title: Cockroach exposure independent of sensitization status and association with hospitalizations for asthma in inner-city children.
abstract: BACKGROUND
  Children with asthma living in urban environments experience disproportionately high asthma hospitalization rates. Excessive exposure to perennial allergens, including cockroach and house dust mite (HDM), have been implicated, but data are limited.
  
  
  OBJECTIVE
  To examine the relation between cockroach and HDM exposure and measures of asthma morbidity and health care utilization.
  
  
  METHODS
  Participants included 86 atopic asthmatic children living in New Orleans, Louisiana. Sensitization status was determined by means of serum specific IgE testing, and vacuum dust samples were collected for allergen analysis. Logistic regression analysis was used to assess the odds of persistent wheezing, emergency department visits, and asthma hospitalization in those with high vs low levels of allergen exposure.
  
  
  RESULTS
  Approximately 44% and 40% of children were exposed to Bla g 1 levels greater than 2 U/g and HDM levels greater than 2 μg/g, respectively, and 24% reported at least 1 hospitalization in the previous 4 months. The median Bla g 1 level was significantly higher in the homes of children hospitalized compared with those with no hospital admissions (7.2 vs 0.8 U/g). In multivariable models, the odds of hospitalization were significantly higher in children exposed to Bla g 1 levels greater than 2 U/g (adjusted odds ratio, 4.2; 95% confidence interval, 1.24-14.17), independent of sensitization status. Exposure to HDMs was not associated with any measure of morbidity.
  
  
  CONCLUSIONS
  Exposure to cockroach allergen was strongly associated with increased hospitalization in children with asthma. This effect cannot be explained entirely by IgE-mediated inflammation. Controlled interventional trials are needed to determine whether isolated cockroach abatement improves asthma control.
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA.
authors.forename: Felicia A
authors.initials: FA
authors.lastname: Rabito
authors.forename: John
authors.initials: J
authors.lastname: Carlson
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Holt
authors.forename: Shahed
authors.initials: S
authors.lastname: Iqbal
authors.forename: Mark A
authors.initials: MA
authors.lastname: James
mesh_terms: D000293:Adolescent; D000818:Animals; D001249:Asthma / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003058:Cockroaches / Q000276:immunology*; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D039981:Pyroglyphidae / Q000276:immunology
chemical_list: D007073:Immunoglobulin E