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Dust mite allergen avoidance in the treatment of hospitalized children with asthma
M L Hayden1, M Perzanowski, L Matheson
1Department of Medicine, University of Virginia, Charlottesville, USA.
Insights
Dust mite allergen avoidance improved lung function in children hospitalized with asthma. Even with challenges, results suggest avoidance strategies can be effective for managing pediatric asthma, especially for sensitized individuals.
Area of Science:
- Pediatric Allergy and Immunology
- Environmental Health
- Respiratory Medicine
Background:
- Childhood asthma is a significant cause of hospital admissions.
- Inhalant allergens, particularly dust mites, are linked to chronic airway inflammation in asthmatic children.
- Understanding allergen exposure is crucial for managing pediatric asthma exacerbations.
Purpose of the Study:
- To assess the feasibility and impact of dust mite allergen avoidance in the homes of children hospitalized with acute asthma.
- To evaluate the effectiveness of specific allergen avoidance measures on asthma control in pediatric patients.
- To determine if reducing dust mite exposure improves respiratory outcomes in children with severe asthma.
Main Methods:
- A randomized controlled trial involving children aged 5-18 hospitalized with asthma.
- Intervention group received active dust mite allergen avoidance (impermeable covers, hot water linen washing, flooring changes, tannic acid spray).
- Placebo group received sham interventions; dust and serum samples analyzed for allergens and IgE; outcomes included PEFR, spirometry, methacholine challenge, and readmissions.
Main Results:
- Both active and placebo groups showed reductions in allergen levels.
- Children in the active avoidance group demonstrated improved peak expiratory flow rates (PEFR) at 3 and 6 months.
- Improved PEFR was observed in sensitized children when dust mite allergen levels decreased, though no significant differences in FEV1 or methacholine challenge were noted.
Conclusions:
- Dust mite allergen avoidance can lead to improved PEFR in children hospitalized with asthma, particularly in sensitized individuals.
- The study supports the efficacy of allergen avoidance strategies for managing pediatric asthma, even in severe cases.
- Limitations included small sample size, compliance issues, and participant severity, suggesting further research is needed.
Background:
Asthma is a leading cause of hospital admission in children. The majority of children with asthma are sensitized and exposed to inhalant allergens that may contribute to chronic airway inflammation.
Objective:
To evaluate the practicality and effects of dust mite (D. farinae and D. pteronyssinus) allergen avoidance in homes of children hospitalized with acute asthma.
Methods:
Children 5 to 18 years of age who were admitted with asthma to a suburban Atlanta hospital were randomly assigned, without knowledge of allergen sensitization or exposure in their houses, to active (n = 13) or placebo (n = 10) treatment group. Active treatment included encasing mattress, box springs, and pillows in allergen impermeable covers; weekly hot water wash of bed linens; replacement of bedroom carpet with polished flooring; and 3% tannic acid spray to living room carpet. Placebo treatment included permeable encasing for bedding, cold water wash, and water spray for carpet. Dust samples were analyzed for dust mite, cockroach, and cat allergens, while serum samples were analyzed for IgE antibodies to the same allergens. Outcome measures included daily peak expiratory flow rates, spirometry, methacholine inhalation challenge, and hospital readmission.
Results:
Children in both groups were similar by demographics, sensitization, and exposure to dust mite allergen. Allergen levels fell > 3-fold in many active and placebo homes. Children in the active group had improved PEFR at 3 and 6 months after intervention (P < .04, P < .05, respectively). Six of seven children in the study who were sensitized and exposed to dust mite allergen demonstrated improved PEFR at 3 months when allergen levels fell in both bedding and bedroom floor. There was no difference in FEV1 or methacholine challenge, although a few children in either group could tolerate methacholine because of bronchial hyperreactivity. Six children (four active and two placebo) were readmitted to hospital during the study.
Conclusion:
Increases in PEFR were recorded among children in the active treatment group and also among sensitized patients whose dust mite allergens fell. These results support the hypothesis that avoidance can be effective even among children admitted to hospital. The study was complicated by insufficient numbers of mite-allergic children and poor compliance with diaries and the protocol. Recruitment from the hospital resulted in participants with more severe asthma than anticipated. The results also suggest that many of the patients in this group will continue to have exacerbations triggered by upper or lower respiratory tract infections.