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Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma

Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma
Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma
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 microg per gram vs. 1.71 microg per gram in the control group; P=0.01) but not at 12 months (1.05 microg per gram vs. 1.64 microg 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.
225-236
Woodcock, Ashley
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Forster, Louise
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Matthews, Edward
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Martin, Jeannett
be734a9d-6466-4f52-9347-cb836d3d0158
Letley, Louise
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Vickers, Madge
ef71e39f-d4f5-47df-b0a2-12f967f09378
Britton, John
6857c532-b076-4fbc-82bd-78a147a54d32
Strachan, David
eb6d9187-54b4-4815-9d7d-eaa91f25fae1
Howarth, Peter
ff19c8c4-86b0-4a88-8f76-b3d87f142a21
Altmann, Daniel
bff58ac5-0b27-4bbd-a6a7-36bb32513170
Frost, Christopher
bbcf6af0-4c0a-4922-a0d0-a3a28b2ef9db
Custovic, Adrian
1e4ed7dd-c49b-4555-a63d-5f2eac5c51d7
Medical Research Council General Practice Research Framework
Woodcock, Ashley
b13cf094-8318-42ef-b8ed-2f4b8d8770f3
Forster, Louise
150190a4-b48e-4936-8163-ef3db9127648
Matthews, Edward
35c0aea6-84a3-4966-8827-e582db8a539b
Martin, Jeannett
be734a9d-6466-4f52-9347-cb836d3d0158
Letley, Louise
8871d4b7-c0ad-43ed-a77e-7a05bcd1266c
Vickers, Madge
ef71e39f-d4f5-47df-b0a2-12f967f09378
Britton, John
6857c532-b076-4fbc-82bd-78a147a54d32
Strachan, David
eb6d9187-54b4-4815-9d7d-eaa91f25fae1
Howarth, Peter
ff19c8c4-86b0-4a88-8f76-b3d87f142a21
Altmann, Daniel
bff58ac5-0b27-4bbd-a6a7-36bb32513170
Frost, Christopher
bbcf6af0-4c0a-4922-a0d0-a3a28b2ef9db
Custovic, Adrian
1e4ed7dd-c49b-4555-a63d-5f2eac5c51d7

Woodcock, Ashley, Forster, Louise, Matthews, Edward, Martin, Jeannett, Letley, Louise, Vickers, Madge, Britton, John, Strachan, David, Howarth, Peter, Altmann, Daniel, Frost, Christopher and Custovic, Adrian , Medical Research Council General Practice Research Framework (2003) Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. New England Journal of Medicine, 349 (3), 225-236. (doi:10.1056/NEJMoa023175).

Record type: Article

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 microg per gram vs. 1.71 microg per gram in the control group; P=0.01) but not at 12 months (1.05 microg per gram vs. 1.64 microg 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.

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Published date: 17 July 2003

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Local EPrints ID: 46707
URI: http://eprints.soton.ac.uk/id/eprint/46707
PURE UUID: 47bcd263-7126-4156-bcdd-9fcaead30719

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Date deposited: 13 Jul 2007
Last modified: 15 Mar 2024 09:26

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Contributors

Author: Ashley Woodcock
Author: Louise Forster
Author: Edward Matthews
Author: Jeannett Martin
Author: Louise Letley
Author: Madge Vickers
Author: John Britton
Author: David Strachan
Author: Peter Howarth
Author: Daniel Altmann
Author: Christopher Frost
Author: Adrian Custovic
Corporate Author: Medical Research Council General Practice Research Framework

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