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Cockroach allergen reduction by cockroach control alone in low-income, urban homes: A randomized control trialAsthma has been increasing in the United States in recent decades. This increase is most apparent among children, especially those living in the inner city. The causes are piled up one upon another. In 1997 the National Institute of Allergy and Infectious Diseases (NIAID) found that asthma morbidity was related to environmental exposures, such as indoor allergens and passive cigarette smoke, to psychological problems of both the children and their caretakers, and to problems with access to medical care and appropriate medications. So, where do we begin to make a difference? Rosenstreich and Eggleston, NEJM 1997, showed that 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. In this current study published in the October 2007 issue of the Journal of Allergy and Clinical Immunology, Sever and Arbes pit the entomologists against the commercial companies to determine who is the most effective in reducing cockroach allergen. After addresses of approximately 150 potentially eligible, cockroach-infested homes were obtained from a real estate management firm, sixty homes were enrolled, randomly assigned to 1 of 3 treatment groups, and followed for 12 months. Group 1had cockroach bait placed and scheduled cockroach counts done by university entomologists; Group 2 received pest control treatments from a commercial company; and the third group was the control group, who despite receiving no pest control treatments for twelve months, were awarded pest control services at the end of the study. Although both of the treatment groups significantly reduced the cockroach infestations, the amount of cockroach allergen in the entomologist-treated homes was lowered significantly while professionals from the commercial companies changed the allergen levels only marginally. This suggests there is a threshold level of cockroach infestation needed to leave enough feces and other secretions to produce allergen levels sufficient to cause disease. The entomologists did a better job of eradicating the cockroaches because rather than just controlling populations they monitored cockroach trap counts and intensively treated infested homes with highly effective gel bait preparations. One limitation of this study is the lack of health outcome data for those living in the homes to correlate with the reductions in cockroaches and cockroach allergen. The next study will pursue a multicenter clinical trial with children with moderate to severe asthma who are both sensitized and exposed to cockroach allergen. The entomologists' methods will be applied in hopes that a significant improvement in asthma morbidity will be achieved |
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