Abstract
BackgroundStudies of avoidance of exposure to group 1 allergens of the Dermatophagoides group (Der p 1) have not yielded consistent improvements in adult asthma through avoidance. We explored whether the use of pillow and bed covers and allergen-avoidance counseling resulted in Der 1-level reduction, as measured by enzyme-linked immunosorbent assay, and thus improved asthma symptoms in adult patients.MethodsTwenty-five adult patients with moderate or severe atopic asthma were randomized into intervention and control groups. Intervention patients slept on pillows and mattresses or futons encased in microfine-fiber covers and were counseled in allergen avoidance through bedroom cleaning. Control patients received neither special covers nor counseling. In the period August to October in 2009 (pre-intervention) and 2010 (post-intervention), dust samples were collected in open Petri dishes placed in bedrooms for 2 weeks and by rapid lifting of dust from bedding and skin using adhesive tape on the morning of 1 day of Petri dish placement. We examined the associations between changes in Der 1 level (as measured by enzyme-linked immunosorbent assay) and clinical symptom score, minimum % peak expiratory flow, and fraction of exhaled nitric oxide.ResultsDer 1 allergen levels on the mattress/futon covers and near the floor of the bedrooms of intervention patients, but not controls, were lower in 2010 than in 2009. From 2009 to 2010, asthma symptom scores decreased significantly, and minimum % peak expiratory flow increased significantly, in intervention patients. The fall in Der p 1 concentration was correlated with a reduction in the fraction of exhaled nitric oxide.ConclusionsMinimization of Der 1 allergen exposure by encasing pillows and mattresses or futons and receiving counseling on avoiding exposure to indoor allergens improved asthma control in adult patients.
Highlights
Studies of avoidance of exposure to group 1 allergens of the Dermatophagoides group (Der p 1) have not yielded consistent improvements in adult asthma through avoidance
These results showed that the concentration of D. pteronyssinus allergen 1 (Der p 1) in mattresses did not decrease after an intervention treatment by using bed covers, or that lung function in terms of peak expiratory flow (PEF), bronchial hyperresponsiveness, asthma symptom score, and asthma medication use did not change after the concentration of Der p 1 in mattresses was decreased by intervention treatments
We explored whether reductions in House dust mite (HDM) levels on bedding and in the bedroom, as measured by fluorometric enzymelinked immunosorbent assay (ELISA), affected asthma control in adult patients who were being treated with Inhaled corticosteroids (ICS) and other asthma medications
Summary
Patients Between August and October 2009, we recruited 25 adult asthma patients at the National Hospital Organization, Sagamihara, National Hospital, Kanagawa, Japan. Study design Between 1 August and 31 October 2009, each patient collected ambient dust samples in open Petri dishes (plastic, not pre-coated with any protein) (90 × 15 mm; SH90-15; Asahi Glass Co. Ltd., Tokyo, Japan) [19,25,26] that had been left in the bedroom for 2 weeks. All patients collected house dust samples in the period 1 August to 31 October 2010 for follow-up clinical measurement. Measurement of peak expiratory flow Patients measured PEF three times every morning and evening before bronchodilator use during the 2-week dust collection period each year with an ASSESS PEF meter (CHEST, Tokyo, Japan) [20]; measurements with an error of less than 10% variance among PEF measured three times were recorded by the patient in a diary. Statistical analysis was performed with SPSS for Windows, version 20 (SPSS Inc., Chicago, IL)
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