C. Gutgesell et al., Double-blind placebo-controlled house dust mite control measures in adult patients with atopic dermatitis, BR J DERM, 145(1), 2001, pp. 70-74
Background Avoidance of allergens has been shown to be of benefit in patien
ts with atopic asthma sensitized to indoor allergens. In atopic dermatitis,
there is so far little information about the effect of house dust mite eli
mination strategies.
Objectives We therefore performed a randomized controlled study of house du
st mite control in patients with this disease.
Methods Twenty adult patients with moderate to severe atopic dermatitis wer
e included. Inclusion criteria were a positive RAST to house dust mite anti
gen (CAP class > 3) and a concentration of > 2 mug g(-1) of the house dust
mite antigen Der p1 in the patient's mattress dust. Patients were randomize
d to either the active treatment group (allergen-impermeable mattress encas
ing, acaricide spray containing tannic acid and benzylbenzoate) or a contro
l group (allergen-permeable encasing, spray containing water and traces of
ethanol). Severity of disease was estimated every 2 months by an establishe
d score (SCORAD), and eosinophil cationic protein (ECP) in the serum was de
termined by enzyme-linked immunosorbent assay. Furthermore, the use of topi
cal steroids was quantified. Patients assessed daytime pruritus and pruritu
s-induced sleeplessness weekly on a visual analogue scale. The study lasted
1 year.
Results At the end of the study, the active treatment group showed a statis
tically significant reduction in Der p1 exposure as compared with the contr
ol group. However, when comparing the change from the start to the end of t
he study, there was no statistically significant difference between active
treatment and control groups as measured by the SCORAD score and by ECP lev
els in the serum. Some patients in the active treatment group reported less
pruritus-induced sleeplessness, but there was no statistically significant
difference between the two treatment groups.
Conclusions For adult patients with atopic dermatitis it was shown that 1 y
ear of house dust mite avoidance reduced the allergen exposure, but an impr
ovement of overall disease activity was not demonstrated.