Few Associations Found between Mold and Other Allergen Concentrations in the Home versus Skin Sensitivity from Children with Asthma after Hurricane Katrina in the Head-Off Environmental Asthma in Louisiana Study

Abstract

Mold and other allergen exposures exacerbate asthma symptoms in sensitized individuals. We evaluated allergen concentrations, skin test sensitivities, and asthma morbidity for 182 children, aged 4–12 years, with moderate to severe asthma, enrolled 18 months after Katrina, from the city of New Orleans and the surrounding parishes that were impacted by the storm, into the Head-off Environmental Asthma in Louisiana (HEAL) observational study. Dust (indoor) and air (indoor and outdoor) samples were collected at baseline of 6 and 12 months. Dust samples were evaluated for dust mite, cockroach, mouse, and Alternaria by immunoassay. Air samples were evaluated for airborne mold spore concentrations. Overall, 89% of the children tested positive to ≥1 indoor allergen, with allergen-specific sensitivities ranging from 18% to 67%. Allergen concentration was associated with skin sensitivity for 1 of 10 environmental triggers analyzed (cat). Asthma symptom days did not differ with skin test sensitivity, and surprisingly, increased symptoms were observed in children whose baseline indoor airborne mold concentrations were below median levels. This association was not observed in follow-up assessments. The lack of relationship among allergen levels (including mold), sensitivities, and asthma symptoms points to the complexity of attempting to assess these associations during rapidly changing social and environmental conditions.

Changes in Skin Allergy Testing Reactivity observed after a Hurricane. Is the Environment Responsible?

“…Several studies assessed the allergen content of the homes in that area. Some studies were done 1-2 months after the hurricanes [18,19], and some studies were done several months later, while cleanup and remediation efforts had already begun [20][21][22]. While all these articles agree that wet conditions provided an ideal environment for mold and bacterial growth with subsequent potential health effects, only in the articles that evaluated the affected area 1-2 months after the hurricanes [18,19] was the concentration of indoor mold found to be significantly higher than the mean concentration outdoors.…”

From Design to Dissemination: Implementing Community-Based Participatory Research in Postdisaster Communities

“…Results from home assessments and a successful environmental asthma counselor intervention are reported elsewhere and are summarized in the following paragraph. [7][8][9] HEAL demonstrated that an evidencebased environmental asthma counselor intervention can be implemented in a postdisaster setting to improve asthma management and assess environmental exposures. We used a novel combination of the efficacious National Cooperative Inner-City Asthma Consortium (NCICAS) asthma counselor intervention 10 and the Inner-City Asthma Study (ICAS) environmental intervention 11 to intervene on 182 participants enrolled in the HEAL Study.…”

“…7 In fact, 94% of HEAL families had moved at least once since Katrina, 68% had initiated renovations that continued during the study, and 47% had completed home renovations before enrollment. 9 In this article, we describe our experience applying CBPR principles in conducting the study, assess their utility in the context of specific strategies we employed, and thereby provide an important perspective for future environmental public health studies conducted in postdisaster communities. Our experience in conducting the HEAL Study was predicated on tenets similar to those of Lurie et al 5 To our knowledge, no comprehensive assessment has been conducted to systematically examine the utility of specific CBPR principles in a postdisaster context, especially in health-disparate, disaster-prone communities served by a fragile health system.…”

Disaster research: a nursing opportunity

“…The Head‐off Environmental Asthma in Louisiana (HEAL) Project, which studied the environmental impact of disaster in children with asthma living in New Orleans, is an example of collaborative research that crossed many agencies, disciplines and universities (Grimsley et al. ).…”

“…New collaborations within the local academic environment were forged as well, as professionals across universities and disciplines partnered, capitalizing on the strengths of diverse disciplines. The Head-off Environmental Asthma in Louisiana (HEAL) Project, which studied the environmental impact of disaster in children with asthma living in New Orleans, is an example of collaborative research that crossed many agencies, disciplines and universities (Grimsley et al 2012). the more unique are the challenges of disaster research'.…”