The Role of Cockroach Allergy and Exposure to Cockroach Allergen in Causing Morbidity among Inner-City Children with Asthma

Rosenstreich, David L.; Eggleston, Peyton A.; Kattan, Meyer; Baker, Dean; Slavin, Raymond G.; Gergen, Peter J.; Mitchell, Herman; Mcniff-Mortimer, Kathleen; Lynn, Henry; Ownby, Dennis R.; Malveaux, Floyd J.

doi:10.1056/nejm199705083361904

Cited by 1,257 publications

(855 citation statements)

References 27 publications

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“…In homes with cats, 85% of preintervention and 77% of post-intervention samples were above the health benchmark, which is in sharp contrast to the 4% of pre-and 2% of post-intervention samples above the benchmark for non-cat homes. In this study, the percentage of nonintervention and preintervention samples with dust mite levels greater than the threshold was 11%, which is lower than was observed in the National Cooperative Inner City Asthma Study (NCICAS) and other studies in both low and higher income communities (Rosenstreich et al, 1997;Chew et al, 1999;Kitch et al, 2000;Leaderer et al, 2002). Our dust mite levels were lower than levels observed in our previous studies in this neighborhood, and thus our results are likely affected by measurement bias, because our QA/QC samples indicate that dust mite results were biased low by approximately 40-50%.…”

Section: Allergen Interventioncontrasting

confidence: 72%

“…House dust, tobacco smoke, and multiple allergens (principally dust mite, cockroach, cat/dog dander, and molds) have been tied to the causation or exacerbation of asthma and related respiratory symptoms (NRC, 2000;Elliott et al, 2007;Wu and Takaro, 2007). Furthermore, evidence suggests that lower income inner-city residences are more likely to have higher concentrations of and children sensitized to cockroach allergens, while higher income residences are more likely to have higher concentrations of and children sensitized to pet and dust mite allergens (Rosenstreich et al, 1997;Leaderer et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

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Allergen levels in inner city homes: baseline concentrations and evaluation of intervention effectiveness

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Ramachandran

Cho

et al. 2007

J Expo Sci Environ Epidemiol

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Allergens in house dust are risk factors for asthma causation and exacerbation, and asthma interventions often focus on exposure reduction using methods that may not be sustainable over time in low-income communities. A randomized controlled trial with up to six home visits was used to evaluate the effectiveness of two interventions focused on reducing dust loading and allergen concentrations in 47 low-income inner-city households in Minneapolis, MN. The interventions, which included education and relatively inexpensive cleaning procedures, were developed using a community-based participatory consultation process with focus groups held in English, Somali, and Spanish to incorporate community feedback from participants into protocols and study design decisions. Change in levels of cat, cockroach, dust mite, and culturable fungi as well as overall dust loading were evaluated by measuring the difference in concentrations before and after the cleaning intervention, and mixed models were used to assess the effect of education and cleaning on baseline allergen levels during the final three home visits. The cleaning intervention significantly lowered dust loading in all households and culturable fungi levels in single family homes, reduced cat allergen concentrations in homes with cats, but had no significant effect on cockroach allergen levels. The cleaning intervention also modestly decreased the frequency of observed allergen concentrations above suggested health benchmarks for cat, cockroach, and fungi. The cleaning and education interventions had similar effects on baseline allergen levels measured during subsequent home visits; both interventions significantly reduced baseline levels of cat and fungal allergens observed in pre-cleaning samples, but had no significant effect on cockroach allergen levels. Overall, the cleaning intervention modestly reduced potential exposure to risk factors associated with asthma mortality and morbidity in a way that can be implemented by most homeowners or renters, independent of education, income, or the ability to speak English.

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Section: Allergen Interventioncontrasting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Allergen levels in inner city homes: baseline concentrations and evaluation of intervention effectiveness

Adgate

Ramachandran

Cho

et al. 2007

J Expo Sci Environ Epidemiol

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“…Common indoor allergens that may trigger asthma include pets—cats and dogs—house dust mite, moulds, cockroaches, and rodents [39–41], and an important part of the patients history includes asking about possible exposures to indoor allergens such as pets, carpeting, and damp housing.…”

Section: Systematic Assessment Of Severe Asthmamentioning

confidence: 99%

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Porsbjerg

Ulrik

Skjold

et al. 2018

European Clinical Respiratory Journal

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Although a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma (‘difficult asthma’) should undergo systematic assessment, in order to differentiate between true severe asthma, and ‘difficult-to-treat’ patients, in whom poor control is related to factors such as poor adherence or co-morbidities. The Nordic Consensus Statement on severe asthma was developed by the Nordic Severe Asthma Network, consisting of members from Norway, Sweden, Finland, Denmark, Iceland and Estonia, including representatives from the respective national respiratory scientific societies with the aim to provide an overview and recommendations regarding the diagnosis, systematic assessment and management of severe asthma. Furthermore, the Consensus Statement proposes recommendations for the organization of severe asthma management in primary, secondary, and tertiary care.

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“…Although we cannot yet quantify the precise role of the indoor environment in the increase in asthma, a variety of exposures concentrated in the indoor environment have been associated with asthma. The most reported exposures that trigger asthma are house dust mites (De Blay et al, 1992; Van der Heide et al, 1994;Carswell et al, 1996;Arlian and PlattsMills, 2001), environmental tobacco smoke (Burchfield et al, 1986;Weitzman et al, 1990;Young et al, 1991;Chilmonczyk et al, 1993), dampness and mold (Brunekreef et al, 1989;Verhoeff et al, 1995;Andriessen et al, 1998;Dharmage et al, 1999Dharmage et al, , 2001Bush and Portnoy, 2001), household pets (Dales, 1991;De Blay et al, 1991;InfanteRivard, 1993;Bierman, 1996;Institute of Medicine, 2000), and cockroaches (Rosenstreich et al, 1997;Institute of Medicine, 2000;Eggleston and Arruda, 2001). Viral infections, endotoxins, and residues from combustion also play a role in childhood asthma (Johnston et al, 1995; Institute of Medicine, 2000;Wooton and Ashley, 2000).…”

Section: Introductionmentioning

confidence: 99%

“…Dharmage et al (1999) suggest that interview and visual inspection can provide valid measures of home environmental conditions when compared with the researcher's assessment for cat antigen, relative humidity, and ergosterol (a surrogate for mold). Antigen assessment in house dust has been correlated with increases in asthma activity (Rosenstreich et al, 1997;Shapiro et al, 1999;Institute of Medicine, 2000;Platts-Mills et al, 2000;Carter et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Effect of environmental interventions to reduce exposure to asthma triggers in homes of low-income children in Seattle

Takaro

Krieger

Song

2004

J Expo Sci Environ Epidemiol

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The effectiveness of community health workers (CHWs) assisting families in reducing exposure to indoor asthma triggers has not been studied. In all, 274 low-income asthmatic children were randomly assigned to high-or low-intensity groups. CHWs visited all homes to assess exposures, develop action plans and provide bedding encasements. The higher-intensity group also received cleaning equipment and five to nine visits over a year focusing on asthma trigger reduction. The asthma trigger composite score decreased from 1.56 to 1.19 (D ¼ À0.37, 95% CI 0.13, 0.61) in the higher-intensity group and from 1.63 to 1.43 in the low-intensity group (D ¼ À0.20, 95% CI 0.004, 0.4). The difference in this measure due to the intervention was significant at the P ¼ 0.096 level. The higher-intensity group also showed improvement during the intervention year in measurements of condensation, roaches, moisture, cleaning behavior, dust weight, dust mite antigen, and total antigens above a cut point, effects not demonstrated in the low-intensity group. CHWs are effective in reducing asthma trigger exposure in low-income children. Further research is needed to determine the effectiveness of specific interventions and structural improvements on asthma trigger exposure and health.

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The Role of Cockroach Allergy and Exposure to Cockroach Allergen in Causing Morbidity among Inner-City Children with Asthma

Abstract: The combination of cockroach allergy and exposure to high levels of this allergen may help explain the frequency of asthma-related health problems in inner-city children.

Cited by 1,257 publications

References 27 publications

Allergen levels in inner city homes: baseline concentrations and evaluation of intervention effectiveness

Allergen levels in inner city homes: baseline concentrations and evaluation of intervention effectiveness

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Effect of environmental interventions to reduce exposure to asthma triggers in homes of low-income children in Seattle

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