Home and allergic characteristics of children with asthma in seven U.S. urban communities and design of an environmental intervention: the Inner-City Asthma Study.

Abstract

Most published environmental remediation interventions have been directed at single allergens and have employed demanding strategies; few have been performed in the homes of inner-city children disproportionately burdened by asthma. Our objective was a) to describe the allergen sensitivities, environmental tobacco smoke (ETS) exposure, and home environmental characteristics of a national sample of inner-city children with moderate to severe asthma and b) to develop and implement a multifaceted, home-based comprehensive intervention to reduce home allergens and ETS, tailored to the specific sensitization and exposure profiles of those children. Allergen skin testing and a home evaluation were performed to determine the presence of ETS and factors known to be associated with increased indoor allergen levels. Based on published remediation techniques, a home environmental intervention, organized into modules, each addressing one of five specific allergen groups or ETS, was designed. Of 994 allergic children from seven U.S. urban communities, 937 successfully completed baseline interviews and home allergen surveys and were enrolled. More than 50% of children had positive skin tests to three or more allergen groups. Cockroaches were reported in 58% of homes, wall-to-wall carpeting in the child's bedroom in 55%, a smoker in 48%, mice or rats in 40%, and furry pets in 28%. More than 60% of enrolled families received four or more modules, and between 94% and 98% of all modules were completed. We conclude that most inner-city children with moderate to severe asthma are sensitized to multiple indoor allergens and that environmental factors known to be associated with asthma severity are commonly present in their homes. The intervention developed for the Inner-City Asthma Study employs accepted methods to address an array of allergens and ETS exposure while ensuring that the intervention is tailored to the specific sensitization profiles and home characteristics of these children.

Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

“…Indeed, medication changes or optimization, such as targeted addition of antihistamines, allergen-specific immunotherapy (23, 24), or omalizumab; or referrals for in-home exposure assessment and remediation have the potential to reduce future exacerbations and improve asthma control (25)(26)(27). Initiation of in-home assessments may be particularly relevant given that reported exposures often differ from what is truly found in the home (21). The inpatient population could be an apt starting point for initiation of such assessments and interventions.…”

“…Skin prick testing for 14 common indoor and outdoor allergens, completed as part of the National Cooperative Inner-City Asthma Study with children aged 4-9 years recruited from emergency departments and inner-city clinics, demonstrated that 77% had at least one positive skin test and 47% had at least three (20). Others have shown that 45% of inner-city children with moderate to severe asthma are exposed to mold and 50% to cockroaches (15,21). Routine allergy testing (22), medication changes or addition of allergen-specific immunotherapy (23,24), and public health interventions to assess in-home allergen exposure and reduce or remediate exposures that are found all have the potential to reduce asthma morbidity among high-risk patients (25)(26)(27).…”

Indoor Environmental Differences between Inner City and Suburban Homes of Children with Asthma

“…2 The reasons for this disparity are complex and include unhealthy home environ-ments. [3][4][5] Home environmental surveys in the inner city have documented that homes are frequently old and in poor repair, with leaky roofs, water damage, and mold contamination. In addition, cigarette smoking rates are high, cockroach and rodent infestation is common, 3,[5][6][7][8] and indoor NO 2 and particulate levels have been reported to be high.…”

“…[3][4][5] Home environmental surveys in the inner city have documented that homes are frequently old and in poor repair, with leaky roofs, water damage, and mold contamination. In addition, cigarette smoking rates are high, cockroach and rodent infestation is common, 3,[5][6][7][8] and indoor NO 2 and particulate levels have been reported to be high. 3,9 All of these factors, especially indoor dampness and mold, airborne particulates, and indoor allergens, have been shown to be associated with increased morbidity among children with asthma.…”

Socioeconomic Factors and Home Allergen Exposure in Children With Asthma

“…Studies from the United States indicated that asthmatic children from low-income families often are sensitized to multiple allergens to which they are frequently exposed (Crain et al, 2002;Perry et al, 2006), including cockroaches, dust mites, and molds (Gruchalla et al, 2005). Although information on skin testing was not available for the present study, the total number of triggers that were reported as worsening asthma was not significantly associated with the number of poor practices.…”