Efficacy of multifaceted avoidance measures in the management of patients with persistent allergic rhinitis and house dust mite allergy

Background

In patients with persistent allergic rhinitis (PAR) and allergy to house dust mites (HDM), the use of HDM avoidance measures is logical. There is however, uncertainty in the literature regarding its efficacy. Single intervention methods were felt to be ineffective. It was proposed that multifaceted interventions may be necessary. We hence designed a study to evaluate the efficacy of multifaceted avoidance measures in patients with PAR and confirmed allergy to HDM.

Method

Newly diagnosed adults with PAR and skin prick test positive to HDM were randomized to receive multifaceted dust mite avoidance measures (group 1, n=51) or no intervention (group 2, n=48). The avoidance measures used were dust mite impermeable bedding covers, ascaricides, removal of dust collecting items and regular cleaning of beddings and bedrooms at stipulated intervals. The study was conducted over 6 weeks. The end points were changes in the total symptoms score (TSS, average of scores for nasal congestion, rhinorrhoea, sneezing, itch and eye symptoms) and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores. 

Results

Of the 89 patients recruited, 27 were excluded from the analysis as they either did not comply with the multifaceted measures or used 15 days or more of rescue medication. The final number in group 1 was 47 and group 2 was 25. There was a significant reduction in dust mite load in group 1 (16.88 ng/ml ± 6.61 (P=0.02)), but not in group 2 (10.21ng/ml ± 7.88 (P=0.21)). Statistically significant improvements were seen in both TSS and RQLQ scores in patients receiving multifaceted avoidance measures. The improvements in TSS were 2.86 + 0.48 and 1.15 ± 0.46 (p<0.05) and RQLQ scores were 38.69 ± 4.59 and 15.49 ± 4.42, (p<0.05), for groups 1 and 2 respectively.

Conclusion

Multifaceted avoidance measures to reduce dust mite exposure is effective in the management of patients with persistent allergic rhinitis, in terms of improvement in total symptoms score and quality of life of patients.