Pest and allergen exposure and abatement in inner-city asthma: A Work Group Report of the American Academy of Allergy, Asthma & Immunology Indoor Allergy/Air Pollution Committee

Abstract

Our work group report details the importance of pest allergen exposure in inner-city asthma. We will focus specifically on mouse and cockroach exposure. We will discuss how exposure to these pests is common in the inner city and what conditions exist in urban areas that might lead to increased exposure. We will discuss how exposure is associated with allergen sensitization and asthma morbidity. Finally, we will discuss different methods of intervention and the effectiveness of these tactics.© 2010 American Academy of Allergy, Asthma & Immunology Reprint requests: Wanda Phipatanakul, MD, MS, Division of Immunology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115. wanda.phipatanakul@childrens.harvard.edu. Disclosure of potential conflict of interest: R. Wood receives research support from the NIH and is on the Advisory Board for FAAN. M. Perzanowski receives honorarium for speaking from Indoor Biotechnologies and received travel support from Phadia. J. M. Seltzer has provided legal consultation services/expert witness testimony in cases related to personal injury related to environmental exposures, including allergens. E. Matsui receives research support from the NIH. W. Phipatanakul receives research support from the NIH, AstraZeneca, and the ACAAI. The rest of the authors declare that they have no conflict of interest.This Work Group Report has been reviewed and approved by the American Academy of Allergy, Asthma & Immunology (AAAAI) Practice, Diagnostics, and Therapeutics Committee. However, this report does not represent an official position of the AAAAI. This statement is not to be construed as dictating an exclusive course of action, nor is it intended to replace the medical judgment of health care professionals. Every patient is unique, and therefore individual circumstances and environments need to be taken into account for any diagnosis or treatment plan. The prevalence of asthma in developed countries has been increasing in recent decades. This increase has been particularly noted in urban areas, where up to 1 in 4 children might be affected by asthma. 1 Environmental factors, including cigarette smoke, air pollution, and allergen exposure, combine to contribute to asthma morbidity. Additionally, inner-city inhabitants might not be knowledgeable of the association of indoor allergen exposures with asthma. 2 Apart from possible differences in socioeconomic status, urban areas provide a unique setting for asthma because of certain environmental conditions existing in the inner city. In this work group report we will discuss the importance of insect and rodent allergen exposure in innercity asthma. Specifically, we will focus on mouse and cockroach allergen exposure, their effects on asthma, and reduction tactics in the inner city. NIH Public AccessPreviously, there have been many review articles focusing on the overall effect of all indoor allergens.3 -5 However, in recent years, there has been an increasing amount of research devoted specifically to exposure to insects and rodents a...

Mouse Sensitivity Is an Independent Risk Factor for Rhinitis in Children with Asthma

“…[2][3][4][5] Previous work has highlighted a similarly high prevalence of AR in the urban pediatric population, with underserved children at higher risk for undiagnosed AR 27 and up to two thirds of these children reportedly receiving inadequate or no treatment for AR. 28 Mouse and cockroach allergens have been previously reported to be the two most abundant aeroallergens in many urban communities 15 and our results here, identifying mouse sensitivity by serology as the dominant association with active rhinitis is also consistent with previous work reporting the dominance of mouse over cockroach allergy in asthma outcomes in a similar cohort of urban children. 17 The association between rhinitis and serologic mouse sensitivity was driven largely by children who were positive for mouse sensitivity by both serology and SPT.…”

“…Greater insight into the poorly understood prevalence and triggers of rhinitis in this population could provide an important opportunity to target rhinitis as an approach to improve asthma control. Previous studies showed that allergies to mouse and cockroach, two of the most common indoor allergens, 15 are associated with worse asthma outcomes and are most likely major contributors to asthma morbidity in the urban pediatric population. 16,17 No study has assessed the relationship that sensitization to mouse and cockroach has with rhinitis in urban children with poorly controlled asthma.…”

Racial and Ethnic Disparities in Current Asthma and Emergency Department Visits: Findings from the National Health Interview Survey, 2001–2010

“…43 Exposures to residential allergens also have been associated with living in urban environments of which the majority of this population is comprised of lower income minorities. 44 Our study found that the proportion of Non-Hispanic black and Puerto Rican children with asthma that reported receiving rental assistance was over seven times that of Non-Hispanic white children. The inclusion of direct environmental measures could have been used to better describe differences in prevalence and morbidity among racial/ethnic groups.…”

Efficacy of Recombinant Allergens for Diagnosis of Cockroach Allergy in Patients with Asthma and/or Rhinitis

“…Another hypothesis would be that the pattern of environmental exposure to cockroach allergens leading to sensitization may be distinct. In our region, the style of housing is peculiar to warmer climates, with homes and schools being ventilated by keeping windows open; these conditions may not be as conducive to a heavy and sustained cockroach infestation as those observed in US inner-city apartments [2,42]. Consistent with this, levels of cockroach allergens Bla g 1 and Bla g 2 in the homes of asthmatic patients in our area were at least 10-fold lower than those previously reported in the homes of inner-city asthmatic patients in the USA [43].…”