Environmental and Occupational Disorders
Effect of mattress and pillow encasings on children with asthma and house dust mite allergy,☆☆

https://doi.org/10.1067/mai.2003.5Get rights and content

Abstract

Background: House dust mite (HDM) allergy is a frequent cause of allergic asthma in children. Reduction of exposure seems to be the most logical way to treat these patients. Objective: Our aim was to investigate whether mattress and pillow encasings resulted in an effective long-term control of HDM allergen levels, thereby reducing the need for asthma medication in children with asthma and HDM allergy. Methods: In a prospective, double-blind, placebo-controlled study 60 children (age range, 6-15 years) with asthma and HDM allergy were randomized to active (allergy control) or placebo mattress and pillow encasings. After a 2-week baseline period, follow-up was performed every 3 months for 1 year. During the entire study period, the dose of inhaled steroids was tapered off to the lowest effective dose according to well-defined criteria. Results: Fifty-two patients completed the trial, and 5 were excluded, leaving data from 47 children (26 in the active treatment group and 21 in the placebo group) for analysis. A significant perennial reduction in HDM allergen concentrations was seen only for the active treatment group. Also, a significant decrease in the dose of inhaled steroids (mean, 408 to 227 μg/d; P < .001) was found for the active treatment group only, with significant differences between groups after 9 and 12 months. After 1 year, the dose of inhaled steroids was reduced by at least 50% in significantly more children in the active treatment group than in the placebo group (73% vs 24%, P < .01). Conclusion: Encasing of mattresses and pillows resulted in a significant long-term reduction in HDM allergen concentrations in mattresses and in the need for inhaled steroids in children with asthma and HDM allergy. (J Allergy Clin Immunol 2003;111:169-76.)

Section snippets

Population

A total of 60 children (age range, 5-15 years) with asthma and documented allergy to HDMs from the Departments of Pediatrics at Sønderborg, Kolding, and Viborg Hospitals, Denmark, were included.

The inclusion criteria were all of the following: doctor-diagnosed asthma; a positive skin prick test (SPT) response to HDM (Dermatophagoides pteronyssinus) ; a positive bronchial provocation test result with HDM allergen extract (D pteronyssinus ; PC20 less than 100,000 SQU); and a total HDM

Results

A total of 60 patients were included and randomized, and as seen in Fig 2, data from 47 children, 26 actively treated patients and 21 control subjects, were included in the final analysis.

. Flow diagram of the progress through the study. (a) Three subjects moved to another region, 2 before they received the encasings; (b) insufficient data concerning asthma medication and lack of dust samples; (c) concomitant treatment with unallowed medication (growth hormone).

A total of 4 children in the

Discussion

HDM allergy is the most common cause of allergic asthma in childhood. The relationship between exposure and asthma symptoms in sensitized individuals is complex, with some patients reacting to very low doses of allergen, whereas other patients tolerate rather high doses.4, 19 Meanwhile, exposure to higher allergen levels usually is associated with more severe asthma in sensitized patients. Avoidance of HDM allergen exposure seems to be the most logical way to treat children with asthma and HDM

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    Supported by the Danish Asthma and Allergy Association and the Danish Research Foundation.

    ☆☆

    Reprint requests: Susanne Halken, MD, Department of Pediatrics, Sønderborg Hospital, DK-6400 Sønderborg, Denmark.

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