My son’s food allergies had taken front seat in our family for the past year, and I took comfort in the fact that my daughter, a.k.a. ‘The Bug’, was allergy-free.
Then she got a ‘cold’ that wouldn’t go away. For months her nose ran and she suffered endless rounds of a horrible, wracking night-time cough. We finally accepted the inevitable: she had developed my husband’s dust mite allergy. I took her along to my son’s allergy specialist and a skin prick test confirmed it.
A flurry of activity followed: I packed away her duvet, tossed her carpet, stuffed most of her plush toys into a vacuum pack and hid them away. I didn’t have the heart to retrench Teddy, who’s done a yeoman’s job keeping her safe from the bogeyman since she was born.
The Bug also made tearful stand over her ‘Guys’ – the core team of six stuffed toys that rank under Teddy but still spend the night on her bed. Watching my baby stand there, clutching Bingo, Bunny and the rest of the team, crying, “Noooo! Not my Guys!” made me feel pretty bad.
They got a reprieve from the plastic bag, but have been relegated to the doll’s pram and booted off the bed. Teddy, meanwhile, hit the washing machine, coming out looking even more bedraggled than he usually does.
Then I started flipping through one of those allergy product brochures. When your kid is wheezing and coughing all night, it’s tempting to cash out her college fund and buy one of those $2,000 anti-allergen steam vacuum cleaners, or at least one with a HEPA (High-Efficiency Particulate Air) filter.
Then there are dust mite proof sheets and pillowcases. I have several friends who’ve spent a small fortune on this kind of speciality bedding. It’s natural for parents to feel they need to spend what it takes to stem the tide. But it is worth it? Do all these work?
I decided to check in with Prof Hugo Van Bever, Head of the Paediatric Allergy, Immunology & Rheumatology Department at the National University Hospital, and Associate Prof Anne Goh, Head of the Paediatric Allergy Department at KK Women’s and Children’s Hospital. Both said the same thing: a resounding “No”.
Singapore is dust mite heaven: it’s hot, it’s humid and the tropical climate is perfectly suited to the lives and loves of the little buggers. They positively flourish here, no matter what you do. You can steam clean your entire flat, top to bottom, each day and you would reduce the number of mites, for sure – but there would still be enough to spark a reaction.
It takes just 10 micrograms of mites per gram of dust to kick off symptoms, and there is no cleaning system in the world that can get dust mite concentrations in a typical home below that threshold.
Dr Goh’s research shows that over 90% of the children treated at KK for eczema, allergic rhinitis or asthma are allergic to dust mites. The mite allergy sets off these other conditions. So what should families do?
“You can reduce the amount of dust mites in your home, but you shouldn’t get obsessed,” advises Prof Van Bever.
Regular vacuuming and mopping helps, and bedding should be washed regularly in super-hot water (around 60 degrees Celsius) or run through a hot dryer for more than 20 minutes. It’s probably a good idea to remove the carpets from your child’s bedroom and get as many stuffed animals off the bed as you can, adds Dr. Goh.
Prof Van Bever advises his patients to buy an inexpensive, thin mattress that costs less than $100 for their child, and replace it once a year. In the meantime, sun the mattress regularly – the sun will drive dust mites out if the mattress is thin enough, Prof Van Bever says. (If the mattress it thick, they’ll just burrow deeper.) He also recommends parents buy their child a pillow that costs less than $10, and replace that every few months.
“You have to try to keep your exposure low, but don’t spend money on stuff that has never been proven to work,” he says.
Dr Goh agrees. A two-year study of over 900 children with asthma induced by dust mite allergies (which was published in the New England Journal of Medicine) deduced that children who’s parents did all the extra stuff – bought allergen-impermeable covers, a HEPA vacuum cleaner and a HEPA air purifier – were only able to reduce the number of days their child was sick in every two-week period by just one more than the control group.
So all that expense bought just one more asthma-free day every fortnight over the people who did nothing. “If you spend a lot and combine these interventions, you may get slightly better outcomes – but not dramatically better,” adds Dr Goh.
Dust mite allergies, and the associated asthma, eczema and allergic rhinitis that children often develop, can be controlled with medication, both doctors say. The topical steroid sprays and inhalers given to kids today are low-dosage and quite safe; they have been around for decades and are among the most widely-trailed and well-tested types of medicine on the market, asserts Prof Van Bever. “You can’t avoid allergens, and you can’t cure allergies – but you can control allergies with medication,” he says.
It’s important not to shy away from giving your child medications to control their symptoms or thinking “Oh, their nose isn’t too stuffed, their cough isn’t too bad”. Chronic inflammation damages the nasal passages and airways, leading to permanent and worse problems in adulthood, Prof Van Bever says.
And don’t be too strict about the stuffed toys. Sure, they may contain dust mites, but they also bring your child joy.
“You have to think of the whole child. I would rather give my child more treatment than make my child unhappy,” he says. “You can always freeze or wash the toys.”
That may be the ticket for Teddy. He wasn’t built to go in the washer, but we’ve done it anyway. Years of suffering through the rinse cycle have taken their toll on the old guy. I fear for his head. Letting him chill out in the freezer for a spell each week may be the way to go.
Cris Sivashanmugam is the co-editor of sneezywheezy.com Singapore’s only allergy blog.