Platts-Mills Thomas A E
Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, Va.
J Allergy Clin Immunol. 2008 Oct;122(4):694-696. doi: 10.1016/j.jaci.2008.07.045.
Decreasing exposure to indoor allergens has been studied extensively and is a well accepted part of the treatment for allergic disease. The 2007 revision of the evidence-based guidelines recommends allergen avoidance as part of the management of asthma. In contrast, a recent meta-analysis concluded that dust mite avoidance is "of no use" in the treatment of asthma. There are obvious sources of bias that could have influenced the evaluation of published trials either by the guideline panel or by the group conducting the meta-analysis. An important issue is whether meta-analysis is a valid method of evaluating studies such as those on dust mite avoidance that are highly variable. Reading the published series of 4 meta-analyses on this subject from the Cochrane Library suggests that decisions about which trials to include can have a major effect on the outcome. The process of meta-analysis may also have other potential conflicts. The recent meta-analysis on dust mite avoidance appears to be seriously flawed because of the decisions about inclusion and exclusion as well as the way in which studies were evaluated. The conclusion is that the criticisms of the recommendations in the 2007 guidelines were not well founded.
减少室内过敏原暴露已得到广泛研究，并且是过敏性疾病治疗中被广泛接受的一部分。2007年循证指南修订版推荐避免接触过敏原作为哮喘管理的一部分。相比之下，最近一项荟萃分析得出结论，避免接触尘螨在哮喘治疗中“毫无用处”。存在明显的偏倚来源，这可能影响了指南小组或进行荟萃分析的团队对已发表试验的评估。一个重要问题是，荟萃分析是否是评估像避免接触尘螨这类高度可变研究的有效方法。阅读Cochrane图书馆发表的关于该主题的4篇荟萃分析系列文章表明，决定纳入哪些试验可能对结果产生重大影响。荟萃分析过程可能还存在其他潜在冲突。最近关于避免接触尘螨的荟萃分析似乎存在严重缺陷，原因在于纳入和排除标准的决定以及研究评估方式。结论是，对2007年指南中建议的批评没有充分依据。
