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Asthma and Infant Bedding

A guide for health professionals
Current suggestions

Bedding and primary prevention of asthma

Quality of the evidence
Identifying high-risk infants
Reducing HDM levels in bedding
Feathers vs synthetic
Volatile organic compounds
Combining interventions
Levels of evidence 
References

Technical writers

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Further information
Content created MAR 2005
Content updated MAR 2005

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NextBackCombining interventions

Four cohort studies into the primary prevention of asthma currently in progress have combined HDM avoidance with other allergen avoidance measures.69

The Canadian Asthma Primary Prevention Study combined measures to reduce exposure to inhalant and food allergens.70 All mattresses and box springs in the parents’ and infants’ bedrooms were encased with vapour-impermeable covers and all bedding was to be washed in hot water weekly. Acaricides (benzyl benzoate) were also applied to carpets and upholstery. Compliance with use of the encasings was high and levels of HDM allergen were reduced by about one-third (primarily due to the encasings rather than the use of benzyl benzoate). The program resulted in a significant reduction in the risk of asthma in high-risk children at two years.71

The Isle of Wight Study used a combination of interventions targeting dust mite and food allergens up to nine months of age.26 Cot mattresses were covered with a polyvinyl impermeable cover and carpets and upholstery in the bedroom and lounge were treated with acaricides.72 This resulted in a five-fold reduction of HDM antigen.26 The combined intervention has resulted in statistically significant reductions in wheeze with bronchial hyper-responsiveness in children aged eight years.

In the Study on the Prevention of Allergy in Children in Europe (SPACE) house dust mite avoidance was combined with breastfeeding or the use of hypoallergenic formulas.73 Mite allergen avoidance focused on the infant’s bed, with mattresses being encased if they were not vinyl. Results reported at one year showed a reduction in sensitisation to mites and also in atopy. There was no difference in the proportion of children who had ever wheezed.

In the Childhood Asthma Prevention Study (CAPS), an HDM reduction intervention was combined with a dietary intervention designed to increase dietary omega-3 fatty acids.74 The HDM reduction protocol was developed to be simple and easy to implement on a large scale,75 using both physical and chemical methods. The mattresses of the child’s bed or cot were covered with an impermeable cover and parents were asked not to used sheepskins or pillows. Bedding was washed with an acaricidal laundry additive. Adherence to the intervention improved as the study progressed. However, 3-year outcomes of the study showed no effect on wheeze resulting from HDM elimination and only a small (but significant) reduction in HDM sensitisation.76

Of these studies, only the CAPS is of factorial design and allows investigators to determine which of the interventions is responsible for the difference in clinical outcomes. Further follow-up of these studies may provide a greater understanding of the aetiology of asthma.  

The results of these trials to date suggest that a combination of interventions may be more effective in primary prevention than single interventions.

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