risk Infants and Sensitized Patients: A Meta-analysis Study. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 6:525-34. [PMID: 25374752 PMCID: PMC4214973 DOI: 10.4168/aair.2014.6.6.525] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/03/2014] [Accepted: 02/25/2014] [Indexed: 11/20/2022]
Abstract
Purpose At this time, there is uncertainty regarding whether allergen avoidance is the most appropriate strategy for managing or preventing allergies. The purpose of this study was to evaluate the effectiveness of allergen avoidance in the prevention of allergic symptoms in previously sensitized patients and newborns that have the potential to develop allergies. Methods We performed online searches of articles published from January 1980 to December 2012 in PubMed and The Cochrane Central Register of Controlled Trials, and selected articles involving randomized controlled trials (RCTs) and allergen avoidance. The parameters used to determine allergenic potential in newborns included the risk ratio (RR) of eczema, asthma, rhinitis, wheeze, and cough. The methods employed to evaluate previously sensitized patients were the standardized mean difference (SMD) of forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR). Data quality was assessed using the Jadad scale. Results A total of 14 RCTs were identified. Meta-analysis demonstrated that allergen avoidance for newborns did not reduce the subsequent incidence of allergic diseases (eczema, P=0.21; rhinitis, P=0.3; cough, P=0.1) but significantly reduced the incidence of asthma and wheezing in high-risk infants (asthma, P=0.03; wheeze, P=0.0004). However, previously sensitized patients who reduced their exposure to known allergens did not show improvement in their lung functions (FEV1, P=0.3; PEFR morning, P=0.53; PEFR evening, P=0.2; PEFR, P=0.29). Conclusions Allergen avoidance may not always be successful in preventing allergic symptoms. However, rigorous methodological studies are required to confirm this hypothesis.
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Affiliation(s)
- Wu Huiyan
- Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, the State Key Laboratory of Respiratory Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong 510260, China
| | - Guo Yuhe
- Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, the State Key Laboratory of Respiratory Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong 510260, China
| | - Wang Juan
- Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, the State Key Laboratory of Respiratory Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong 510260, China
| | - Zhang Junyan
- Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, the State Key Laboratory of Respiratory Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong 510260, China
| | - Wang Shan
- Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, the State Key Laboratory of Respiratory Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong 510260, China
| | - Zhang Xiaojun
- Respiratory Department, Southern Building, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Tao Ailin
- Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, the State Key Laboratory of Respiratory Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong 510260, China
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14
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Arroyave WD, Rabito FA, Carlson JC, Friedman EE, Stinebaugh SJ. Impermeable dust mite covers in the primary and tertiary prevention of allergic disease: a meta-analysis. Ann Allergy Asthma Immunol 2014; 112:237-48. [PMID: 24484971 DOI: 10.1016/j.anai.2014.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/10/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Up to 40% of the world's population has been diagnosed with an allergic disease. The most prevalent allergy is to house dust mites. Impermeable mattress covers are often the first treatment in the prevention and decrease of symptoms of allergic disease. OBJECTIVE To perform a meta-analysis evaluating the effectiveness of impermeable mattress covers in the primary prevention of allergic disease and as a single intervention in the tertiary prevention of allergic disease symptoms. METHODS MEDLINE, Embase, Web of Science, and CINAHL were systematically searched for relevant publications. Seven primary prevention trials (n = 3,461) and 17 tertiary prevention trials (n = 1,671) met the inclusion criteria and were included in the review. All article reviews and abstractions were performed in duplicate. RESULTS No significant pooled relative risks were found for the prevention of allergic disease. The pooled relative risks were 0.97 (95% confidence interval [CI] 0.62-1.51) for house dust mite sensitization, 0.92 (95% CI 0.81-1.05) for wheeze, 0.85 (95% CI 0.70-1.02) for asthma, 1.03 (95% CI 0.90-1.19) for allergic rhinitis, and 1.05 (95% CI 0.84-1.32) for allergic dermatitis. Likewise, no significant pooled standardized mean differences were found in the tertiary prevention of symptoms. The pooled standardized mean differences were -0.03 (95% CI -0.15 to 0.09) for peak flow, -0.06 (95% CI -0.32 to 0.20) for asthma symptom score, and -0.39 (95% CI -0.88 to 0.11) for nasal symptom score. A significant effect was seen in the decrease of house mite dust level in the mattress (-0.79, 95% CI -0.98 to -0.60). CONCLUSION No evidence was found to support the use of impermeable mattress covers in the primary prevention of allergic disease or in the tertiary prevention of allergic disease symptoms.
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Affiliation(s)
- Whitney D Arroyave
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
| | - Felicia A Rabito
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - John C Carlson
- Department of Pediatrics, Tulane School of Medicine, New Orleans, Louisiana
| | - Eleanor E Friedman
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Sarah J Stinebaugh
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
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15
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Portnoy J, Miller JD, Williams PB, Chew GL, Miller JD, Zaitoun F, Phipatanakul W, Kennedy K, Barnes C, Grimes C, Larenas-Linnemann D, Sublett J, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D. Environmental assessment and exposure control of dust mites: a practice parameter. Ann Allergy Asthma Immunol 2013; 111:465-507. [PMID: 24267359 PMCID: PMC5156485 DOI: 10.1016/j.anai.2013.09.018] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/20/2013] [Indexed: 12/15/2022]
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16
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Tsurikisawa N, Saito A, Oshikata C, Nakazawa T, Yasueda H, Akiyama K. Encasing bedding in covers made of microfine fibers reduces exposure to house mite allergens and improves disease management in adult atopic asthmatics. Allergy Asthma Clin Immunol 2013; 9:44. [PMID: 24499343 PMCID: PMC3829998 DOI: 10.1186/1710-1492-9-44] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies of avoidance of exposure to group 1 allergens of the Dermatophagoides group (Der p 1) have not yielded consistent improvements in adult asthma through avoidance. We explored whether the use of pillow and bed covers and allergen-avoidance counseling resulted in Der 1-level reduction, as measured by enzyme-linked immunosorbent assay, and thus improved asthma symptoms in adult patients. METHODS Twenty-five adult patients with moderate or severe atopic asthma were randomized into intervention and control groups. Intervention patients slept on pillows and mattresses or futons encased in microfine-fiber covers and were counseled in allergen avoidance through bedroom cleaning. Control patients received neither special covers nor counseling. In the period August to October in 2009 (pre-intervention) and 2010 (post-intervention), dust samples were collected in open Petri dishes placed in bedrooms for 2 weeks and by rapid lifting of dust from bedding and skin using adhesive tape on the morning of 1 day of Petri dish placement. We examined the associations between changes in Der 1 level (as measured by enzyme-linked immunosorbent assay) and clinical symptom score, minimum % peak expiratory flow, and fraction of exhaled nitric oxide. RESULTS Der 1 allergen levels on the mattress/futon covers and near the floor of the bedrooms of intervention patients, but not controls, were lower in 2010 than in 2009. From 2009 to 2010, asthma symptom scores decreased significantly, and minimum % peak expiratory flow increased significantly, in intervention patients. The fall in Der p 1 concentration was correlated with a reduction in the fraction of exhaled nitric oxide. CONCLUSIONS Minimization of Der 1 allergen exposure by encasing pillows and mattresses or futons and receiving counseling on avoiding exposure to indoor allergens improved asthma control in adult patients.
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Affiliation(s)
- Naomi Tsurikisawa
- Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan.
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17
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Abstract
Allergic rhinitis affects a large portion of the population. Patients are frequently sensitized to indoor allergens. The most important contributors are house dust mites, pets, and fungi. In very controlled environments where allergen exposure is significantly reduced, individuals have been shown to have clinical improvement in allergic rhinitis and/or asthma symptoms. Achieving sufficient exposure reduction in the home has proven difficult. Nonetheless, evidence exists that demonstrates exposure avoidance can be useful as an adjunct to other therapies, such as pharmacotherapy and immunotherapy, for the treatment of allergic rhinitis.
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Affiliation(s)
- Robert K Bush
- Department of Medicine, University of Wisconsin-Madison, K4/910 CSC #9988, 600 Highland Avenue, Madison, WI 53792, USA.
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18
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Krieger J, Jacobs DE, Ashley PJ, Baeder A, Chew GL, Dearborn D, Hynes HP, Miller JD, Morley R, Rabito F, Zeldin DC. Housing interventions and control of asthma-related indoor biologic agents: a review of the evidence. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2010; 16:S11-20. [PMID: 20689369 PMCID: PMC3934496 DOI: 10.1097/phh.0b013e3181ddcbd9] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Subject matter experts systematically reviewed evidence on the effectiveness of housing interventions that affect health outcomes, primarily asthma, associated with exposure to moisture, mold, and allergens. Three of the 11 interventions reviewed had sufficient evidence for implementation: multifaceted, in-home, tailored interventions for reducing asthma morbidity; integrated pest management to reduce cockroach allergen; and combined elimination of moisture intrusion and leaks and removal of moldy items to reduce mold and respiratory symptoms. Four interventions needed more field evaluation, 1 needed formative research, and 3 either had no evidence of effectiveness or were ineffective. The 3 interventions with sufficient evidence all applied multiple, integrated strategies. This evidence review shows that selected interventions that improve housing conditions will reduce morbidity from asthma and respiratory allergies.
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Affiliation(s)
- James Krieger
- Chronic Disease and Injury Prevention Section, Public Health-Seattle and King County, Seattle, Washington 98104, USA.
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19
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Cruz AA, Souza-Machado A, Franco R, Souza-Machado C, Ponte EV, Moura Santos P, Barreto ML. The impact of a program for control of asthma in a low-income setting. World Allergy Organ J 2010; 3:167-74. [PMID: 23268428 PMCID: PMC3488909 DOI: 10.1097/wox.0b013e3181dc3383] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The prevalence of asthma is increasing in developing countries and the burden of uncontrolled asthma affects patients, families, and the health system. This is to summarize, evaluate, and discuss previous reports on the impact of a targeted and comprehensive approach to the most severe cases of asthma in a low-income setting. A Program for Control of Asthma (ProAR) was developed in Salvador, Bahia, Brazil, prioritizing the control of severe asthma. By facilitating referrals from the public health system and providing proper multidisciplinary but simple management including education and medication, for free, the Program enrolled 2385 patients in 4 reference clinics. They are offered regular follow up and discharged back to primary health care only when asthma control can be maintained without requirement of a combination of an inhaled corticosteroid and a long-acting β2 agonist. ProAR has markedly reduced health resource utilization and decreased the rate of hospital admissions because of asthma in the entire City (2.8 million inhabitants) by 74%. Moderate to severe rhinitis was associated with lack of control of asthma. The average income of the families in the ProAR was US$2955 a year, and they spent 29% of all their income attempting to control the severe asthma of one member, a unbearable expenditure for a low-income family. The ProAR was shown to be cost-effective, reducing costs to the public health system (US$387 patient/year) and the families (US$789 patient/year). In a low-income setting of Brazil, an intervention prioritizing the control of severe asthma was feasible, effective, and reduced costs.
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Affiliation(s)
- Alvaro A. Cruz
- ProAR-Faculdade de Medicina da Bahia (FMB), Federal University of Bahia (UFBA), and CNPq, Brazil
| | | | - Rosana Franco
- ProAR-Hospital Especializado Octavio Mangabeira, Secretaria de Saude do Estado da Bahia, Brazil
| | | | - Eduardo V. Ponte
- ProAR-Hospital Universitario Professor Edgar Santos, Federal University of Bahia (UFBA), Brazil
| | - Pablo Moura Santos
- ProAR-Hospital Universitario Professor Edgar Santos, Federal University of Bahia (UFBA), Brazil
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20
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Macdonald C, Sternberg A, Hunter P. A systematic review and meta-analysis of interventions used to reduce exposure to house dust and their effect on the development and severity of asthma. CIENCIA & SAUDE COLETIVA 2009; 13:1907-15. [PMID: 18833368 DOI: 10.1590/s1413-81232008000600026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 09/24/2007] [Indexed: 11/21/2022] Open
Abstract
We assessed whether any household dust reduction intervention has the effect of increasing or decreasing the development or severity of atopic disease. Electronic searches on household intervention and atopic disease were conducted in 2007 in EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing asthma outcomes in a household intervention group with either placebo intervention or no intervention. Meta-analyses on the prevention studies found that the interventions made no difference to the onset of wheeze but made a significant reduction in physician-diagnosed asthma. Meta-analysis of lung function outcomes indicated no improvement due to the interventions but found a reduction in symptom days. Qualitatively, health care was used less in those receiving interventions. However, in one study that compared intervention, placebo, and control arms, the reduction in heath care use was similar in the placebo and intervention arms. This review suggests that there is not sufficient evidence to suggest implementing hygiene measures in an attempt to improve outcomes in existing atopic disease, but interventions from birth in those at high risk of atopy are useful in preventing diagnosed asthma but not parental-reported wheeze.
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Affiliation(s)
- Clare Macdonald
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
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21
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22
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Abstract
The major allergen in house dust comes from mites. We performed a systematic review of the randomized trials that had assessed the effects of reducing exposure to house dust mite antigens in the homes of people with mite-sensitive asthma, and had compared active interventions with placebo or no treatment. Fifty-four trials (3002 patients) were included. Thirty-six trials assessed physical methods (26 mattress covers), 10 chemical methods and eight a combination of chemical and physical methods. Despite the fact that many trials were of poor quality and would be expected to exaggerate the reported effect, we did not find an effect of the interventions. For the most frequently reported outcome, peak flow in the morning (1565 patients), the standardized mean difference was 0.00 (95% confidence interval (CI) -0.10 to 0.10). There were no statistically significant differences in number of patients improved (relative risk 1.01, 95% CI 0.80-1.27), asthma symptom scores (standardized mean difference -0.04, 95% CI -0.15 to 0.07) or in medication usage (standardized mean difference -0.06, 95% CI -0.18 to 0.07). Chemical and physical methods aimed at reducing exposure to house dust mite allergens cannot be recommended.
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Affiliation(s)
- P C Gøtzsche
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark
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23
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Abstract
EDITORIAL NOTE This 2011 review predates current reporting standards and methodological expectations for Cochrane Reviews. It should not be used for clinical decision‐making. BACKGROUND The major allergen in house dust comes from mites. Chemical, physical and combined methods of reducing mite allergen levels are intended to reduce asthma symptoms in people who are sensitive to house dust mites. OBJECTIVES To assess the effects of reducing exposure to house dust mite antigens in the homes of people with mite-sensitive asthma. SEARCH STRATEGY PubMed and The Cochrane Library (last searches Nov 2007), reference lists. SELECTION CRITERIA Randomised trials of mite control measures vs placebo or no treatment in people with asthma known to be sensitive to house dust mites. DATA COLLECTION AND ANALYSIS Two authors applied the trial inclusion criteria and evaluated the data. Trial authors were contacted to clarify information. MAIN RESULTS Fifty-four trials (3002 patients) were included. Thirty-six trials assessed physical methods (26 mattress encasings), 10 chemical methods, and 8 a combination of chemical and physical methods. Despite the fact that many trials were of poor quality and would be expected to exaggerate the reported effect, we did not find an effect of the interventions. For the most frequently reported outcome, peak flow in the morning (1565 patients), the standardised mean difference was 0.00 (95% confidence interval (CI) -0.10 to 0.10). There were no statistically significant differences either in number of patients improved (relative risk 1.01, 95% CI 0.80 to 1.27), asthma symptom scores (standardised mean difference -0.04, 95% CI -0.15 to 0.07), or in medication usage (standardised mean difference -0.06, 95% CI -0.18 to 0.07). AUTHORS' CONCLUSIONS Chemical and physical methods aimed at reducing exposure to house dust mite allergens cannot be recommended. It is doubtful whether further studies, similar to the ones in our review, are worthwhile. If other types of studies are considered, they should be methodologically rigorous and use other methods than those used so far, with careful monitoring of mite exposure and relevant clinical outcomes.
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Affiliation(s)
- P C Gøtzsche
- Rigshospitalet, Dept. 3343, Nordic Cochrane Centre. Blegdamsvej 9, Copenhagen Ø, Denmark, 2100.
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24
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Macdonald C, Sternberg A, Hunter PR. A systematic review and meta-analysis of interventions used to reduce exposure to house dust and their effect on the development and severity of asthma. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115:1691-1695. [PMID: 18087584 PMCID: PMC2137102 DOI: 10.1289/ehp.10382] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 09/24/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVES We assessed whether any household dust reduction intervention has the effect of increasing or decreasing the development or severity of atopic disease. DATA SOURCES Electronic searches on household intervention and atopic disease were conducted in January 2007 in EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. No date or language restriction was placed on the literature search. DATA EXTRACTION We included randomized controlled trials comparing asthma outcomes in a household intervention group with either placebo intervention or no intervention. DATA SYNTHESIS Fourteen studies met the inclusion criteria. Eight recruited antenatally and measured development of atopic disease. Six recruited known atopic individuals and measured disease status change. Meta-analyses on the prevention studies found that the interventions made no difference to the onset of wheeze but made a significant reduction in physician-diagnosed asthma. Meta-analysis of lung function outcomes indicated no improvement due to the interventions but found a reduction in symptom days. Qualitatively, health care was used less in those receiving interventions. However, in one study that compared intervention, placebo, and control arms, the reduction in heath care use was similar in the placebo and intervention arms. CONCLUSIONS This review suggests that there is not sufficient evidence to suggest implementing hygiene measures in an attempt to improve outcomes in existing atopic disease, but interventions from birth in those at high risk of atopy are useful in preventing diagnosed asthma but not parental-reported wheeze.
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Affiliation(s)
| | | | - Paul R. Hunter
- Address correspondence to P.R Hunter, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK. Telephone: 44 1603 591004. Fax: 44 1603 593752. E-mail:
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25
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Charpin D, Ercoli J, Griol S, Mouche JM, Maurel G, Felipo R, Dumon H, Max G, Charpin-Kadouch C. Risques liés à l'habitat: les interventions possibles et leur efficacité. Presse Med 2007; 36:1643-50. [PMID: 17433612 DOI: 10.1016/j.lpm.2007.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Numerous health risks have been identified in dwellings and are a public health priority. Homes most often accumulate several different risks. Intervention programs must take this reality into account. Identification of a source of chemical pollution in the home makes it possible to correct indoor air quality quickly and inexpensively and provides immediate health benefits. Extermination of mites requires implementation of a group of complementary techniques in all contaminated areas, with help, when possible, from an indoor environment counselor. A team of multidisciplinary indoor habitat and health advisors must assess the health risks of the home. This inexpensive strategy reduces risks, although its effectiveness still requires confirmation. When the building has structural defects or abnormalities, more complex methods of renovation, or even moving, are necessary. There again, a complete assessment of their benefits to occupants' health is necessary.
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Affiliation(s)
- Denis Charpin
- Service de pneumologie-allergologie, Hôpital Nord, Marseille.
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26
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Shedd AD, Peters JI, Wood P, Inscore S, Forkner E, Smith B, Galbreath AD. Impact of home environment characteristics on asthma quality of life and symptom scores. J Asthma 2007; 44:183-7. [PMID: 17454335 DOI: 10.1080/02770900701209699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We explore the relationship between home-based triggers, asthma symptoms, and quality of life (QOL) with data from 177 adult and pediatric participants who received a home environmental assessment. Outcomes included the Asthma Quality of life Questionnaire, the Prediatric Asthma Quality of Life Questionnaire, the Paediatric Asthma Caregiver's Quality of Questionnaires and the Lara Asthma Symptom Scale. The absence of roaches and the use of dust mite covers were positively associated with QOL in pediatric and adult participants. Frequent bed sheet washing was associated with increased symptoms and decreased quality of life in adults and caregivers of pediatric participants. These findings confirm existing wisdom on roaches and dust mite covers and raise important questions about bed sheet washing recommendations.
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Affiliation(s)
- Angela D Shedd
- University of Texas Health Science Center at San Antonio, TX 78229, USA.
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27
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Chinn S, Heinrich J, Antó JM, Janson C, Norbäck D, Olivieri M, Svanes C, Sunyer J, Verlato G, Wjst M, Zock JP, Burney PG, Jarvis DL. Bronchial responsiveness in atopic adults increases with exposure to cat allergen. Am J Respir Crit Care Med 2007; 176:20-6. [PMID: 17446334 DOI: 10.1164/rccm.200612-1840oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The association of asthma with sensitization and allergen exposure is known to be complex. There have been few studies of bronchial responsiveness in relation to both risk factors in adults. OBJECTIVES To determine the relation of bronchial responsiveness to allergen exposure and IgE sensitization in a community study taking into account the major determinants of bronchial responsiveness in adulthood. METHODS Cross-sectional data were drawn from 1,884 participants in 20 centers in the European Community Respiratory Health Survey follow-up, which included measurement of house dust mite and cat allergen in mattress dust samples, and IgE sensitization to four allergens. Bronchial responsiveness to methacholine was expressed as a continuous variable, and analyzed by multiple regression. MEASUREMENTS AND MAIN RESULTS The trend toward greater bronchial responsiveness with increasing exposure to cat allergen was greater in those sensitized to any of the four allergens than those not sensitized (p = 0.001); there was no significant interaction between cat sensitization and Fel d 1 exposure. No trend was found with house dust mite allergen exposure. The difference in bronchial responsiveness between those exposed to the highest levels compared with the lowest was approximately -2.02 doubling doses of PD20 (95% confidence interval, -3.06 to -0.97), and nearly as great in those exposed to more moderate levels. CONCLUSIONS Cat allergen exposure at moderate levels may be harmful to all atopic adults. The clinical implication is that it is insufficient to test patients with asthma for cat sensitization; all atopic individuals may benefit from reduced cat exposure.
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Affiliation(s)
- Susan Chinn
- Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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28
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Pham-Thi N, Scheinmann P, Fadel R, Combebias A, Andre C. Assessment of sublingual immunotherapy efficacy in children with house dust mite-induced allergic asthma optimally controlled by pharmacologic treatment and mite-avoidance measures. Pediatr Allergy Immunol 2007; 18:47-57. [PMID: 17295799 DOI: 10.1111/j.1399-3038.2006.00475.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although several studies have demonstrated the efficacy of subcutaneous immunotherapy in allergic asthma, few have shown the same benefit using sublingual immunotherapy (SLIT) in asthmatic patients. This study was conducted to assess the efficacy of house dust mite (HDM) SLIT in addition to allergen avoidance and standard pharmacologic treatment. A double-blind, placebo-controlled trial was performed in 111 children (aged 5-15 yr) with HDM-induced mild-to-moderate asthma. After a 4-week baseline phase, patients were randomly assigned to receive SLIT with tablets of HDM extract (n = 55) or placebo (n = 56) for 18 months. Pharmacologic treatment was adjusted every 3 months following a step-down approach. Asthma symptom scores, reduction in use of inhaled corticosteroids and inhaled beta(2)-agonists, rhinitis symptoms, lung function tests, skin sensitivity to HDM, dust mite-specific immunoglobulin (Ig) E and IgG(4), and quality of life (QoL) were assessed during the study. After 18 months of treatment, diurnal and nocturnal asthma symptoms scores did not show significant differences between SLIT and placebo groups. Inhaled corticosteroids and inhaled beta(2)-agonists use was reduced in both groups without significant differences between groups. There were no significant differences in lung function (forced expiratory volume in 1 s and peak flow rate variations) between groups. Rhinitis symptom score decreased in both groups, with no difference between the two groups. The severity dimension of QoL was significantly improved in the SLIT group (age 6-12 yr). SLIT induced a significant reduction of skin sensitivity to HDM (p < 0.01) and a significant increase in HDM-specific IgE and IgG(4) antibodies (p < 0.001) in the SLIT group compared with the placebo group. SLIT was well tolerated with mild/moderate local adverse events. No severe systemic reactions were reported. This study indicates that, when mild-moderate asthmatic children are optimally controlled by pharmacologic treatment and HDM avoidance, SLIT does not provide additional benefit, despite a significant reduction in allergic response to HDM. Under such conditions, only a complete, but ethically unfeasible, discontinuation of inhaled corticosteroid would have demonstrated a possible benefit of SLIT.
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Affiliation(s)
- Nhân Pham-Thi
- Department of Paediatric Pneumology and Allergy, Hôpital Necker-Enfants Malades, Paris, France
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Perry TT, Wood RA, Matsui EC, Curtin-Brosnan J, Rand C, Eggleston PA. Room-specific characteristics of suburban homes as predictors of indoor allergen concentrations. Ann Allergy Asthma Immunol 2007; 97:628-35. [PMID: 17165271 DOI: 10.1016/s1081-1206(10)61092-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Room characteristics predicting indoor allergen exposure in suburban homes have not been clearly identified. OBJECTIVE To examine relationships between room characteristics and concentrations of indoor allergens in homes of suburban asthmatic patients. METHODS The homes of 339 asthmatic children ages 6 to 17 years were studied. Home inspections were conducted by a trained technician, and dust samples were analyzed for indoor allergen content. A high allergen concentration was defined as 8 microg (U)/g or more of fine dust. RESULTS Infrequent sheet washing and wall-to-wall carpet were risk factors for high bedroom dust mite concentrations. Infrequent sheet washing was also a risk factor for high Fel d 1 concentrations. Food remains in the bedroom was a risk factor for high bedroom Bla g 1 levels, and exposed food, leaks, and dirty pots were all risk factors for high kitchen Bla g 1 levels. The combination of lack of mattress or pillow encasements, infrequent sheet washing, and carpeting was associated with a 24-fold increase in odds of a high dust mite concentration (odds ratio [OR], 24.1; 95% confidence interval [CI], 3.2-181.4). Among non-cat owners, the combination of stuffed toys on the bed, lack of mattress or pillow encasements, and infrequent sheet washing was associated with a 49-fold increase in odds of a high Fel d 1 level (OR, 49.4; 95% CI, 2.8-887.3). The combination of leaks, exposed food, and dirty pots was associated with a high kitchen Bla g 1 concentration (OR, 10.6; 95% CI, 2.8-40.5). CONCLUSIONS Specific room characteristics predict high indoor allergen exposure among children with asthma, and a combination of these characteristics may further increase the risk of high allergen exposure.
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Affiliation(s)
- Tamara T Perry
- Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital Research Institute, Little Rock, Arkansas 72202, USA.
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Semic Jusufagic A, Simpson A, Woodcock A. Dust mite allergen avoidance as a preventive and therapeutic strategy. Curr Allergy Asthma Rep 2006; 6:521-6. [PMID: 17026879 DOI: 10.1007/s11882-006-0031-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Asthma is a global health problem with genetic and environmental components. Indoor allergens have a major impact on asthma, and exposure in sensitized subjects can compromise lung function. A reduction in allergen exposure would seem a logical facet to treatment. Methods for reducing mite allergen levels that are effective in the laboratory may not work in the home and may not result in a clinical benefit. Six ongoing studies are investigating the effects of environmental control on the primary prevention of asthma and allergies. Although the Isle of Wight and Canadian studies provide encouraging results at age 8 and 7 years, respectively, it will be some time before a definitive public health message emerges. For secondary prevention, there is little evidence to support the use of mite-proof encasings as a single intervention in adults. In children, however, single or multifaceted interventions appear to be of some benefit.
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Affiliation(s)
- Aida Semic Jusufagic
- Academic Division of Medicine and Surgery, 2nd Floor Education and Research Center, University of Mancester, Wythenshawe Hospital, Southmoor Road, Mancester M23 9LT, UK
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Liccardi G, Cazzola M, Walter Canonica G, Passalacqua G, D'Amato G. New insights in allergen avoidance measures for mite and pet sensitized patients. A critical appraisal. Respir Med 2006; 99:1363-76. [PMID: 15890511 DOI: 10.1016/j.rmed.2005.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2004] [Accepted: 03/09/2005] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Gennaro Liccardi
- Department of Chest Diseases. Division of Pneumology and Allergology A. Cardarelli Hospital, Rione Sirignano, no. 10, 80121, Naples Italy
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Marks GB. Environmental factors and gene-environment interactions in the aetiology of asthma. Clin Exp Pharmacol Physiol 2006; 33:285-9. [PMID: 16487276 DOI: 10.1111/j.1440-1681.2006.04360.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The importance of early life environmental influences on the aetiology of asthma is implied by the observed geographic and temporal variation in the prevalence of the disease among children. 2. There is evidence pointing to the role of exposure to allergen, various aspects of diet and hygiene-related factors in the aetiology of asthma. 3. There is also evidence that heritable factors influence the impact of hygiene-related exposures on the risk of having asthma. Polymorphism within genes coding for the toll-like receptor-lipopolysaccharide (TLR-LPS) signalling pathway may underlie variations in effects of hygiene-related exposures, including specifically endotoxin, on the risk of developing allergic sensitization and allergic disease. 4. At present there is no unifying theory to explain the childhood origins of asthma and, hence, no solid basis for developing preventative interventions. Progress towards this goal requires better understanding of the heterogeneous nature of the disease in early childhood, improved characterization of relevant environmental exposures and long-term follow up of birth cohorts with reliable and valid measures of allergy and asthma outcomes.
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Affiliation(s)
- Guy B Marks
- Woolcock Institute of Medical Research and South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia.
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Dharmage S, Walters EH, Thien F, Bailey M, Raven J, Wharton C, Rolland J, Light L, Freezer N, Abramson M. Encasement of bedding does not improve asthma in atopic adult asthmatics. Int Arch Allergy Immunol 2005; 139:132-8. [PMID: 16374022 DOI: 10.1159/000090388] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Accepted: 09/14/2005] [Indexed: 11/19/2022] Open
Abstract
AIM We evaluated the impact of impermeable bed covers on asthma in asthmatics with clinically relevant house dust mite (HDM) sensitization. METHODS The study included 32 HDM-sensitized asthmatics in whom HDM allergy was considered as a significant factor in their asthma. They were randomized into either an intervention group whose bedding was encased with impermeable covers, or a control group who received cotton covers. Before and 3 and 6 months after encasement, dust samples were collected from the bedding and assayed for Der p 1. Clinical outcomes included quality of life, lung function, bronchial reactivity to methacholine, symptoms, medications and peak flow rates. RESULTS Baseline Der p 1 levels in both the active and the placebo groups were comparable and high (19.2 vs 18.9 microg/g of dust). There was a significant reduction in Der p 1 levels in the active group after 6 months, but not in the placebo group (7.3 vs 21.9 microg/g of dust). Quality of life improved significantly in both the intervention and control groups, but there was no significant difference in the improvements between the groups. There was no significant change in lung function, symptoms, and requirements for medications. CONCLUSIONS Encasement of bedding significantly reduced the Der p 1 levels. However, this was not sufficient to produce worthwhile clinical improvement in those in whom dust mite avoidance might well have been recommended as part of their clinical management.
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Affiliation(s)
- S Dharmage
- Department of Public Health, The University of Melbourne, Australia.
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Romei I, Boner AL. Possible reasons for lack of effect of allergen avoidance in atopy-prone infants and sensitive asthmatic patients. Clin Rev Allergy Immunol 2005; 28:59-71. [PMID: 15834169 DOI: 10.1385/criai:28:1:059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The basic paradigm that allergen exposure produces atopic sensitization, and that continued exposure leads to clinical asthma throughout the development of airway inflammation and bronchial hyperreactivity has been challenged. However, because it was observed that epidemiological evidence suggests that around 40% of asthma cases are attributable to atopy (even using restrictive criteria), the obvious corollary is that if allergen avoidance begins before the onset of sensitization (primary prevention), then it should be associated with a reduced number of new cases of the disease. However, there are conflicting results regarding the effect of allergen avoidance on primary prevention of atopic sensitization and asthma onset. Instead, more uniform and positive results are available from secondary prevention studies. Secondary prevention obviously is an attractive opportunity for pediatricians who may recognize the patients who might benefit from these interventions simply by screening for food allergy in young children with atopic dermatitis. The conflicting results of tertiary prevention are most frequently observed in adult patients and sometimes result from incomplete avoidance of allergens responsible for the sensitization.
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Affiliation(s)
- I Romei
- Department of Pediatrics, University of Verona Italy, Policlinico G.B. Rossi, Piazzale L. Scuro, 1 Verona, Italy
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Custovic A, Wijk RG. The effectiveness of measures to change the indoor environment in the treatment of allergic rhinitis and asthma: ARIA update (in collaboration with GA(2)LEN). Allergy 2005; 60:1112-5. [PMID: 16076293 DOI: 10.1111/j.1398-9995.2005.00934.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Custovic
- North West Lung Centre, Wythenshawe Hospital, University of Manchester, Manchester, UK
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Simpson A, Custovic A. The role of allergen avoidance in the secondary prevention of atopic disorders. Curr Opin Allergy Clin Immunol 2005; 5:223-7. [PMID: 15864079 DOI: 10.1097/01.all.0000168785.51711.27] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Allergen avoidance is recommended as part of the treatment programme of many patients with allergic diseases in Europe and the USA. However, clinical trials of allergen avoidance tend to be small and the findings inconsistent. Several larger studies have recently been published, making a review of the new literature timely. RECENT FINDINGS There have been two large double-blind, placebo-controlled studies on the use of encasings (mattress, pillow and duvet) as a single intervention in adults with asthma. In both studies, participants in the active and the control group showed an improvement in peak flow, but there was no difference between groups over a 12-month period. A further smaller study of encasings reported an improvement in peak flow from 1 week in the active group; this study, however, was only of 9 weeks' duration. In children, the use of encasings was associated with a reduction in asthma medication usage, but not until 6 months into the study. A multifaceted intervention study, with the intervention tailored to the child's sensitization status and home environment (including environmental tobacco smoke), resulted in significant reductions in emergency room visits and symptoms in the active group. SUMMARY The evidence suggests that interventions in children (either single or multifaceted) are associated with a meaningful and sustained improvement in asthma control. However, for adults, allergen proof encasings as a single intervention cannot be recommended. There is a need for a large-scale multifaceted intervention study in adults with asthma.
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Affiliation(s)
- Angela Simpson
- North West Lung Centre, Wythenshawe Hospital, Manchester, UK.
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Abstract
BACKGROUND Simple, inexpensive methods of sampling from allergen reservoirs are necessary for large-scale studies or low-cost householder-operated allergen measurement. METHODS We tested two commercial devices: the Indoor Biotechnologies Mitest Dust Collector and the Drager Bio-Check Allergen Control; two devices of our own design: the Electrostatic Cloth Sampler (ECS) and the Press Tape Sampler (PTS); and a Vacuum Sampler as used in many allergen studies (our Reference Method). Devices were used to collect dust mite allergen samples from 16 domestic carpets. Results were examined for correlations between the sampling methods. RESULTS With mite allergen concentration expressed as microg/g, the Mitest, the ECS and the PTS correlated with the Reference Method but not with each other. When mite allergen concentration was expressed as microg/m2 the Mitest and the ECS correlated with the Reference Method but the PTS did not. In the high allergen conditions of this study, the Drager Bio-Check did not relate to any methods. CONCLUSIONS The Mitest Dust Collector, the ECS and the PTS show performance consistent with the Reference Method. Many techniques can be used to collect dust mite allergen samples. More investigation is needed to prove any method as superior for estimating allergen exposure.
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Affiliation(s)
- J K Sercombe
- Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
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Valero A, Serrano C. [Are environmental controls effective for house-dust-mite allergies?]. Arch Bronconeumol 2004; 40:389-91. [PMID: 15458613 DOI: 10.1016/s1579-2129(06)60340-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
BACKGROUND The major allergen in house dust comes from mites. Chemical, physical and combined methods of reducing mite allergen levels are intended to reduce asthma symptoms in people who are sensitive to house dust mites. OBJECTIVES To assess the effects of reducing exposure to house dust mite antigens in the homes of people with mite-sensitive asthma. SEARCH STRATEGY Cochrane Airways Group trials register, and PubMed and The Cochrane Library (last searches June 2004), reference lists. SELECTION CRITERIA Randomised trials of mite control measures vs placebo or no treatment in asthmatic people known to be sensitive to house dust mites. DATA COLLECTION AND ANALYSIS Two reviewers applied the trial inclusion criteria, assessed their quality and extracted the data independently. Study authors were contacted to clarify information. MAIN RESULTS Forty-nine trials (2733 patients) were included; the number of patients has more than doubled since the last version of this review. Thirty-one trials assessed physical methods, ten assessed chemical methods, and eight a combination of chemical and physical methods. Despite the fact that many trials were of poor quality and would be expected to exaggerate the reported effect, we did not find an effect of the interventions. For the most frequently reported outcome, peak flow in the morning (1339 patients), the standardised mean difference was -0.02 (95% confidence interval (CI) -0.13 to 0.08). There were no statistically significant differences either in number of patients improved (relative risk 1.01, 95% CI 0.80 to 1.27), asthma symptom scores (standardised mean difference -0.01, 95% CI -0.10 to 0.13), or in medication usage (standardised mean difference -0.05, 95% CI -0.18 to 0.09). REVIEWERS' CONCLUSIONS Chemical and physical methods aimed at reducing exposure to house dust mite allergens cannot be recommended. It is doubtful whether further studies, similar to the ones in our meta-analysis, are worthwhile. If other types of studies are considered, they should be methodologically rigorous and use other methods than those used so far, with careful monitoring of mite exposure and relevant clinical outcomes.
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Affiliation(s)
- P C Gøtzsche
- Nordic Cochrane Centre, Rigshospitalet, Dept. 7112, Blegdamsvej 9, Copenhagen Ø, Denmark, 2100
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Rijssenbeek-Nouwens LHM, Oosting AJ, Bruijnzeel-Koomen CAFM, de Bruin-Weller MS. Anti-allergic mattress covers in asthma: to do or not to do? Clin Exp Allergy 2004; 33:1613-7. [PMID: 14656344 DOI: 10.1111/j.1365-2222.2003.01829.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Valero A, Serrano C. ¿Son eficaces las normas ambientales en la alergia a ácaros? Arch Bronconeumol 2004. [DOI: 10.1016/s0300-2896(04)75556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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