References: Pillow and Mattress Encasings

These pillow- and mattress-encasing citations are provided for allergy specialists and other medical professionals. A full understanding of the role of impermeable pillow and mattress covers in allergen avoidance requires a critical reading of the complete text of these and other studies on allergen-avoidance, barrier fabrics, indoor allergens, and allergic conditions including asthma, allergic rhinitis, and atopic dermatitis.

Preventing Severe Asthma Exacerbations in Children - A Randomized Trial of Mite-Impermeable Bedcovers

AUTHORS: Murray CS, Foden P, Sumner H, Shepley E, Custovic A, Simpson A

SOURCE: Pediatrics 1983 Mar; 71(3): 418-22

CITATION IDS: PMID: 28282501 doi: 10.1164/rccm.201609-1966OC

ABSTRACT:

RATIONALE:

Allergen exposure in sensitized individuals with asthma interacts with viruses to increase the risk of asthma exacerbation.

OBJECTIVES:

To evaluate the use of house dust mite-impermeable bedding and its impact on severe asthma exacerbations in children.

METHODS:

We randomized mite-sensitized children with asthma (ages 3-17 yr.) after an emergency hospital attendance with an asthma exacerbation to receive mite-impermeable (active group) or control (placebo group) bed encasings.

MEASUREMENTS AND MAIN RESULTS:

Over a 12-month intervention period, the occurrence of severe asthma exacerbations was investigated. Of 434 children with asthma who consented, 286 (mean age, 7.7 yr; male sex, 65.8%) were mite sensitized, and 284 were randomized (146 to the active group and 138 to the placebo group). At 12 months, significantly fewer children in the active group than in the placebo group had attended the hospital with an exacerbation (36 [29.3%] of 123 vs. 49 [41.5%] of 118; P = 0.047). In the multivariable analysis, the risk of emergency hospital attendance was 45% lower in the active group (hazard ratio, 0.55; 95% confidence interval [CI], 0.36-0.85; P = 0.006) than in the placebo group.

CONCLUSIONS:

Mite-impermeable encasings are effective in reducing the number of mite-sensitized children with asthma attending the hospital with asthma exacerbations but not the number requiring oral prednisolone. This simple measure may reduce the health care burden of asthma exacerbations in children.

Dust-free bedrooms in the treatment of asthmatic children with house dust or house dust mite allergy: a controlled trial.

AUTHORS: Murray AB; Ferguson AC

SOURCE: Pediatrics 1983 Mar; 71(3): 418-22

CITATION IDS: PMID: 6338475 UI: 83143089

ABSTRACT:

Twenty asthmatic children with prick tests positive for house dust or house dust mites were allocated to two groups that were matched for severity. One group was provided with zippered vinyl covers for pillows, mattresses, and box springs, and instructions for making the bedroom as easy to keep clean as a hospital ward; the other group was not. At the end of a 1-month study period, there was a marked and statistically significant difference in symptoms and signs of asthma between the two groups. Those with a dust-free bedroom had fewer days on which wheezing was observed, medication was given, or an abnormally low peak expiratory flow rate was recorded. Bronchial tolerance to aerosolized histamine significantly improved in the group whose bedrooms had been modified. A dust-free bedroom diminishes bronchial irritability and is a practical and effective method for decreasing asthma in children with house dust or house dust mite allergy.

Allergen avoidance in house dust mite sensitive adult asthma.

AUTHORS: Walshaw MJ; Evans CC

SOURCE: Q J Med 1986 Feb; 58(226): 199-215

CITATION IDS: PMID: 3520626 UI: 86233964

ABSTRACT:

Fifty adult asthmatic patients with strongly positive skin prick tests to the house dust mite were admitted into a prospective randomised controlled trial of house dust mite avoidance in the community. Twenty- two of the experimental group completed one year of dust avoidance and 19 of these tolerated the use of plastic mattress and pillow covers. Twenty of the control group (who did not alter their housecleaning habits) also completed one year of study. A fall in mite and dust levels was noted in the homes of the experimental but not the control group. Fifteen of the experimental group who completed the study were strongly RAST positive (score 3 or more) to the house dust mite. These patients had a significant improvement in FEV1/FVC, PEFR, PC20, use of treatment, and symptom score at one year, whilst the seven experimental patients who were not strongly RAST positive (score 2 or less) did not, suggesting that the change noted in the former patients was not merely due to a placebo effect. Fifteen of the control group who completed the study were also strongly RAST positive for the house dust mite and these patients showed no change in any of the parameters. This study demonstrates that adult asthmatic patients can successfully carry out house dust eradication procedures in the community over a long period of time, and that those patients who are allergic to the house dust mite appear to have both subjective and objective improvement in their asthma.

The Melbourne house dust mite study: eliminating house dust mites in the domestic environment.

AUTHORS: Hill DJ; Thompson PJ; Stewart GA; Carlin JB; Nolan TM; Kemp AS; Hosking CS

AUTHOR AFFILIATION: Department of Allergy, Royal Children's Hospital, Parkville, Australia.

SOURCE: Journal of Allergy and Clinical Immunology. 1997 Mar;99(3):323-9

CITATION IDS: PMID: 9058687 UI: 97211720

ABSTRACT:

BACKGROUND:

Hypersensitivity to house dust mite allergens is associated with increased asthma morbidity. Asthma severity appears to be related to the degree of mite allergen exposure. Short-term studies suggest that complete avoidance reduces disease severity.

OBJECTIVE:

The study was designed to assess the effect of different mattress covers and floor coverings on mite allergen concentrations in the homes of mite- sensitive children with asthma in the city of Melbourne, Australia.

METHODS:

Mite allergen Der p 1 concentration was measured on mattress covers, mattress surfaces, and carpeted and uncarpeted floors in 107 dwellings; and measurement was performed on three occasions over a 5- month period. After the first sampling, all mattress covers and impermeable encasements were permanently removed.

RESULTS:

The initial geometric mean concentrations of Der p 1 (micrograms per gram of fine dust) from the surfaces of sheepskin, wool, and cotton mattress coverings were greater than those from the surfaces of impermeable mattress encasements (116, 113, and 19 vs 0.4) (p < 0.001); corresponding concentrations on the underlying mattresses were 142, 38, 20, and 0.6, respectively (p < 0.05 to 0.001). At the end of the study these mattress surface concentrations were 79, 65, 9.7, and 3.1, respectively. In 24 dwellings an uncarpeted room was adjacent to a carpeted room. At each visit the concentration of Der p 1 in uncarpeted rooms was below the reported threshold for sensitization and significantly less than that in the adjacent carpeted room.

CONCLUSION:

In homes of children with asthma, "asthmogenic" concentrations of Der p 1 were found on nonencased mattresses and carpeted floors, but the use of impermeable mattress encasements and carpet exclusion were associated with concentrations of Der p 1 below the reported threshold for sensitization.

Evaluation of materials used for bedding encasement: effect of pore size in blocking cat and dust mite allergen.

AUTHORS: Vaughan JW; McLaughlin TE; Perzanowski MS; Platts-Mills TA

AUTHOR AFFILIATION: University of Virginia Asthma and Allergic Diseases Center, Charlottesville 22908, USA.

SOURCE: Journal of Allergy and Clinical Immunology. 1999 Feb; 103(2 Pt 1): 227-31

CITATION IDS: PMID: 9949312 UI: 99135988

ABSTRACT:

BACKGROUND:

Mattress and pillow encasings are recommended for patients allergic to dust mites. Many encasements block allergen and are vapor permeable but do not allow free passage of air through the material. Recently, breathable fabrics made from tightly woven synthetic fibers or nonwoven synthetics have been recommend as encasements.

OBJECTIVE:

The purpose of this study was to develop a method for testing encasement materials made of breathable fabrics. METHODS: Dust samples containing a known quantity of allergen (Der f 1, Der p 1, and Fel d 1) were pulled across a variety of fabrics using a modified dust trap. Airflow through the dust trap was controlled with a vacuum pump. Five minutes after dust was introduced, the pump was shut off. A filter located downstream of the fabric collected allergen passing through the fabric during the test and was assayed with ELISA for the relevant allergen. Fabrics to be tested were obtained from manufacturers and specialty catalogs.

RESULTS:

As the average pore size decreases, the airflow through a fabric becomes restricted, and the pressure differential created by the vacuum pump increases. Dust mite allergens (Der f 1 and Der p 1) were blocked below detectable limits by fabrics of less than 10 microm in pore size. Fabrics with an average pore size of 6 microm or less blocked cat allergen (Fel d 1).

CONCLUSION:

The method we developed provided a rigorous and reliable test for leakage of common indoor allergens through breathable barrier fabrics. Our results show that tightly woven fabrics and nonwoven synthetic fabrics can block common indoor allergens but still allow airflow.

Mite penetration of different types of material claimed as mite proof by the Siriraj chamber method.

AUTHORS: Mahakittikun V, Boitano JJ, Tovey E, Bunnag C, Ninsanit P, Matsumoto T, Andre C.

SOURCE: J Allergy Clin Immunol. 2006 Nov;118(5):1164-8

Summary: Dust mites penetrated and often colonized non-woven and membrane-coated bed encasings, but were unable to penetrate tightly woven microfiber or plastic encasings.

Nonwoven in contrast to woven mattress encasings accumulate mite and cat allergen.

AUTHORS: Miller, J.D., Naccara, L., Satinover, S., and Platts-Mills, T.A.

SOURCE: J Allergy Clin Immunol. 2007; 120: 977–979

Summary: Non-woven mattress encasings were shown in the laboratory to have spaces within their fabric large enough to allow dust mite penetration and mite fecal particle accumulation.  In contrast to woven encasings, non-woven mattress covers used by patients for at least 1 year had high levels of mite allergen on there surface, as well as high levels of cat allergen if a cat was present in the home.

House dust mite allergen in US beds: results from the First National Survey of Lead and Allergens in Housing.

AUTHORS: Arbes SJ Jr1, Cohn RD, Yin M, Muilenberg ML, Burge HA, Friedman W, Zeldin DC

SOURCE: J Allergy Clin Immunol. 2003 Feb;111(2):408-14.

Summary: A survey of beds in 831 U.S. homes showed levels of dust mite allergen associated with the development of dust mite allergy in 46% of homes, and levels of dust mite allergen associated with acute asthma or allergy symptoms in 24% of homes.

The role of mattress bases in the mite infestation of dwellings.

AUTHORS: Pauli G1, de Blay F, Bessot JC, Ott M, Gries P

SOURCE: J Allergy Clin Immunol. 1997 Feb;99(2):261-3.

Summary: High levels of dust mite allergen sufficient to cause allergy symptoms were found in mattress bases (box-springs), with 44 of 54 houses studied showing higher levels than those found in the mattresses.

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