Home and allergic characteristics of children with asthma in seven U.S. urban communities and design of an environmental intervention: the Inner-City Asthma Study.

Most published environmental remediation interventions have been directed at single allergens and have employed demanding strategies; few have been performed in the homes of inner-city children disproportionately burdened by asthma. Our objective was a) to describe the allergen sensitivities, environmental tobacco smoke (ETS) exposure, and home environmental characteristics of a national sample of inner-city children with moderate to severe asthma and b) to develop and implement a multifaceted, home-based comprehensive intervention to reduce home allergens and ETS, tailored to the specific sensitization and exposure profiles of those children. Allergen skin testing and a home evaluation were performed to determine the presence of ETS and factors known to be associated with increased indoor allergen levels. Based on published remediation techniques, a home environmental intervention, organized into modules, each addressing one of five specific allergen groups or ETS, was designed. Of 994 allergic children from seven U.S. urban communities, 937 successfully completed baseline interviews and home allergen surveys and were enrolled. More than 50% of children had positive skin tests to three or more allergen groups. Cockroaches were reported in 58% of homes, wall-to-wall carpeting in the child's bedroom in 55%, a smoker in 48%, mice or rats in 40%, and furry pets in 28%. More than 60% of enrolled families received four or more modules, and between 94% and 98% of all modules were completed. We conclude that most inner-city children with moderate to severe asthma are sensitized to multiple indoor allergens and that environmental factors known to be associated with asthma severity are commonly present in their homes. The intervention developed for the Inner-City Asthma Study employs accepted methods to address an array of allergens and ETS exposure while ensuring that the intervention is tailored to the specific sensitization profiles and home characteristics of these children.

[1]  A. Dubois,et al.  Clinical effects of air cleaners in homes of asthmatic children sensitized to pet allergens. , 1999, The Journal of allergy and clinical immunology.

[2]  H. Nelson,et al.  Evaluation of devices for skin prick testing. , 1998, The Journal of allergy and clinical immunology.

[3]  A. Bandura.  Social Foundations of Thought and Action , 1986 .

[4]  T. Platts-Mills,et al.  Sensitisation, asthma, and a modified Th2 response in children exposed to cat allergen: a population-based cross-sectional study , 2001, The Lancet.

[5]  Alfred O. Berg,et al.  Clinical Guidelines And Primary Care Guidelines For The Diagnosis And Management Of Asthma , 2012 .

[6]  S. Redline,et al.  Characteristics of inner‐city children with asthma: The National Cooperative Inner‐City Asthma Study , 1997, Pediatric pulmonology.

[7]  Jennifer A. Jones,et al.  Increasing asthma knowledge and changing home environments for Latino families with asthmatic children. , 2001, Patient education and counseling.

[8]  T. Platts-Mills,et al.  The role of intervention in established allergy: avoidance of indoor allergens in the treatment of chronic allergic disease. , 2000, The Journal of allergy and clinical immunology.

[9]  M. Chapman,et al.  Risk factors for asthma in inner city children. , 1992, The Journal of pediatrics.

[10]  A. Bandura.  Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychological review.

[11]  G. Redding,et al.  Indoor risk factors for asthma and wheezing among Seattle school children. , 1997, Environmental health perspectives.

[12]  R. Dales,et al.  Indoor air quality and health: validity and determinants of reported home dampness and moulds. , 1997, International journal of epidemiology.

[13]  F. Martinez,et al.  Increased incidence of asthma in children of smoking mothers. , 1992, Pediatrics.

[14]  D. Strachan,et al.  Parental smoking and childhood asthma: longitudinal and case-control studies , 1998 .

[15]  D. Lilienfeld,et al.  Childhood asthma and passive smoking. Urinary cotinine as a biomarker of exposure. , 1992, The American review of respiratory disease.

[16]  J. Haddow,et al.  Association between exposure to environmental tobacco smoke and exacerbations of asthma in children. , 1993, The New England journal of medicine.

[17]  Paul J Lioy,et al.  Typical Household Vacuum Cleaners: The Collection Efficiency and Emissions Characteristics for Fine Particles. , 1999, Journal of the Air & Waste Management Association.

[18]  Ennis,et al.  THE ROLE OF COCKROACH ALLERGY AND EXPOSURE TO COCKROACH ALLERGEN IN CAUSING MORBIDITY AMONG INNER-CITY CHILDREN WITH ASTHMA , 2000 .

[19]  M. Chapman,et al.  Sensitization and exposure to indoor allergens as risk factors for asthma among patients presenting to hospital. , 1993, The American review of respiratory disease.

[20]  J. Warner,et al.  The effect of high‐efficiency and standard vacuum‐cleaners on mite, cat and dog allergen levels and clinical progress , 2000, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[21]  P. Gergen,et al.  Relationship of indoor allergen exposure to skin test sensitivity in inner-city children with asthma. , 1998, The Journal of allergy and clinical immunology.

[22]  F. Martinez,et al.  Alternaria as a major allergen for asthma in children raised in a desert environment. , 1997, American journal of respiratory and critical care medicine.

[23]  F. Forastiere,et al.  Passive smoking as a determinant of bronchial responsiveness in children. , 1994, American journal of respiratory and critical care medicine.

[24]  S T Holgate,et al.  Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study. , 1990, The New England journal of medicine.

[25]  D. Strachan.  Damp housing and childhood asthma: validation of reporting of symptoms. , 1988, BMJ.

[26]  B. Kang,et al.  Atopic profile of inner-city asthma with a comparative analysis on the cockroach-sensitive and ragweed-sensitive subgroups. , 1993, The Journal of allergy and clinical immunology.

[27]  Third Expert Panel on theDiagnosis,et al.  Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma , 1997 .

[28]  W. Phipatanakul,et al.  Mouse allergen. II. The relationship of mouse allergen exposure to mouse sensitization and asthma morbidity in inner-city children with asthma. , 2000, The Journal of allergy and clinical immunology.

[29]  G. Ayala,et al.  Theories and intervention approaches to health-behavior change in primary care. , 1999, American journal of preventive medicine.

[30]  M. Zwarenstein,et al.  Risk factors for childhood asthma and wheezing. Importance of maternal and household smoking. , 1996, American journal of respiratory and critical care medicine.

[31]  S. H. Arshad,et al.  Sensitization to common allergens and its association with allergic disorders at age 4 years: a whole population birth cohort study. , 2001, Pediatrics.

[32]  A. Custovic,et al.  The effect of air filtration on airborne dog allergen , 1999, Allergy.

[33]  V. Persky,et al.  Asthma prevalence and risk factors in selected Head Start sites in Chicago. , 1998, The Journal of asthma : official journal of the Association for the Care of Asthma.