title: Contamination of nebulizers with environmental allergens.
abstract: BACKGROUND
  A previous article described cockroach allergen in the nebulizer reservoir of an asthmatic patient who experienced a life-threatening exacerbation after nebulizer use.
  
  
  OBJECTIVE
  To determine whether indoor allergens can be measured in home nebulizers.
  
  
  METHODS
  As part of a large study examining nebulizer use in underserved asthmatic children, visiting nurses replaced nebulizer sets in patients' homes. Twenty used sets were randomly selected for analysis, without linkage to clinical or home environmental data. Nebulizer reservoirs and negative controls (buffer and albuterol) were extracted overnight with 2 mL of buffer. For positive controls, nebulizer sets were placed in homes with cats and dogs, and other reservoirs were intentionally contaminated with cat (Fel d 1), dog (Can f 1), cockroach (Bla g 1 and Bla g 2), and mouse (Mus m 1) skin test solutions. Extracts were tested for allergens in a masked manner using enzyme-linked immunosorbent assay.
  
  
  RESULTS
  Of 17 reservoirs with adequate specimens for allergen detection, 5 (29%) had measurable levels for at least 1 of 5 allergens tested. One reservoir had measurable Can f 1, 2 had Bla g, 3 had Mus m 1, and none had Fel d 1 allergen. Two of 3 homes with cats where nebulizer setups were placed had measurable Fel d 1 in the reservoir, and 1 of 2 homes with dogs had measurable Can f 1. Reservoirs kept in sealed plastic bags had no detectable allergen.
  
  
  CONCLUSIONS
  Indoor allergens can be found in the nebulizer equipment of children with asthma, with the potential for adverse consequences. Storing nebulizer sets in sealed plastic bags may prevent contamination.
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: Arlene
authors.initials: A
authors.lastname: Butz
authors.forename: Kim
authors.initials: K
authors.lastname: Mudd
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hamilton
mesh_terms: D000485:Allergens / Q000032:analysis*; D000818:Animals; D001249:Asthma / Q000188:drug therapy / Q000209:etiology*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002415:Cats; D003058:Cockroaches / Q000276:immunology*; D004285:Dogs; D004866:Equipment Contamination / Q000706:statistics & numerical data; D006801:Humans; D051379:Mice; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data
chemical_list: D000485:Allergens; D001993:Bronchodilator Agents