Allergic Rhinitis and House Dust Mite Sensitization Determine Persistence of Asthma in Children.

OBJECTIVE: To specify clinical and immunological parameters of the mechanisms, which may lead to development of persistent asthma, or regression of the disease symptoms. METHODS: Eighty children with childhood asthma, diagnosed in the past by using the modified Asthma Predicted Index (mAPI), were divided into two groups: remission group and persistent group. There were 3 study visits (baseline, at 6 mo, and at 12 mo). Clinical remission of asthma was defined as the absence of asthma symptoms for at least 12 mo without treatment. The patients could switch from one group to another during the 12 mo of follow-up. Clinical, inflammatory, and immunoregulatory predictors of asthma remission/persistence were analyzed. RESULTS: The presence of mAPI criteria as well as house dust mite (HDM) allergy and allergic rhinitis at 7-10 y, were associated with a reduced prevalence of asthma remission. The increased eosinophil blood count in mAPI criteria was associated with a lower expression of CD25 positive cells. HDM allergy was associated with a higher fractional exhaled nitric oxide (FeNO) level (p = 0.0061) and higher expression of CD25CD71 (p = 0.0232). Allergic rhinitis was associated with a higher expression of PPAR (p = 0.0493) and CD25CD71 (p = 0.0198), and lower expression of glycoprotein A repetitions predominant (GARP). CONCLUSIONS: Persistence of childhood asthma was largely determined by the presence of allergic rhinitis and sensitization to HDM. Additionally, API criteria but not immunoregulation processes, were related to asthma persistence.

Associations between sensitization to perennial/seasonal allergens and childhood asthma.

BACKGROUND: Childhood asthma is an important public health problem worldwide. Risk factors for asthma development include allergic sensitization and exposure to animals. OBJECTIVE: To identify which (perennial or seasonal) inhalant allergens are associated with asthma and allergic rhinitis in children. METHODS: This was a cross-sectional, retrospective study. We evaluated data from medical documentation of 6,000 children (aged 6 - 18 years) with diagnosed asthma and/or allergic rhinitis who had attended our allergy outpatient clinic. Into the analyses we included those subjects who had specific IgE test done during diagnostic procedures to confirm allergen sensitization. RESULTS: We included 5,076 children in the analysis. We showed that among seasonal allergens only sensitization to timothy or birch significantly changed the prevalence of allergic rhinitis and asthma diagnosis. Of the perennial allergens, house dust mite or cat were most closely related with both allergic rhinitis and asthma. Results of ROC curve analysis showed that in atopic children the specific IgE level of seasonal allergens did not significantly change the prevalence of asthma diagnosis. Sensitization to more than one perennial allergen significantly increased the prevalence of allergic rhinitis and asthma. CONCLUSION: We showed that sensitization to the seasonal allergens timothy and birch as well as to the perennial allergens house dust mite and cat, is associated with asthma and allergic rhinitis in children. Our study determined the role of multiple perennial indoor allergens in the developement of allergic diseases in children. The identification of the specific allergens makes them potential targets for intervention and prevention strategies.

Effectiveness of immunotherapy in children depends on place of living - A pilot study.

BACKGROUND: It is considered that farm areas protect young patients from allergy and asthma due to high exposure to endotoxins. Allergen immunotherapy (AIT) is the only treatment of allergy modifying the immune response with the potential to change the natural history of allergic diseases. It seems that studies evaluating the efficacy of immunotherapy in large cohorts of allergic patients living in farm areas are needed to understand the influence of environment on immune response during AIT. AIM: To compare the clinical effectiveness of immunotherapy between children living in farm versus urban areas. MATERIALS AND METHODS: This was a retrospective analysis of 87 children living in farm area (n=42) and city area (n=45), aged 8-16, who completed three years of subcutaneous immunotherapy due to allergic rhinitis/asthma. An AIT efficacy questionnaire has been designed to be filled in by the allergy specialist during a regular immunotherapy visit before and after AIT. RESULTS: We observed significantly higher improvement in total score among children from farm area compared to children from city area (p<0.001). Between-group differences in symptoms and drug scores did not reached the level of significance. Multivariate logistic regression analysis (adjustment for the effect of gender and type of allergy) showed that living in farm areas was independently associated with significant improvement in total score after immunotherapy (OR: 10.9; 95%CI: 3.7-32.2). CONCLUSION: The current analysis of the better AIT effectiveness in the farm population has shown the protective influence of environmental exposures on asthma and allergic rhinitis in our children.

Cord serum 25-hydroxyvitamin D correlates with early childhood viral-induced wheezing.

BACKGROUND: There are investigations concluding that reduced vitamin D status in pregnancy, may be a risk factor for the development of allergic outcomes in offspring. However, studies on the relationship between cord levels of 25-hydroxyvitamin D (25[OH]D) and risk of early childhood wheezing and early-onset atopic dermatitis/food allergy are very limited. OBJECTIVE: To assess the associations between cord blood concentration of 25[OH]D and occurrence of the incidence of wheezing, atopic dermatitis, food allergy, during the first two years of life. METHODS: We evaluated 240 children by the age of 2 years from the Polish Mother and Child Cohort Study. Women were interviewed during pregnancy to collect demographic and socioeconomic data, the medical and reproductive history. At delivery, umbilical cord blood plasma was sampled. The child's health status were examined at approximately 2 years. In the analyses multivariable model was used. RESULTS: Data from 190 participants were included into the analysis. The median value and quartile range of 25[OH]D in cord blood [ng/ml] were as follows: 6.33, 4.16-8.53. 25[OH]D in cord blood below lower quartile increases the risk of multi-triggered wheezing (MTW) in children during first 2 years of life (OR: 2.81; 95% CI: 1.13-7.00). Higher cord serum level of 25[OH]D reduces the risk of viral induced wheezing (VIW). The cord serum level of 25[OH]D below median value (OR: 6.06; 95% CI: 1.3-28.3) or below lower quartile (OR: 5.43; 95% CI: 1.66-17.7) increases the risk of VIW. All above effects of vitamin D level in cord blood were corrected for the effects other independent risk factors of wheezing and VIW in this cohort. CONCLUSIONS: Cord serum 25[OH]D levels were inversely associated with the risk of multi-triggered wheezing, and especially viral-induced wheezing by the age of 2 years, but no association was found with food allergy, atopic dermatitis and frequencies of infections.

The A/A genotype of an interleukin-17A polymorphism predisposes to increased severity of atopic dermatitis and coexistence with asthma.

INTRODUCTION: Studies have found that the interleukin-23/T helper 17 (IL-23/Th17) pathway plays an important role in the pathogenesis of atopic dermatitis (AD). Inhibition of the IL-23/Th17 pathway with monoclonal antibodies reduces skin inflammation in animal models. AIM: To investigate the association between IL-17A and IL-23R gene single nucleotide polymorphisms (SNPs) and the development of AD in a Polish population. METHODS: Blood samples were collected from 166 patients with AD and 160 controls. We analyzed two SNPs, -152 G/A IL-17A and 1142 G/A IL-23R, using PCR and restriction fragment length polymorphism (RFLP) analysis. RESULTS: There was no statistically significant difference between the examined IL-17A SNP and the incidence of AD (P > 0.05 for all comparisons). Analysis of the IL-23R gene SNP showed no relationship between AD and the G/A genotype or presence of the A allele. The study did not establish any links between the IL-23R and IL-17A gene SNPs and the likelihood of developing AD resulting from gene-gene interaction. However, there was a significant relationship between the A/A genotype in the -152 G/A IL1-7A SNP and the coexistence of AD and asthma (P < 0.04). Analyzing the association between AD severity and the occurrence of IL-17A SNP, we found that subjects with the A/A genotype were at higher risk of developing moderate or severe AD (P = 0.02). CONCLUSIONS: We found no evidence of any effect of IL-17A or IL-23R SNPs on the occurrence of AD in our Polish population. However, the A/A genotype in IL-17A was found to predispose to increased AD severity and coexistence of AD and asthma.

Reduced visfatin levels in aortic stenosis increase after aortic valve replacement and may contribute to reverse left ventricular remodelling.

AIM: Visfatin may play a part in reverse left ventricular remodelling. Using a mouse model of reversible left ventricle pressure overload, we examined if visfatin was altered in the myocardium. Furthermore, we addressed this issue in patients with aortic stenosis (AS) and examined whether visfatin levels are related to reverse remodelling following aortic valve replacement (AVR). METHODS: Myocardial visfatin was analysed after aortic banding (AB) and debanding (DB) in mice and compared to sham operated animals. Myocardial visfatin was measured in biopsies from patients undergoing AVR and compared to controls. Serum visfatin was measured before and after AVR in patients with AS and correlated with echocardiographic measurments of cardiac morphology and function. RESULTS: Four weeks after AB, myocardial visfatin protein was reduced by 50% compared to sham. Three days after DB, myocardial protein levels increased significantly. Myocardial visfatin and serum visfatin levels were reduced by 23% and 64%, respectively, in patients with AS compared to controls. Twelve months after AVR, serum visfatin levels increased compared to preoperative values and correlated negatively with degree of left ventricular hypertrophy. CONCLUSION: Myocardial visfatin and serum visfatin levels are reduced by cardiac pressure overload. Visfatin levels increase after correction of pressure overload and may play a part in postoperative reverse remodelling.

Comparative effect of pre-coseasonal and continuous grass sublingual immunotherapy in children.

BACKGROUND: One of the most important aspects of sublingual immunotherapy (SLIT) is the regimen of administration. The aim of the study was to compare the efficacy and the safety of SLIT given pre-coseasonally (starting before the pollen season and continuing until the end of it) and continuously (all year round, independent of the pollen season) in children allergic to grass pollen. METHODS: Sixty children aged 6-18, sensitive only to grass pollen, with rhinitis (20 patients had concomitant asthma) participated in the 2-year prospective, randomized, double-blind, placebo-controlled trial. RESULTS: Both pre-coseasonal and continuous SLIT were associated with a substantial reduction in the combined symptoms/medication score when compared with placebo; there were no significant differences between the regimens (mean difference: 18.1 ± 12.4, P > 0.05). Similar changes were observed in the total symptoms score. Pre-coseasonal therapy, compared with continuous, was more effective in the reduction of nasal symptoms (mean difference: -18.0 ± 2.5, P = 0.006). We did not observe significant differences in medication, ocular, and asthma scores between the regimens. We did not observe changes in morning PEF, FEV1, and PD20 in any of the three groups nor between the groups throughout the study. We showed a significant decrease in FeNO level comparable in both active groups. There were no differences between groups in the induction of CD4CD25Foxp3-positive cells in peripheral blood during the study. CONCLUSION: Both protocols were effective compared with placebo and showed similar decreases for combined symptoms/medication score and all secondary endpoints, with the exception of nasal symptoms that were lower in the pre-coseasonal group.

One-year follow-up of clinical and inflammatory parameters in children allergic to grass pollen receiving high-dose ultrarush sublingual immunotherapy.

BACKGROUND: In a previous double-blind placebo-controlled study, we analyzed a high-dose sublingual immunotherapy (SLIT) ultrarush protocol in asthmatic children monosensitized to grass pollen. In the present open-label study, we assessed the effect of SLIT on symptom score and nonspecific bronchial hyperreactivity in the same cohort followed for 1 subsequent year. METHODS: The study population comprised 35 children who were enrolled in our previous study. Placebo-treated patients were switched to active treatment; therefore, SLIT was administered for a further year to all patients. SLIT was considered effective if it reduced the severity of clinical symptoms and decreased the use of symptomatic medication. The effect of SLIT on nonspecific bronchial hyperreactivity (methacholine challenge test) was also measured. RESULTS: The symptom scores for asthma and rhinitis and medication score remained unchanged in the group who continued SLIT. We also observed further significant improvement in the results of the methacholine challenge test during the third year of treatment. CONCLUSIONS: High-dose ultrarush SLIT reduced the severity of allergic symptoms in the first 2 grass pollen seasons but continuously improved bronchial hyperreactivity in children with asthma, suggesting that SLIT should be continued despite the lack of further improvement in clinical symptoms.

The effect of oral steroids with and without vitamin D3 on early efficacy of immunotherapy in asthmatic children.

BACKGROUND: The possibility of additional strategies to enhance the effectiveness of specific immunotherapy (SIT) is highly attractive. AIM: The aim of our study was to assess the influence of oral corticosteroids and oral corticosteroids combined with vitamin D(3) on the early clinical and immunological effects of SIT. METHODS: It was a randomized, double-blind, placebo-controlled trial conducted in 54 asthmatic children allergic to house dust mites. Intervention was based on receiving a single dose of oral steroid, with or without vitamin D(3), or placebo only on the day of the build-up phase of SIT. RESULTS: After 12 months of SIT, the median daily inhaled corticosteroid (ICS) dose, which controls the symptoms of asthma, was reduced by 25% in the steroid group. However, a 50% reduction of the median daily ICS dose was observed in the control group. The clinical effects of SIT were not affected in the steroid+D(3) group. Concomitantly, we found that intervention with prednisone significantly impaired the induction of T regulatory lymphocytes. Importantly, the clinical and immunological effects of SIT were not affected by intervention with steroids administered with vitamin D(3). CONCLUSIONS: Our study failed to show a beneficial effect of oral corticosteroids on allergen-specific immunotherapy. We observed that the combined administration of a corticosteroid drug and allergen extract suppressed the early clinical and immunological effects of SIT and that vitamin D(3) prevented this 'adverse' influence of steroids.

Early exposure to unhygienic conditions and infections is associated with expression of different Toll-like receptors.

BACKGROUND: We have previously shown a lower prevalence of atopy in children living in foster homes than in children living with their parents. OBJECTIVES: In this study, we explored the associations between atopy and expression of Toll-like receptors (TLRs) 2, 4, 7 and 9 in the same groups of children. MATERIAL AND METHODS: We enrolled all the atopic children living in foster homes in Lodz, Poland and carefully selected, on the basis of age, sex, sensitization profile, clinical manifestation of allergy, and treatment, a similar number of nonatopic children living in foster homes, and a similar number of both atopic and nonatopic children living with their parents. Expression of TLRs 2, 4, 7 and 9 was analyzed in all children. RESULTS: Expression of TLR2 in foster care children was significantly higher in nonatopic children than atopic children (P = .047), while that of TLR7 and TLR9 was significantly higher in atopic children than in nonatopic children. Additionally, expression of TLR9 in nonatopic children in foster care was significantly lower than in nonatopic children living with their parents (P = .003).We also found that both groups of nonatopic children had a greater number of features characteristic of foster home children (poor living conditions in the first year of life) than atopic children. CONCLUSION: Our results may suggest that alternative mechanisms might underlie the in vivo regulation of the expression of different TLRs involved in the development of atopy.

Efficacy and safety of high-doses sublingual immunotherapy in ultra-rush scheme in children allergic to grass pollen.

BACKGROUND: Although sublingual immunotherapy (SLIT) has been used with increasing frequency, the data on the efficacy of SLIT in pediatric asthma are limited. AIM: The aim of our study was to evaluate the efficacy and the safety of high-dose SLIT given pre-seasonally and co-seasonally in an ultra-rush scheme in children with bronchial asthma allergic to grass pollen. METHODS: Fifty children with asthma, aged 6-17, sensitive to grass pollen, participated in the 2-year prospective, randomized, double-blind, placebo-controlled trial, to investigate the efficacy and safety of SLIT (Staloral 300 IR, Stallergenes SA, 25 microg major allergens) as a standardized extract of five grass pollen with ultra-rush induction. RESULTS: SLIT significantly improved asthma symptom scores (41% vs. placebo group), reduced nasal symptoms (25% vs. placebo group) and the use of rescue medications (10% vs. placebo group), improved forced expiratory volume in 1 s, but had no effect on ocular symptoms, nasal hyper-reactivity, peak expiratory flow and forced expiratory volume between 25% and 75% of vital capacity. Serum levels of immunoglobulin E and IgG4 did not change after SLIT. After the second season of SLIT, an improvement in bronchial hyperresponsiveness was observed; however, compared with placebo, this effect was not significant. Among all subjects in SLIT group, predominantly local reactions have been recorded in 59% of subjects in the first year of treatment and in 35% in the second. CONCLUSIONS: Our study indicated that high-dose ultra-rush, co-seasonal SLIT given for 2 years, was safe and reduced a multiple symptom-medication score.

Early effects of Asthma Prevention Program on asthma diagnosis and hospitalization in urban population of Poland.

BACKGROUND: Asthma is one of the commonest public health problems in Poland and the commonest chronic disorder in children. Lodz Regional Health Insurance Fund was a sponsor of the Prevention Asthma Program in 2000-03, directed at increasing early detection and providing optimal treatment of allergies by specialists in children. METHODS: All funds were divided between 127 primary and 12 specialized care centres participated in the programme. Primary care centre goals were: anamnestic information, mapping of allergy-causing factors, repeated auscultation of the lungs, bronchial dilation test, peak expiratory flow (PEF) measurement at the clinic and at home for 2 weeks. After preliminary diagnosis patients have been send to specialized centres. Specialized care centre goals were as follows: skin testing, spirometry, repeated bronchial dilation test, determination of eosinophilic white blood cells and eosinophil cationic protein (ECP) in blood. RESULTS: Increasing trend of new asthma diagnosis, expressed per 1000 inhabitants, was observed from 0.99 in 2000 to 2.19 in 2003. In the first year of Asthma Prevention Program, we observed more hospital episodes because of asthma exacerbation in comparison with year 1999 but from the second year of programme we showed systematically decreasing number of hospital episodes as a result of asthma exacerbation from 1.48 in 2000 to 0.84 in 2003. We found significantly decreasing trend in duration of hospitalization due to asthma exacerbation (P = 0.001). CONCLUSIONS: Effects of this programmes are: early identification of allergic diseases, mainly asthma, reduced number and shorter duration of hospitalization because of asthma exacerbation and establishing new Asthma Schools Education.

The effect of treatment with montelukast on in vitro interleukin-10 production of mononuclear cells of children with asthma.

BACKGROUND: The effects of leukotriene modifiers on IL-10 production have not been studied in children with asthma. OBJECTIVE: The primary objective of this study was to determine the changes in IL-10 concentrations, clinical efficacy and peripheral blood eosinophil counts after treatment with montelukast. METHODS: The study was conducted on 27 patients: 13 patients monoallergic to grass pollen during the pollen season (GPs group) and out of the pollen season (GPos group), and on 14 patients monoallergic to house dust mite (HDM) from May to September (HDM group). Main outcome measures were changes in concentrations of IL-10 in the supernatant after a 4-week treatment with montelukast. Measurements of asthma severity score, forced expiratory volume in 1 s (FEV1) and peripheral blood eosinophil counts were the secondary end-points. RESULTS: Montelukast resulted in a within-group significant increase in IL-10 concentration in the supernatant in the GPs (54.0 vs. 125.5 pg/mL) and in the HDM (51.2 vs. 77.1 pg/mL) group. Montelukast had no effect on changes of IL-10 concentration in the supernatant from peripheral blood mononuclear cell (PBMC) culture after non-sensitizing allergen stimulation. Montelukast significantly improved asthma control and FEV1, and significantly decreased eosinophil blood count in the GPs and in the HDM group after a 4-week treatment. Montelukast did not lead to changes of all measured parameters within the GPos group. CONCLUSION: Montelukast increased IL-10 concentration in supernatants from sensitizing allergen-stimulated PBMC culture obtained from children with asthma monoallergic to grass pollen during the pollen season, and from children with asthma monoallergic to HDM.

Cockroach allergy and exposure to cockroach allergen in Polish children with asthma.

BACKGROUND: Asthma morbidity increases every year, especially among children, and exposure to high levels of indoor allergens is a very important factor. We evaluated the prevalence and exposure to cockroach (CR) allergen in asthmatic children in Poland, and also tested the hypothesis that asthma with allergy to CR is more severe than with allergy to other antigens. METHODS: One hundred and sixty children with asthma were examined, had skin prick tests (SPT) with common and CR allergens, underwent spirometry, and provocation tests to histamine. Children with positive SPT to CR had measured specific IgE levels to this antigen and Bla g 2 concentrations were measured in their homes. RESULTS: The most common allergen, was dust mite 51.3%, followed by pollen 48.8% and CR allergen 24.3%. In children with CR sensitivity, 13% had mild asthma, 26% moderate and 61% had severe asthma. Their levels for forced expiratory volume in one second (FEV1), and the provocative concentration of histamine that caused a 20% fall in FEV1 (PC20), were statistically lower than in the group of children with other than CR allergies. Bla g 2 antigen was detected in 55.13% samples. The highest levels of Bla g 2 were found in old houses, without central heating, and in houses with lower income. CONCLUSION: In Polish children, CR allergen is a very important factor of sensitivity. Concentrations of Bla g 2 in homes are higher than previously reported in other European countries, and are strongly related to the houses' characteristics. Also, children with CR hypersensitivity have severe asthma more often than children with other allergies.

[The effect of inhaled heparin on airway responsiveness to metacholine in asthmatic children]. / Wplyw wziewnej heparyny na pometacholinowy skurcz oskrzeli u dzieci z astma oskrzelowa.

UNLABELLED: Atopic asthma is a chronic inflammatory disorder of the airways associated with airway hyperresponsiveness to various bronchoconstrictor stimuli. There are several pharmacologic agents, involved in the inflammatory process, that can produce acute bronchoconstriction, such as metacholine. Heparin possesses multiple noncoagulant properties, including anti-inflammatory actions. OBJECTIVES: The purpose of the present study was to investigate the effect of inhaled heparin on the airway response to metacholine in children with asthma. METHODS: Fifteen children with mild atopic asthma participated in the study. It was randomized, double-blind, cross-over, placebo controlled study. There were three study visits. At the first visit patients were included into the study and beta-agonists were withheld for at least 12 hours before the next visit (second day). At the second visit provocation test with metacholine, inhalation with single dose of heparin or placebo followed by provocation test with metacholine were performed. After two weeks, tests were performed in the same manner except of that patients instead of heparin inhaled placebo or opposite. RESULTS: Fourteen children completed the study. Single dose of inhaled heparin significantly decreased bronchial hyperresponsiveness to metacholine when compared to placebo. CONCLUSION: The exact mechanism of anti-inflammatory role of heparin is still under investigation and needs to be studied further. The possible anti-inflammatory effect of heparin can be through effect on the neuronal M2 receptors or on receptor-protein G binding or direct effect on the smooth muscles, and in such mechanisms, heparin can decrease bronchial hyperreactivity to metacholine.

[The effect of triamcinolone, montelukast and formoterol on serum levels of il-4, IgE and clinical parameters in children with asthma]. / Wplyw acetonidu triamcinolonu, montelukastu i formoterolu na stezenia IL-4 i IgE w surowicy oraz na kliniczny przebieg astmy u dzieci.

Levels of pro-allergic cytokine IL-4 are increased in asthmatic airways, contributing to allergic inflammation. The purpose of this study was to define the effect of treatment with triamcinolon, montelukast, and formoterol on serum level of IL-4 and IgE, clinical parameters (symptom score, FEV1) and bronchial hyperreactivity (BHR) in children with moderate asthma. It was 8 week, placebo-controlled and randomized, double blind trial of 99 children with moderate atopic asthma allergic to dust mite. Patients were randomly allocated to receive 400 mg triamcinolon (n = 20), 5 or 10 mg (according to age) montelukast (n = 18), 24 mg formoterol (n = 19), or placebo (n = 42). 80 children completed the study. After treatment with triamcinolon, montelukast, and formoterol the level of IL-4 in blood serum in all study groups significantly decreased, and all clinical parameters improved; treatment with triamcinolon, formoterol, and montelukast had no effect on IgE level in serum. Mean IL-4 levels in serum before and after treatment with triamcinolon were 0.129 pg/ml with 95% Cl, 0.1-0.145 pg/ml and 0.086 pg/ml with 95% Cl, 0.023-0.109 pg/ml respectively (p = 0.02); with montelukast were 0.123 pg/ml with 95% Cl, 0.57-0.82 pg/ml and 0.102 pg/ml with 95% Cl, 0.62-0.82 pg/ml respectively (p < 0.001); with formoterol were 0.128 pg/ml with 95% Cl, 0.108-0.164 pg/ml and 0.113 pg/ml with 95% Cl, 0.096-0.146 pg/ml respectively (p = 0.002). No correlations have been found between changes in serum IL-4 and any other clinical parameters after treatment. This study demonstrates that one of the possible ways by which triamcinolon, montelukast, and formoterol contribute to inhibition of allergic inflammation is by decreasing IL-4 levels.

[Hypersensitivity to cockroach allergen among children with bronchial asthma living in the Lódz district]. / Nadwrazliwosc na antygeny karalucha u dzieci chorych na astme oskrzelowa w regionie Lódzkim.

Asthma morbidity increase every year, especially among children. The cause of this is multifactorial, but exposure to high levels of indoor allergens is thought to be one important factor, since we spend the large fraction (appx. 90%) of time indoors. Next to other popular indoor allergens (i.e. dust mites), many studies underline the importance of cockroach allergen. The purpose of this study was to evaluate the prevalence and importance of cockroach allergen in asthma among children in Lódz district. One hundred and sixty children, age 4-17, with bronchial asthma, were participated in this study. Each patient was examined, had skin prick test with common and cockroach allergens, measured total IgE level and undergone spirometry. Children with positive skin test to cockroach allergen had also measured specific IgE level to this antigen (immunoassay, CAP system). Our results showed that the most common allergen (by skin test), among these children, was dust mite 51.3%, followed by pollen 48.8% and cockroach allergen 24.3%. Among children with hypersensitivity to cockroach allergen 62% had also positive skin test with house dust mite and 59% with pollen. Average time of asthma duration in patients sensitive to cockroach antigen was 4 years and was similar to that of patients sensitive to dust mites and pollen. In children with cockroach sensitivity 13% had mild asthma, 26% moderate and 61% had severe asthma. We concluded that children with cockroach hypersensitivity have severe asthma more often than children with dust and pollen sensitivity. Class 3 and 4 in specific IgE levels correlated with severity of asthma. Our results showed that in children of Lódz distict, cockroach allergen is very important factor of sensitivity, next to dust mites and pollen. Hypersensitivity to cockroach antigen seems to influence the course and severity of asthma in children.