Correspondence

Cockroach Allergen and Asthma

N Engl J Med 1997; 337:791-792September 11, 1997

Article

To the Editor:

The results of skin testing with cockroach allergen among inner-city children, reported by Rosenstreich et al. (May 8 issue),1 are similar to my experience almost 30 years ago.2 While working in the allergy clinics at Gouverneur Hospital and Beth Israel Medical Center, on New York's lower east side, I found that with intradermal testing, 75 percent of children living in nonpublic housing and 30 percent of children living in public housing were sensitive to cockroach allergen, whereas there were no positive tests among children seen in a suburban allergy practice.

Frederic A. Schulaner, M.D.
546 Westfield Ave., Westfield, NJ 07090

2 References

1. 1

   Rosenstreich DL, Eggleston P, Kattan M, et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med 1997;336:1356-1363
   Full Text | Web of Science | Medline

2. 2

   Schulaner FA. Sensitivity to the cockroach in three groups of allergic children. Pediatrics 1970;45:465-466
   Web of Science | Medline

To the Editor:

Rosenstreich et al. do not discuss an important factor in the exacerbation and initiation of asthma: environmental tobacco smoke.1 They report that 58.3 percent of their subjects lived in homes with at least one smoker present. This finding is not surprising. Cigarette use is common in inner-city communities.

In view of the availability of effective interventions for smoking cessation that physicians can use in their offices,2 it is time to integrate all efforts aimed at the control of asthma and of tobacco use in poor urban areas. This approach is necessary to counteract the specific targeting of inner-city communities by tobacco companies using promotions and billboard advertising.3,4

Carlos Roberto Jaén, M.D., Ph.D.
State University of New York at Buffalo, Buffalo, NY 14215

4 References

1. 1

   Respiratory health effects of passive smoking: lung cancer and other disorders. Smoking and tobacco control monographs no. 4. Washington, D.C.: Environmental Protection Agency, 1993.
   

2. 2

   The Smoking Cessation Clinical Practice Guideline Panel and StaffThe Agency for Health Care Policy and Research smoking cessation clinical practice guideline. JAMA 1996;275:1270-1280
   CrossRef | Web of Science

3. 3

   Robinson RG, Barry M, Block M, et al. Report of the Tobacco Policy Research Group on marketing and promotions targeted at African Americans, Latinos, and women. Tob Control 1992;1:Suppl:S24-S30
   

4. 4

   Hackbarth DP, Silvestri B, Cosper W. Tobacco and alcohol billboards in 50 Chicago neighborhoods: market segmentation to sell dangerous products to the poor. J Public Health Policy 1995;16:213-230
   CrossRef | Web of Science | Medline

Author/Editor Response

Dr. Rosenstreich replies:

To the Editor: There are a number of factors that contribute to asthma-related morbidity in inner-city children, and exposure to cigarette smoke is one of them.1 We agree with Dr. Jaén that an integrated approach may reduce this morbidity. The second phase of the National Cooperative Inner-City Asthma Study is specifically designed to assess the efficacy of an integrated intervention, which includes a reduction in smoking in order to reduce asthma-associated morbidity.

Dr. Schulaner's observations provide confirmation that cockroach allergy has been an urban problem for a long time. His findings are consistent with ours, as well as with many other reports of high prevalences of cockroach allergy among persons with asthma throughout the world.2-4 It is interesting to speculate about why the prevalence of asthma and morbidity associated with it have increased so dramatically among inner-city children over the past 30 years, even though the prevalence of allergy to cockroaches seems to have been as high 30 years ago as it is now. Since an increase in cases of asthma associated with cockroaches requires the combination of allergy plus exposure to high levels of allergen, these findings suggest that either cockroach-allergen levels have increased or children are spending more time in contact with cockroach allergen (the “television theory of asthma”).5 More research in this important area is obviously required.

David L. Rosenstreich, M.D.
Albert Einstein College of Medicine, Bronx, NY 10461

For the Environmental Subcommittee of the National Cooperative Inner-City Asthma Study

5 References

1. 1

   Chilmonczyk BA, Salmun LM, Megathlin KN, et al. Association between exposure to environmental tobacco smoke and exacerbations of asthma in children. N Engl J Med 1993;328:1665-1669
   Full Text | Web of Science | Medline

2. 2

   Kang B, Sulit N. A comparative study of prevalence of skin hypersensitivity to cockroach and house dust antigens. Ann Allergy 1978;41:333-336
   Medline

3. 3

   Sastre J, Ibanez MD, Lombardero M, Laso MT, Lehrer S. Allergy to cockroaches in patients with asthma and rhinitis in an urban area (Madrid). Allergy 1996;51:582-586
   Web of Science | Medline

4. 4

   Sarpong SB, Hamilton RG, Eggleston PA, Adkinson NF Jr. Socioeconomic status and race as risk factors for cockroach allergen exposure and sensitization in children with asthma. J Allergy Clin Immunol 1996;97:1393-1401
   CrossRef | Web of Science | Medline

5. 5

   Platts-Mills TAE, Carter MC. Asthma and indoor exposure to allergens. N Engl J Med 1997;336:1382-1384
   Full Text | Web of Science | Medline