Common allergies in urban adolescents and their relationships with asthma control and healthcare utilization

Abstract

BackgroundUrban adolescents suffer a disproportionate burden of asthma morbidity, often in association with allergies. Literature is limited on comparing various types of allergies regarding prevalence and associations with asthma morbidity in urban dwelling adolescents. The purpose of this study was to examine the prevalence of common allergies reported by urban adolescents and to assess their relationships to healthcare utilization and asthma control.MethodsStudy participants included 313 urban adolescents (12–20 years of age) with persistent asthma who were recruited from three states in the United States. Self-report data were collected on nine indoor and outdoor allergies, healthcare utilization, and asthma exacerbation. Logistic regressions and zero-inflated Poisson regressions were conducted to examine the relationships between allergies and asthma morbidity.ResultsThe mean age of participants was 14.58 (± 1.97) and 52% were female, and 79% were black. Seventy-three percent (n = 229) reported one or more allergies. Dust mite and grass allergies were most common, each reported by 50%. The prevalence of pest allergies (cockroach and mouse) was 27.5% and 19%, respectively. Those with pest allergies were more likely to report ED visits (cockroach- Odds Ratio (OR) = 2.16, 95% CI 1.18–3.94, p = .01; mouse- OR = 2.13, 95% CI 1.09–4.07, p = .02), specialist visits (cockroach-OR = 2.69, 95% CI 1.60–4.54, p < .001; mouse- OR = 2.06, 95% CI 1.15–3.68, p = .01) and asthma exacerbation (cockroach-OR = 2.17, 95% CI 1.26–3.74, p < .001; mouse- OR = 2.30, 95% CI 1.26–4.18, p = .01). Cockroach allergies were associated with 2.2 times as many nights in the hospital (95% CI 1.053–3.398, p = 0.036) and 2.2 times as many specialist visits (95% CI 1.489–3.110, p < 0.001), and mouse allergy was associated with 1.6 times as many ED visits (95% CI 1.092–2.257, p = 0.015) compared to those without pest allergies.ConclusionsConcomitant occurrence of allergies is ubiquitous among urban adolescents with asthma. Only pest allergies, of those examined, appear to have implications for poorly controlled asthma, exacerbation and acute healthcare utilization. To reduce asthma burden in urban adolescents, identification and management of high-risk adolescents with pest allergen sensitization and exposure are warranted.

A cross sectional study of patients with poorly controlled asthma at a referral centre

“…Cockroach allergies was associated with 2.2 times as many specialist visits, while mouse allergies was associated with 1.6 times as many emergency department visits. 20 These results are similar to this study findings and this points towards doing a detailed sensitization testing for cases of poorly controlled asthma. In such cases, it may be necessary to re-consider environmental and allergen control measures.…”

The influence of urban exposures and residence on childhood asthma

“…Numerous studies in the United States have demonstrated the association between both mouse and cockroach allergen exposure and increased asthma morbidity, including increased asthma symptoms and exacerbations, increased acute visits and hospitalizations for asthma, and lower lung function in urban children with asthma. [12][13][14][26][27][28] The above-mentioned study of Polish children with asthma found cockroach exposure to be associated with more severe asthma and lower lung function. 25 In addition to increased exposure to pest allergens, children in urban neighborhoods are also at increased risk of exposure to mold, which has also been associated with housing disrepair and low-income housing.…”

“…Pest allergen exposure, especially when combined with sensitization, has been repeatedly associated with asthma morbidity. Numerous studies in the United States have demonstrated the association between both mouse and cockroach allergen exposure and increased asthma morbidity, including increased asthma symptoms and exacerbations, increased acute visits and hospitalizations for asthma, and lower lung function in urban children with asthma 12–14,26–28 25 …”

Asthma and the social determinants of health

“…[61][62][63] Pest allergen exposure has been repeatedly linked to risk of asthma, asthma prevalence, morbidity, and abnormal lung function. 59,[64][65][66][67] Recent data suggest that pest allergen exposure may lead to reduced lung function growth, 68 which has implications for future risk of adult lung disease and mortality. [69][70][71][72] Similarly, poor housing quality and housing disrepair are associated with risk of exposure to mold, 73 and exposure to mold is associated with childhood wheeze and asthma prevalence and morbidity.…”