Which asthmatic children benefit most from mouse allergen reduction?
Published online: September 11, 2019
Mouse allergen is a major contributor to asthma morbidity among children living in low-income, urban environments. Although reductions in mouse allergen levels in this population have been associated with improvements in asthma control and exacerbations, some children may benefit more than others. The predictors of response to allergen reduction are not well understood and may be important for understanding how best to tailor home-based interventions targeting indoor allergen exposure.
In an article recently published in the The Journal of Allergy and Clinical Immunology: In Practice, Ahmed and colleagues performed a secondary analysis of data from the Mouse Allergen and Asthma Intervention Trial (MAAIT), which was a randomized clinical trial that tested the effect of an intensive mouse allergen-targeted integrated pest management (IPM) intervention plus pest management education, as compared to pest management education alone, among 5-17 year old’s with persistent asthma and mouse sensitization and exposure. In this trial, there were no differences in mouse allergen exposure or clinical outcomes between groups, but across the entire study population substantial reductions in mouse allergen were observed, which were associated with improvements in asthma control and exacerbation-related outcomes. Ahmed et al examined the effects of clinical characteristics on relationships between mouse allergen reduction and asthma outcomes among 297 predominantly Black and Hispanic children and adolescents. They examined whether there was a differential response to mouse allergen reduction based on the degree of atopy, demographics, lung function, asthma control, and asthma severity.
The study found that children with a higher degree of atopy (greater number of positive skin prick tests to common environmental allergens) tended to have fewer asthma symptoms with reduced mouse allergen exposure compared to children who were less atopic; however, there was no evidence that atopic status influenced the effect of mouse allergen reduction on exacerbation-related outcomes. Although older children (≥9 years) tended to experience greater improvement in some asthma outcomes with reduction of mouse allergen exposure than younger children, the finding was not consistent across asthma outcomes. There was no evidence that the other clinical characteristics examined influenced the effect of mouse allergen reduction on any asthma outcomes.
Overall, there were no clinical characteristics that clearly identified a subgroup to whom the intervention should be targeted, suggesting interventions aimed at reducing mouse allergen exposure should not be restricted to populations with certain clinical characteristics, especially given that mouse allergen reduction is a low-risk and modest cost intervention.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.