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House dust mite allergen avoidance different in adults vs children? Two recent articles cover the ineffectiveness of bedding covers in reducing asthma and allergic rhinitis symptoms in adults. The UK study used only mite-impermeable mattress covers whereas the Dutch study covered mattresses, pillows, duvets etc. The latter study is of significance in the Netherlands where healthcare funders cover the purchase of such bedding to the tune of $2.4m per annum. Sensitivity to house dust mites was demonstrated in both studies, but clinical responses were insignificant at 12 months even though some changes were noted in the allergenic burden. These results in adult subjects are in keeping with meta-analyses on the subject but differ from paediatric experiences. The question is: Is this discrepancy real? One theory proposes that allergen avoidance will be effective after exposure of shorter duration but not after prolonged exposure in sensitized subjects where there might be persistent and progressive deterioration of symptom control even if the exposure has ceased. Read more: N Engl J Med 2003;349:pp207-8 pp225-36 pp237-46 J Allergy Clin Immunol 2000;105:252-8 1992;90:135-8 2003;111:169-76 Clin Exp Allergy 1996;26:386-96 1997;27:1145-50 Eur Respir J 1994;7:761-7 |