Terreehorst Ingrid, Hak Eelko, Oosting Albert J, Tempels-Pavlica Zana, de Monchy Jan G R, Bruijnzeel-Koomen Carla A F M, Aalberse Rob C, Gerth van Wijk Roy
Department of Allergology, Erasmus Medical Center, Rotterdam, Netherlands.
N Engl J Med. 2003 Jul 17;349(3):237-46. doi: 10.1056/NEJMoa023171.
Encasing bedding in impermeable covers reduces exposure to house-dust mites, but the clinical benefit of this intervention as part of mite-avoidance measures for patients with allergic rhinitis is not known. We performed a multicenter, randomized, placebo-controlled trial of one year of use of impermeable bedding covers in the bedrooms of patients with rhinitis who were sensitized to house-dust mites to determine the effects on the signs and symptoms of disease.
Three participating university medical centers enrolled 279 patients with allergic rhinitis who were randomly assigned to receive impermeable or non-impermeable (control) covers for their mattress, pillow, and duvet or blanket. At the start of the study, all participants received information on general allergen-avoidance measures. The severity of rhinitis was measured on a rhinitis-specific visual-analogue scale and by means of a daily symptom score and nasal allergen provocation testing. We also measured the concentrations of Dermatophagoides pteronyssinus (Der p1) and D. farinae (Der f1) in dust from patients' mattresses, bedroom floors, and living-room floors at base line and after 12 months as a measure of the efficacy of the intervention.
A total of 232 patients completed the study. There was a significant reduction in Der p1 and Der f1 concentrations in the mattresses of the impermeable-cover group, whereas there was no significant reduction in the control group. However, there was no significant effect on the clinical outcome measures. Analyses of subgroups defined according to age, level of exposure, type and severity of sensitization, or characteristics of the patient's home had similar results.
Mite-proof bedding covers, as part of a structured allergy-control program, reduced the level of exposure to mite allergens. Despite the success of the intervention, this single avoidance measure did not lead to a significant improvement of clinical symptoms in patients with allergic rhinitis.
使用不可渗透的床罩可减少接触屋尘螨，但作为变应性鼻炎患者螨回避措施一部分的这种干预措施的临床益处尚不清楚。我们进行了一项多中心、随机、安慰剂对照试验，对尘螨致敏的鼻炎患者在卧室使用不可渗透床罩一年，以确定其对疾病体征和症状的影响。
三家参与研究的大学医学中心招募了279例变应性鼻炎患者，将其随机分配，分别使用不可渗透或可渗透（对照）的床垫、枕头和羽绒被或毛毯罩。在研究开始时，所有参与者均获得了关于一般变应原回避措施的信息。采用变应性鼻炎特异性视觉模拟量表、每日症状评分和鼻变应原激发试验来测量鼻炎的严重程度。我们还测量了患者床垫、卧室地板和客厅地板灰尘中粉尘螨（Der p1）和户尘螨（Der f1）在基线时和12个月后的浓度，以此作为干预效果的指标。
共有232例患者完成了研究。不可渗透床罩组床垫中的Der p1和Der f1浓度显著降低，而对照组则无显著降低。然而，对临床结局指标无显著影响。根据年龄、接触水平、致敏类型和严重程度或患者家庭特征定义的亚组分析结果相似。
作为结构化变应性疾病控制计划的一部分，防螨床罩可降低螨变应原的接触水平。尽管干预措施取得了成功，但这一单一的回避措施并未使变应性鼻炎患者的临床症状得到显著改善。
