THE ROLE OF COCKROACH ALLERGY AND EXPOSURE TO COCKROACH ALLERGEN
IN CAUSING MORBIDITY AMONG INNER-CITY CHILDREN WITH ASTHMA
Morbidity due to asthma is
disproportionately high among inner-city residents. It has been suggested that exposure to
the highly allergenic cockroach allergen may be an important factor. Levels may be high
and ubiquitous in bedroom dust.
This "Nation Cooperative Inner-city Asthma Study" tested the hypothesis that
morbidity due to asthma is highest among children who are both allergic to a specific
allergen and exposed to high levels of that allergen in bedroom dust.
Conclusion: Cockroach allergy plus high levels of exposure to the allergen may help to
explain the frequency of asthma-related health problems in inner-city children.
STUDY
Recruited over 450 children (age 4-9) from 8 inner-city areas.
Determined immediate hypersensitivity to cockroach, house dust mite, and cat allergens
by skin testing.
Collected dust from bedrooms. Measured levels of major allergens of cockroach, dust
mite, and cat dander by enzyme-linked immunosorbent assays.
Collected data on morbidity due to asthma at baseline and at 1 year.
RESULTS
Of the children, 37% were allergic to cockroach allergen; 35% to dust-mite; and 23% to
cat dander allergen.
Of the bedrooms, 50% had high levels of cockroach allergen in the dust; 10% high levels
of dust-mite allergen, and 13% high levels of cat allergen.
Children who were both allergic to cockroach allergen and exposed to high levels of
allergen had rate of 0.37 hospitalizations per year compared with 0.11 for other
children—and 2.6 unscheduled medical visits for asthma per year compared with 1.4.
They also had significantly more days of wheezing, missed school days, and nights with
lost sleep.
Care givers were more often awakened during the night and changed their daytime plans
because of the child’s asthma.
Similar patterns were not found for the combination of allergy to dust mites or cat
dander and high levels of the allergen.
DISCUSSION
Among inner-city children, the highest levels of morbidity due to asthma were associated
with the presence of both a positive skin-test response to cockroach allergen and current
exposure to high levels of cockroach allergen in the bedroom.
CONCLUSION "Our findings provide evidence that exposure to cockroach allergen
has an important role in causing morbidity due to asthma among inner-city children."
Reducing exposure to cockroach allergen should be an important component of plans for
management of asthma.
NEJM May 8, 1997; 336: 1356-63 Original investigation, first author from Albert Einstein
College of Medicine, Bronx, NY.
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