The report from NIAID's National Cooperative Inner-City Asthma Study (NCICAS), and an accompanying editorial, appear in the May 8, 1997, issue of The New England Journal of Medicine.
"Some of the most vulnerable of our citizens, children in the poorest neighborhoods of our large cities, suffer disproportionately from asthma," says Anthony S. Fauci, M.D., NIAID director. "Allergy and exposure to cockroach allergen clearly play an important role in the alarming rates of asthma-related sickness among these children."
"Reducing exposure to cockroach allergen, as part of a multi-faceted approach to asthma management, may be a cost-effective way of reducing the burden of this serious disease," says Daniel Rotrosen, M.D., acting director of NIAID's Division of Allergy, Immunology and Transplantation. "Simple and relatively low-cost interventions that have been explored in the NCICAS, such as patient education, roach traps and child-safe insecticides, are potentially important adjuncts to previously established medical therapies that can help asthmatic patients."
The first five-year phase of the NCICAS, recently completed, enrolled more than 1,500 children with asthma, ages 4 to 11, living in eight major metropolitan areas: The Bronx, N.Y.; East Harlem, N.Y.; St.Louis, Mo.; Washington, D.C.; Baltimore, Md.; Chicago, Ill.; Cleveland, Ohio; and Detroit, Mich.
In the current analysis, David L. Rosenstreich, M.D., of the Albert Einstein College of Medicine in the Bronx, N.Y., and his NCICAS colleagues studied 476 of these children. Most of the children were either African-American (78 percent) or Hispanic (16 percent). The researchers measured levels of cockroach, dust mite and cat allergens in the children's homes, and determined with allergy skin tests that 37 percent of the children were allergic to cockroaches, 35 percent to dust mites, and 23 percent to cats. The investigators then assessed the severity of the children's asthma over 12 months.
They found that children who were both allergic to cockroaches and exposed to high cockroach allergen levels were hospitalized for their asthma 3.3 times more often than children who were allergic but not exposed to high levels of cockroach allergen, or children who were exposed to high levels of cockroach allergen but who were not allergic.
Children who were both allergic and heavily exposed to cockroach allergen also missed school more often, needed nearly twice as many unscheduled asthma-related medical visits, and suffered through more nights with lost sleep. In addition, the activities of the adults who cared for these children were frequently disrupted.
In contrast, neither the combination of allergy to dust mites and high exposure to mites, nor the combination of allergy to cats and high exposure to cats was associated with more severe asthma among the 476 children in the study sample.
Despite the availability of effective asthma therapies, asthma-related deaths among individuals younger than 25 in the United States increased 118 percent between 1980 and 1993. "These disturbing trends, which are especially pronounced in minority populations, underscore the importance of the Institute's research into understanding, preventing and treating asthma," says Dr. Fauci.
NIAID, a component of the National Institutes of Health (NIH), conducts and supports research aimed at preventing, diagnosing and treating illnesses such as AIDS and other sexually transmitted diseases, tuberculosis, asthma and allergies. NIH is an agency of the U.S. Department of Health and Human Services.
Platts-Mills TA and Carter MC. Asthma and indoor exposure to allergens. New Engl J Med 1997;336:1382-1384.
Rosenstreich DL, et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. New Engl J Med 1997;336;1356-63.
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