Effect of house dust mite avoidance measures in children with atopic dermatitis

Ricci, Giampaolo; Patrizi, Annalisa; Specchia, Fernando; Menna, Lucia Francesca; Bottau, Paolo; D’Angelo, Valentina; Masi, Massimo

doi:10.1046/j.1365-2133.2000.03666.x

Cited by 108 publications

(74 citation statements)

References 19 publications

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“…It is unlikely that 2 months of intervention in the trial by Ricci and colleagues 369 is long enough to be of clinical relevance when testing house dust mite reduction for a long-term condition such as eczema. On the other hand, two other trials 367,368 with a duration of 1 year saw no significant effects in favour of house dust mite reduction interventions.…”

Section: Benefitsmentioning

confidence: 99%

“…All three trials [367][368][369] failed to show any benefit of house dust mite reduction interventions for eczema compared with placebo or normal cleaning practices over a period of up to 12 months. The trial by Ricci and colleagues 369 showed a mean decrease in SCORAD scores from 33 to 24 in the first month for the mite avoidance group compared with a mean decrease from 27 to 22 in the placebo group.…”

Section: Benefitsmentioning

confidence: 99%

“…The trial by Ricci and colleagues 369 showed a mean decrease in SCORAD scores from 33 to 24 in the first month for the mite avoidance group compared with a mean decrease from 27 to 22 in the placebo group. After the additional 10 months of the mite avoidance intervention for all participants, the groups had SCORAD values of 16 and 17, respectively.…”

Section: Benefitsmentioning

confidence: 99%

“…Three new trials [367][368][369] have been reported since 2000. Ricci and colleagues 369 randomised a group of 41 children aged from 2 to 10 years and sensitised to food or inhalant allergens to either 'recommended' house dust mite reduction measures (mattress and pillow encasings, hot wash of bedding at least once a week, vacuuming the living room and bedroom at least twice a week, carpets vacuumed at least once a week or removed and no pets) or no recommendations (normal cleaning patterns) for 2 months.…”

Section: Studiesmentioning

confidence: 99%

“…The three trials [367][368][369] gave only scant details of the trial methodology, with none reporting the method of randomisation and allocation concealment. It is unlikely that 2 months of intervention in the trial by Ricci and colleagues 369 is long enough to be of clinical relevance when testing house dust mite reduction for a long-term condition such as eczema.…”

Section: Benefitsmentioning

confidence: 99%

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Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Benefitsmentioning

confidence: 99%

Section: Benefitsmentioning

confidence: 99%

Section: Benefitsmentioning

confidence: 99%

Section: Studiesmentioning

confidence: 99%

Section: Benefitsmentioning

confidence: 99%

See 3 more Smart Citations

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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House dust mite reduction and avoidance measures for treating eczema

Nankervis

Pynn

Boyle

et al. 2015

Cochrane Database of Systematic Reviews

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BackgroundEczema is an inflammatory skin disease that tends to involve skin creases, such as the folds of the elbows or knees; it is an intensely itchy skin condition, which can relapse and remit over time. As many as a third of people with eczema who have a positive test for allergy to house dust mite have reported worsening of eczema or respiratory symptoms when exposed to dust. ObjectivesTo assess the effects of all house dust mite reduction and avoidance measures for the treatment of eczema. Search methodsWe searched the following databases up to 14 August 2014: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 8), MEDLINE (from 1946), Embase (from 1974), LILACS (from 1982), and the GREAT database. We also searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant studies. We handsearched abstracts from international eczema and allergy meetings. Selection criteriaRandomised controlled trials (RCTs) of any of the house dust mite reduction and avoidance measures for the treatment of eczema, which included participants of any age diagnosed by a clinician with eczema as defined by the World Allergy Organization. We included all non-pharmacological and pharmacological interventions that sought to reduce or avoid exposure to house dust mite and their allergenic faeces. The comparators were any active treatment, no treatment, placebo, or standard care only. Data collection and analysisTwo authors independently checked the titles and abstracts identified, and there were no disagreements. We contacted authors of included studies for additional information. We assessed the risk of bias using Cochrane methodology. 1 House dust mite reduction and avoidance measures for treating eczema (Review)

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