The Role of Cockroach Allergy and Exposure to Cockroach Allergen in Causing Morbidity among Inner-City Children with Asthma
David L. Rosenstreich, M.D., Peyton Eggleston, M.D., Meyer Kattan, M.D., Dean Baker, M.D., M.P.H., Raymond G. Slavin, M.D., Peter Gergen, M.D., Herman Mitchell, Ph.D., Kathleen McNiff-Mortimer, M.P.H., Henry Lynn, Ph.D., Dennis Ownby, M.D., Floyd Malveaux, M.D., Ph.D., for The National Cooperative Inner-City Asthma Study
Background It has been hypothesized that asthma-related healthproblems are most severe among children in inner-city areaswho are allergic to a specific allergen and also exposed tohigh levels of that allergen in bedroom dust.
Methods From November 1992 through October 1993, we recruited476 children with asthma (age, four to nine years) from eightinner-city areas in the United States. Immediate hypersensitivityto cockroach, house-dust-mite, and cat allergens was measuredby skin testing. We then measured major allergens of cockroach(Bla g 1), dust mites (Der p 1 and Der f 1), and cat dander(Fel d 1) in household dust using monoclonal-antibody–basedenzyme-linked immunosorbent assays. High levels of exposurewere defined according to proposed thresholds for causing disease.Data on morbidity due to asthma were collected at base lineand over a one-year period.
Results Of the children, 36.8 percent were allergic to cockroachallergen, 34.9 percent to dust-mite allergen, and 22.7 percentto cat allergen. Among the children's bedrooms, 50.2 percenthad high levels of cockroach allergen in dust, 9.7 percent hadhigh levels of dust-mite allergen, and 12.6 percent had highlevels of cat allergen. After we adjusted for sex, score onthe Child Behavior Checklist, and family history of asthma,we found that children who were both allergic to cockroach allergenand exposed to high levels of this allergen had 0.37 hospitalizationa year, as compared with 0.11 for the other children (P = 0.001),and 2.56 unscheduled medical visits for asthma per year, ascompared with 1.43 (P < 0.001). They also had significantlymore days of wheezing, missed school days, and nights with lostsleep, and their parents or other care givers were awakenedduring the night and changed their daytime plans because ofthe child's asthma significantly more frequently. Similar patternswere not found for the combination of allergy to dust mitesor cat dander and high levels of the allergen.
Conclusions The combination of cockroach allergy and exposureto high levels of this allergen may help explain the frequencyof asthma-related health problems in inner-city children.
Source Information
From the Division of Allergy and Immunology, Department of Medicine, Albert Einstein College of Medicine, Bronx, N.Y. (D.L.R.); the Division of Pediatric Allergy and Immunology, Johns Hopkins School of Medicine, Baltimore (P.E.); the Department of Pediatrics, Mount Sinai School of Medicine, New York (M.K.); the Center for Occupational and Environmental Health, University of California, Irvine (D.B.); the Division of Allergy and Immunology, Department of Medicine, St. Louis University School of Medicine, St. Louis (R.G.S.); the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (P.G.); New England Research Institutes, Watertown, Mass. (H.M., K.M.-M., H.L.); the Division of Allergy, Henry Ford Hospital, Detroit (D.O.); and Howard University, Washington, D.C. (F.M.). Presented in part at the Annual Meeting of the American Thoracic Society, New Orleans, May 11–15, 1996.
Address reprint requests to Dr. Rosenstreich at Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461.
Cockroach Allergen and Asthma
Schulaner F. A., Jaén C. R., Rosenstreich D. L., The Environmental Subcommittee of the National Cooperative Inner-City Asthma Study
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N Engl J Med 1997;
337:791-792, Sep 11, 1997.
Correspondence
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