Research objectives and content
eczema, hayfever) in childhood has increased during the last decades to about 20 - 30 %. House dust mite (HDM) sensitization has a key role in the pathogenesis of asthma and has an impact on eczema and perennial rhinitis. Complex avoidance measures during the first year of life can prevent the atopic manifestation in a significant number of children. Encasing of mattress and bedding - simple to do, but at significant costs - has proved to be efficient in treatment of HDM-allergic patients; its role in prevention still has to be defined. Objectives : The proposed concerted action facilitates the evalutation of simpl preventive measurements against the development of atopic diseases from birth to the age of nine years, both in terms of efficiency and cost-effectiveness under the different health plans of five European countries. Study design : The prospective randomised study includes newborns, children at and 6 years, each cohort to be followed for 3 years to cover the whole timespan quickly. The recruitment procedure has to identify children at risk for atopic disease (family history, sensitization already present in the child). The prevention/intervention measures will consist of health counselling, HDM allergen avoidance measures, namely encasing mattress and bedding, and simple reinforcment visits. The controls will have health counselling alone. The outcome variables are sensitization against HDM and manifestation of atopic disease. Task for concerted action : The European dimension of the study will facilitate a quick recruitment of the study population. At the same time the standardization of study instruments (questionaires, allergy tests, counselling, allergen avoidance procedures, diary cards, outcome protocols) allows a valid comparison of the population despite the different nationality. To cover a wide spectrum of the European lifestyles, children from Austria, Germany, Greece, Lithuania, and the UK are included. The prevention/intervention measures are so simple, that it could be implemented in the general population immediately, if successful. However, if this general approach is to be proved successful, it is necessary to have the study to be done in different countries from the beginning. Thus, for each country the following issues are checked prospectively: the number of children at risk, the means by which they are identified, the local living conditions and customs interfering with the prevention measures, and the efficency and costs-effectiveness of the prevention programme. Conclusion : The proposal describes a study which has a scientific rationale an includes health education plus a new technology of allergen avoidance. The design can be implemented immediately among the population of five differing countries. The value of this approach will be revealed by data on health economics derived as the scientific study progresses.