Relationship of indoor allergen exposure to skin test sensitivity in inner-city children with asthma,☆☆,,★★,

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Abstract

Background: It is important to understand the relationship between environmental allergen exposure dose and the risk of atopic individuals becoming sensitized to that allergen if we are to change the risk of sensitization and morbidity from allergic disease. Objective: The objective of these studies was to determine whether there was a dose response between current exposure to mite, cockroach, and cat allergen in inner-city children and to determine the prevalence of sensitization to these allergens. Methods: A sample of 500 children was selected from the 1528 children enrolled in the National Cooperative Inner City Asthma Study. Children were selected who had a sample of home dust and valid skin test responses performed with a MultiTest skin test device. The samples of home dust were collected from the floor and furniture in the kitchen, bedroom, and television/living room and were assayed for Der p 1, Der f 1, Bla g 1, and Fel d 1 allergens. Results: Each allergen level correlated significantly between rooms in individual homes. Mite (Der p 1 and Der f 1) and cat (Fel d 1) allergen levels were frequently below the detection limit of the assay. Cockroach allergen (Bla g 1) concentrations in the child’s bedroom were related to the prevalence of positive skin test responses to cockroach allergen extract among the children, with an odds ratio for sensitization of 1.45 (1.11-1.92). Positive skin test responses to cockroach allergen were seen in 15% of children exposed to bedroom dust with a Bla g 1 concentration below the level of detection compared with a rate of 32% in bedrooms with Bla g 1 levels of 1 to 2 U/g and 40% to 44% among those in rooms with 4 U/g or greater. The relationship between exposure and positive skin test responses was clearly stronger among atopic children with a greater number of positive skin test responses. Conclusions: Despite widespread exposure to household allergens, the strongest relationship between exposure and sensitization was seen in the bedroom. The dose response between exposure to cockroach allergen and sensitization suggested that exposure to low doses of allergen, 2 U/g or less, was a risk factor and that the risk plateaus above 4 U/g. Atopy modified the relationship of exposure to sensitization. (J Allergy Clin Immunol 1998;102:563-70.)

Keywords

Allergens
cockroach
cat
dust mite
skin test

Cited by (0)

From a the Department of Pediatrics, Johns Hopkins University, Baltimore; b the Division of Allergy and Immunology, Department of Medicine, Albert Einstein College of Medicine, New York; c New England Research Institute, Watertown; d Center for Occupational and Environmental Health, University of California, Irvine; e the Department of Pediatrics, Mount Sinai School of Medicine, New York; f National Institute of Allergy and Infectious Diseases, Bethesda; g the Section of Allergy and Immunology, Medical College of Georgia, Augusta; h the Division of Allergy and Immunology, Department of Medicine, St Louis University School of Medicine, St Louis; i Howard University, College of Medicine Washington.

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Supported by grant AI30773 from The Hospital for Consumptives of Maryland (Eudowood Fund).

* From the Environmental Subcommittee, National Cooperative Inner City Asthma Study.

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Reprint requests: Peyton A. Eggleston, MD, Division of Allergy and Immunology, Department of Pediatrics, The Johns Hopkins Hospital, CMSC 11-117, 600 North Wolfe St, Baltimore, MD 21287.

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