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Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma.
N Engl J Med 2003; 349(3):225-36NEJM

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.

Authors+Show Affiliations

South Manchester Academic Group, University of Manchester, North West Lung Centre, Wythenshawe Hospital, Manchester, United Kingdom. ashley.a.woodcock@man.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12867606

Citation

Woodcock, Ashley, et al. "Control of Exposure to Mite Allergen and Allergen-impermeable Bed Covers for Adults With Asthma." The New England Journal of Medicine, vol. 349, no. 3, 2003, pp. 225-36.
Woodcock A, Forster L, Matthews E, et al. Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. N Engl J Med. 2003;349(3):225-36.
Woodcock, A., Forster, L., Matthews, E., Martin, J., Letley, L., Vickers, M., ... Custovic, A. (2003). Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. The New England Journal of Medicine, 349(3), pp. 225-36.
Woodcock A, et al. Control of Exposure to Mite Allergen and Allergen-impermeable Bed Covers for Adults With Asthma. N Engl J Med. 2003 Jul 17;349(3):225-36. PubMed PMID: 12867606.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. AU - Woodcock,Ashley, AU - Forster,Louise, AU - Matthews,Edward, AU - Martin,Jeannett, AU - Letley,Louise, AU - Vickers,Madge, AU - Britton,John, AU - Strachan,David, AU - Howarth,Peter, AU - Altmann,Daniel, AU - Frost,Christopher, AU - Custovic,Adnan, AU - ,, PY - 2003/7/18/pubmed PY - 2003/7/23/medline PY - 2003/7/18/entrez SP - 225 EP - 36 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 349 IS - 3 N2 - 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. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/12867606/Control_of_exposure_to_mite_allergen_and_allergen_impermeable_bed_covers_for_adults_with_asthma_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa023175?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -