Effectiveness of occlusive bedding in the treatment of atopic dermatitis -: a placebo-controlled trial of 12 months' duration

Background: Several studies on avoidance of house-dust-mite (HDM) and cat allergens have been carried out, most of them in asthmatic patients and only a few in patients with atopic dermatitis (AD). No study so far has focused on which subgroup of AD patients benefits from avoidance measures. Methods: Forty adult patients with AD completed the 12-month avoidance study. They were divided into an active treatment (n=22) and a placebo (n=18) group. Active treatment comprised use of polyurethane-coated cotton encasings for bedding, and placebo use of cotton covers. Patients came for regular checkups during the 12-month period, when enema severity was assessed and blood samples were analyzed for total IgE, HDM- and cat-specific IgE and soluble CD30 (sCD30) in serum. Dust samples were collected from mattresses before treatment and after 3, 6, and 12 months, and analyzed for content of HDM and cat allergen. Results: Eczema severity decreased significantly in both groups (P<0.001), with a more pronounced decrease in patients with active covers. The HDM exposure decreased significantly in the active treatment group (P < 0.001), and the levels of HDM-specific IgE were reduced (P<0.05). Exposure to cat allergens was unchanged in the active treatment group but decreased, albeit not significantly (P=0.19), in the placebo group. sCD30 levels were significantly reduced in both groups (P<0.001). Patients not sensitized to HDM allergens benefited from the bedcovers as much as sensitized patients. Conclusions: Occlusive bedding significantly reduced HDM exposure in bed (P<0.001) and eczema severity, and sCD30 levels decreased significantly (P < 0.001). Patients not sensitized to HDM and not exposed to HDM allergens benefited equally from use of the bedcovers, a result which could be due to a reduction of other important allergens, superantigens, or irritants in bed. We therefore recommend the use of bedcovers as part of treatment for AD.