What allergen is most likely responsible for the disproportionately high morbidity from asthma among inner city residents: cat dander, dog dander, cockroach allergen, house dust mite allergen, or mold spores?

From the Guidelines

Cockroach allergen is most likely responsible for the disproportionately high morbidity from asthma among inner city residents. This allergen is particularly prevalent in urban environments where cockroach infestations are common in multi-unit dwellings and older buildings with structural issues that allow pest entry. Cockroach allergens come from the insect's saliva, fecal material, and body parts, which become airborne and can trigger severe asthmatic responses in sensitized individuals. Studies have consistently shown that exposure to cockroach allergen is strongly associated with increased asthma symptoms, emergency room visits, and hospitalizations among inner city populations, particularly children, as seen in the National Cooperative Inner-City Asthma Study (NCICAS) 1.

Some key points to consider:

• The relationship between cockroach allergen exposure and asthma morbidity is stronger than with other common allergens like dust mites, which require higher humidity levels, or pet danders, which depend on pet ownership 1.
• Effective management includes integrated pest management strategies such as sealing cracks and crevices, eliminating food and water sources, using appropriate insecticides, regular cleaning to remove allergen reservoirs, and in some cases, medical interventions like allergen immunotherapy for sensitized individuals with persistent symptoms despite environmental control measures 1.
• The use of HEPA filters can help reduce airborne particles, but it is most effective when used in combination with extermination and home-based education to reduce cockroach allergen levels 1.
• A study found that a single integrated pest management visit was more effective than the regular application of pesticides alone in managing pests and their consequences, and was associated with lower cockroach allergen concentrations in kitchens and beds 1.

Overall, the evidence suggests that cockroach allergen is a significant contributor to asthma morbidity in inner city residents, and that effective management strategies can help reduce exposure and improve health outcomes.

From the Research

Allergens Responsible for High Morbidity from Asthma

The allergen most likely responsible for the disproportionately high morbidity from asthma among inner city residents is:

• Cockroach allergen, as evidenced by multiple studies 2, 3, 4, 5

Key Findings

Some key findings from the studies include:

• Cockroach allergen exposure and sensitivity are associated with increased asthma morbidity in inner city children 3, 5
• Children who are both sensitive and exposed to cockroach allergen have significantly more asthma symptom days, more caretaker interrupted sleep, and more school days missed than children who are not sensitive or exposed 3
• Cockroach allergen levels are highest in high-rise apartments, and exposure to cockroach allergen is a significant predictor of asthma morbidity 3, 4
• The combination of cockroach allergy and exposure to high levels of this allergen may help explain the frequency of asthma-related health problems in inner-city children 5

Comparison with Other Allergens

In comparison to other allergens, such as:

• Dog dander
• Cat dander
• House dust mite allergen
• Mold spores Cockroach allergen appears to have a greater effect on asthma morbidity in inner city residents 3, 5