***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Several studies on avoidance of house‐dust‐mite ( HDM ) and cat allergens have been carried out , most of them in asthmatic patients and only a few in patients with atopic dermatitis ( AD ) . No study so far has focused on which subgroup of AD patients benefits from avoidance measures OBJECTIVE To evaluate the impact of childhood atopic eczema on families and assess the personal financial cost of its management . DESIGN Cross sectional survey . SETTING Paediatric dermatology and paediatric diabetology outpatient clinics . PATIENTS Parents of 48 r and omly selected children with atopic eczema and 46 with insulin dependent diabetes mellitus . MAIN OUTCOME MEASURES The impact on family score , the reported cost of relevant medical treatments , medical consultations , relevant hospitalisation , and income loss . RESULTS Families of children with moderate or severe atopic eczema had a significantly higher impact on family score than families of diabetic children . A conservative estimate of the annual personal financial cost of managing mild , moderate , and severe eczema was Aus$330 , 818 , and 1255 , respectively . The financial cost to the community for the management of atopic eczema in the study groups was greater . The personal financial cost of managing eczema was greater than for asthma . CONCLUSION Childhood atopic eczema has a profound impact on the social , personal , emotional , and financial perspectives of families Background Avoidance of allergens has been shown to be of benefit in patients with atopic asthma sensitized to indoor allergens . In atopic dermatitis , there is so far little information about the effect of house dust mite elimination strategies OBJECTIVE To evaluate hypersensitivity to Dermatophagoides pteronyssinus ( D. pteronyssinus ) and D. farinae in pediatric patients with atopic dermatitis ( AD ) , and to assess the therapeutic value of using acaricides with other environmental anti house dust mites ( HDM ) measures . METHODS Ninety-eight children with AD were chosen r and omly from the Pediatric Allergy Clinic in Al-Noor Hospital , Khalifa branch , Abu Dhabi , United Arab Emirates during the period between January 2008 to January 2009 and were evaluated for severity and chronicity . They were subjected to skin prick test ( SPT ) including D. pteronyssinus and D. farinae antigens and were also assessed for the therapeutic value of acaricides and environmental anti HDM measures . RESULTS We found that 74.5 % of patients were sensitive to one or both strains of HDM . A highly significant association was found between the severity of the symptoms of AD and its persistence with hypersensitivity to HDM ( p=0.001 ) . Acaricides and environmental anti HDM measures can improve patients with mild AD . CONCLUSION Hypersensitivity to HDM is an important factor for the more acute , more chronic , and more severe AD .  Anti HDM measures including the use of acaricides can help control mild AD . We recommend SPT as a part of the work up of patients with AD . The HDM sensitive patients can benefit from anti HDM measures Background : Environmental control has been put forward as an integral part of the management of house dust mite ( HDM ) allergy in sensitized patients . To vali date this statement allergic disorders involved in HDM allergy – allergic asthma , rhinitis and atopic eczema/dermatitis syndrome ( AEDS ) – should be taken together and studied in terms of the efficacy of environmental control . Because a generic quality of life question naire exceeds the border of disease , this may be used as major outcome parameter BACKGROUND Encasing bedding in impermeable covers reduces exposure to house-dust mites , but the clinical benefit of this intervention as part of mite-avoidance measures for patients with allergic rhinitis is not known . We performed a multicenter , r and omized , placebo-controlled trial of one year of use of impermeable bedding covers in the bedrooms of patients with rhinitis who were sensitized to house-dust mites to determine the effects on the signs and symptoms of disease . METHODS Three participating university medical centers enrolled 279 patients with allergic rhinitis who were r and omly assigned to receive impermeable or non-impermeable ( control ) covers for their mattress , pillow , and duvet or blanket .  At the start of the study , all participants received information on general allergen-avoidance measures . The severity of rhinitis was measured on a rhinitis-specific visual-analogue scale and by means of a daily symptom score and nasal allergen provocation testing . We also measured the concentrations of Dermatophagoides pteronyssinus ( Der p1 ) and D. farinae ( Der f1 ) in dust from patients ' mattresses , bedroom floors , and living-room floors at base line and after 12 months as a measure of the efficacy of the intervention . RESULTS A total of 232 patients completed the study . There was a significant reduction in Der p1 and Der f1 concentrations in the mattresses of the impermeable-cover group , whereas there was no significant reduction in the control group . However , there was no significant effect on the clinical outcome measures . Analyses of subgroups defined according to age , level of exposure , type and severity of sensitization , or characteristics of the patient 's home had similar results . CONCLUSIONS Mite-proof bedding covers , as part of a structured allergy-control program , reduced the level of exposure to mite allergens . Despite the success of the intervention , this single avoidance measure did not lead to a significant improvement of clinical symptoms in patients with allergic rhinitis BACKGROUND Little is known about the prevalence of atopic eczema outside Northern Europe . OBJECTIVES We sought to describe the magnitude and variation in the prevalence of atopic eczema symptoms throughout the world . METHODS A cross-sectional question naire survey was conducted on r and om sample s of schoolchildren aged 6 to 7 years and 13 to 14 years from centers in 56 countries throughout the world . Those children with a positive response to being question ed about the presence of an itchy relapsing skin rash in the last 12 months that had affected their skin creases were considered to have atopic eczema . Children whose atopic eczema symptoms result ed in sleep disturbance for 1 or more nights per week were considered to have severe atopic eczema . RESULTS Complete data was available for 256,410 children aged 6 to 7 years in 90 centers and 458,623 children aged 13 to 14 years in 153 centers . The prevalence range for symptoms of atopic eczema was from less than 2 % in Iran to over 16 % in Japan and Sweden in the 6 to 7 year age range and less than 1 % in Albania to over 17 % in Nigeria for the 13 to 14 year age range . Higher prevalences of atopic eczema symptoms were reported in Australasia and Northern Europe , and lower prevalences were reported in Eastern and Central Europe and Asia . Similar patterns were seen for symptoms of severe atopic eczema . CONCLUSIONS Atopic eczema is a common health problem for children and adolescents throughout the world . Symptoms of atopic eczema exhibit wide variations in prevalence both within and between countries inhabited by similar ethnic groups , suggesting that environmental factors may be critical in determining disease expression . Studies that include objective skin examinations are required to confirm these findings BACKGROUND The intestinal microflora is a likely source for the induction of immune deviation  in infancy . OBJECTIVE The purpose of this study was to prospect ively relate the intestinal microflora to allergy development in 2 countries differing with respect to the prevalence of atopic diseases . METHODS Newborn infants were followed prospect ively through the first 2 years of life in Estonia ( n = 24 ) and Sweden ( n = 20 ) . By that age , 9 Estonian and 9 Swedish infants had developed atopic dermatitis and /or positive skin prick test results .  Stool sample s were obtained at 5 to 6 days and at 1 , 3 , 6 , and 12 months , and 13 groups of aerobic and anaerobic microorganisms were cultivated through use of st and ard methods . RESULTS In comparison with healthy infants , babies who developed allergy were less often colonized with enterococci during the first month of life ( 72 % vs 96 % ; P < .05 ) and with bifidobacteria during the first year of life ( 17 % to 39 % vs 42 % to 69 % ; P < .05 ) . Furthermore , allergic infants had higher counts of clostridia at 3 months ( median value , 10.3 vs 7.2 log(10 ) ; P < .05 ) . The prevalence of colonization with Staphylococcus aureus was also higher at 6 months ( 61 % vs 23 % ; P < .05 ) , whereas the counts of Bacteroides were lower at 12 months ( 9.9 vs 10.6 log(10 ) ; P < .05 ) . CONCLUSION Differences in the composition of the gut flora between infants who will and infants who will not develop allergy are demonstrable before the development of any clinical manifestations of atopy . Because the observations were made in 2 countries with different st and ards of living , we believe that our findings could indicate a role for the intestinal microflora in the development of and protection from allergy BACKGROUND The role of housedust-mite ( HDM ) allergen ( Der p1 ) in the pathogenesis of atopic dermatitis is controversial . We tested the hypothesis that atopic dermatitis improves if amounts of HDM allergen in the home are reduced . METHODS Active treatment comprised Goretex bedcovers ( placebo , cotton covers ) , benzyltannate spray ( placebo , water ) , and a high-filtration vacuum cleaner ( placebo , a conventional domestic vacuum cleaner ) . Dust was sample d monthly from the mattress covers and bedroom and living-room carpets . 48 patients ( 24 adults [ mean age 30 ] and 24 children [ mean age 10 ] ) completed the 6-month study . 28 were in the active treatment group and 20 in the placebo group . FINDINGS The weight of dust collected from Goretex-covered mattresses had fallen by 98 % at 1 month ( from 386 to 9 mg/m2 ) with no change thereafter . Placebo covers caused a smaller reduction in dust load ( 361 to 269 mg/m2 ) ; the difference between active and placebo covers at 6 months was highly significant ( p = 0.002 ) . Both active and placebo treatments caused significant reductions in Der p1 concentrations in bedroom and living-room carpets and the differences between the treatments were not significant . The severity of eczema decreased in both groups , but the active group showed significantly greater improvements in severity score ( difference between mean final scores 4.3 units , p = 0.006 ) and area affected ( difference between mean final areas 10 % , p = 0.006 ) in analysis of covariance with initial mattress dust weights and bedroom carpet Der p1 load as covariates . Reported analysis with final values for the covariates showed that most of the treatment effect was due to the reduction in mattress dust and carpet Der p1 . INTERPRETATION The activity of atopic dermatitis can be greatly reduced by effective HDM avoidance . Methods to identify individuals who will benefit most from such measures are needed Exposure to high allergen levels in early life is a risk factor for the development of allergy . We previously reported limited effects of mite allergen impermeable mattress covers in the prevention and incidence of asthma and mite allergy ( PIAMA ) cohort at the age of 1 and 2 yr . We now present the results of follow-up at 4 yr objectives . To examine the effects of early reduction of house dust mite ( HDM ) allergen exposure by means of mattress covers on the incidence of allergy and asthma symptoms in the PIAMA birth cohort at the age of 4 yr . High-risk children ( allergic mother ) were prenatally recruited and r and omly allocated to three groups ; receiving mite allergen impermeable mattress covers ( n = 416 ) , placebo covers ( n = 394 ) or no intervention ( n = 472 ) . At 4 yr of age , atopy was assessed by question naire ; specific Immunoglobulin E ( IgE ) to inhalant and food allergens was measured in serum . Dust sample s collected from the children 's mattresses were analysed for mite allergens . Dermatophagoides farinae1 allergen ( Der f 1 ) levels in dust were reduced in the active group . However , Dermatophagoides pteronissinus 1 ( Der p 1 ) levels , sensitization and atopic symptoms were similar in all groups . We found no effect of mite allergen impermeable mattress covers on sensitization and atopy at 4 yr . Moreover , the allergen reducing effects of the covers had disappeared for one of the two mite allergens that were measured Allergic reactivity to house‐dust mites ( HDM ) can be detected in patients with atopic eczema by prick and patch test challenge . To determine the clinical relevance of this reactivity , we performed a placebo‐controlled , double‐blind trial of anti‐HDM measures . Active treatment comprised Gortex bags for all the bedding elements , a high‐powered vacuum cleaner , and a spray containing benzyl alcohol and tannic acid to kill mites and denature allergens . Placebo treatment was light cotton bags , a cheap vacuum cleaner , and water spray .  Forty‐eight patients ( 28 active group ) completed the trial , which lasted 6 months . D 
    Output:
    
We were unable to determine clear implication s to inform clinical practice from the very low- quality evidence currently available .
The modest treatment responses reported were in people with atopic eczema , specifically with sensitivity to one or more aeroallergens .
Thus , their use in the eczema population as a whole is unknown .