Allergen reduction interventions for preventing asthma in children at high risk.
Evidence Summaries Level of Evidence = C
Multifaceted interventions, characterised by dietary allergen reduction and environmental remediation, may reduce the odds of a physician diagnosis of asthma later in childhood.
A Cochrane review 1 included 9 studies with a total of 3,271 subjects. Three were multifaceted and six monofaceted intervention studies. Physician diagnosed asthma in children less than five years, and asthma as defined by respiratory symptoms and lung function criteria in children aged five years and older, both favoured treatment with a multifaceted intervention compared to usual care (< 5 years: OR 0.72, 95% CI 0.54 to 0.96, and > 5 years: OR 0.52, 95% CI 0.32 to 0.85). However, there was no significant difference in outcome between monofaceted intervention and control interventions (< 5 years: OR 1.12, 95% CI 0.76 to 1.64, and > 5 years: OR 0.83, 95% CI 0.59 to 1.16). Indirect comparison between these treatments did not demonstrate a significant difference between multiple interventions and mono-interventions in reducing the frequency of asthma diagnosis in children under five years (relative OR 0.64 (95% CI 0.40 to 1.04, P = 0.07) or five years and older (relative OR 0.63, 95% CI 0.35 to 1.13, P = 0.12). There was also no significant difference between either mono- and multifaceted intervention and control in reducing the likelihood of symptoms of nocturnal coughing at follow up. Wheezing, however, showed a significant difference between multifaceted and mono-interventions (relative OR 0.59, 95% CI 0.35 to 0.99, P = 0.04), but the significance was lost when data on treatment only was analysed.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and by indirectness (no head-to-head comparisons of multi- and monofaceted interventions).
1. Maas T, Kaper J, Sheikh A, Knottnerus JA, Wesseling G, Dompeling E, Muris JW, van Schayck CP. Mono and multifaceted inhalant and/or food allergen reduction interventions for preventing asthma in children at high risk of developing asthma. [Review content assessed as up-to-date]: 18 January 2011. Cochrane Database Syst Rev 2009 Jul 8;(3):CD006480. [PMID:19588394]
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