Allergen sensitization evaluation and allergen avoidance education in an inner-city adult cohort with persistent asthma.
BACKGROUND
Asthma morbidity, mortality, and health services utilization are highest among inner-city populations. The National Asthma Education and Prevention Program Expert Panel recommends that all patients with moderate and severe persistent asthma be evaluated for sensitization to environmental allergens.


OBJECTIVE
This study examined whether a cohort of inner-city adults hospitalized with asthma had been evaluated for allergen sensitization, received avoidance counseling, and followed through on these recommendations.


METHODS
One hundred sixty-nine eligible patients who were part of a prospective cohort of all adults hospitalized in an inner-city hospital over a consecutive 12-month period completed a questionnaire to assess allergen sensitization evaluation, avoidance education, and adherence.


RESULTS
Overall, 60% of patients had ever been evaluated for allergen sensitization. Among those who were evaluated, 94.0% were sensitized to at least one antigen: 91.5% to dust mites, 90.5% to outdoor allergens, 77.9% to cats, 69.5% to dogs, 68.4% to molds, and 61% to cockroaches. Approximately half of the patients sensitized to dust mite (55.1%) or mold (52.8%) were given any avoidance-abatement advice. Patient adherence to this advice was highly variable. Allergen sensitization evaluation was more likely among women (odds ratio, 3.05; CI, 1.64-8.64) and those who use oral steroids most or all of the time (odds ratio, 7.14; CI, 2.25-22.56) and less likely among smokers (odds ratio, 0.26; CI, 0.11-0.61).


CONCLUSIONS
In this population of inner-city adults hospitalized with asthma, the quality of allergen sensitization evaluation, avoidance education, and patient adherence with these recommendations was suboptimal.
Department of Clinical Immunology, Mount Sinai School of Medicine, New York, NY 10029, USA. paula.busse@mssm.edu
Paula J
PJ
Busse
Jason J
JJ
Wang
Ethan A
EA
Halm
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016902:Air Pollution, Indoor / Q000009:adverse effects; D000485:Allergens / Q000276:immunology*; D001249:Asthma / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006403:Hematologic Tests / Q000706:statistics & numerical data; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D012882:Skin Tests / Q000706:statistics & numerical data; D014504:Urban Health / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data
D000485:Allergens