title: Effect of an Integrated Pest Management Intervention on Asthma Symptoms Among Mouse-Sensitized Children and Adolescents With Asthma: A Randomized Clinical Trial.
abstract: Professionally delivered integrated pest management (IPM) interventions can reduce home mouse allergen concentrations, but whether they reduce asthma morbidity among mouse-sensitized and exposed children and adolescents is unknown.
  
  
  
  To determine the effect of an IPM intervention on asthma morbidity among mouse-sensitized and exposed children and adolescents with asthma.
  
  
  
  Randomized clinical trial conducted in Baltimore, Maryland, and Boston, Massachusetts. Participants were mouse-sensitized and exposed children and adolescents (aged 5-17 years) with asthma randomized to receive professionally delivered IPM plus pest management education or pest management education alone. Enrollment occurred between May 2010 and August 2014; the final follow-up visit occurred on September 25, 2015.
  
  
  
  Integrated pest management consisted of application of rodenticide, sealing of holes that could serve as entry points for mice, trap placement, targeted cleaning, allergen-proof mattress and pillow encasements, and portable air purifiers. Infestation was assessed every 3 months, and if infestation persisted or recurred, additional treatments were delivered. All participants received pest management education, which consisted of written material and demonstration of the materials needed to set traps and seal holes.
  
  
  
  The primary outcome was maximal symptom days defined as the highest number of days of symptoms in the previous 2 weeks among 3 types of symptoms (days of slowed activity due to asthma; number of nights of waking with asthma symptoms; and days of coughing, wheezing, or chest tightness) across 6, 9, and 12 months.
  
  
  
  Of 361 children and adolescents who were randomized (mean [SD] age, 9.8 [3.2] years; 38% female; 181 in IPM plus pest management education group and 180 in pest management education alone group), 334 were included in the primary analysis. For the primary outcome, there was no statistically significant between-group difference for maximal symptom days across 6, 9, and 12 months with a median of 2.0 (interquartile range, 0.7-4.7) maximal symptom days in the IPM plus pest management education group and 2.7 (interquartile range, 1.3-5.0) maximal symptom days in the pest management education alone group (P = .16) and a ratio of symptom frequencies of 0.86 (95% CI, 0.69-1.06).
  
  
  
  Among mouse-sensitized and exposed children and adolescents with asthma, an intensive year-long integrated pest management intervention plus pest management education vs pest management education alone resulted in no significant difference in maximal symptom days from 6 to 12 months.
  
  
  
  clinicaltrials.gov Identifier: NCT01251224.
authors.affiliation: Division of Pediatric Allergy/Immunology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Matsui
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Matthew
authors.initials: M
authors.lastname: Perzanowski
authors.affiliation: Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Peng
authors.affiliation: Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wise
authors.affiliation: Division of Pediatric Allergy/Immunology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Balcer-Whaley
authors.affiliation: Division of Pediatric Allergy/Immunology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Michelle
authors.initials: M
authors.lastname: Newman
authors.affiliation: Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard University Medical School, Boston, Massachusetts.
authors.forename: Amparito
authors.initials: A
authors.lastname: Cunningham
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Adnan
authors.initials: A
authors.lastname: Divjan
authors.affiliation: Division of Pulmonary, Allergy, and Immunology, School of Medicine, University of Maryland, Baltimore.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Bollinger
authors.affiliation: Division of Pediatric Allergy/Immunology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Shuyan
authors.initials: S
authors.lastname: Zhai
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Ginger
authors.initials: G
authors.lastname: Chew
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York7Division of Pulmonary, Allergy, and Critical Care Medicine, College of Physicians and Surgeons, Columbia University, New York, New York8Division of Pediatric Allergy, Immunology, and Rheumatology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Miller
authors.affiliation: Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard University Medical School, Boston, Massachusetts.
authors.forename: Wanda
authors.initials: W
authors.lastname: Phipatanakul
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000009:adverse effects*; D000818:Animals; D001249:Asthma / Q000175:diagnosis* / Q000517:prevention & control*; D015142:Baltimore; D001512:Bedding and Linens; D001900:Boston; D002648:Child; D002675:Child, Preschool; D004391:Dust / Q000517:prevention & control; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D051379:Mice; D010353:Patient Education as Topic / Q000379:methods*; D010571:Pest Control / Q000379:methods*; D012378:Rodenticides; D063189:Symptom Assessment / Q000379:methods; D013997:Time Factors
chemical_list: D000485:Allergens; D004391:Dust; D012378:Rodenticides