Department of Internal Medicine, Section of Allergology, Erasmus Medical Center, Rotterdam, The Netherland.
Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
Clin Exp Allergy. 2019 Apr;49(4):400-409. doi: 10.1111/cea.13340. Epub 2019 Feb 11.
Asthma affects three hundred million people worldwide. The effectiveness of house dust mite allergen control for asthma treatment is debatable. One aspect that has been little discussed in existing meta-analyses is the possible role of environmental strategies. Here, we reintroduce the previously defined strategies for mite allergen control and discuss their importance to the debate on clinical effectiveness. The strategy of concurrent bedroom interventions is related to the combined use of a priori defined interventions, while the strategy of exposure-based control relates to the treatment of relevant textiles after assessing exposure. The air purification strategy aims to purify the human breathing zone of airborne allergens. In Western European patient practice, the use of these strategies differs. A post hoc study of the dominant Cochrane review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187) appears to indicate that a majority of the underlying trials reported on the strategy of concurrent bedroom interventions, which were mainly executed in a minimal manner. Some trials have reported on the air purification strategy and may potentially alter the debate on effectiveness. No trial has reported on the strategy of exposure-based control. We therefore hypothesize that the absence of evidence for the effectiveness of mite allergen control for asthma treatment applies to the strategy of concurrent bedroom interventions. The evidence-based effectiveness of the exposure-based control strategy appears to be undetermined. The results of our post hoc reanalysis urge that future meta-analyses of mite allergen control should a priori define the environmental strategy under study. Future trials of mite allergen control are warranted to test the exposure-based strategy as well as the sparsely tested strategy of air purification.
哮喘影响着全球 3 亿人。屋尘螨变应原控制对哮喘治疗的有效性存在争议。在现有的荟萃分析中，一个讨论较少的方面是环境策略的可能作用。在这里，我们重新引入之前定义的螨变应原控制策略，并讨论它们对临床有效性争论的重要性。同时进行卧室干预的策略与预先定义的干预措施的联合使用有关，而基于暴露的控制策略与评估暴露后对相关纺织品的处理有关。空气净化策略旨在净化人体呼吸区域内的空气传播过敏原。在西欧患者的实践中，这些策略的使用存在差异。对 Gøtzsche 和 Johansen 主导的 Cochrane 综述（Cochrane Database of Systematic Reviews，2008，Art. No：CD001187）的事后研究似乎表明，大多数基础试验报告了同时进行卧室干预的策略，该策略主要以最小化的方式执行。一些试验报告了空气净化策略，可能会改变有效性的争论。没有试验报告基于暴露的控制策略。因此，我们假设缺乏螨变应原控制对哮喘治疗有效性的证据适用于同时进行卧室干预的策略。基于暴露的控制策略的循证有效性似乎尚未确定。我们事后重新分析的结果敦促未来的螨变应原控制荟萃分析应预先定义所研究的环境策略。未来有必要对螨变应原控制进行试验，以测试基于暴露的策略以及空气净化这一测试较少的策略。
