title: Contamination of nebulizer equipment with cockroach allergen: there's a bug in the system!
abstract: BACKGROUND
  Physicians often have anecdotal reports of patients describing increased asthma symptoms after the use of nebulizers; however, there are few published reports of nebulizer-associated exacerbations.
  
  
  OBJECTIVE
  To present 2 cases of asthmatic children who experienced a life-threatening exacerbation of their symptoms after nebulizer use.
  
  
  METHODS
  Case 2's nebulizer was tested for cockroach allergen by washing the medication reservoir with 2 mL of sterile filtered 1% phosphate-buffered saline, 0.05% bovine serum albumin, and Tween 20 overnight with rotation. The patient's sealed albuterol nebulizer medication was used as a control. The control albuterol and test solutions were analyzed for Blattella germanica 1 and 2 allergens using a monoclonal antibody-based immunoenzymetric assay.
  
  
  RESULTS
  The reservoir from case 2 was found to have measurable levels of both Bla g 1 and Bla g 2. The control albuterol solution had no measurable cockroach allergen. An insect found in the nebulizer box of case 2 was identified as an infantile German cockroach.
  
  
  CONCLUSIONS
  Nebulizer use provides an opportunity for antigen exposure directly to small airways, which may lead to severe allergic reactions in patients using contaminated equipment.
authors.affiliation: Division of Pediatric Pulmonology/Allergy, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. mbolling@peds.umaryland.edu
authors.forename: Mary E
authors.initials: ME
authors.lastname: Bollinger
authors.forename: Brian
authors.initials: B
authors.lastname: Wolf
authors.forename: Christina
authors.initials: C
authors.lastname: Schwindt
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hamilton
mesh_terms: D000293:Adolescent; D000420:Albuterol / Q000627:therapeutic use; D000485:Allergens / Q000009:adverse effects*; D000730:Androstadienes / Q000627:therapeutic use; D000818:Animals; D001249:Asthma / Q000188:drug therapy / Q000209:etiology*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D003058:Cockroaches / Q000276:immunology*; D004866:Equipment Contamination; D000068298:Fluticasone; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers
chemical_list: D000485:Allergens; D000730:Androstadienes; D001993:Bronchodilator Agents; D000068298:Fluticasone; D000420:Albuterol