House dust mite avoidance measures improve peak flow and symptoms in patients with allergy but without asthma: A possible delay in the manifestation of clinical asthma?☆,☆☆,★,★★
Section snippets
Patients
Patient characteristics are given in Table I. Patients were recruited after their general practitioners referred them to the hospital for intradermal skin testing. All patients had an allergy test because they had some very mild signs of asthma (mostly early morning dyspnea or wheeze), but none had a diagnosis of asthma. After this test, patients remained under the medical care of the general practitioner and not of a specialist. Patients were excluded if they had a confirmed diagnosis of
Patient characteristics
Twenty-nine patients were included in the study. After randomization and stratification, a slightly unbalanced distribution was achieved, with 16 patients in the treatment group and 13 patients in the placebo group. Patient characteristics are shown in Table I. Only age differed significantly between the groups, in that the treatment group was older than the placebo group (31 vs 24 years). In all analyses, the difference in age had no influence on any of the effects studied (n values always
Discussion
Sufficient evidence has accumulated to confirm a close relation between sensitivity to mite allergens and asthma. 7, 29, 30 A causal relationship between mite allergen sensitization and the development of asthma seems plausible. 3, 8, 31 Consequently, in some patients allergy might be an indication of a genetic disposition for asthma; in other words, allergy might be considered in these patients as a subclinical (early) expression of asthma. Therefore, in these patients, preventing further
Acknowledgements
We thank Mr. R. Akkermans for his statistical support.
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From the aDepartment of General Practice and Social Medicine and bDepartment of Pulmonary Diseases, Medical Centre Dekkerswald, University of Nijmegen, the cDepartment of Allergy, University of Groningen, and the dDepartment of Epidemiology and Public Health, University of Wageningen.
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Supported by the Dutch Asthma Foundation, by CIBA, and by 3M Pharma Industries.
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Reprint requests: Dr. S.G.M. Cloosterman, Department of General Practice and Social Medicine, 229, University of Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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