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Medical Forum / Diseases and Disorders / Sinusitis / April 2008

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?OT: Cochrane concludes you can't eliminate dust mites

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judy.n - 29 Apr 2008 16:18 GMT
Once again, the Cochrane collaborative, by looking at other studies,
concluded that the National Asthma guidelines for dust mite removal/
reduction are useless. Here's an internet article on it:
http://www.healthcentral.com/allergy/news-249790-31.html

As someone who is allergic to dust mites, and has done all the things
recommended--mattress encasings, hardwood floors, HEPA filters--was it
all for nothing? I actually don't think so.

Judy
Susan - 29 Apr 2008 16:36 GMT
> Once again, the Cochrane collaborative, by looking at other studies,
> concluded that the National Asthma guidelines for dust mite removal/
[quoted text clipped - 4 lines]
> recommended--mattress encasings, hardwood floors, HEPA filters--was it
> all for nothing? I actually don't think so.

So here's the thing; mites die at humidity under 50%, so how on earth do
they conclude you can't prevent them?

OTOH, antigen from their poop may not be as easy to get rid of; that's
what barriers and air cleaners are good for.  Thing is, unless you're
tireless, consistent and thorough every day, every week, it doesn't
work.  I also think it doesn't work enough unless you also desensitize,
but it certainly helps me with symptom relief.  Just allergen bedding
barriers allowed my cleaning woman to stop waking up itchy and
congested, overnight clearance.

Susan
judy.n - 29 Apr 2008 16:50 GMT
> x-no-archive: yes
>
[quoted text clipped - 19 lines]
>
> Susan
Susan, I completely agree--I know that the mattress barriers/carpeting
removal/reduction of humidity have helped everyone in our family--and
two of us get shots for mites.
Typical Cochrane--they're so busy debunking "myths" through
retrospective analysis of existing studies, and completely discount
clinical and anecdotal experience. They're the ones who declared
antibiotics of no use for sinusitis, after examining only a handful of
the thousands of possible studies. This is evidence based medicine??
Judy
Susan - 29 Apr 2008 17:04 GMT
 They're the ones who declared
> antibiotics of no use for sinusitis, after examining only a handful of
> the thousands of possible studies. This is evidence based medicine??
> Judy

Judy, the new definition of "evidence based medicine" seems to translate
to "anything BUT the experience the patient is reporting."

Osler is spinning in his grave.

Susan
Murray Grossan - 29 Apr 2008 18:23 GMT
On 4/29/08 8:18 AM, in article
5cdecfbc-1956-4b42-80ee-372713636e72@b1g2000hsg.googlegroups.com, "judy.n"

> Once again, the Cochrane collaborative, by looking at other studies,
> concluded that the National Asthma guidelines for dust mite removal/
[quoted text clipped - 6 lines]
>
> Judy
Why dust proof?

        A recent article in the Los Angeles Times quoted an authority that
claimed dust proofing was overdone. The ³authority² felt it was more
important to use drugs than to worry about dust proofing the bedroom.

        Having treated 10,000 plus patients with allergy and sinusitis, I
must disagree here.

        If you sleep in a dusty bedroom or work in a heavily dusty place,
you can develop dust allergy  or make an existing dust sensitivity worse.
The body can be overwhelmed by so much allergenic product.

        If you have a simple cold, the dust can add significantly to your
symptoms. The dust didn¹t bother you before the cold, but with the cold the
dust adds significantly to the symptoms.

        More important, if it is only dust allergy, you might not need any
drugs if the bedroom is free of dust. To me, the goal is to get people well
without drugs ­ if possible.

        Suppose you are only allergic to Oak and on skin test you are not
allergic to dust. Do you still need to dust proof? Yes.  This is because
allergy symptoms are a matter of arithmetic. If you take pollen at 2, add
dust as a 5, you don¹t reach 10 with symptoms.

        But if the pollen reaches 5, plus your dust 5, then you have
symptoms.

        On the other hand, when the pollen count is very high, say at 10,
even if the dust is absent, you will still have symptoms.

        In theory, dust proofing should keep you allergy free about 75% of
the time during the pollen season, esp if you rinse out the pollen and IgE.

        Today we are more concerned about reducing allergy symptoms.  Poor
sleep during allergy season can take a severe toll. If symptoms are severe,
you can end up with nasal cilia ­ the tiny cilia that remove dust and
bacteria ­ exhausted. When the cilia don¹t pulsate to remove bacteria, then
an infection, including a sinus infection can develop.  Allergy itself
doesn¹t cause sinus disease; it is when the cilia are exhausted after weeks
of sneezing and nose blowing that an infection can occur.

        It is true that certain medications are needed for allergy season,
but it is also true that if you can reduce or eliminate those medications to
let natural healing take place, the patient is better off.  Therefore I
recommend dust proofing to my patients.
Steven L. - 29 Apr 2008 21:51 GMT
> On 4/29/08 8:18 AM, in article
> 5cdecfbc-1956-4b42-80ee-372713636e72@b1g2000hsg.googlegroups.com, "judy.n"
[quoted text clipped - 25 lines]
> symptoms. The dust didn¹t bother you before the cold, but with the cold the
> dust adds significantly to the symptoms.

Yes, let me follow up with something my own allergist said:  He said
that with sufferers of allergies, asthma, colds, sinusitis, etc., the
mucous membranes are so hypersensitive that just the physical irritation
from the particulates is enough to set off a reaction.  It can be just a
physical irritation that's making you sneeze, rather than a true
IgE-mediated allergic reaction.

Having said that, it's insufficient to control the dust in your bedroom
alone.  This very computer I'm typing on picks up a huge amount of dust
and spores due to the static electric charges on the monitor and  the
air vents in the computer.  (And our heads are so close to the monitors
that we breathe in all that gunk.)  I've had occasion to open up my
computer to replace circuit boards, and let me tell you, it's a real
chamber of horrors inside there.  I had to wear a face mask.

To really remediate your home, including the A/C and heating ducts and
whatnot, you may need to call in a professional.

Signature

Steven L.
Email:  sdlitvin@earthlinkNOSPAM.net
Remove the NOSPAM before replying to me.

Susan - 30 Apr 2008 01:30 GMT
> Having said that, it's insufficient to control the dust in your bedroom
> alone.  This very computer I'm typing on picks up a huge amount of dust
[quoted text clipped - 3 lines]
> computer to replace circuit boards, and let me tell you, it's a real
> chamber of horrors inside there.  I had to wear a face mask.

 I have to open mine up my cpu and use a pressure blower with a vacuum
cleaner on next to it periodically to prevent allergy attacks.

> To really remediate your home, including the A/C and heating ducts and
> whatnot, you may need to call in a professional.

Duct cleaning is very important, and coil cleaning of central ac units.

Susan
judy.n - 30 Apr 2008 01:38 GMT
> x-no-archive: yes
>
[quoted text clipped - 15 lines]
>
> Susan

Okay, so those of us in the real world know that reducing dust mites
and particulates is beneficial, and here's what the article said,
based on the Cochrane review:

The review, Gotzsche said, shows people are being mislead by the 2007
U.S. guidelines from the National Asthma Education and Prevention
program. The program recommends actions such as putting mattresses and
pillows in dust-proof encasings, and weekly hot water washings of
sheets, blankets and stuffed toys.

"Reviews and guidelines should reflect the facts," he said. "It is
difficult, perhaps, to realize that we cannot really do anything, but
there is no evidence to support these guidelines, and they are
misleading. It is about time specialists start becoming honest with
patients."

Just who is being honest with patients here?
Judy
Steven L. - 30 Apr 2008 03:52 GMT
>> x-no-archive: yes
>>
[quoted text clipped - 31 lines]
>
> Just who is being honest with patients here?

Like I said, if the National Asthma Education and Prevention Program
focuses on making a "sanctuary" out of your bedroom, I agree that's
pretty much of a lost cause.  Your bedroom is not a Level 4 biosafety
containment facility, and you're bringing in dust mites and mold spores
just by walking on the floor or opening a window in any urban or
suburban environment.  Not to mention cockroaches and other insects that
are crawling in the walls and can set off allergic reactions.

As I said, I think that avoidance strategies must focus on minimizing
the exposures caused by YOUR specific lifestyle.  In my case, it's the
damn computer, which I use some 30-40 hours a week now.  Much more gunk
there than in my bed, let me tell you.

If you live in New Orleans, the mold and pollen capital of America, then
my advice to you is NOT to make a sanctuary out of your bedroom, but to
MOVE ELSEWHERE.  Don't bother trying to avoid allergens in New Orleans,
unless you wear a HAZMAT suit w/ respirator all spring and summer.  :-)

Signature

Steven L.
Email:  sdlitvin@earthlinkNOSPAM.net
Remove the NOSPAM before replying to me.


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