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Manchester Asthma and Allergy Study: low-allergen environment can be achieved and maintained during pregnancy and in early life.
Custovic A, Simpson B, Simpson A, Hallam C, Craven M, Brutsche M, Woodcock A
J Allergy Clin Immunol. 2000;105( 2 Pt 1):252-8.
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Abstract
BACKGROUND: Early exposure to dust mite allergens may be critical for primary sensitization.Reducing exposure may offer a realistic chance for primary prevention ofsensitization and asthma, but it is essential to implement measures thatcan achieve and maintain the low-allergen environment. OBJECTIVE: Ourpurpose was to assess the effectiveness of mite allergen avoidancemeasures in achieving and maintaining a low-allergen environment duringpregnancy and in the first year of life. METHODS: The Manchester Asthmaand Allergy Study is a prospective, prenatally randomized study thatfollows the development of asthma and atopy in a cohort of infants at highrisk (both parents atopic) who are randomly allocated to full miteallergen avoidance or to a normal regimen. Avoidance measures comprise (1)mite-proof covers (mattress, pillow, and quilt) for parental bed, (2)high-filtration vacuum cleaner, (3) vinyl flooring in infant's bedroom,(4) new crib and portable crib mattresses encased in mite-proof material,(5) benzyl benzoate (Acarosan) applied on carpets and soft furniture, (6)bed linens washed in hot water weekly, and (7) washable soft toys. Dustsamples from the parental bed, bedroom floor, living room floor, infant'smattress, and nursery floor were collected between the 10th and 14th weeksof pregnancy, immediately after birth, and then at age 6 months and 1year, and Der p 1 levels were determined by mAb-based ELISA. RESULTS:Recovered Der p 1 from maternal mattress was reduced by 97. 25% (95%confidence interval [CI] 95.25%-98.41%) during the second and thirdtrimesters of pregnancy, with the effect persisting for 6 months (98%reduction, 95% CI 97.25%-99.1%) and 12 months (97.6% reduction, 95% CI95.7%-98.6%) after the birth (active vs control, P <.000001). Total Derp 1 from bedroom floor in the active group was reduced by 53.7% (95% CI25.7%-71.2%) in samples collected within 4 weeks of the child's birth,with the percentage reduction being 62. 8% (95% CI 39.3%-77.2%) at 6months and 26.5% (95% CI -24% to 57.1%) at 1 year (active compared vscontrol, P <.007). Der p 1 levels in crib mattress and nursery floor inthe active group were extremely low (crib mattresses geometric mean [95%CI] 2.3 ng [1.6-3.4] at birth, 6.8 ng [4.5-10] at age 6 months, and 15.6ng [9.8-24.8] at age 1 year [active vs control, P =.001]; nursery 1 ng[0.9-1.1] at birth, 1.7 ng [1.2-2.5] at age 6 months, and 2 ng [1.3-3.5]at age 1 year [active vs control, P <.00001]). The total amount ofallergen recovered at age 1 year was 29-fold (95% CI 15.1- to 56.7-fold)higher in the control group than in the active group. CONCLUSIONS: Theavoidance measures used in this study achieved and maintained a low miteallergen environment during pregnancy and in the first year of life inhomes of infants at risk of atopy.
Keyword(s)
Animals; Antigens, Dermatophagoides; Bedding and Linens; Female; Housing; Humans; Infant; Infant Equipment; Infant, Newborn; Male; Pregnancy; Prenatal Exposure Delayed Effects; Prospective Studies; Research Support, Non-U.S. Gov't; immunology: Allergens; immunology: Asthma; immunology: Environmental Pollutants; immunology: Glycoproteins; immunology: Hypersensitivity; immunology: Mites