Inner City Asthma Study: relationships among sensitivity, allergen exposure, and asthma morbidity.
BACKGROUND
Asthma-associated morbidity is rising, especially in inner city children.


OBJECTIVE
We evaluated the allergen sensitivities, allergen exposures, and associated morbidity for participants in the Inner City Asthma Study. We also determined geographic variations of indoor allergen levels.


METHODS
Nine hundred thirty-seven inner city children 5 to 11 years old with moderate to severe asthma underwent allergen skin testing. Bedroom dust samples were evaluated for Der p 1, Der f 1, Bla g 1, Fel d 1, and Can f 1.


RESULTS
Skin test sensitivities to cockroach (69%), dust mites (62%), and molds (50%) predominated, with marked study site-specific differences. Cockroach sensitivity was highest in the Bronx, New York, and Dallas (81.2%, 78.7%, and 78.5%, respectively), and dust mite sensitivity was highest in Dallas and Seattle (83.7% and 78.0%, respectively). A majority of homes in Chicago, New York, and the Bronx had cockroach allergen levels greater than 2 U/g, and a majority of those in Dallas and Seattle had dust mite allergen levels greater than 2 microg/g. Levels of both of these allergens were influenced by housing type. Cockroach allergen levels were highest in high-rise apartments, whereas dust mite allergen levels were highest in detached homes. Children who were both sensitive and exposed to cockroach allergen had significantly more asthma symptom days, more caretaker interrupted sleep, and more school days missed than children who were not sensitive or exposed.


CONCLUSIONS
Geographic differences in allergen exposure and sensitivity exist among inner city children. Cockroach exposure and sensitivity predominate in the Northeast, whereas dust mite exposure and sensitivity are highest in the South and Northwest. Cockroach allergen appears to have a greater effect on asthma morbidity than dust mite or pet allergen in these children.
Gruchalla
Rebecca S
RS
University of Texas Southwestern Medical Center at Dallas, 75390-8859, USA. Rebecca.Gruchalla@utsouthwestern.edu
Pongracic
Jacqueline
J
Plaut
Marshall
M
Evans
Richard
R
Visness
Cynthia M
CM
Walter
Michelle
M
Crain
Ellen F
EF
Kattan
Meyer
M
Morgan
Wayne J
WJ
Steinbach
Suzanne
S
Stout
James
J
Malindzak
George
G
Smartt
Ernestine
E
Mitchell
Herman
H
D016902:Air Pollution, Indoor; D000485:Allergens / Q000276:immunology*; D001249:Asthma / Q000453:epidemiology* / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure; D005260:Female; D005658:Fungi / Q000276:immunology; D006801:Humans; D019476:Insect Proteins / Q000276:immunology; D008297:Male; D009017:Morbidity; D011204:Poverty Areas; D039981:Pyroglyphidae / Q000276:immunology; D012882:Skin Tests; D014504:Urban Health / Q000706:statistics & numerical data*
D000485:Allergens; D019476:Insect Proteins