Original articleFeather bedding and house dust mite sensitization and airway disease in childhood
Introduction
There is growing recognition of the bed as a major source of high house dust mite (HDM) allergen exposure. Although feather bedding has been considered historically to be associated with allergy, the current evidence challenges this view. Feather pillows appear to accumulate the HDM Dermatophagoides pteronyssinus (Der p) allergen more slowly [1], and Der p allergen levels have been found to be eight-fold [2] or five-fold [3] lower in feather pillows.
In 1995, feather pillow use was found to be inversely associated with severe wheeze (adjusted odds ratio [AOR], 0.36; confidence interval [CI]. 0.28–0.53) in a large cross-sectional survey 4, 5. A similar, but less consistent, pattern was found for feather quilts [4]. Feather bedding was also inversely associated with asthma in a German survey [6], and nonfeather pillow use was associated with rhinitis in a recent hospital outpatient survey [7]. Consistent with these findings from cross-sectional studies, an ecological analysis comparing 1978–1991 data for children in London found that, of the studied potential risk factors that changed over time, only the declining use of feather pillows appeared to contribute to the wheeze increase over time [8].
Possible mechanisms for the lower wheeze prevalence associated with feather bedding use includes reduced HDM sensitization, reduced levels of allergen exposure in sensitized subjects, or a combination of both. Previously, it has been suggested that the lower prevalence of severe wheeze among children using feather pillows may reflect lower HDM allergen exposure [2]. However, a subsample analysis of the Sheffield study found no difference in the effect of feather pillows on severe wheeze by whether the child had a 1-mm or greater reaction to Der p1 HDM allergen [5]. However, because the environmental levels of HDM allergen are considered to relate both to sensitization and causation of symptoms among HDM-sensitized individuals 9, 10, 11 and because several studies demonstrate significant reduction of HDM allergen levels in feather bedding 10, 11, an examination of these possible mechanisms is indicated. The aims of this study were to examine if feather bedding was related to reduced HDM sensitization and/or reduced respiratory symptoms or improved lung function among HDM-sensitized children.
Section snippets
The Tasmanian Infant Health Survey
The Tasmanian Infant Health Survey (TIHS) is a birth cohort study operated from six hospitals where approximately 93% of births in Tasmania, Australia, occurred [12]. The sample of eligible infants represented approximately one fifth of live births in the state from 1988–1995 with an overall statewide response rate during this period of 89% [13]. Infants born were scored to assess the risk of sudden infant death syndrome using a local predictive model based on maternal age, birthweight, infant
General features
The prevalence of a history of asthma ever and recent wheeze was high at 37.8% (188/497) and 30.7% (153/499), respectively. Overall, 31.5% (157/498) of children were sensitized to at least one HDM allergen (Der p, n = 153; Der f, n = 95), and 41.4% (206/498) were sensitized to at least one aeroallergen. Feather bedding use was rare at 1 month of age: Only four infants slept on a feather pillow, and two infants slept under a feather quilt. Thus, the relationship between infant feather bedding
Discussion
In this study, children using a feather quilt were less likely to be sensitized to HDM and were less likely to have severe asthma symptoms. The reduction in symptom severity was particularly marked in children with HDM sensitization. Several features in this cross-sectional study indicate that feather bedding avoidance by children with asthma may not explain these findings. First, even among children with no history of asthma, feather quilt use was associated with reduced HDM sensitization.
Acknowledgements
We thank the parents, families, infants, and children who participated in these studies and the hospitals participating in the cohort study. We thank the participating schools, the Department of Education, and the Catholic Education Office. H. Donaldson and V. Hennessy undertook data collection for the 1997 follow-up study. C. Goff coordinated the 1995 asthma survey. K. Mackenzie and E. Sebo conducted literature searches and were involved in manuscript preparation. R. Attewell contributed
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