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Als
einzige Maßnahme zur Vermeidung des Hausstaubmilbenallergens
ist milbenundurchlässige Bettwäsche bei erwachsenen Patienten
mit allergisch bedingtem Asthma nicht geeignet, um die Atemnot
zu bessern.
New England Journal of Medicine, Volume 349:225-236 July
17, 2003 Number 3
Control of Exposure to Mite Allergen and Allergen-Impermeable
Bed Covers for Adults with Asthma
Ashley Woodcock, M.D., Louise Forster, Ph.D., Edward Matthews,
B.A., Jeannett Martin, M.A., Louise Letley, R.G.N., Madge
Vickers, Ph.D., John Britton, M.D., David Strachan, M.D.,
Peter Howarth, M.D., Daniel Altmann, D.Phil., Christopher
Frost, Dip.Stat., Adnan Custovic, M.D., and The Medical
Research Council General Practice Research Framework
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@man.ac.uk.
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