David L. Rosenstreich, M.D., Peyton
Eggleston, M.D., Meyer Kattan, M.D., Dean Baker, M.D., M.P.H., Raymond
G. Slavin, M.D., Peter Gergen, M.D., Herman Mitchell, Ph.D., Kathleen
McNiff-Mortimer, M.P.H., Henry Lynn, Ph.D., Dennis Ownby, M.D., Floyd
Malveaux, M.D., Ph.D., for The National Cooperative Inner-City Asthma
Study
May 8th,
1997
New England Journal of Medicine
ABSTRACT
Background
It has been hypothesized that asthma-related health
problems are most severe among children
in
inner-city areas who
are allergic
to a specific
allergen and also exposed
to high levels of
that
allergen
in bedroom
dust.
Methods
From November 1992 through October
1993, we recruited 476 children with asthma (age, four
to nine
years) from eight
inner-city areas
in the United States. Immediate
hypersensitivity
to
cockroach, house-dust-mite, and
cat
allergens was measured
by skin
testing.
We then measured major
allergens of
cockroach (Bla g 1),
dust mites (Der p 1 and Der f 1), and cat dander (Fel d 1)
in household dust using
monoclonal-antibody–based enzyme-linked
immunosorbent assays. High levels of
exposure were defined
according
to proposed thresholds for
causing disease. Data
on
morbidity due
to asthma were collected at base
line
and over a one-year period.
Results
Of the children, 36.8 percent were allergic
to
cockroach
allergen, 34.9 percent
to dust-mite
allergen, and 22.7 percent
to cat
allergen. Among the children's
bedrooms, 50.2 percent had high levels of
cockroach
allergen
in dust, 9.7 percent had
high levels of dust-mite
allergen, and 12.6 percent had
high levels of cat
allergen. After we adjusted for
sex, score on the Child Behavior Checklist, and family history
of asthma, we found that children who were both allergic
to
cockroach
allergen and exposed
to high levels of this
allergen had 0.37
hospitalization a year, as compared with 0.11 for the other
children (P = 0.001), and 2.56 unscheduled medical visits
for asthma per year, as compared with 1.43 (P < 0.001).
They also had significantly more days of wheezing,
missed school days, and nights with lost sleep, and their
parents or other care givers were awakened during
the night and changed their daytime plans because of the
child's asthma significantly more frequently. Similar patterns
were not found for the combination
of
allergy
to dust mites or cat
dander and high levels of the
allergen.
Conclusions
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.
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