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Board Review

"Hypoallergenic" vs. feather bedding: Which is better?

Q. Which is preferable as a recommendation a person with allergies - "hypoallergenic" synthetic bedding or bedding made with natural down/feathers?

A. : Feathers have long been blamed as potential allergens in worsening nasal allergies and asthma. Much of this thinking is a result of case reports showing improvement in symptoms when people limited exposure to feather bedding, rather than any data from controlled clinical trials. Despite a lack of solid evidence, it has been common practice to advise people with allergies and asthma to avoid feather or down comforters, pillows, etc. Studies have shown that true allergic sensitivity to feathers themselves is quite rare. Positive skin test results to feathers are instead thought to be due to extract contamination with house dust mites or other mites.

Over the past few decades, there has been increased availability of synthetic bedding products, which attempt to offer a “best of both worlds” scenario of being “hypoallergenic” while maintaining their natural feel. Unfortunately, synthetic pillows and duvets have been associated with an increased risk of wheezing, nasal allergies, and eczema when compared to their natural feather counterparts, in multiple international studies.

This raises the interesting question of how allergic individuals can react to seemingly benign, synthetic materials. Indoor allergens, namely house dust mites and mold, permeating through synthetic pillow and comforter coverings have been predominantly implicated. Confirmatory studies have demonstrated up to an 8-times higher allergen load with dust mite, cat and dog allergens in synthetic pillows, when compared to those made from natural feathers. Feather pillow and comforter casings are usually produced with a tighter weave, leading to smaller pore size, in order to maintain integrity of the bedding product. This small pore size could potentially function as a typical after-market dust mite cover would, to reduce allergen load. Other investigators have shown that the heat-washing process used to prepare natural feathers actually lowers their dust mite content.

Based on this evidence, it would be reasonable to advise people with allergies and asthma to continue using their natural feather beddings over synthetic alternatives, with additional dust mite-proof encasings recommended as appropriate. Of note, more recently introduced synthetic pillows and comforters having smaller pore size coverings would also have the potential to reduce allergen loads.

References:
Fitzharris P, Siebers R, Crane J. Pillow talk: have we made the wrong beds for our patients to lie in? Clin Exp Allergy. 1999 Apr;29(4):429-32

Dryer AL, Chandler MJ, Hamilton RG. Dust-mite allergen removal from feathers by commercial processing. Ann Allergy Asthma Immunol. 2002 Jun;88(6):576-7.

Siebers R, Nam HS, Crane J. Permeability of synthetic and feather pillows to live house dust mites and house dust. Clin Exp Allergy. 2004 Jun;34(6):888-90.

Siebers R, Fitzharris P, Crane J. Feather bedding and allergic disease in children: a cover story? Clin Exp Allergy. 2002 Aug;32(8):1119-23.

 
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