Environmental and Occupational Disorders
Cockroach allergen exposure and sensitization in suburban middle-class children with asthma,☆☆

https://doi.org/10.1067/mai.2003.1588Get rights and content

Abstract

Background: Exposure to cockroach allergen is prevalent in inner-city homes and is associated with an increased risk of cockroach sensitization. Objective: We sought to determine the prevalence of cockroach allergen exposure in suburban middle-class homes and to study its relationship to cockroach sensitization. Methods: Children with asthma, 6 to 17 years of age, were recruited from 3 pediatric practices located in counties surrounding Baltimore city and from 1 practice located within Baltimore city limits. Participants underwent skin prick testing and completed baseline questionnaires. In addition, their homes were inspected, and settled dust samples were collected for allergen analysis. Results: Forty-one percent of the total study population (n = 339) had kitchen Bla g 1 levels of greater than 1 U/g. Forty-nine percent were white, 53% had annual incomes of greater than $50,000, and 48% of mothers had college degrees. Seventy-seven percent of the study population resided in a suburban or rural location, and 30% of kitchens in these homes had Bla g 1 levels of greater than 1 U/g. Among the suburban-rural subgroup, 21% were sensitized to cockroach compared with 35% of the city group. In multivariate analysis, exposure to kitchen Bla g 1 levels of greater than 1 U/g was associated with cockroach sensitization for both the total study population (odds ratio, 2.29; 95% CI, 1.28-4.11) and the suburban-rural subgroup (odds ratio, 2.37; 95% CI, 1.23-4.57). Conclusions: Cockroach allergen exposure might be more common in suburban middle-class homes of asthmatic children than previously thought. Moreover, the data suggest that low-level cockroach exposure is a risk factor for cockroach sensitization. (J Allergy Clin Immunol 2003;112:87-92.)

Section snippets

Study population

Participants were recruited for a randomized controlled trial of environmental allergen control from 3 pediatric practices in the counties surrounding Baltimore and 1 practice located within Baltimore city limits. Children between the ages of 6 and 17 years who had physician-diagnosed asthma were contacted, and if the family was interested in participating, a screening questionnaire was administered to determine eligibility. Participants were eligible if they had currently active asthma,

Results

Three hundred thirty-nine study participants had valid skin test results and completed the baseline questionnaire and home evaluation (Table I).

. Sociodemographic characteristics

Race (336)African American, n (%)128 (38)
White165 (49)
Other43 (13)
Annual income (339)<15,000, n (%)32 (9)
15-29,99933 (10)
30–49,99941 (12)
50–74,99957 (17)
≥75,000123 (36)
Refused-missing53 (16)
Maternal education (334)Some high school, n (%)19 (6)
High school degree58 (17)
Some college98 (29)
College graduate99 (30)
Postgraduate

Discussion

We have found a surprisingly high prevalence of cockroach allergen exposure and sensitization in a predominantly suburban middle-class population. Previously published studies suggested that the prevalence of cockroach allergen in suburban middle-class homes was well below the 41% that we found in our population.2, 3, 4 Further analysis of our data revealed that almost half of the mothers of our participants held college degrees and that over 50% of families had annual incomes of greater than

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    Supported by grants from the NHLBI (#R18-HL058942), the NIEHS (#PO1 ES09606), the US Environmental Protection Agency (#R-82672401), the NIAID (#T32 AI07007), and the Johns Hopkins Hospital Eudowood Foundation.

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    Reprint requests: Elizabeth C. Matsui, MD, Johns Hopkins Hospital, CMSC 1102, 600 N Wolfe St, Baltimore, MD 21287.

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