o":iz`:,4

aus
Sonderdruck
Hllergolog
Dustrivedag
DrKa tuistie
vereinigtmit rAllergieund lmmunologie"
lmmunbiologische
Grundlagen
Diagnostik
undTherapiefirr
Praxis
undKlinik
T h i s j o u r n a ll s r e s L l a r l yl i s t e di n C u r e n t C o n l e n l s / C l l n l c a
Pracllce
Resultsof a retrospective
study
on the efficacyol
an allergen-and miteproof
encasing
D. Mallerschevenr,F. Kniest' [,4 Disuel, M Hollman-weckel
1M D. lntenal, Lung and Bronchial Medicine/A eryology, Hambury
'?AllergapharnaJoachin Ganzer KG, Reinbek, Gernany
A uthonzed TI z n sIati an f rantAIIe.galogie
o":iz':,4
Allergophormo
Withcompliments
Allergophormo
GonzerKG
Joochim
A etgotoie.Jahryang
21,Nt 1l/1998,5.534540
Resultsof a retrospective
study
on the efficacyof
an allergenandmiteproof
encasing
D. Milller-schevenr.
F. Kniest2.
M. Dislef. N4.Hoftman-WeckeF
1M.D.,lntenal, Lungand BtohchiatMedicine/Altergology,
Hambury
'AllergopharmaJoachimGanzetKG, Reinbek,Getmany
None of the patientscomplainedof odour or
additional
weigbt.In moslcases
the€ncasings
werewashed
twiceayear.Atleast20different
Mite and allergenproof
pro- brandsof encasingsare oll the Germanmar
encasings
videa:iuccessful
prophylactic
me$urein the ket. Although nany claim to be mite- and
treatmenr
of houseduslmiteallergy.A ques- allergenproofas well as being comfonable,
tionnaire(multiplechoice)was senito 300 the majorityhave not beenthe subjectof
publishedstudies.The resultsof the present
palientswhopurchased
encasings
in theyears
1993 1994.in order to evaluarcclinical studyenableus to concludethat encasings
producedfrom tightly-wovenpolyesterfabric
efficacyof mattress,
duvetandpillow covers
efficiendy
reducethe concenFationsof airmadefrom a tighllywovenpolyesterfabric
bome
mite
allefgensemanatingfrom ma.
(Allergocover)
. A totatof300 quesdonnaires
tresses
and
bedding
withoutiDfluencingthe
wercdispatched,
but 20E ofthesecouldnot
comfon
in
a
way
such
thatthe users'symp,
b€ deliv€red.
Ofthe renaining240queslionwere
toms
decreased
dramatically
within a
naircs, I I I (46./o)were retumedand evalufew
days.
This
benefit
was
maintained
overa
ated.Themeanageofthe userswrs 23 years
-4 years.
(range5 72 yeart. 629. of the userswere periodofal leasi3
childrenand young adolescents.
The most
imporlantsymptonrsrecordedwere ,sthma
andrhinitis-Patients
documented
theirclini- Introduction
cal slal€beforeandafteruseotlhe encasings
using! linearanaloguescalefrom I 10.
The useof miteproofencasings
for bed
Only3%ofrespondcnts
reponed
th€irclinical
(rnattress,
pillow,
ding
duvet)
as
aprophylacstateashavingbeengoodor verygood(score
greater
I -.1 on theanalogu€
scale)beforeusingthe tic orsupponingmei;ureis assuming
cncasings,
but this improvedlo 86",1after impon.ncein ftescopeof derapyofallergies
(p < 0.001). This objec- altibutableto housedust mites [161.The
usingthc encasings
tiveimprovement
wASobserved
by 59. of the lherapeulicobjective of improvementor
patientsafteroneday,3l 9. after.tfewdays,
27%afiera few wecksandafurth€r2890
after eliminationof symptomscausedby mite alwith symptomatic
or
a fcw monlhs.Only 99. of the reipondents lergy,throughFeatment
medicalion,is achieved
recorded
no improvement.
Clinicalimprove- immunostimulatory
menthasoccuredon thebasisoia numberof rnorequicklyandabove
allmoresafelywhen
performedmeasures
Ganihtion,medication, theinlakeof allergens
is reduced,or
in thebest
AuihorlEd T.ansl.ii
desensitisation)
and can be seenas an out- caseeliminated.
Encasings
pro
rcpresentone
on. Ouotation only accomeofall measurer
together.
However,thc
phylactic
measure
in
addition
to
sanilation.
linearanalogue
scaleshowsthatpatients'im'
Eeebnisse
ener retrc- provement
occunedmainlyafterapplication i.e.all€rgenremoval,or theuseofacaricides
speklivenstudie ilber of th€cncasings.
The influenceofth€ encas- (mirc killing agents)and allergenreducing
die Wnksamkeit
eines ing
on thecomfono[ thebedwasa$sessed
in preparations.Current allergologicalpractice
termsof sweating,
odour.weightandnoise dictatesthat sanitationand prophylaxisare
level.Morethan8070ofthepatienlsreporied
carriedoutin additionto theusualtherap€utic
tbat thcrcwasno increase
in disturbance
oi
(Encasns).
when treatingallergicrnanifestatheirsleep,especially
in respectof sweatin8. measures
tions
alrributable
to m;res.Trearmenr
of |he
Thc majoriryof complaintsconcemedthe
21,
Jahrgang
noiselevel
associalcd
with
duv€t
covers.
synptoms
with
Nr.11/1998,
d.!gs or specificimmunoS 534-540
palionts'
En@sng
evalualion- aslhmaininitis- conjunctivilis
dermalilis- hous€dusl
- all€r
mile- pr€venlion
Results of a retrocpective sludy on the
eflicacy of an allergen- and mileproof encasing
Miiller Schever, Kniesl.Disler und Ho{lman-Wecker
Tab. 1. Frequencyol clinicalsymploms(ienosp6live interogatio. using a
queslionnaire,
N = lll palienls).
(including
aslhma)
FespiEtoryobslruclions
32
68
9l
32
1
29%
61%
a2v"
29v"
Morerhanonearswerwaspossb o
Tab- 2. Frequencyof slrongesicomplaints(relrospecliveinleffogationlsing
N = 111parienls).
a ousslionnair€,
(including
asthma)
Fespi€ioryobstructions
5
5v"
69
624/"
15L
54"
6
Mo€ lhan one answerwas mssible
therapy!k)nc without simultancoussanitatron
aDdprophyhclic neasufesis lcssellective.
banier tunctionand the highestpossiblelevel
ol air cxchange,which nccessitatea ccnain
pofosity of lhe fabric'151. Furthermorerhe
h igh-tcch-nuterialof lhcseencasingsis washxble ri 60'C, dries quickly aod does nol
Unlil I 995 the cncnsingstestedherecould
only be purchaseddirecrly from the manulic
turer. A roralof 300 cu(omers who had prrchNed encxsingsin 19.)4/1995werc writlcn
to ( l60 who bought a m ttrcsscncasingonly.
l4O who bouShtthc colDpleteseo. Il proved
lo be impossibleto dclivcr 207. ofthc ques'
lionnaires-But fron rhe rcm:dning2.r0 qucs'
IionnairesI I I (46%) sc.e answeredand returncd and included in fie statiltical
evalu tion. The responsctale of nearly 507.1
is considcrcdlobe very good fbr sucha mail
ing inquiry t131.The resullsofrhis study arc
brscd upon the rhtments of ! standardized
4 pagequesdonnairewith 15questionsin to
ul.The answe.swerctobegiven by checking
oll oprions(sometnnesm(xc rhanone checkofl w.rs possible),nnd thereforca statislic l
evalua(ionwas greatly sirmplified.Thc slalisticrlcvaluaiion ofihe slmploms was madeby
applyirS the Wicoron SiSnedRants Test l6l.
Thesignificancelevelwas setat 0.001.Quesri{)nswere askcd nbort medical complaintr.
etfectilcncss,direct application,i.e. comtbrt
ol lying and sleepiog,as wcll as about frc
qucncy of use and washinlgof the single en-
Materialand methods
Thc cncasingscxrmined Arc rnLrdetionr a
tightl) woven l0(l'l. polyester microfabric.
There is no dditionalchcnricrl enhancement
(c.g. colrin8 with plastic Durtcrialsuch as
polyucrDrhrneor poly!iny1),but rarbon fibers
are woven into the fab.ic in orde.lo prerent
the btrild-upofan elecrostaticch rge. Unde.
normal slccpingconditionsthc cncasings.in
cludingzippeN
m d s e a n s s, h o u l db e i m p e n e
trlblc to n)itesand their allergcns.ln accord
ance$ nh hlgienic limir !rlucs serfordlcrgic
persons.thee)ichangeof warer!apoL'randai..
necessary
lbfsleepconfon andhygicne.Inust
guarantced.
also be
These prope(ies havc
been clalLurtedtechnicrlly rnd r(csled fbf
encasingsrrrde of tabric ft)f prctectivegirr
menls: ]'hc $idely used banicr proteclilc
grrment (clean'roon clothnrg) isbasedetlec
tively on a compromisc betweenunlimil€d
Results
In respectof thc initidl complaintsques'
rhns were askedregard;rglhe frequcncynnd
selerily otsymptonrs.and thenmorethrn one
answerwas possible.Evcn (houghthe qucstions were posedrctrospectively,it musl be
lakcn iito accountthat ll prtientspurchascd
thc encasings bccruse of thcir symploms
(qucslionl5 of thc qucsrionnairc) and in nrcsl
cirscspaid lbr them thcnrselves.Respiralory
synrproms(cough.congcstion.asthmn)were
thc nrost trequenrnnmed by 827. of the rcspondcnts.followed by rhinitis wirh 617. and
coniunctivitisandeczcrr.rwith297,,each(Trblc l). 627. of the Flicn(s consideredthc
rcspiratorysymplo s.rs thc most disturbing.
folk)wed by rhinitis (371z) and eczema!vith
l5t1 (Table 2). lhe dirgnostic cxaminatbn
Fesuilsol a retrcspeclve sludyon the eiiicacyof an a erger- and mileprooiencasng
l. B.lo€ oppliane ol All€lgo.d€r I h I
2. Afi€r opplionca of A l.rsoo.r
f.h
Tab.3. Diag.oslicexaminations
donewilh the
palient(ietrospeclive
interrogalion
usinga quee
l o n n a i r eN, = 1 i 1 p a r i e n r s ) .
2
99
62
40
Fig 1 L fearanaloguescae (most mporlanlqueslion ol lhe quesllonare).
89%
56%
36%
I
0
linearanaloguescale
100
97
tx&{t,
*******
te.ent (487. temale,527. m!le). The average
agewas23years(5 to 72 yer.9. Childrenand
adolescenlsaccouDtedfor 607. of the subjects. Ther questionnaireswere filled in by
.1rr**r**
theif parents.Maltrcss cncasings were the
nost $,idcly usedpfoduct with 72E. Duvct
cncasrngswerc used by 327omd pilbw en
ttt
Ittt
casingsby347, of lhe rcspoDdents.
687. ofdre
ll
doctorsprescribingcDcasnrgwere allergists,
327. were lanily doctors.About half of ihe
respondcntswashed!he encasinglwice a ycar
ttr
at 60'C. l5a/. washedthen monthly or only
bad (5 10)
sood (1 4)
once lt yc,tr respectively.Those qoeslioncd
wcrc askedto assess
the severilyofthcircom
slepson lhe scale
plaints rctrcsFctively belbre and aftcr rppli
crtion ofihe encasingsusingr lnrerranalogue
b e t o r ea p p l r c d r r o nI a f t e . p p h . a n o n
scale (Figure 1). Thc rcsuk can be seen nl
Table
4. Trkmg poinrs 5 l0 ( 'bad") on rhc
F g 2 S c a i n go i r h ec o m p a n t so i t h ep a l t e n t s
(s1epI - 4:verygoodro good/ srep5 t0 badto linear symptom-scorescalc, 99 patie.ts (=
verybad)beforeandafrerappicalonof the enca 977d) gradcd thenrlelvesin this area bcforc
using covers.and a maximun of 3l pcrsons
(= 30%) gmded themselvesat poinr 8. After
appti.rtion of the encasings88 prtients (=
relencd to thc organs:skin - blood lung
86%) graded thenseh,csiD the range I :l
(Trblc l). lhe divisionsbetweenthc gcDders ("good").rDd only l4 perions(= 147.)graded
of ihe test personswcrc not substantiallydit'
thcmselvesinto the area5 10 ("bxd") (Fig
rt
60
40
2A
*rr****
.***r***
****r*,
*rr***,
Tab.4. Assessmenl{in q/a)oithe pal enls wel-being beforeand atterapplicalonoi encasingsusng a lneaf anatoguescae irom 1
lo 10 (verygoodloverybad). N = 102 pallerts,
Esl mationoi wellbeing ( iiea. sca e)
very
!ood
12
0%
17"
35./"
47"
2%
50/o
19%
19%
30%
a"/"
17.
100q/"
100%
102
102
Miillerscheven. Kniesl.Oislleru.d Hotlman-Wecker
4
months(median:3 months)irom thc lime they
strted to use the encrsings.Only 9% felt no
improvemenl(Table5). Weregardthescfindingsasvery impofian! astheyslrcssthelheralmprov6m6nl
oi thecompalnlsaner...
on6day
days
we€ks months
pcutic valueofthe encasings.The pfeventi!c
and medical mersurcsmcnln)ncd ir the rbl
lowing were obviously strooglysupponcdby
2A7a
100% 96
277"
9%
rheapplicalionofthe encasinBs.
Convcnlional
preventivernd medicalslcpswcrc inil ialedby
practicallyall palients(only one paticntgalc
no rnswers). iD most ot the c s€s p.obably
Tab.6. Prevenlivemeasuresundenakenbefo€ applkrtion o, encasings(N =
werc used( l'ablc6).507.
beforetheencasings
of the paticnts had thcir liltcd crrpels and
Funhefprsvenltsmeasures
curtainsremoled, and 57 - 78? boughr n€w
nuttresses,synthelicdulcts o. pillows. 45%
used rnit killing prepararions.Additional
medicalmeasuresare listed in lable 7. 619.
6l
55%
spfuys.55%
of the respondcntsusedLrsrhnm
c!.lainsandolh€rlextieobjecls
55
s0%
usedeye or nosedrops, and 2l% ol tbe lest
mie kilingpfepa€lons
50
personsunderwentaddirionalspecificimmu
speclalwash
ng addilv€slor mileklling
5
5%
nolherapy(SIT). The quarrliticsol-drugsuscd
63
suggestthat the paticnls had sullered fiom
86
considcrablesymptoms.Anorherdspcclofthc
87
queslionnaireconcernedthc comlbn ol sleepalleQyvacuumcieaner
30
ing a decisivemark lbr rhe complimcc ol
27
1
the use..93'l. of the palicmlsq ucslionedrated
fie comfon oflying and sleepingon (hc maG
oore lhan one answerpossible
lressencasings
asgood. ard wcrcol the opin'
ion thar their slccp was nor disrurbed.or ifso
only a lirle (Table8). The useolduver cncrs
ings led to dislu.bcd slccp rlt.ibutable to
cithe.
Tab.7. Msdcalm€asoresLndenakenbeioreapplcationotlheencasings(N= noiseorrhe slipperynrrurcollhc libric
for 28% ofthc rcspondenls.Usc ol the €ncrs
ings did not give rise to .rn) odou .rnd tlrFudhermedca measures
thermoretheir additionlrlwcighl wlrs seenas
Patents
Perc€nt
Thc conclusionth l iJ:tr%
of no consequencc.
purchasedtbr nr uresses.pilolall
encasings
25
23%
specilicmmunoiheapy
ldvs and duvctsdid nol gi!e risc kr iicrcascd
55%
347,
sweatingis of great nnportancclar the conr
codisonecoilainingsprat€(lorttrelung)
37
33"/.
pliaDcc.Thc queslionnaire!l{) eontrinedtwo
conisone
containing
creams
21
openquestions.The questionaboul.rddilional
30
positi!e characlcristics
ol lhc cocrsingswhich
6%
uses considercd $orrh{ hilc mentioning
morelhanoneanswerwasposible
drelvconnnentsffom 56.l of rlrcp tienls.The
€ifectivcncssofthe encasingsresultingin bec
ter health was thc most imporlrnt point
sfessedbl .10%of the respondcnrs( = 2l ?; of
rhe entiregroup).The easycarc ol tlre encas
irgt wls mcnrioncdby 36S?,(= 20{ oI lhc
u f e2 ) .T h i s r c s u l ti s s t a t i s t i c r l lsyi g n i f i c a n( tp cntiregroup)ol the paiients.167 (= 9./. ofthe
< 0.001 ). This i proveruell wLrsscenby 5% entiregurp ) rcferred1othe rgr0crblccon1pliance.and 87. (= 57. ofthc enlirc group) men
ofthe patientsrftcr onedry only. hy 30% dfiel
a few days. by 279t rftcr a Duller of weeks tioned posiiive propenies ol lhc cncasings
(nrcdian:3 weeks).and b) 28.1 rlicr a lew
when using them during lralcls (T,rble9).
ol lhe compainlslookplace
Tab.5. Timoduringwhicha clinialimprovement
(N = 96 palients).
afts|application
oi lhe encasings
Fesuls ot a rerospecrv6
studyonlhe efli€cy ot an atlergen,
andm ep.@iencasing
5
of encasingsis not only dcpendenlon thcse
facors. but ahoonth€ permeabiliryro airand
water vapour md on crireria such as sleep
comlo'1. handling. nrainlcnance.durabilily,
Comforlol lylngandslo€ping
nodislubance appr6cable
washing propenies. etc. 1101. These lasl
/]iltr€
dislubance
slatenent
poinls crn only be evaloatedby a retrospec,
distu6anc€
tive study. A number ol studies have been
p u b l i s h e dw h i c h d e m o n s t . a tteh e c l i n i c x l e l 2Ao
1 0 0 % a7
11%
100% 45
ficacy of encasingsmnde of foil or coatcd
65"/"
247"
43
texlile aswellrs iighdy wovenmicrofabric14,
85./,
54"
I 0 0 % 20
8 , l l , 1 5 , l 6 l . I n 1 9 9 . 1t h e e n g l i s hN a t i o n a l
AsthmaCamp.rignpublishcdan encasinglcsl
in cooperarionwith rhc Brirish Consumel
Associationin which ihe watervapourpermeTab. 9. Lisl ot positivopropeniesot en@sings ability was
analysedas.rcriterion lb.comfort
wonhwhile
(openqu€mentioning
bythecuslomer
during
sleep
13l.l-urthcrmore.rhercare techs l i o nN
, = 111).
nical studies using small piecesof fabric in
which auemptr havebcen madero rdve al a
conciusionin respectofelficacy (prrticle pcrmcabilily) and sleeping comfon (water va25
23eh
pour p€rmeability) [, 91. The authorscon10
cede that the use of rhesetechniquesonly
22
20.4
5
allow statementsto be nradeabout Lheprop10%
eniesof the m:rterialand nol abourtheclinical
efficacy.Fi.sdy, conplete encasingsembody
other propenies ovcr nnd abov€ those of
morothanonsanswerwaspo$ibl€
pieccsoffabricalone,and secondly,rhesimu,
lation ofcondirions during practicrl use was
overkbked duriDg these lcchnical studics.
Discussionsare currenlly b€ing conductedin
an atlcmpt to define conditions of prac(ic.rl
Discussion
use of complelecncasingswhich will cnable
an inrematioDalsrandaJdoi quality to be esMeasureso I allefgenaloidincr rcondir r o s r n e q u a n o ns h o u l dh eu n d e n a k c n s n n u l - tablished (Round Table Talk, Bem, May
tancouslywilh causrl lrclrtmenror imnruno, 199E).l'heresultsof the prlient-qucstionnaire
p.esenledhererfe,lts far as we are aware.the
thcfup). lhey should begin ,s carly rs
p o s s i b l e( b i n h l ) l l 4 l . l , r o p h y l a r i si s o f g r c a r first which rellect the efficacy and subjec,
livcly lelt.omli)ft of entire encasingsafrer
importancefor high risl infots lnd fbr pre
ventlrg a proSressionol dkase in sensitiTed couplc ofyears use.The questionnaireswere
4 ycars aftcr acquisition of lhe
persons.Mite xnd allcrgenproofencasings issued 3
encasings.In yiew of the lengthyexperience
are thc nrethodofchoicc in thesecNes l2l. In
addilion othcr potential $urces of allergens of lhe usersone hasto presumethal the eval -
(notdistu&inglo verydistubing)of comtonot Vinsand
Tab.s. Assessmenl
sleeping
w'lhdiFerenr
lypesolgncasrngs
{N - 20 871.
en€sing
shouldbc elinrinated.The useofenclsings in
thc bdddnrghrs no allcrgen .edLrcingeffccr
upon lhe carpcriving on thc floor bcnearhit.
This was shoq by \ .n dcr Heidc cr al. [7 ] irr
a study with n gr)up ol 59 palicnls divided
into 3 subgfoups.This pubiicrrion, in comnron $ith olhcrs.also shdlvedlhrl rbe use ol
encasingscould Iower the air$,!y rcsistancc
s i g n i l i c a n t lw
y i l h i n6 m o r u h s l.h e r c a r e v a r i
ous p.odu.ers ol encisings iD (;ermany. and
mosl of lherr claim lhrl rhcir p()ducts are
'nite- and allcrge proof. IIowe\cr. thequality
atior ofefficacy. comfon of lying nd sleeping as well as complianccare sornd. Il nray
be considereddcsirableir(nn a scientiiic poinl
ofview to recordclinical pdnmeters.such!s
skin tcst, RAST. provocaliontest,lung function lcsr etc. ii additionl() anamnesis,beforc
andespeciallyduring.tpplicationof rheenc,s
ings. Nevcftheless,the advaniageol lhe present stLrdyis that it achicvcs a conctusivc
resrlr which finally gnins grealcr nnd rhus
decisivcvalue. na|llei) a statisticallysignificant und definitc rrte ofirnprovcment during
6
Miill6rsch6v6n,
Knl€si,DlsllffundHotlman-w€ck€.
which was
4 y€arsof use,an improvement
appreciatedby most usersafter only a short
periodof applicationof the encasings.
Anlies in theexclusionof psyotheradvantage
influence,
asno "disturbing"inlerchological
rogationswere conductedduring the whole
periodofuse.Thecomplaints
beforeusewerc
very considerableandcould be describedexwerccomactly at the time the questionnaires
pletedwhich is demonstrated
by the fact that,
for €xamples,the useof medicationcould be
given clear'y and that the encasings
wer€
mosdyboughton thepatienfsown accounl.
Prospectivestudieson the efficacy of encasingsmadeof foil, coaledfabric or microfabric
textiles have been published. The prcsent
study may be se€nas a supplementto these
studiesbecaus€of irs r€trosp€ctivepoint of
view. Adyantagesof this retrospectiveassessment lie in the fact that the final resultswer€
gdinedv,/i(hou(anyinfluencebeingbroughtto
b€aron the patientsand that a full statistical
evaluationwas possible.One dnwback of
to include
sucha studyis thatil is notpossible
group.
placebo
a
Feferences
aou./ Ce j Hau$uubnilb.f,all.rgicr Asp€kc z!.
scnsibilisicrung&d All.rg.Nduldon. Piidiatri'
*hc All.rSolo8i..i, 6-12( 1998),
t2l A.rsrum KCr,j Sind Milbcnb.zitg. sinnvoll ?
AucreoJoumalJ, l2?-130(194).
t l l British Conswrt' Astuciatim ia colkborution
'f6tihg
*ih he N4noMI a{hm c@npaien:
of
miElss covc^. Fol{hr ocroh.r 194.
I4l Ehn t 8., S. Lu-Schad.dod A. W.bcr et al:
Rcdrcin8 domstic .rpos@ to dut mitc alLreen
cdues blpftnial hyprocdvity in e.sitilc childiEn wnh s6tu. J. Allergy Clin, Im@d
90.
r 3 5 - 1 3(8t 9 2 ) .
t5l ttrl€' Ar Tcxtiltcchnishe B€wenungvon Erc6ines. In: Allcrgopnma Sclrifi.neihc Bad 20
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