House dust mite control measures for asthma

Background The major allergen in house dust comes from mites. Chemical, physical and combined methods of reducing mite allergen levels are intended to reduce asthma symptoms in people who are sensitive to house dust mites. Objectives To assess the effects of reducing exposure to house dust mite antigens in the homes of people with mite- sensitive asthma. Search strategy PubMed and The Cochrane Library ( last searches Nov 2007), reference lists. Selection criteria Randomised trials of mite control measures vs placebo or no treatment in people with asthma known to be sensitive to house dust mites. Data collection and analysis Two authors applied the trial inclusion criteria and evaluated the data. Trial authors were contacted to clarify information. Main results Fifty- four trials ( 3002 patients) were included. Thirty- six trials assessed physical methods ( 26 mattress encasings), 10 chemical methods, and 8 a combination of chemical and physical methods. Despite the fact that many trials were of poor quality and would be expected to exaggerate the reported effect, we did not find an effect of the interventions. For the most frequently reported outcome, peak flow in the morning ( 1565 patients), the standardised mean difference was 0.00 ( 95% confidence interval ( CI) - 0.10 to 0.10). There were no statistically significant differences either in number of patients improved ( relative risk 1.01, 95% CI 0.80 to 1.27), asthma symptom scores ( standardised mean difference - 0.04, 95% CI - 0.15 to 0.07), or in medication usage ( standardised mean difference - 0.06, 95% CI - 0.18 to 0.07). Authors' conclusions Chemicaland physical methods aimed at reducing exposure to house dust mite allergens cannot be recommended. It is doubtful whether further studies, similar to the ones in our review, are worthwhile. If other types of studies are considered, they should be methodologically rigorous and use other methods than those used so far, with careful monitoring of mite exposure and relevant clinical outcomes.