Environmental interventions for mite-induced asthma: a journey between systematic reviews, contrasting evidence, and clinical practice
Abstract
House dust mites (HDM) are one of the most important sources of indoor allergens worldwide.Exposure to high environmental levels of dust mite allergen is associated with anincreased risk of sensitization, asthma and deterioration of lung function. On the basis ofthese data, it would be logical to assume that asthmatic patients with mite allergy couldbenefit from a reduction of exposure to these allergens. Several environmental prophylacticactions against HDM, either physical or chemical have been tried, alone or in differentcombinations.However, a recent Cochrane Systematic Review did not detect specific clinicalbenefits from the use of prophylactic environmental measures in asthmatic patientssensitive to HDM and concluded that such measures can no longer be recommended asthey are ineffective.This paper presents the results of a web-based questionnaire, administeredto more than 200 Italian paediatricians, and shows that physicians' behaviour in reallife is very far from SR conclusions. It also summarizes the indications of the most authoritativeguidelines, highlighting some contrasting evidence and some significantweaknesses of the SR, that could make the final conclusions at least uncertain. In the lightof these findings, it seems that the recent Cochrane SR cannot be considered the definitivedocument on the uselessness of environmental prevention of mite-related asthma.
Keywords
House dust mites, avoidance, asthma
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