Pest and allergen exposure and abatement in inner-city asthma: a work group report of the American Academy of Allergy, Asthma & Immunology Indoor Allergy/Air Pollution Committee.

Our work group report details the importance of pest allergen exposure in inner-city asthma. We will focus specifically on mouse and cockroach exposure. We will discuss how exposure to these pests is common in the inner city and what conditions exist in urban areas that might lead to increased exposure. We will discuss how exposure is associated with allergen sensitization and asthma morbidity. Finally, we will discuss different methods of intervention and the effectiveness of these tactics.

Age-specific prevalence of outdoor and indoor aeroallergen sensitization in Boston.

Questions exist regarding the appropriate age for referral of an atopic child to an allergist for environmental skin prick testing. This study evaluates age-specific prevalence of sensitization to aeroallergens from infancy through adolescence. A total of 1394 patients were skin tested, with 57.2% being sensitized to at least 1 aeroallergen. In children younger than 2, the authors found that 26.5% were sensitized, including to dogs (15.5%) and cats (9.2%). Additionally, tree sensitization was demonstrated in the youngest age group (7.8% at 0-2 years; 17.1% at 2-4 years), including in 3 infants less than 1 year old. Sensitization rates to dust mites and trees were the highest in all ages above 4 years, with a peak tree sensitization of 56.4% at 10 to 12 years and a peak dust mite sensitization of 56.8% in the >12 group. Overall, the authors observed increasing sensitization rates throughout childhood for indoor and outdoor aeroallergens (P < .001). Aeroallergen sensitization begins at a young age and increases during childhood.

Mouse allergens in urban elementary schools and homes of children with asthma.

BACKGROUND: The association between allergens in schools and childhood asthma has not been well studied, particularly in the United States. OBJECTIVE: To investigate allergen exposure in schools compared with homes with a specific focus on children with asthma. METHODS: Dust samples were collected from 46 rooms in 4 urban elementary schools (northeastern United States) and from 38 student bedrooms. Samples were analyzed for cat (Fel d 1), dog (Can f 1), cockroach (Bla g 2), dust mites (Der f 1/Der p 1), and mouse urinary protein (MUP). Questionnaires identified students with physician-diagnosed asthma. RESULTS: Cat and dog allergens were detectable in most school samples (96% and 78%, respectively), but at low levels. Cockroach allergen was detectable in only 11% of school samples. Mouse allergen was detectable in 89% of school samples, with 68% having MUP levels greater than 0.5 microg/g. In contrast, MUP was detectable in only 26% of bedroom samples. Matched classroom and home samples from 23 asthmatic students showed higher geometric mean MUP levels in the classroom vs the home (6.45 microg/g vs 0.44 microg/g, P < .001). However, there were lower geometric mean dust mite (Der f 1) levels in the classroom vs the home (0.04 microg/g vs 0.66 microg/g, P < .001). CONCLUSIONS: There are significantly higher levels of MUP but lower levels of Der f 1 in schools vs homes. It is important to recognize that children with asthma may encounter varying levels of allergens in environments outside the home, such as schools.