Allergen avoidance shows promise as asthma treatment strategy in poor setting

NEW YORK (Reuters Health) – Allergen avoidance strategies can be difficult to implement in lower socioeconomic settings, but they can reduce the number of acute pediatric visits for asthma, according to a recent report.

Dr. Thomas A. E. Platts-Mills and colleagues, from the University of Virginia in Charlottesville, randomized 104 inner-city children with asthma to one of three allergen avoidance groups.

Children in the active avoidance group received allergen-impermeable mattress and pillow covers and effective cockroach bait (Combat). Their parents were instructed to wash bed linens once a week in hot water. The parents were also given instructions on other cleaning measures to control dust mites and roaches.

Children in the placebo group were given allergen-permeable mattress and pillow covers, ineffective roach traps, and their parents were instructed to wash linens in cool or cold water.

Children in the control group received routine medical care but no allergen-control measures or instructions.

Home visits were made at enrollment and at 3, 8, and 12 months after enrollment for the active and placebo groups. During each visit, covers were checked and replaced if needed and additional cockroach traps were provided. In the control group, home visits were made 12 months after enrollment for dust collection.

Children whose homes were visited had fewer acute visits for asthma than children whose homes were not visited, the investigators note (p < 0.001). However, there was no significant difference between the active and placebo groups in terms of the number of acute visits or home allergen concentrations, the authors state in the November issue of the Journal of Allergy and Clinical Immunology.

In children with mite allergy, a decrease in mite allergen levels at home was associated with a decrease in acute visits (p < 0.01). Cockroach allergen avoidance measures appeared to be ineffective and there was no link between changes in home levels of the allergen and changes in acute visits.

"Applying allergen avoidance as a treatment for asthma among children living in poverty is difficult because of multiple sensitivities and problems applying the protocols in this environment," the authors state. However, the current findings with mite allergy suggest that avoidance strategies can be effective in this population.

In a related editorial, Dr. Peyton A. Eggleston, from Johns Hopkins University in Baltimore, comments that "allergen avoidance provides a really promising approach in allergic asthma, with benefit potentially gained in chronic symptom control and medication reduction."

J Allergy Clin Immunol 2001;108:685-687,732-737.

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