Cockroaches Important Cause of Asthma Morbidity
Among Inner-City Children
A large study supported by the National Institute of Allergy and Infectious
Diseases (NIAID) has conclusively demonstrated that the combination
of cockroach allergy and exposure to the insects is an important cause
of asthma-related illness and hospitalizations among children in U.S.
inner-city areas.
The report from NIAID's National Cooperative Inner-City Asthma Study
(NCICAS), and an accompanying editorial, appear in the May 8, 1997,
issue of The New England Journal of Medicine.
"Some of the most vulnerable of our citizens, children in the
poorest neighborhoods of our large cities, suffer disproportionately
from asthma," says Anthony S. Fauci, M.D., NIAID director. "Allergy
and exposure to cockroach allergen clearly play an important role in
the alarming rates of asthma-related sickness among these children."
"Reducing exposure to cockroach allergen, as part of a multi-faceted
approach to asthma management, may be a cost-effective way of reducing
the burden of this serious disease," says Daniel Rotrosen, M.D.,
acting director of NIAID's Division of Allergy, Immunology and Transplantation.
"Simple and relatively low-cost interventions that have been explored
in the NCICAS, such as patient education, roach traps and child-safe
insecticides, are potentially important adjuncts to previously established
medical therapies that can help asthmatic patients."
The first five-year phase of the NCICAS, recently completed, enrolled
more than 1,500 children with asthma, ages 4 to 11, living in eight
major metropolitan areas: The Bronx, N.Y.; East Harlem, N.Y.; St.Louis,
Mo.; Washington, D.C.; Baltimore, Md.; Chicago, Ill.; Cleveland, Ohio;
and Detroit, Mich.
In the current analysis, David L. Rosenstreich, M.D., of the Albert
Einstein College of Medicine in the Bronx, N.Y., and his NCICAS colleagues
studied 476 of these children. Most of the children were either African-American
(78 percent) or Hispanic (16 percent). The researchers measured levels
of cockroach, dust mite and cat allergens in the children's homes, and
determined with allergy skin tests that 37 percent of the children were
allergic to cockroaches, 35 percent to dust mites, and 23 percent to
cats. The investigators then assessed the severity of the children's
asthma over 12 months.
They found that children who were both allergic to cockroaches and
exposed to high cockroach allergen levels were hospitalized for their
asthma 3.3 times more often than children who were allergic but not
exposed to high levels of cockroach allergen, or children who were exposed
to high levels of cockroach allergen but who were not allergic.
Children who were both allergic and heavily exposed to cockroach allergen
also missed school more often, needed nearly twice as many unscheduled
asthma-related medical visits, and suffered through more nights with
lost sleep. In addition, the activities of the adults who cared for
these children were frequently disrupted.
In contrast neither the combination of allergy to dust mites and high
exposure to mites, nor the combination of allergy to cats and high exposure
to cats was associated with more severe asthma among the 476 children
in the study sample.
Despite the availability of effective asthma therapies, asthma-related
deaths among individuals younger than 25 in the United States increased
118 percent between 1980 and 1993.
"These disturbing trends, which are especially pronounced in minority
populations, underscore the importance of the Institute's research into
understanding, preventing and treating asthma," says Dr. Fauci.
