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	Full Text PDF PDA Full Text Perspective by Platts-Mills, T. A.E. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The effectiveness of avoidance of house-dust-mite allergen (Dermatophagoides pteronyssinus 1 [Der p1]) in the management of asthma is uncertain.

Methods We conducted a double-blind, randomized, placebo-controlled study of allergen-impermeable bed covers involving 1122 adults with asthma. The primary outcomes were the mean morning peak expiratory flow rate over a four-week period during the run-in phase and at six months and the proportion of patients who discontinued inhaled corticosteroid therapy as part of a phased-reduction program during months 7 through 12. Der p1 was measured in mattress dust in a 10 percent random subsample of homes at entry and at 6 and 12 months.

Results The prevalence of sensitivity to dust-mite allergen was 65.4 percent in the group supplied with allergen-impermeable bed covers (active-intervention group) and 65.1 percent in the control group supplied with non-impermeable bed covers. The concentration of Der p1 in mattress dust was significantly lower in the active-intervention group at 6 months (geometric mean, 0.58 µg per gram vs. 1.71 µg per gram in the control group; P=0.01) but not at 12 months (1.05 µg per gram vs. 1.64 µg per gram; P=0.74). The mean morning peak expiratory flow rate improved significantly in both groups (from 410.7 to 419.1 liters per minute in the active-intervention group, P<0.001 for the change; and from 417.8 to 427.4 liters per minute in the control group, P<0.001 for the change). After adjustment for base-line differences (by analysis of covariance), there was no significant difference between the groups in the peak expiratory flow rate at six months (difference in means, active-intervention group vs. control group, –1.6 liters per minute [95 percent confidence interval, –5.9 to 2.7] among all patients [P=0.46] and –1.5 liters per minute [95 percent confidence interval, –6.9 to 3.9] among mite-sensitive patients [P=0.59]). There was no significant difference between the groups in the proportion in whom complete cessation of inhaled corticosteroid therapy was achieved (17.4 percent in the active-intervention group and 17.1 percent in the control group) or in the mean reduction in steroid dose, either among all patients or among mite-sensitive patients.

Conclusions Allergen-impermeable covers, as a single intervention for the avoidance of exposure to dust-mite allergen, seem clinically ineffective in adults with asthma.

Source Information

From the South Manchester Academic Group, University of Manchester, North West Lung Centre, Wythenshawe Hospital, Manchester (A.W., A.C.); Medical Research Council General Practice Research Framework, London (L.F., E.M., J.M., L.L., M.V.); the Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham (J.B.); the Department of Public Health Sciences, St. George's Hospital Medical School, London (D.S.); University Medicine, Southampton University General Hospital, Southampton (P.H.); and the Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London (D.A., C.F.) — all in the United Kingdom.

Address reprint requests to Dr. Woodcock at the North West Lung Centre, Wythenshawe Hospital, Manchester M23 9LT, United Kingdom, or at ashley.a.woodcock{at}man.ac.uk.

Full Text of this Article

Related Letters:

Bed Covers and Dust Mites
Boggs P. B., Simon M. R., Chowdhury B. A., Tovey E. R., O'Meara T. J., Marks G. B., Weinberger M., Woodcock A., Custovic A., Terreehorst I., Hak E., Gerth van Wijk R.
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N Engl J Med 2003; 349:1668-1671, Oct 23, 2003. Correspondence

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