-
Allergy Feb 2012To assess the benefits and harms of measures designed to reduce house dust mite (HDM) exposure in the management of house dust mite-sensitive allergic rhinitis. (Review)
Review
BACKGROUND
To assess the benefits and harms of measures designed to reduce house dust mite (HDM) exposure in the management of house dust mite-sensitive allergic rhinitis.
METHODS
Systematic review of randomized controlled trials was made, in which HDM control measures have been evaluated in comparison with placebo or other HDM avoidance measures, in patients with clinically proven allergic rhinitis.
RESULTS
Nine trials involving 501 participants satisfied the inclusion criteria. These trials have investigated the effectiveness of bedroom environmental control programmes involving the use of HDM impermeable bedding covers (n = 4), acaricides (n = 2), high-efficiency particulate air filters (n = 2) and, using a factorial design, acaricide and HDM impermeable bedding covers in isolation and combination (n = 1). Seven of the nine trials reported that, when compared with control, the interventions studied resulted in significant reductions in HDM load. Of the interventions studied to date, acaricides appear to be the most promising, although the findings from these studies need to be interpreted with care because of their methodological limitations. House dust mite impermeable bedding as an isolated intervention is unlikely to offer benefit.
CONCLUSIONS
Trials have tended to be small and of poor methodological quality, making it difficult to offer any definitive recommendations. Interventions that achieve substantial reductions in HDM load may offer some benefit in reducing rhinitis symptoms. Isolated use of HDM impermeable bedding is unlikely to prove effective.
Topics: Animals; Antigens, Dermatophagoides; Humans; Pyroglyphidae; Rhinitis, Allergic, Perennial; Tick Control
PubMed: 22103686
DOI: 10.1111/j.1398-9995.2011.02752.x -
BMJ Clinical Evidence May 2011Eczema, as defined by the World Allergy Organization (WAO) revised nomenclature in 2003, affects 15% to 20% of school children and 2% to 5% of adults worldwide. About... (Review)
Review
INTRODUCTION
Eczema, as defined by the World Allergy Organization (WAO) revised nomenclature in 2003, affects 15% to 20% of school children and 2% to 5% of adults worldwide. About 50% of people with eczema demonstrate atopy, with specific immunoglobulin E responses to allergens.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of topical medical treatments, and dietary interventions in adults and children with established eczema? What are the effects of breastfeeding, reducing allergens, or dietary interventions for primary prevention of eczema in predisposed infants? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 54 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: breastfeeding, controlling house dust mites, corticosteroids, dietary exclusion of eggs or cow's milk, elementary diets, emollients, essential fatty oils, few-foods diet, multivitamins, pimecrolimus, probiotics, pyridoxine, reducing maternal dietary allergens, tacrolimus, vitamin E, and zinc supplements.
Topics: Adrenal Cortex Hormones; Animals; Dermatitis, Atopic; Eczema; Emollients; Humans; Hypersensitivity; Pyroglyphidae
PubMed: 21609512
DOI: No ID Found -
Allergy Jun 2008The major allergen in house dust comes from mites. We performed a systematic review of the randomized trials that had assessed the effects of reducing exposure to house... (Review)
Review
The major allergen in house dust comes from mites. We performed a systematic review of the randomized trials that had assessed the effects of reducing exposure to house dust mite antigens in the homes of people with mite-sensitive asthma, and had compared active interventions with placebo or no treatment. Fifty-four trials (3002 patients) were included. Thirty-six trials assessed physical methods (26 mattress covers), 10 chemical methods and eight a combination of chemical and physical methods. Despite the fact that many trials were of poor quality and would be expected to exaggerate the reported effect, we did not find an effect of the interventions. For the most frequently reported outcome, peak flow in the morning (1565 patients), the standardized mean difference was 0.00 (95% confidence interval (CI) -0.10 to 0.10). There were no statistically significant differences in number of patients improved (relative risk 1.01, 95% CI 0.80-1.27), asthma symptom scores (standardized mean difference -0.04, 95% CI -0.15 to 0.07) or in medication usage (standardized mean difference -0.06, 95% CI -0.18 to 0.07). Chemical and physical methods aimed at reducing exposure to house dust mite allergens cannot be recommended.
Topics: Allergens; Animals; Asthma; Bedding and Linens; Dust; Environmental Exposure; Humans; Insecticides; Pest Control; Pyroglyphidae; Randomized Controlled Trials as Topic
PubMed: 18445182
DOI: 10.1111/j.1398-9995.2008.01690.x -
The British Journal of Dermatology Sep 2006Flares of eczema are attributed to many factors, often with minimal scientific evidence. (Review)
Review
BACKGROUND
Flares of eczema are attributed to many factors, often with minimal scientific evidence.
OBJECTIVES
Systematically to search, summarize and critically appraise the scientific evidence to support the roles of individual 'flare factors' in eczema.
METHODS
We searched Medline from 1966 until 20 April 2005 to identify relevant articles for inclusion in this review. No language restrictions were imposed. All study designs were included and were ranked according to the strength of evidence. Experimental and provocation studies were restricted to those using a double-blind design. We included randomized controlled trials if they were provocation studies. Meta-analysis was not possible due to differences in study populations and methodology. The studies are therefore described qualitatively.
RESULTS
The roles of foodstuffs (13 studies), house dust mite (three), other aeroallergens (two), seasonality (two), bacterial infections (one), textiles (three), detergents (one), sunlight (one) and stress (two) were assessed in different study populations, using a variety of study designs. All studies were performed on selected groups and only four were longitudinal in design. Collectively, these studies provide some evidence that certain foods, house dust mite, stress and seasonal factors are relevant causes of disease worsening in certain subgroups with eczema. No good evidence could be found to support the role of detergents, textiles and irritants in causing worsening of eczema.
CONCLUSIONS
Despite anecdotal lists in textbooks and review articles, very little good evidence exists for 'flare factors' in eczema. The focus of all of the included studies was on disease worsening rather than clinically relevant flares. Studies of longitudinal design are required to clarify the roles of these and other putative flare factors in eczema.
Topics: Allergens; Animals; Disease Progression; Dust; Eczema; Evidence-Based Medicine; Food Hypersensitivity; Humans; Pyroglyphidae; Research Design; Risk Factors
PubMed: 16911274
DOI: 10.1111/j.1365-2133.2006.07381.x -
The Journal of Family Practice Apr 2005Citations in scientific articles may tend to favor the views presented. We studied whether there is such reference bias in narrative review articles that discuss... (Review)
Review
BACKGROUND
Citations in scientific articles may tend to favor the views presented. We studied whether there is such reference bias in narrative review articles that discuss interventions against house dust mites for people with asthma.
DESIGN
Systematic review of reviews identified in a Medline search that expressed an opinion about the clinical effects of physical or chemical intervention methods.
MAIN OUTCOME MEASURE
Positive bias was judged to have occurred if the reference list contained a higher proportion of trial references with significant results than among all trials available to the authors (published 2 years or more prior to the review).
RESULTS
Seventy reviews were included, of which 63 (90%) recommended physical interventions. Forty-six reviews had trial references, 4 of these only to chemical interventions. In the remaining 42 reviews, reference bias was detected (P=2 x 10-8). The most quoted trial had only 7 patients per group, its claimed significant result was probably erroneous, and it did not report a clinical outcome. Intervention recommendations were often based on nonrandomized evidence, and the most quoted nonrandomized controlled study had included only 10 patients per group but claimed very positive results.
CONCLUSION
The narrative review articles were severely biased, and their positive intervention recommendations are at variance with the systematic Cochrane Review on this topic and a recent very large trial of physical intervention, both of which failed to find an effect.
Topics: Asthma; Bias; Evidence-Based Medicine; Humans; Mite Infestations; Pyroglyphidae; Review Literature as Topic
PubMed: 15833223
DOI: No ID Found -
House dust mite avoidance measures for perennial allergic rhinitis: a systematic review of efficacy.The British Journal of General Practice... Apr 2003Perennial allergic rhinitis is a common chronic disorder that results most frequently from sensitivity to house dust mites. National and international guidelines for the... (Review)
Review
Perennial allergic rhinitis is a common chronic disorder that results most frequently from sensitivity to house dust mites. National and international guidelines for the management of allergic rhinitis recommend that house dust mite avoidance measures be considered in all patients with house dust mite-provoked rhinitis. To assess the benefit and harm of measures designed to reduce house dust mite exposure in the management of house dust mite-sensitive allergic rhinitis, published and unpublished randomised controlled trials were systematically searched. A methodological assessment of trial quality was conducted using the Cochrane approach. Four trials satisfied the inclusion criteria, all of which were small and judged to be of poor quality. The results indicate that, when compared with controls, significant reductions of allergen load can be achieved by physical and chemical means, but there is little evidence at present that these reductions translate into sustained improvements in clinical outcomes. No serious adverse effects were reported from the interventions.
Topics: Adolescent; Adult; Allergens; Child; Child, Preschool; Chronic Disease; Dust; Environmental Exposure; Female; Humans; Male; Middle Aged; Pyroglyphidae; Randomized Controlled Trials as Topic; Rhinitis, Allergic, Perennial
PubMed: 12879834
DOI: No ID Found