Indoor Pest Exposures Tied to Respiratory Issues in Kids With Asthma

WASHINGTON — Among kids with asthma, indoor allergen exposure to pests like mice and cockroaches was associated with occurrence of upper respiratory infections (URIs), according to a longitudinal study.

Among 90 mostly Black kids sensitized to allergens, mouse allergen concentration was associated with URI with reduced lung function (OR 1.58, 95% CI 1.10-2.27), as was cockroach allergen concentration (OR 1.79, 95% CI 1.05-3.03), reported Darlene Bhavnani, PhD, MPH, of Dell Medical School at the University of Texas at Austin, during the American Academy of Allergy, Asthma & Immunology (AAAAI) annual meeting.

There were also associations observed between these allergens and symptomatic URI, but these were not statistically significant. Findings also showed an association between mouse and cockroach allergen concentrations and URI with pulmonary eosinophilic inflammation.

Of note, cat and dog allergen concentrations were not associated with any URI outcomes.

Previous research has shown that URIs are reported more often by Black children compared with white children with asthma. Similar disparities have also been observed for food allergies.

“Now, it follows that if there are these racial and ethnic disparities in asthma exacerbations and many of these exacerbations are triggered by viruses, what role, then, do these viruses play in the disparities that we see?” Bhavnani posed, noting that already-existing healthcare disparities may be exacerbated by other kinds of disparities, such as housing inequities.

“You can conclude that indoor pest allergen concentrations were consistently associated with having an upper respiratory infection with upper and lower respiratory symptoms, and it’s possible that the differences in pest allergen concentrations may contribute to the disparity in the risk of acquiring an upper respiratory infection, having upper respiratory symptoms, and by extension potentially also disparities in viral-associated asthma exacerbations,” she said.

Bhavnani told MedPage Today that by understanding the impacts of patients’ environments, there may be a chance, in the future, to stop or limit potential health issues before they start.

“Thinking about treating a kid in clinic and sending them back to those conditions where they became sick in the first place doesn’t make sense, right? So, from my perspective, it’s about prevention … so definitely thinking about these home environmental interventions or even something broader, larger on an environmental scale — we’re starting to think about neighborhood effects and what we can do,” she said.

For this study, the researchers used longitudinal data collected from sensitized children in the Environmental Control as Add-on Therapy for Childhood Asthma study. A total of 90 participants were included: 60% were male, 92% were Black, and 92% had public health insurance.

Throughout the study, 191 observations occurred, and 27% were positive for URI.

Allergen concentrations were measured in home air samples (mouse) and in settled dust (cockroach, cat, and dog) taken at baseline, 3, and 6 months. At clinic visits, which occurred every 2 months from baseline to 6 months, patients were assessed with spirometry and nasal mucus samples, which were tested for rhinovirus, respiratory syncytial virus, influenza, coronavirus, adenovirus, parainfluenza, and human metapneumovirus.

Reduced lung function was defined as a percent predicted forced expiratory volume (FEV₁) less than 80%, and pulmonary eosinophilic inflammation was defined as a fractional exhaled nitric oxide (FENO) of 35 ppb or more.

Odds ratios were adjusted for age, sex, month of study, season, health insurance type, and household size.

The researchers noted that low concentrations of allergens and the moderate sample size of their study may have limited their ability to detect associations.

Additionally, data were collected from a low-income and mostly Black population from a single inner-city setting, which may limit the generalizability of the findings.

Bhavnani said further studies including multiracial and multiethnic patients are needed to address the impacts of real-world disparities on patients with asthma.

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