The combined influence of immunotherapy and mite allergen reduction on bronchial hyperresponsiveness in mite-sensitive asthmatic children.
Encasings for mattresses, blankets and pillows in combination with mite allergen reduction on the floor have proved effective in reducing bronchial hyperreactivity of mite-allergic children. We studied the effect of combining the use of encasings with specific immunotherapy in comparison to the use of encasings alone (control group). Twenty mite-allergic children (Skin Prick Test, RAST, mean age 10 years) with asthma and high domestic mite allergen exposure ( > 2 microg Der p 1 + f 1/g mattress dust) were included in our study. The concentration of these major allergens as well as specific and nonspecific bronchial hyperreactivity (PC20 FEV1 histamine) were assessed before, 6 months after and 1 year after start of treatment. All children received elongated polytetrafluorethylene (ePTFE; Goretex/Intervent Allergy Bedding System) encasings. A subgroup of eight children were treated additionally by specific immunotherapy with a partially purified mite extract (ALK Scherax) and a maximum dose of 100000 SQ-U Der p + f. Initially both groups were comparable with respect to the parameters assessed. In 80% of children, encasings reduced Der p 1 and Der f 1 concentrations on the mattress to below 3% of the initial values (P < 0.01). The median reduction was 99%. PC20 FEV1 histamine increased from 0.4 to 1.4 mg/dl (median) in the combined group with immunotherapy and encasings (P < 0.05) and remained essentially unchanged in the control group. PC20 FEV1 Der p did not increase significantly in either group.


CONCLUSIONS
Specific immunotherapy with allergen extracts is an effective adjunct to encasings. Encasings, a key factor for reducing Der p 1 and Der f 1 on the mattress, should be used in combination with other avoidance measures (e.g. removal of carpets) in order to improve allergen-induced bronchial hyperreactivity.
Paul
K
K
Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität zu Berlin, Pädiatrie m.S. Pneumologie/Immunologie, Germany.
Klettke
U
U
Wahn
U
U
D000293:Adolescent; D000818:Animals; D001249:Asthma / Q000503:physiopathology*; D001512:Bedding and Linens; D016535:Bronchial Hyperreactivity / Q000276:immunology* / Q000517:prevention & control*; D001985:Bronchial Provocation Tests; D002648:Child; D004391:Dust / Q000009:adverse effects; D004781:Environmental Exposure; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006632:Histamine / Q000032:analysis; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology / Q000517:prevention & control; D007167:Immunotherapy; D008297:Male; D008925:Mites / Q000276:immunology*; D011138:Polytetrafluoroethylene; D018709:Statistics, Nonparametric
D004391:Dust; D006632:Histamine; D011138:Polytetrafluoroethylene