Environmental Health and Preventive Medicine

, Volume 17, Issue 5, pp 377–384

Environmental intervention for house dust mite control in childhood bronchial asthma

Regular Article

Abstract

Objectives

This study was carried out to determine the effectiveness of physical and chemical environmental control measures for house dust mites (HDM) in controlling bronchial asthma in children.

Methods

A total of 160 asthmatic children who were sensitized to HDM underwent clinical and environmental assessment. The children were randomly allocated into one of four groups according to the intervention (chemical, physical, both chemical and physical, none) and the effectiveness of the intervention was assessed at 8 and 16 weeks.

Results

The group for which physical control measures were used showed significant improvement in all outcome measures, including mean differences of forced expiratory volume after 1 s (FEV1) and peak expiratory flow rate (PEFR), which were 2.05% and 4.65 l/min, respectively, at the 8-week follow-up evaluation. The percentage of severe asthma decreased from 45 to 22%. Similar results were obtained for the group with both chemical (tannic acid) and physical interventions (p < 0.05 for all measures). In the group where tannic acid was used as a chemical measure, the number of children with moderate and severe asthma decreased from 15 in each category to 11 and 7, respectively. In the control group, only the mean difference of PEFR (1.62 l/min) was significant after 16 weeks. Despite these promising findings, only the FEV1 was significantly different (p = 0.014) when the four groups were compared.

Conclusions

Based on these results, we conclude that simple physical control measures have the potential to contribute to the control of asthma symptoms in asthmatic children sensitized to HDM allergen.

Keywords

House dust mite Asthma Children Environmental intervention Control 

References

  1. 1.
    Masoli M, Fabian D, Holt S, Bealey R. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004;59(5):469–78.PubMedCrossRefGoogle Scholar
  2. 2.
    Pearce N, Aït-Khaled N, Beasley R, Mallol J, Keil U, Mitchell E, et al. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2007;62(9):758–66.PubMedCrossRefGoogle Scholar
  3. 3.
    Kay AB. Allergy and allergic diseases. Second of two parts. N Engl J Med. 2001;344(2):109–13. Review.PubMedCrossRefGoogle Scholar
  4. 4.
    The National Institute of Health (NIH). Global initiative for asthma: global strategy for asthma management and prevention. NIH publication 2004 no. 02-3659. Bethesada: NIHGoogle Scholar
  5. 5.
    Khallaf N, el-Ansary S, Hassan M. Acute respiratory infections: sentinel survey in Egypt. National ARI Control Programme, Child Survival Project, Ministry of Health, Bab El Louk, Cairo, Egypt. 1993.Google Scholar
  6. 6.
    El-Hefny AM, Nassar SI, El-Heneidy FM, Said M, El-Beleidy AS, El-Marsam E, et al. Epidemiology of childhood asthma in Cairo. Med J Cairo Univ. 1994;62:505–18.Google Scholar
  7. 7.
    Georgy V, Fahim HI, El-Gaafary M. Prevalence and socioeconomic associations of asthma and allergic rhinitis in northern Africa. Eur Respir J. 2006;28:756–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Khedr MS. Epidemiology of asthma in Egypt. Paper presented at the Middle East Asthma Symposium, Cairo, Egypt: 1988.Google Scholar
  9. 9.
    Zedan M, Settin A, Farag M, Ezz-Elregal M, Osman E, Fouda A. Prevalence of bronchial asthma among Egyptian school children. Egypt J Bronchology. 2009;3:124–30.Google Scholar
  10. 10.
    Custovic A, Simpson A, Woodcock A. Importance of indoor allergens in the induction of allergy and elicitation of allergic disease. Allergy. 1998;53:115–20.PubMedCrossRefGoogle Scholar
  11. 11.
    GINA (Global Initiative for Asthma). The global strategy for asthma management and prevention 2009. Available at: http://www.ginasthma.org.
  12. 12.
    Peat J, Bjforksten B. Primary and secondary prevention of allergic asthma. Eur Respir J. 1998;12(27):28s–34s.Google Scholar
  13. 13.
    Dietemann A, Bessot JC, Hoyet C, Ott M, Verot A, Pauli G. A double-blind, placebo-controlled trial of solidified benzyl benzoate applied in dwellings of asthmatic patients sensitive to mites: clinical efficacy and effect on mite allergens. J Allergy Clin Immunol. 1993;91:738–46.PubMedCrossRefGoogle Scholar
  14. 14.
    Hayden ML, Rose G, Diduch KB, Domson P, Chapman MD, Heymann PW, et al. Benzyl benzoate moist powder: investigation of acarical activity in cultures and reduction of dust mite allergens in carpets. J Allergy Clin Immunol. 1992;89:536–45.PubMedCrossRefGoogle Scholar
  15. 15.
    Carter MC, Perzanowski MS, Raymond A, Platts-Mills TA. Home intervention in the treatment of asthma among inner-city children. J Allergy Clin Immunol. 2001;108:732–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Gotzsche PC, Johansen HK, Burr ML, Hammarquist C. House dust mite control measures for asthma. Cochrane Database Syst Rev. 2001; 3:CD001187.Google Scholar
  17. 17.
    Htut T, Higenbottam TW, Gill GW, Darwin R, Anderson PB, Syed N. Eradication of house dust mite from homes of atopic asthmatic subjects: a double-blind trial. J Allergy Clin Immunol. 2001;107:55–60.PubMedCrossRefGoogle Scholar
  18. 18.
    Woodcock A, Forster L, Matthews E, Martin J, Letley L, Vickers M. Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. N Engl J Med. 2003;349:225–36.PubMedCrossRefGoogle Scholar
  19. 19.
    Morgan WJ, Crain EF, Gruchalla RS, O’Connor GT, Kattan M, Evans CR, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. 2004;351:1068–80.PubMedCrossRefGoogle Scholar
  20. 20.
    American Academy of Allergy and Immunology. Skin testing and radioallergosorbent testing (RAST) for diagnosis of specific allergens responsible for IgE-mediated diseases. J Allergy Clin Immunol. 1983;72:515–7.CrossRefGoogle Scholar
  21. 21.
    National Asthma Education and Prevention Program. National Asthma Education and Prevention Program Expert Panel Report 3—guidelines for the diagnosis and management of asthma, Summary Report 2007. J Allergy Clin Immunol. 2007;120(5):S94–138.CrossRefGoogle Scholar
  22. 22.
    Hamilton RG, Eggleston PA. Environmental allergen analyses. Methods. 1997;13:53–60.PubMedCrossRefGoogle Scholar
  23. 23.
    Matts J, Lachin J. Properties of permuted-block randomization in clinical trials. Control Clin Trials. 1988;9:327–44.PubMedCrossRefGoogle Scholar
  24. 24.
    Crain EF, Walter M, O’Connor GT, Mitchell H, Gruchalla RS, Kattan M, et al. Home and allergic characteristics of children with asthma in seven US urban communities and design of an environmental intervention: the Inner-City Asthma Study. Environ Health Perspect. 2002;110:939–45.PubMedCrossRefGoogle Scholar
  25. 25.
    Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice-Hall; 1986.Google Scholar
  26. 26.
    Pajares F. Self-efficacy beliefs in academic settings. Rev Educ Res. 1996;66(4):543–78.Google Scholar
  27. 27.
    de Blay F, Fourgaut G, Hedelin G, Vervloet D, Michel FB, Godard P, et al. Medical Indoor Environment Counselor (MIEC): role in compliance with advice on mite allergen avoidance and on mite allergen exposure. Allergy. 2003;58(1):27–33.PubMedCrossRefGoogle Scholar
  28. 28.
    Frederick JM, Warner JO, Jessop WJ, Enander I, Warner JA. Effect of a bed covering system in children with asthma and house dust mite hypersensitivity. Eur Respir J. 1997;10:361–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Causer SM, Lewis RD, Batek JM Sr, Ong KH. Influence of wear, pile height and cleaning method on removal of mite allergen from carpet. J Occup Environ Hyg. 2004;1:237–42.PubMedCrossRefGoogle Scholar
  30. 30.
    Eggleston PA. Improving indoor environments: reducing allergen exposures. J Allergy Clin Immunol. 2005;116:122–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Terreehorst I, Duivenvoorden HJ, Tempels-Pavlica Z, Oosting AJ, de Monchy JG, Bruijnzeel-Koomen CA, et al. The effect of encasings on quality of life in adult house dust mite allergic patients with rhinitis, asthma and/or atopic dermatitis. Allergy. 2005;60(7):888–93.PubMedCrossRefGoogle Scholar
  32. 32.
    Dharmage S, Walters EH, Thien F, Bailey M, Raven J, Wharton C, et al. Encasement of bedding does not improve asthma in atopic adult asthmatics. Int Arch Allergy Immunol. 2006;139:132–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Warner JA, Frederick JM, Bryant TN, Weich C, Raw GJ, Hunter C, et al. Mechanical ventilation and high-efficiency vacuum cleaning: a combined strategy of mite and mite allergen reduction in the control of mite-sensitive asthma. J Allergy Clin Immunol. 2000;105(1 Pt 1):75–82.PubMedCrossRefGoogle Scholar
  34. 34.
    Takaro TK, Wu F. Childhood asthma and environmental interventions. Environ Health Perspect. 2007;115(6):971–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Gotzsche PC, Hammarquist C, Burr M. House dust mite control measures in the management of asthma: meta-analysis. Br Med J. 1998;317:1105–10.CrossRefGoogle Scholar
  36. 36.
    Meltzer AA, Smolensky MH, D’Alonzo GE, Harrist RB, Scott PH. An assessment of peak expiratory flow as a surrogate measurement of FEV, in stable asthmatic children. Chest. 1989;96:329–33.PubMedCrossRefGoogle Scholar
  37. 37.
    Murray AB, Ferguson AC. A comparison of spirometric messurements in allergen bronchial challenge testing. Clin Allergy. 1981;11:87–93.PubMedCrossRefGoogle Scholar
  38. 38.
    Bérubé D, Cartier A, L’Archevêque J, Ghezzo H, Malo JL. Comparison of peak expiratory flow rate and FEV1 in assessing bronchomotor tone after challenges with occupational sensitizers. Chest. 1991;99:831–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Mihrshahi S, Marks GB, Criss S, Tovey ER, Vanlaar CH, Peat JK. CAPS Team. Effectiveness of an intervention to reduce house dust mite allergen levels in children’s beds. Allergy. 2003;58(8):784–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Lau S, Wahn J, Schulz G, Sommerfeld C, Wahn U. Placebo-controlled study of the mite allergen-reducing effect of tannic acid plus benzyl benzoate on carpets in homes of children with house dust mite sensitization and asthma. Pediatr Allergy Immunol. 2002;13(1):31–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Gotzsche PC, Johansen HK, Schmidt LM, Burr ML. House dust mite control measures for asthma. Cochrane Database Syst Rev. 2004;3:CD001187.Google Scholar
  42. 42.
    Gotzsche PC, Johansen HK. House dust mite control measures for asthma. Cochrane Database Syst Rev. 2008;3:CD001187.Google Scholar
  43. 43.
    Jung-Wook S, Ju-Hee S, Tae-Won S, Kyung-Won K, Eun-Soo K, Myung HS, et al. Atopy and house dust mite sensitization as risk factors for asthma in children. Yonsei Med J. 2005;46(5):629–34.CrossRefGoogle Scholar

Copyright information

© The Japanese Society for Hygiene 2012

Authors and Affiliations

  1. 1.Tropical Health Department, High Institute of Public HealthAlexandria UniversityAlexandriaEgypt
  2. 2.Environmental Chemistry and Biology, Environmental Health Department, High Institute of Public HealthAlexandria UniversityAlexandriaEgypt
  3. 3.Public Health Sciences, Biology Department, College of Science and Humanities StudiesSalman Bin Abdulaziz UniversityAl-Kharj, Al-RiyadhKingdom of Saudi Arabia

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