Department of General Practice, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
Pediatr Allergy Immunol. 2011 Dec;22(8):794-802. doi: 10.1111/j.1399-3038.2011.01192.x. Epub 2011 Jul 13.
Although the effectiveness of the multifaceted allergen-reducing interventions for the prevention of asthma in susceptible children was showed to be proven, the feasibility was not clear.
The research question of the PREVention of asthma in susceptible children (PREVASC) trial was focused on the assessment of the effectiveness and feasibility of a multifaceted intervention on the prevention of allergic asthma in general practice. The effectiveness and feasibility of an intervention aimed at the simultaneous reduction in the environmental exposures to inhalant- and food allergens in susceptible children was investigated. A total of 476 children susceptible for developing asthma were initially included during pregnancy and were randomly divided over an intervention group of n = 222 children whose parents were offered a multifaceted environmental exposure-reducing intervention. Controls (n = 221) received usual care. The main outcome was 'diagnosis of allergic asthma at age 6'.
A significant reduction in inhalant allergen exposure levels of house dust mite [(Der p1), p = 0.043], cat [(Fel d1), p = 0.037], and dog [(Can f1), p = 0.012] was reached. Significantly more intervention group children started using cow's milk and solids after the age of 6 months (p ≤ 0.001). No statistical difference, however, was reached between groups on the duration of breast-feeding (p = 0.635) and the reduction in smoke exposure (p = 0829). At age 6, the intervention had no influence on the development of main outcome allergic asthma (OR = 1.010 (CI 0.580-1.758).
Other primary preventive asthma-reducing interventions were shown to be effective in reducing the occurrence of asthma for at least the first 7-8 yr of life. The multifaceted PREVASC allergic asthma primary preventive intervention was effective in reducing the exposure to inhalant and food allergens, but was not feasible for the parents. A lack of sufficient room for improvement focus on stimulating adherence seemed to be involved. It is suggested that a multifaceted environmental exposure-reducing intervention may have to be adapted to the personal circumstances of patients at baseline.
尽管多方面的过敏原减少干预措施在预防易感儿童哮喘方面的有效性已被证明，但其实用性尚不清楚。
PREVention of asthma in susceptible children (PREVASC) 试验的研究问题侧重于评估多方面干预措施预防普通儿科中过敏性哮喘的有效性和可行性。旨在同时减少易患儿童吸入性和食物过敏原环境暴露的干预措施的有效性和可行性进行了研究。共有 476 名易患哮喘的儿童在怀孕期间最初被纳入研究，并随机分为干预组 222 名儿童，其父母获得了多方面的环境暴露减少干预措施。对照组（n=221）接受常规护理。主要结局是“6 岁时诊断为过敏性哮喘”。
达到了室内尘螨（[Der p1]，p=0.043）、猫（[Fel d1]，p=0.037）和狗（[Can f1]，p=0.012）吸入性过敏原暴露水平的显著降低。干预组的儿童在 6 个月后开始使用牛奶和固体食物的比例显著更高（p≤0.001）。然而，两组之间的母乳喂养时间（p=0.635）和吸烟暴露减少（p=0.829）无统计学差异。在 6 岁时，干预措施对主要结局过敏性哮喘的发展没有影响（OR=1.010（CI 0.580-1.758））。
其他主要的预防性哮喘减少干预措施在减少哮喘发生方面至少在生命的前 7-8 年是有效的。多方面的 PREVASC 过敏性哮喘一级预防干预措施在减少吸入性和食物过敏原暴露方面是有效的，但对父母来说不可行。缺乏足够的改进空间，关注于提高依从性似乎是一个问题。建议多方面的环境暴露减少干预措施可能需要根据患者的基线情况进行调整。
