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Socioeconomic predictors of high allergen levels in homes in the greater Boston area.

Socioeconomic predictors of high allergen levels in homes in the greater Boston area. Articles Socioeconomic Predictors of High Allergen Levels in Homes in the Greater Boston Area T. Kitch,1 Ginger Chew,2 Harriet A. Burge,2 Michael L. Scott T. Weiss,1 3 Thomas A.E. Barrenf Muilenberg,2 Platts-MiIIs,4 George O'Connor,5 and Diane R. Gold1'3'6 1Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; 2Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA; 3Pulmonary Division, Boston's Beth Israel Hospital, Boston, Massachusetts, USA; 4Department of Medicine, Division of Allergy and Immunology, University of Harvard Medical School, USA; 5The Pulmonary Center, Department of Medicine, Boston University School of Virginia Medical Center, Charlottesville, Virginia, Amalie Kass Fellow at Harvard Medical School, Boston, Massachusetts, USA Medicine, Boston, Massachusetts, USA; 6Edward and Methods Materials and rates are the in less Cohort. Between 1994 and June In the United States, childhood asthma morbidity and prevalence September highest More than 80% of childhood asthmatics are allergic to one 1996, 499 families with a history of asthma affluent urban communnities. minority or more inhalant We evaluated whether socioeconomic status was associated with a dif- or allergy in at least one parent were enrolled allergens. in a birth cohort study designed to examine ferential in the levels and of indoor home allergens. Dust samples for an ELISA allergen types families as of a metropolitan Boston, the effects of early life allergen exposure on assay were collected from the homes of 499 part birth cohort of home allergens and asthma in children with a the development of childhood asthma. On Massachusetts, study longitudinal parental history of asthma or allergy. The proportion of homes with maximum home allergen lev- weekdays (Monday-Friday), all mothers in was for dust mite 10 Der 1 or Der f 13% who delivered their babies at a large Boston els the highest category 42% allergen (. p 1), pg/g for cockroach (> 2 UIg Bla g 1 or Bla g 2), 26% for cat allergen (. 8 pglg Fel d 1), and hospital were approached for screening 24 to allergen if 20% for dog allergen (. 10 pg/g Can f 1). Homes in the area (> 20% of the popula- 48 hours after delivery they lived within high-poverty have cockroach levels than homes 128 roughly encircles the tion below the level) were more likely to high allergen Route (which poverty in the area [51 vs. 3%; OR, 33; 95% confidence interval (CI), 12-90], but less likely greater metropolitan area), were . 18 years low-poverty English or to have levels of dust mite allergen (16 vs. 53%; OR, 0.2; CI, 0.1-0.4). Lower family old, and were able to speak high or vs. were also associ- Families were not screened if they income, less maternal education, and (black Hispanic white) Spanish. race/ethnicity with lower of dust mite levels and a risk of high cockroach allergen levels. were identified by the floor nurse as unlikely ated a risk high greater Within a single U.S. metropolitan area we found marked between-community differences in the to be comfortable with an interview, or if the child was premature (< 36 weeks), had of allergens present in the home, but not in the overall burden of allergen expo- index types necessarily work dust indoor allergens, inner city. Environ a congenital anomaly, or was in the sure. asthma, cat, cockroach, dog, mite, major Key Health Perspect 108:301-307.(2000). [Online 18 Febmary 2000] neonatal intensive care unit. Mothers were niehs. nib.ov/docs/l2 /1l /tml asked the following simple screening ques- httpnx//empnetl. 08p301-307kitechabstract. tions: Have ever had a doctor's diagnosis you of asthma, hay fever, or allergies? Has the bio- in recent in father of your child ever had a doctor's Asthma prevalence has increased allergen were apparently rare the eastern logic and hospitalization, and U.S. homes of asthmatic children of hay fever, or allergies? If years prevalence, inner-city diagnosis asthma, mortality rates are disproportionately high participating in the National Inner City the mothers answered yes to one or both of and Asthma Study (13), nearly 25% of the these were asked to a among inner-city disadvantaged pop- questions, they complete ulations in the United States (1-4). inner-city asthmatic cohort in an Atlanta, more detailed screening questionnaire. Exposure to indoor allergens may con- study had high levels of mite aller- Over the enrollment period, we identified Georgia, to the of childhood in few women who lived within the Route tribute development gen the home (10). Additionally, 7,657 and it has been that studies and contrast the levels of 128 area and were 18 years of age or older; asthma, suggested compare and geographic variation in exposure allergen in the homes of asthmatics of dif- 5,973 were approached and asked about temporal in within maternal or of asthma or levels may partially account for variations fering socioeconomic backgrounds paternal history asthma and both over the same city. Finally, whereas some data allergy. Most of the mothers (5,904) agreed to prevalence morbidity homes from time and across socioeconomic and geographic suggest that inner-city differ- answer the simple screening questions. Of boundaries ent of the United States have had a maternal or paternal histo- (5,6). regions may these, 1,539 or Consistent with this hypothesis, levels of high levels of at least some allergens, ry of asthma allergy, and 1,405 families indoor to whether disadvantaged to a more detailed screening at least some allergens appear vary socioeconomically agreed complete Nine hundred six of the location and socioeconomic homes have a greater burden of indoor questionnaire. 1,405 by geographic dust mite is a overall is unknown. were excluded from the study before conditions. Although allergen allergens in south- We had the unique opportunity to relatively abundant allergen many eastern U.S. it is examine levels in the homes of ern and cities, apparently allergen Address to B. Channing correspondence Kitch, New and two asthmatic or from a wide less so in Arizona, Mexico, allergic people 181 Boston, MA Laboratory, Longwood Avenue, Canadian cities Cockroach is spectrum of socioeconomic backgrounds (7-9). allergen USA. 525-2738. Fax: 02115 Telephone: (617) in of low within a urban as of a more common homes relatively single area, part large E-mail: (617) 525-0968. barry.kitch@channing. of the role of harvard.edu socioeconomic status than in homes of birth cohort study allergen (SES) D. and K. We thank M. Barr, J. Maldonis, Sredl, whereas the is in the of asthma. relatively high SES, opposite exposure development for technical and V. for McGaffigan support Carey We examined the differences in the true for cat allergen (10-12). types in statistical assistance analysis. of Yet about distribu- and levels allergens by income, questions allergen National Institutes of Health by Supported location of the racial/ethnic and tion remain. For example, importance backgrounds, ROl and HL07427. grants AI/EHS-35789 in the inner the of the dust mite as an the homes within greater Boston, 10 December 21 allergen Received 1998, accepted October 1999. levels of mite Massachusetts, area. city is unclear. Although high Number 2000 Health Volume Environmental Perspectives * 108, 4, April * Articles Kitch et al. measurement of home allergen levels. The cockroach For dust herself allergen (Bla g 2). the household was mite, Hispanic, reasons for exdusion induded plans to move and we cat, dog allergens, used two-site as in the designated Hispanic. Similarly, within the next year (39% of those monoclonal screened), ELISA absence of a antibody assays black or if (14-16). Hispanic parent, reluctance to participate in a longitudinal The cockroach assay differed in that a either him- considered or herself poly- parent study (45%), loss to follow-up (14%), and clonal rabbit antibody specific for cock- the household was Asian, as designated other (2%). The study was roach was approved by the used for All Asian. The antigen capture household was white if (17). designated Brigham and Women's Hospital antibodies and (Boston, reference were neither him- allergens considered or herself parent MA) Human Research Committee. obtained from M. Chapman (University of or other. black, Hispanic, Asian, Questionnaires. Home visits were Virginia, Charlottesville, income VA). was as Family categorized conducted by trained research assistants Statistical 2-3 analysis. For the of 2 to < purpose $50,000, or $30,000 50,000, months after the birth of the index child. analysis, we categorized dust < mite We education on allergen $30,000. the categorized The assistants a levels as f administered detailed home Der 1 or Der 1 at one of three basis of p maternal education education; characteristics questionnaire. The levels: < 2.0 question- (induding assays below the were or pg/g categories postcollege, college, high naire included questions about limits of detection and parental those samples with no school or less. education, family income, and characteristics dust); 2-10 or 10 The home pg/g; . Cockroach characteristic have pg/g. categories of the home. allergen levels were as Bla 1 been categorized g or described the previously (22). Briefly, Collection and measurement Bla 2 at one of three of allergen g levels: < 0.05 of home was into U/g type grouped buildings levels. Dust samples were collected from the (including below the limits with three or assays of detec- more versus houses apartments kitchen, living room, child's bed, and child's tion); 0.05 to < 2 or 2 and U/g; . U/g. Seasons were as duplexes. categorized bedroom floor of all of the homes within We the performed regression analyses for winter (November-February), spring first 3 months of the index child's birth. If dust mite and cockroach allergen, with aller- summer and (March-May), (une-August), the child spent 2 3 hr in the level parents' bed for gen (greater than or to the fall equal The of floor speci- (September-October). type . 3 nights a week, a sample was also collect- fied cut as the point) dependent variable for was defined as smooth or covering carpeted ed from the parents' bed. Participants were each of the We and was based analyses. performed two on a field technician's sep- asked not to clean arate (vacuum, sweep, mop, analyses for dust mite allergens observation. using for etc.) 3 days before the visit. A Eureka the cut Der points f 1 or Der p 2 at 2 2 We examined each of the jig/g following Mighty-Mite vacuum cleaner and Der f 1 or Der variables (model 3621; p 2 at 2 10 for association with levels: respec- pg/g, allergen The Eureka Co., Bloomington, was tively. Similarly, we performed IL) two separate maternal poverty area, education, family modified to collect dust in x mm 19 90 cel- analyses for cockroach allergens; the of cut income, home race/ethnicity, type (single lulose extraction thimbles. The time points were Bla 1 spent g or Bla g 2 at 2 0.05 or and U/g season of family multiapartment), and the and vacuuming area vacuumed were Bla g 1 or Bla 2 at 2 2 The g U/g. cate- were with chi- sampling. Analyses performed standardized. Dust from the child's for bed and gories each of the allergens were based on and For the square simple logistic regression. the child's bedroom floor was collected in levels that have been associated with we used the logistic regression analyses, binary separate thimbles. For the child's bed sam- sensitization or exacerbation or outcome level development in the or allergen (moderate ple, all layers of bedding, including the mat- of asthma (5,10,11,17-19). or for each of the Uncertainty aller- high) category (yes no) tress surface, were vacuumed for min. For about such cut points or thresholds as the 5 motivat- variables. For the cock- gens dependent the bedroom floor 2 m2 ed us sample, of the floor to explore two different levels for we considered the both in roach, allergen present surrounding the bed was vacuumed for dust mite and cockroach 5 allergen the if either Bla 1 (20,21). high category or Bla 2 g g In min. the living room, the vacuum- The highest level of an were 5-min allergen recorded above the cut present point. Similarly, ing included 2 m2 of the floor and an from any of the four sample sites in a for the dust we uphol- home considered the mite, allergen stered chair or seat where the child and was termed the maximum allergen level in the in the if present either Der 1 high category p often sat such a caregiver (if chair was identi- home, or home maximum. We or Der f 1 were performed above the cut present point. fied). In the the floor the kitchen, surrounding logistic regression analyses using this variables were value Independent dummy-coded, the cabinets, around the and for each of the homes. and in refrigerator, each case the was the largest group under the sink was vacuumed for We 5 min. used zip-code boundaries to baseline. We define performed multivariable analysis Dust were samples placed in areas within the Boston airtight greater vicinity. The using logistic regression. multiple plastic bags immediately after collection, percent of the population below the poverty Results then returned to the laboratory. Within 48 level was determined for each of the zip-code hr after the dust was collection, weighed and areas based on data from the 1990 U.S. Population characteristics. There were sifted through a mesh Census sieve, and a (U.S. Census Bureau, Suitland, families in the MD). final all of whom lived 425-pm cohort, portion of the fine dust The was extracted (50 zip-code areas were then in the combined to Boston area. Characteristics greater of mg/mL borate-buffered saline). Extracts form three poverty area categories: the enrolled low are in study population given were stored at -20°C until analysis. Each (< 5% of individuals below the Table 1. poverty As to those compared dassified as liv- was for sample analyzed allergens from dust level), medium (> 5-20% of individuals in ing low-poverty areas, families classified as mite 1 (Der p and Der f 1), below cockroach (Bla g the poverty level), and high (> in 20% of areas were living high-poverty significantly 1), and cat (Fel d 1). The Bla g 1 and Bla g 2 individuals below the poverty level). The more to have a likely income < family $30,000 lower limits of detection were 0.05 U/g, the level data poverty were based on data from and were more to be black or likely Hispanic, Der 1 p and Der f 1 lower limits were 0.025 the 1990 U.S. Census. as shown in Table 2. Homes located in the pg/g, and the Fel d 1 lower limit was 0.0125 Household race/ethnicity was assigned areas high-poverty were also more to likely be When an adequate amount of based on the pg/g. living race/ethnicity in designation of the multiapartment or buildings (three more room sample was available, we also per- parents. If either of the parents considered in a apartments single building). formed an assay for dog allergen (Can f 1); him- or herself black, the household was des- levels. Of Allergen the homes assayed, when an adequate amount of kitchen ignated as sample black. In the absence of a 42% black (213) had dust mite allergen levels in was available, we also measured a second parent, if either parent considered him- or the highest category (Der p 1 or Der f 1, Volume 108, Number 4, April 2000 * Environmental Health Perspectives Articles * Socioeconomic predictors of allergen levels 24% of the homes in the low-poverty area Socioeconomic predictors of dust mite > 10 and 13% (66) had cockroach pg/g) g 1 had levels in the highest category, as com- and cockroach allergen, adjusting for home allergen levels in the highest category (Bla . 2 Results are shown in pared to 11 % in the high-poverty area. characteristics. Chew et al. (22) reported or Bla g 2, U/g). 3 and Figure 1. Nearly 50% of Asian households and 27% that the type of home, the type of floor cov- Table 1 levels in the and the season of sampling are asso- Der f 1 was more commonly present at of white households had Fel d ering, than Der 1. Der f 1 levels were highest category, as compared to 8% of the ciated with dust mite levels in our study high levels p homes. As compared to apartments, houses in the highest category in 40% of the homes, black households (p < 0.05). 1 levels were in the highest High levels of dog allergen were more were twice as likely to have high levels of whereas Der p in of the homes. Overall, evenly distributed between the poverty level dust mite allergen. Homes with carpeted category only 11% 18% of the high- floors or those that were sampled in the sum- 67% of the homes had Der f 1 or Der p 1 areas than cat allergen; . 2 67% had Fel d 1 levels . 1.0 area, 18% of the mid-poverty area, mer were also more likely to have high levels levels poverty pg/g, pg/g, and 60% had Bla g 1 or Bla g 2 levels and 23% of the low-poverty area homes had of dust mite whether 2 2 pg/g or 2 10 pg/g as the cut point, although homes > 0.05 U/g. Can f 1 levels . 10 i'g/g. Levels of dog aller- was used these characteristics frequently had Poverty area, socioeconomic, and gen varied substantially by race/ethnicity, without homes, 9% of high levels (22). racial/ethnic risk factors for moderate or however; 4% of Hispanic area of Asian homes, and 23% In the present analysis, these home char- high allergen levels. Poverty (Figure 2) black homes, 17% associated with the type and level of of white homes had levels 2 10 acteristics only partially accounted for the was pg/g. between the various SES indica- allergen exposure (Figure 1 and Tables 4 and Consistent with the associations noted associations in high-poverty region of the for allergen levels, having a cat or dog in the tors of disadvantage and lower dust mite lev- 5). Living the Boston area was associated with an increased home was less common among those living els. Frequency of room vacuuming, a weak in areas, in black or of mite levels, did risk of moderate or high levels of cockroach the high-poverty univariate predictor dust a decreased risk of Hispanic households, or in those with the not influence associations between SES and allergen and, conversely, more cats type of moderate or high levels of dust mite allergen. lowest family income. One or dust mite allergens. Similarly, the were in each of were allowed in the homes of 4% (2 of 45) home and the season of sampling only par- These associations present at two cut for of those who lived in the high-poverty area, tially explained the associations between SES the rooms sampled and points both An exception to these associa- as compared to 16% (31 of 195) of those and cockroach allergens, which remained allergens. in were home tions was dust mite allergen in the kitchen; living the low-poverty area. Dogs significant after controlling for these or less common in high-poverty areas characteristics. For example, the odds ratio there was a low prevalence of moderate slightly levels of in the kitchen in all of than in low-poverty areas (13 vs. 19%). As for dust mite . 10 for homes in the high allergen pg/g the areas. In univariate logistic shown elsewhere (22), nearly all (96 of 98, areas with high-poverty rates versus the areas poverty mite and cockroach or of those homes in which a cat was regression analysis, dust 98%) levels also varied income allowed inside the home had an Fel d 1 level allergen by family Table 2. Relationship between family income, and race/ethnicity (Tables 4 and 5). . 8 pg/g, as compared to 35 of 399 (8.7%) race/ethnicity, and poverty area. of the homes in A Overall, although 53% of those without a cat. similar relationship Poverty area the areas had dust mite allergen between the presence of an animal and a low-poverty Low Medium High in levels . 10 only 16% of the homes in the high level of allergen the home was seen Characteristic no. (%) no. (%) no. 1%) pg, areas had levels . 10 jig (p- for 64 of of those with a high-poverty dogs; 67 (95.5%) Family income value < 0.001). Approximately 50% of white allowed in the home had Can Fl levels dog > $50,000 11 (25) 173(90) 164(63) households and about 20% of the black . 10 as compared to 18 of 354 (5.2%) of to < 50,000 17 60 11 $30,000 (9) (23) (25) in without. 1 26(10) 21 (48) households had mite allergen levels the those <$30,000 (1) Race/ethnicity 10 dust highest category (> Similarly, pg). White 170 190 (73) 10 (22) (87) levels in the moderate or highest cate- mite 1. of cohort Table General characteristics family Black 35(14) 28(62) 11<1) n = gories were more common among those (total 499). Hispanic 6 (3) 17 (7) 7 (16) with incomes and those with higher family Asian 13 15 Percent (7) (6) (0) Characteristic No. greater maternal education. Other 5 2 0 (3) (1) (0) Area of residence in Conversely, homes the high-poverty Low poverty 195 39 were more to have cockroach area likely high Medium poverty 259 52 2 than homes in the levels max- allergen (. U/g) Table 3. Overall prevalence of allergens by High poverty 45 9 area vs. imum allergen level in the home. low-poverty (51 3%; p-value Maternal education of the black Post college 231 46 < 52% 0.001). Approximately Allergen No. Percent 159 32 College of the homes had homes and 40% Hispanic school or less 109 22 Der p 1 or Der f 1 498 High (pg/g) levels in the (. 2 cockroach highest category income .10 213 42 Family white and as to of the U/g), compared 5% 348 70 2 to < 10 120 24 2 $50,000 of the Asian homes. Family income and 7% < 88 18 166 33 to <2 $30,000 50,000 maternal both of which were asso- < 48 1 0 Bla 1 or Bla g 2 499 education, $30,000 g (U/g) .2 66 13 and location in our Insurance ciated with race/ethnicity 463 93 0.05 to < 2 232 47 Private showed the same those population, pattern: 26 5 < 0.05 201 40 Medicaid lower income and households with family No insurance 9 2 Fel d 1 498 (pg/g) were also at less maternal education greater 131 26 Race/ethnicity cockroach levels. risk for high allergen 204 41 White 370 74 1 to <8 areas <1 163 33 Living in the low- or mid-poverty Black 64 13 Can f 1 412 Hispanic 30 6 classification as white or Asian were each (pg/g) and 28 6 .10 82 20 Asian associated with increased risk of cat allergen 7 1 < 1 0 330 80 Other levels in the Approximately high category. * Volume Number 2000 Environmental Health Perspectives 108, 4, April * Kitch et al. Articles for home character- variables, although race/ethnicity appeared to with low-poverty rates changed from 0.2 to allergen after adjustment associations with dust mite cockroach allergen 2 2 istics and race/ethnicity, and was therefore have significant 0.3; the odds ratio for in final model for dust mite. and cockroach levels that were independent for homes in the areas with high-pover- not included the U/g areas were at lower risk of of the other SES and home characteristics ty rates versus the areas with low-poverty High-poverty for both cut variables considered. from to 18. dust mite exposure points, rates changed 33 association was not significant In multivariable models adjusting for although the Discussion when we used a cut point of . 2 ,ug/g. Area other SES variables as well as home character- homes in the high-poverty of area appears to poverty was the most important risk factor We found that istics, the level poverty of a large metropolitan area were differences in both dust for having any detectable cockroach allergen, regions explain some of the family income was more strongly more likely to have high levels of cockroach allergen levels, although whereas mite and cockroach levels of allergen and, conversely, less likely to have for both allergens the significance of the associated with the risk of high mite or cat allergens. Colinearity issues and high levels of dust relationships varies with the cut point used cockroach allergen. in levels was also associated 4 income was not a size limit interpretation of models Variation allergen (Tables and 5). Family sample SES and home characteristics with family income and race/ethnicity. predictor of dust mite containing all significant independent our study include the The strengths of measurement of multiple allergens, the col- _8 .... _ 80 ::::: .......i.. 780 lection of dust from multiple sites in all of JS70A and the of a large num- 60 .. the homes, sampling cp 50 ..... o .... ........ .. : . ber of homes. We also sampled homes from ::.i.: ,.5 5: ... .:~~~~~~~~~~~~~~~~.. ... .. 50 ... y °o:J different residential areas or regions (which j40 B~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.. .:. within a sin- we designated as poverty areas) u 30 ..3 .::. .... .... ~~~~~~~~~~~~~~~~~~~~... ..0........... metropolitan area, and the homes of ;. ..: gle g 10 :~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~. .......... -.s ............ ..: families with different racial and socioeco- nomic backgrounds, allowing us to study the Bia.0.5 Bia 2 Ulg Ulg Der?t2jigg Der2A0pgIg determinants of within-city between-group in allergen type and level. variation _ 80 Other studies have shown that cockroach - 70 be in inner- allergen levels tend to highest O 60 R in certain minority, and in lower city, m 50 hous- income homes (10-12). Substandard *S 40 multiunit which are gen- ing and buildings, erally more common in the inner city, are ' 20 infestation thought to promote cockroach io o 0 the lev- and thus contribute to high allergen o0 Bla.0.5U/g Bia"2Ufg Der.>lO0iglg els In our those who k2uig ueralugg/g (23). study population, Der>2z[gig Derk2gg/g Allergen Allergen lived in high-poverty areas were considerably in build- more likely to live multiapartment of moderate or levels of dust mite or cockroach allergen for (A) child's bedroom Figure 1. Prevalence high more in a single and area. Low poverty was defined as < 5% of ings (three or apartments floor, (B) child's bed, (C) living room, (D) kitchen, by poverty level based on 1990 U.S. Census mid was defined as > 5-20% individuals below the poverty data; poverty than those who lived in low-pover- building) the and was defined as > 20% of individuals below the of individuals below poverty level; high poverty area vs. ty areas (58% of the high-poverty poverty level. of the 4% low-poverty area). Other studies have also demonstrated that location within a cat allergen levels vary by race/ethnicity, and by socioeconomic city, by In our those who status (10,11). population, lived in the high-poverty areas were less likely that to keep cats as pets, and it follows they would be less to have cat allergen levels likely in the category. Although Fel d 1 has highest been found in dust samples of homes both with and without cats, the presence of aller- > with gen levels 8 is strongly associated pg/g the of a cat presence (22). Significantly, in our Boston cohort we found that dust mite levels also vary within a poverty area, by race/ethnicity, single city by and by income variables. Previous studies of dust mite levels in the urban setting have The National Inner produced varied results. a lower City Asthma Study (13) reported prevalence of high levels of dust mite among homes than in our study (10% of inner-city in homes had levels 2 2 vs. 42% our 2. of the Boston area showing the distribution of poverty areas in our cohort. Scale: 1 inch upg/g, Figure Map 4.5 miles. A study of 57 homes in Atlanta by equals approximately study). Number 2000 Health Perspectives 304 Volume 108, 4, April * Environmental * Articles Socioeconomic of predictors allergen levels Call et al. (10) and a of study 186 homes in levels. Unmeasured In our allergen characteristics Der f 1 was more cohort, Wilmington, Delaware, by Gelber et al. winter (11) (e.g., indoor better mea- than Der which temperature, was 1, prevalent p expected reported much higher prevalences of high sures of indoor humidity, or additional because other studies have shown that the levels of dust mite allergen in inner-city details on home dust condition) may account for mite is species Dermatophagoidesfarinae homes (- 25% had levels 2 10 than the unexplained of the observed more common in the aspect dif- less humid pg/g) cooler, either our study or the National Inner ferences. For City example, other northern climates than investigators Dermatophagoides Asthma Study (13). Of these have other studies suggested that certain homes may have pteronyssinus (8). the only Wilmington study examined both air rates higher exchange and may therefore Some researchers have that postulated urban and suburban be homes; levels were simi- drier we did the (26,27). Although not find a increased burden of asthma experienced lar between the two areas. The difference absence of a in humidity between and different low-income is at by inner-city groups difference in dust mite levels between home our pover- types, measurements were made least attributable to a burden partly greater ty areas in which Wilmington, contrasts a home of during single visit, and may not allergen exposure among poor inner-city with our results, may be a function reflect of the household averages or microenviron- this minority populations (2,28). Although geographic location of the cities mental relative studied still humidity. our showed that may prove true, study and/or a function of differences in We also found that heating black and Hispanic not all levels are in the allergen higher high- systems and indoor humidity. race/ethnicity are independently associated areas. homes in poverty Though high-pover- We believe that differences in home char- with reduced dust mite levels. Sarpong et al. areas were more have levels ty to likely high acteristics and housing stock are responsible (12) showed that African American race is of cockroach were less to allergen, they likely for the within-metropolitan-area an socioeco- independent predictor of cockroach have expo- dust mite and cat high allergen levels. nomic and race/ethnicity gradients in dust sure. As has been suggested for cockroach As a the risk of at least one result, having mite and cockroach levels that we observed allergens, it seems likely that differences in level in the did not allergen highest category (8,22,24,25). The home home characteristics, characteristics and housing stock area of residence vary significantly by (69% which we measured and reported elsewhere explain the differences in dust mite of the area allergen vs. 71% of the low- high-poverty (22) as predictors of dust mite allergens (the levels attributable to race/ethnicity. The area We did find that those poverty homes). of type building, the type of floor of covering, inability home characteristics to in the lowest fully income all of group, whom and the season) and cockroach account for the allergens (the effect of race/ethnicity in our lived in had a high-poverty areas, greater risk type of and the building season), only partial- multivariate analysis suggests important of at least one level in the having allergen ly explained these socioeconomic gradients in unmeasured characteristics. highest category. Table 4. Estimates of associations between socioeconomic factors and maximum level of Der p 1 or Der f 1 in the home, shown as OR (95% confidence limit). .2 Der or Derf 1 pg/g p1 orDerfi .lOpglgDerpl Variable Model la Model 2 Model 3 18 Model Model Model 2 Model 3 Model a 4b Family income 2 $50,000 1 - - - - 1.0 - $30,000 to < 50,000 0.7 (0.4, - 1.1) - - 0.8 - (0.5,1.3) - $30,000 0.3 - - - (0.2, 0.5) - - 0.3 (0.1, 0.6) - Area poverty Low - - 1.0 - - 1.0 1.0 1.0 - - Medium - - 0.4 0.6) (0.3, 0.6 (0.4, 1.0) 0.6 (0.4, 0.8) 0.7 (0.5,1.1) - - High - - 0.2 (0.1, 0.4) 0.6 (0.3,1.5) 0.2 (0.1, 0.4) 0.4 (0.1,1.0) Race/ethnicity White - - 1.0 - 1.0 1.0 1.0 Asian - - - 0.7 (0.3, 1.6) 0.9 (0.4, 2.1) 0.8 (0.4, 1.7) 0.9 (0.4,1.9) - - Black - - 0.2 (0.1, 0.4) 0.4 0.7) (0.2, 0.3 (0.1, 0.5) 0.5 (0.2,1.1) - - Hispanic - - 0.1 (0.1, 0.3) 0.2 (0.1, 0.5) 0.1 (0.1, 0.4) 0.2 (0.1,0.6) aModels 1-3 are univariate logistic regression with the variables analyses for family area and income, poverty, race/ethnicity as the independent variables, bModel 4 is a respectively. multivariate model containing the variables for home characteristics (season of and sampling house/duplex vs. area and apartment), poverty, race/ethnicity. Table 5. Estimates of associations between socioeconomic factors and maximum level of 1 or 2 in Bla g Bla the shown as OR g home, (95% confidence limit). 20.05U/gBlag orBlag2 o2rU/Blag orBlag2 Variable Model Model 2 la Model 3 Model 4b 1a Model Model 2 3 Model 4b Model Family income 2 1.0 - $50,000 - 1.0 1.0 - 1.0 to < 1.2 - $30,000 50,000 - (0.8, 2.0) 0.9 3.4 (0.5, 1.5) - - (1.6, 6.9) 1.5 (0.7, 3.5) < - - $30,000 3.5 (1.6, 7.4) 1.8 21.1 (0.7, - - 4.5) (10.2, 43.6) 4.9 (1.9,12.9) Area poverty Low - 1.0 1.0 - 1.0 - 1.0 Medium - 1.2 (0.8, 1.7) 1.0 5.3 (0.6, 1.5) - 1.9 (2.2, 12.7) (0.7, 5.3) High 8.6 4.2 - (3.0, 25) - 32.9 (1.3, 14.0) 2.3 (12.1, 89.6) (0.6, 8.9) Race/ethnicity - - White - 1.0 1.0 1.0 1.0 Asian - - 1.3 1.4 1.4 1.4 (0.6, 2.8) (0.6, 3.2) 6.4) 6.7) (0.3, (0.3, Black - 5.0 3.7 - (2.4, 10.6) 19.7 7.7 (1.6, 8.8) (10, 38.6) (3.2, 18.4) Hispanic 1.7 0.9 - (0.8, 12.3 3.7) (0.3, 2.3) 5.6 (5.2, 29.2) (1.9, 16.6) aModels 1-3 are univariate logistic with the variables for regression analyses area and as the family income, poverty, bModel 4 is a race/ethnicity independent variables, respectively. multivariable model the variables for home characteristics of and vs. containing (season area and sampling house/duplex income, apartment), family poverty, race/ethnicity. Environmental Health Volume Perspectives * Number 2000 305 108, 4, April Articles * Kitch et al. risk is dust mite allergen levels tended to be lower Whether equivalent imposed by 3. Gergen PJ, Mullally DI, Evans R Ill. National survey of prevalence of asthma among children in the United each of these allergens is not known, and this and cockroach levels higher in the lower SES States, 1976 to 1980. Pediatrics 81:1-7 (1988). in comparing the bur- (high-poverty) areas. The only exception was should lead to caution 4. Weiss KB, Wagener DK. Changing patterns of asthma den of allergen exposure across groups. the kitchen, where dust mite levels were low mortality: identifying target populations at high risk. JAMA 264:1683-1687 (1990). to cock- in most homes. A separate but important Asthmatic patients who are sensitive 5. Sporik R, Holgate ST, Platts-Mills TAE, Cogswell JJ. roach allergens may have particularly high question is whether exposure in the home is Exposure to house-dust mite allergen (Der p 1) and the levels of IgE, more chronic and perennial best characterized by the allergen level in the in N Med development of asthma childhood. Engl J 323:502-507 (1990). in the symptoms, and greater disease severity child's bedroom, the highest level 6. Sporik R, Chapman MD, Platts-Mills TAE. House dust allergen plays a home, or some average of all of the rooms. Whether cockroach (13,29). mite exposure as a cause of asthma. Clin Exp Allergy greater role than dust mite or cat allergens in The answer to this question is likely to vary 22:897-906 (1992). the development of asthma remains to be with age and activity patterns of the child Arlian LG, Bernstein D, Bernstein IL, Friedman S, Grant A, Lieberman P, Lopez M, Metzger J, Platts-Mills T, determined. Additionally, indoor allergens and family. These issues have been explored M. Prevalence of dust mites in the homes of Schatz peo- such as in more detail in analyses of allergen levels as that are not yet routinely measured, ple with asthma living in eight different geographic those derived from rat or mouse, may be predictors of health outcomes (30). areas of the United States. J Allergy Clin Immunol 90:292-300 (1992). of to important in the development or morbidity The levels allergen necessary 8. Arlian LG. Biology and ecology of house dust mites, of the disease. Nearly 21% of our cohort induce sensitization are uncertain for each Dermatophagoides spp. and Euroglyphus spp. Immunol reported having seen signs of rats or mice in of the allergens studied. Although one Allergy Clin North Am 9:(2)339-356 (1989). 9. Becker Lam Dimich-Ward Chan-Yeung M, A, J, H, the over the prospective study of dust mite exposure home past year. Ferguson A, Warren P, Simons E, Broder I, Manfreda J. Just as dust mite levels were lower but found a substantially increased risk for asth- House dust mite levels in two cities in Canada: allergen to . 10 not undetectable in poorer homes, cock- ma among children exposed effects of and home characteris- season, humidity, city, pg/g tics. Clin Exp Allergy 25:240-246 (1995). not undetectable Der p 1 (5), other studies showed that sensi- roach levels were lower but 10. Call RS, Smith TF, Morris E, Chapman MD, Platts-Mills in homes. Although a low pro- tization may occur with exposure to consid- more affluent TAE. Risk factors for asthma in inner city children. J in portion of high-income homes had cock- erably lower levels (20,21). With this Pediatr 121:862-866 (1992). 11. Gelber LE, Seltzer LH, Bouzoukis JK, Pollart we examined two cut for both SM, roach antigen levels 2 2 U/g, 50% of those mind points TAE. Chapman MD, Platts-Mills Sensitization and expo- incomes 2 $50,000 had cockroach dust mite and cockroach allergens and with sure to indoor allergens as risk factors for asthma levels . 0.05 but < 2 U/g. demonstrated a relationship between SES among patients presenting to hospital. Am Rev Respir and level at both moderate and Dis 147:573-578 (1993). Our study has several limitations. First, allergen 12. Sarpong SB, Hamilton RG, Eggleston PA, Adkinson NF. we measured allergen levels in settled rather high levels. Socioeconomic status and race as risk factors for cock- Finally, our study was not designed to be than airborne dust samples. Allergen expo- roach allergen exposure and sensitization in children will for a settled a random of the in the with asthma. J Allergy Clin Immunol 97:1393-1401 sure itself likely vary given sample population (1996). 13. Rosenstreich DL, Eggleston P, Kattan M, Baker D, Slavin we for a stable dust concentration with the activity level of greater Boston area; selected RG, Gergen P, Mitchell H, McNiff-Mortimer K, Lynn H, of the with a of asthma subjects, air exchange characteristics population parental history et al. The role of cockroach and Ownby D, allergy expo- of in settled or and an interest in a sure to cockroach in home, etc. The amount allergen allergy longitudinal allergen causing morbidity among with N inner-city children asthma. EngI J Med dust, however, is a substantial determinant study. Our findings of socioeconomic gradi- 336:1356-1363 (1997). is in levels have the most rele- of exposure, and when sampling of levels ents allergen 14. Chapman M, Aalberse RC, Brown MJ, Platts-Mills TA. settled dust concentration is con- vance to the Northeastern U.S. pediatric infrequent, Monoclonal antibodies to the major feline allergen Fel d 1. Il: Single step affinity purification of Fel d 1, N-terminal for asthma. a better index of concentration than populations most at risk They ceivably and of a sensitive two- sequence analysis, development This is the have internal relevance as our aerosolized levels. particularly longitudinal site to assess Fel d 1 J Immunol immunoassay exposure. case for dust mite and cockroach to examine whether allergens, study begins allergen 140:812-818 (1988). 15. Arruda Platts-Mills Miller burden is of Luczynska CM, LK, TA, JD, Lopez which are only transiently airborne. type or total allergen predictive M, Chapman MD. A two site monoclonal antibody ELISA the of airborne aller- asthma incidence in children at risk for asth- Moreover, availability for the quantification of the major Dermatophagoides spp. measurements is unlikely to have ma because of family history. Assessment of gen allergens, Der p 1 and Der f 1. J Immunol Methods in terms the distribution of SES in a 1 18(2):227-235 (1989). changed the ranking of households allergens by gen- 16. de Groot Goei Van Swicter Aalberse RC. H, KG, P, Affinity of level or the relationship between eral population would require a different allergen of a purification major and minor allergen from dog in the home. based on both SES and SES and the level of allergen sampling strategy extract: serologic activity of affinity-purified Can f 1 and our variables for race/ethnicity, housing stock. Second, Can f 1-depleted extract. J Allergy Clin Immunol 87:1056-1061 In we have shown that (1991). indicators of SES, and poverty were summary, 17. Pollart Smith Morris SM, TF, EC, Gelber LE, Platts-Mills TA, associated with one and levels another, potentially allergen types vary substantially Chapman MD. Environmental exposure to cockroach aller- interfering with multivariate analysis. In the by area of residence, family income, and with monoclonal gens: analysis antibody-based enzyme multivariate model dust mite J Clin Immunol 87:505-510 predicting race/ethnicity. However, the net allergen immunoassays. Allergy (1991). 18. Platts-Mills TA, Thomas W, Aalberse R, Vervioet D, allergens, we now include only area poverty burden faced by inner-city and suburban M. Chapman Dust mite allergens and asthma: report of a and excluding income, which is not a residents may be more similar than race, second international workshop. J Allergy Clin Immunol significant predictor of dust mite after previously suspected. The implications of 89:1046-1060 (1992). 19. Ingram JM, Sporik R, Rose G, Honsinger R, Chapman MD, adjusting for race and family income. The these findings for asthma risk in vulnerable Platts-Mills TA. Quantitative assessment of exposure to confidence intervals in the adjusted analyses such as the children in populations our f and cat (Fel d dog (Can 1) 1) allergens: relation to sensi- are widened as those in the compared to cohort is as yet unknown. tization and asthma among children living in Los Alamos, crude analyses, and although this may partly New Mexico. J Allergy Clin Immunol 96:449-456 (1995). Warner AM, Bjorksten B, Munir AK, Moller C, Schou C, represent the effects of correlation, it also REFERENCES AND NOTES Kjellman NI. Childhood asthma and exposure to indoor in our reflects the relatively small numbers allergens: low mite levels are associated with sensitivity. lower SES categories. 1. Gottlieb DJ, Beiser AS, O'Connor GT. Poverty, race, and Pediatr Allergy Immunol 7:61-67 (1996). We as have medication use are correlates of asthma hospitalization 21. Wahn Lau found, others, that allergen U, S, Bergmann R, Kulig M, Forster J, rates. Chest 108:28-35 (1995). Bauer I. Indoor Bergmann K, CP, Guggenmoos-Holdzman levels varied substantially from room to 2. Marder D, Targonski P, Orris P. Persky V. Addington W. is a risk factor allergen exposure for sensitization during room within given home (10,11,1/). Effect of racial and socioeconomic factors on asthma the first three years of life. J Allergy Clin Immunol Regardless of the room sampled, however, mortality in Chicago. Chest 101(6):426S-429S (1992). 99:763-769 (1997). Volume 108, Number 4, April 2000 * Environmental Health Perspectives * Socioeconomic of levels Articles allergen predictors Evans R. Asthma among minority children: a growing Chew GL, Burge HA, Dockery DW, Muillenberg MS, 25. Brandt RL, Arlian LG. Mortality of house dust mites, 28. Chest 101:(6)368S-371S (1992). Weiss ST, Gold DR. Limitations of a home characteristics Dermatophagoides farinae and D. pteronyssinus, problem. BC, Johnson J, Veres-Thorner C. Atopic profile of questionnaire as a predictor of indoor allergen levels: exposed to dehydrating conditions or selected pesti- 29. Kang asthma with a comparative analysis on the and epidemiologic implications. Am J Respir Crit cides. J Med Entomol 13:(3)327-331 (1976). inner-city clinical Care Med 157:1536-1541 11998). 26. Korsgaard HH, Dahl J. House-dust mites and associated cockroach sensitive and ragweed sensitive subgroups. J Immunol 92:802-811 (1993). 23. Koehler PG, Patterson RS, Brewer RJR. German environmental conditions in Danish homes. Allergy Allergy Clin 48:106-109 (1993). 30. Gold DR, Carey V, Milton DK, Platts-Mills T, Weiss ST, cockroach infestations in low income apartments. J HA. Predictors of repeated wheeze in the first Entomol 80:446-450 (1987). 27. Wickman M, Perhagen G, Nordvall SL, Schwartz B. Burge Econ AK, Einarsson R, Dreborg SK. Vacuum cleaning House dust mite sensitization in children and residential year of life: the relative roles of cockroach, birth weight, 24. Munir illness, and maternal smoking. characteristics in a temperate region. J Allergy Clin acute lower respiratory decreases the levels of mite allergens in house dust. Immunol 4:136-143 (1993). Immunol 88:89-95 (1991). Am J Respir Crit Care Med 160(1):227-236 (1999). Pediatr Allergy For as little as $ 3.09* user, per year per have your students can full Internet access to the Environmental Health Information Service (EHIS)! The EHIS offers online, searchable access to: * Environmental Health Perspectives Health Environmental Perspectives Supplements * National Toxicology Program Technical and Toxicity Reports on Report Carcinogens * Chemical Health and Safety Database J* Rodent Histon'cal Control Database on For more information call 1-800-315-3010. ordering I r] is bsdo ulip Ue Interne Accss *Price is based on User Internet Access. 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Socioeconomic predictors of high allergen levels in homes in the greater Boston area.

Kitch, B T; Chew, G; Burge, H A; Muilenberg, M L; Weiss, S T; Platts-Mills, T A; O'Connor, G; Gold, D R
Environmental Health Perspectives – Apr 1, 2000
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Articles Socioeconomic Predictors of High Allergen Levels in Homes in the Greater Boston Area T. Kitch,1 Ginger Chew,2 Harriet A. Burge,2 Michael L. Scott T. Weiss,1 3 Thomas A.E. Barrenf Muilenberg,2 Platts-MiIIs,4 George O'Connor,5 and Diane R. Gold1'3'6 1Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; 2Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA; 3Pulmonary Division, Boston's Beth Israel Hospital, Boston, Massachusetts, USA; 4Department of Medicine, Division of Allergy and Immunology, University of Harvard Medical School, USA; 5The Pulmonary Center, Department of Medicine, Boston University School of Virginia Medical Center, Charlottesville, Virginia, Amalie Kass Fellow at Harvard Medical School, Boston, Massachusetts, USA Medicine, Boston, Massachusetts, USA; 6Edward and Methods Materials and rates are the in less Cohort. Between 1994 and June In the United States, childhood asthma morbidity and prevalence September highest More than 80% of childhood asthmatics are allergic to one 1996, 499 families with a history of asthma affluent urban communnities. minority or more inhalant We evaluated whether socioeconomic status was associated with a dif- or allergy in at least one parent were enrolled allergens. in a birth cohort study designed to examine ferential in the levels and of indoor home allergens. Dust samples for an ELISA allergen types families as of a metropolitan Boston, the effects of early life allergen exposure on assay were collected from the homes of 499 part birth cohort of home allergens and asthma in children with a the development of childhood asthma. On Massachusetts, study longitudinal parental history of asthma or allergy. The proportion of homes with maximum home allergen lev- weekdays (Monday-Friday), all mothers in was for dust mite 10 Der 1 or Der f 13% who delivered their babies at a large Boston els the highest category 42% allergen (. p 1), pg/g for cockroach (> 2 UIg Bla g 1 or Bla g 2), 26% for cat allergen (. 8 pglg Fel d 1), and hospital were approached for screening 24 to allergen if 20% for dog allergen (. 10 pg/g Can f 1). Homes in the area (> 20% of the popula- 48 hours after delivery they lived within high-poverty have cockroach levels than homes 128 roughly encircles the tion below the level) were more likely to high allergen Route (which poverty in the area [51 vs. 3%; OR, 33; 95% confidence interval (CI), 12-90], but less likely greater metropolitan area), were . 18 years low-poverty English or to have levels of dust mite allergen (16 vs. 53%; OR, 0.2; CI, 0.1-0.4). Lower family old, and were able to speak high or vs. were also associ- Families were not screened if they income, less maternal education, and (black Hispanic white) Spanish. race/ethnicity with lower of dust mite levels and a risk of high cockroach allergen levels. were identified by the floor nurse as unlikely ated a risk high greater Within a single U.S. metropolitan area we found marked between-community differences in the to be comfortable with an interview, or if the child was premature (< 36 weeks), had of allergens present in the home, but not in the overall burden of allergen expo- index types necessarily work dust indoor allergens, inner city. Environ a congenital anomaly, or was in the sure. asthma, cat, cockroach, dog, mite, major Key Health Perspect 108:301-307.(2000). [Online 18 Febmary 2000] neonatal intensive care unit. Mothers were niehs. nib.ov/docs/l2 /1l /tml asked the following simple screening ques- httpnx//empnetl. 08p301-307kitechabstract. tions: Have ever had a doctor's diagnosis you of asthma, hay fever, or allergies? Has the bio- in recent in father of your child ever had a doctor's Asthma prevalence has increased allergen were apparently rare the eastern logic and hospitalization, and U.S. homes of asthmatic children of hay fever, or allergies? If years prevalence, inner-city diagnosis asthma, mortality rates are disproportionately high participating in the National Inner City the mothers answered yes to one or both of and Asthma Study (13), nearly 25% of the these were asked to a among inner-city disadvantaged pop- questions, they complete ulations in the United States (1-4). inner-city asthmatic cohort in an Atlanta, more detailed screening questionnaire. Exposure to indoor allergens may con- study had high levels of mite aller- Over the enrollment period, we identified Georgia, to the of childhood in few women who lived within the Route tribute development gen the home (10). Additionally, 7,657 and it has been that studies and contrast the levels of 128 area and were 18 years of age or older; asthma, suggested compare and geographic variation in exposure allergen in the homes of asthmatics of dif- 5,973 were approached and asked about temporal in within maternal or of asthma or levels may partially account for variations fering socioeconomic backgrounds paternal history asthma and both over the same city. Finally, whereas some data allergy. Most of the mothers (5,904) agreed to prevalence morbidity homes from time and across socioeconomic and geographic suggest that inner-city differ- answer the simple screening questions. Of boundaries ent of the United States have had a maternal or paternal histo- (5,6). regions may these, 1,539 or Consistent with this hypothesis, levels of high levels of at least some allergens, ry of asthma allergy, and 1,405 families indoor to whether disadvantaged to a more detailed screening at least some allergens appear vary socioeconomically agreed complete Nine hundred six of the location and socioeconomic homes have a greater burden of indoor questionnaire. 1,405 by geographic dust mite is a overall is unknown. were excluded from the study before conditions. Although allergen allergens in south- We had the unique opportunity to relatively abundant allergen many eastern U.S. it is examine levels in the homes of ern and cities, apparently allergen Address to B. Channing correspondence Kitch, New and two asthmatic or from a wide less so in Arizona, Mexico, allergic people 181 Boston, MA Laboratory, Longwood Avenue, Canadian cities Cockroach is spectrum of socioeconomic backgrounds (7-9). allergen USA. 525-2738. Fax: 02115 Telephone: (617) in of low within a urban as of a more common homes relatively single area, part large E-mail: (617) 525-0968. barry.kitch@channing. of the role of harvard.edu socioeconomic status than in homes of birth cohort study allergen (SES) D. and K. We thank M. Barr, J. Maldonis, Sredl, whereas the is in the of asthma. relatively high SES, opposite exposure development for technical and V. for McGaffigan support Carey We examined the differences in the true for cat allergen (10-12). types in statistical assistance analysis. of Yet about distribu- and levels allergens by income, questions allergen National Institutes of Health by Supported location of the racial/ethnic and tion remain. For example, importance backgrounds, ROl and HL07427. grants AI/EHS-35789 in the inner the of the dust mite as an the homes within greater Boston, 10 December 21 allergen Received 1998, accepted October 1999. levels of mite Massachusetts, area. city is unclear. Although high Number 2000 Health Volume Environmental Perspectives * 108, 4, April * Articles Kitch et al. measurement of home allergen levels. The cockroach For dust herself allergen (Bla g 2). the household was mite, Hispanic, reasons for exdusion induded plans to move and we cat, dog allergens, used two-site as in the designated Hispanic. Similarly, within the next year (39% of those monoclonal screened), ELISA absence of a antibody assays black or if (14-16). Hispanic parent, reluctance to participate in a longitudinal The cockroach assay differed in that a either him- considered or herself poly- parent study (45%), loss to follow-up (14%), and clonal rabbit antibody specific for cock- the household was Asian, as designated other (2%). The study was roach was approved by the used for All Asian. The antigen capture household was white if (17). designated Brigham and Women's Hospital antibodies and (Boston, reference were neither him- allergens considered or herself parent MA) Human Research Committee. obtained from M. Chapman (University of or other. black, Hispanic, Asian, Questionnaires. Home visits were Virginia, Charlottesville, income VA). was as Family categorized conducted by trained research assistants Statistical 2-3 analysis. For the of 2 to < purpose $50,000, or $30,000 50,000, months after the birth of the index child. analysis, we categorized dust < mite We education on allergen $30,000. the categorized The assistants a levels as f administered detailed home Der 1 or Der 1 at one of three basis of p maternal education education; characteristics questionnaire. The levels: < 2.0 question- (induding assays below the were or pg/g categories postcollege, college, high naire included questions about limits of detection and parental those samples with no school or less. education, family income, and characteristics dust); 2-10 or 10 The home pg/g; . Cockroach characteristic have pg/g. categories of the home. allergen levels were as Bla 1 been categorized g or described the previously (22). Briefly, Collection and measurement Bla 2 at one of three of allergen g levels: < 0.05 of home was into U/g type grouped buildings levels. Dust samples were collected from the (including below the limits with three or assays of detec- more versus houses apartments kitchen, living room, child's bed, and child's tion); 0.05 to < 2 or 2 and U/g; . U/g. Seasons were as duplexes. categorized bedroom floor of all of the homes within We the performed regression analyses for winter (November-February), spring first 3 months of the index child's birth. If dust mite and cockroach allergen, with aller- summer and (March-May), (une-August), the child spent 2 3 hr in the level parents' bed for gen (greater than or to the fall equal The of floor speci- (September-October). type . 3 nights a week, a sample was also collect- fied cut as the point) dependent variable for was defined as smooth or covering carpeted ed from the parents' bed. Participants were each of the We and was based analyses. performed two on a field technician's sep- asked not to clean arate (vacuum, sweep, mop, analyses for dust mite allergens observation. using for etc.) 3 days before the visit. A Eureka the cut Der points f 1 or Der p 2 at 2 2 We examined each of the jig/g following Mighty-Mite vacuum cleaner and Der f 1 or Der variables (model 3621; p 2 at 2 10 for association with levels: respec- pg/g, allergen The Eureka Co., Bloomington, was tively. Similarly, we performed IL) two separate maternal poverty area, education, family modified to collect dust in x mm 19 90 cel- analyses for cockroach allergens; the of cut income, home race/ethnicity, type (single lulose extraction thimbles. The time points were Bla 1 spent g or Bla g 2 at 2 0.05 or and U/g season of family multiapartment), and the and vacuuming area vacuumed were Bla g 1 or Bla 2 at 2 2 The g U/g. cate- were with chi- sampling. Analyses performed standardized. Dust from the child's for bed and gories each of the allergens were based on and For the square simple logistic regression. the child's bedroom floor was collected in levels that have been associated with we used the logistic regression analyses, binary separate thimbles. For the child's bed sam- sensitization or exacerbation or outcome level development in the or allergen (moderate ple, all layers of bedding, including the mat- of asthma (5,10,11,17-19). or for each of the Uncertainty aller- high) category (yes no) tress surface, were vacuumed for min. For about such cut points or thresholds as the 5 motivat- variables. For the cock- gens dependent the bedroom floor 2 m2 ed us sample, of the floor to explore two different levels for we considered the both in roach, allergen present surrounding the bed was vacuumed for dust mite and cockroach 5 allergen the if either Bla 1 (20,21). high category or Bla 2 g g In min. the living room, the vacuum- The highest level of an were 5-min allergen recorded above the cut present point. Similarly, ing included 2 m2 of the floor and an from any of the four sample sites in a for the dust we uphol- home considered the mite, allergen stered chair or seat where the child and was termed the maximum allergen level in the in the if present either Der 1 high category p often sat such a caregiver (if chair was identi- home, or home maximum. We or Der f 1 were performed above the cut present point. fied). In the the floor the kitchen, surrounding logistic regression analyses using this variables were value Independent dummy-coded, the cabinets, around the and for each of the homes. and in refrigerator, each case the was the largest group under the sink was vacuumed for We 5 min. used zip-code boundaries to baseline. We define performed multivariable analysis Dust were samples placed in areas within the Boston airtight greater vicinity. The using logistic regression. multiple plastic bags immediately after collection, percent of the population below the poverty Results then returned to the laboratory. Within 48 level was determined for each of the zip-code hr after the dust was collection, weighed and areas based on data from the 1990 U.S. Population characteristics. There were sifted through a mesh Census sieve, and a (U.S. Census Bureau, Suitland, families in the MD). final all of whom lived 425-pm cohort, portion of the fine dust The was extracted (50 zip-code areas were then in the combined to Boston area. Characteristics greater of mg/mL borate-buffered saline). Extracts form three poverty area categories: the enrolled low are in study population given were stored at -20°C until analysis. Each (< 5% of individuals below the Table 1. poverty As to those compared dassified as liv- was for sample analyzed allergens from dust level), medium (> 5-20% of individuals in ing low-poverty areas, families classified as mite 1 (Der p and Der f 1), below cockroach (Bla g the poverty level), and high (> in 20% of areas were living high-poverty significantly 1), and cat (Fel d 1). The Bla g 1 and Bla g 2 individuals below the poverty level). The more to have a likely income < family $30,000 lower limits of detection were 0.05 U/g, the level data poverty were based on data from and were more to be black or likely Hispanic, Der 1 p and Der f 1 lower limits were 0.025 the 1990 U.S. Census. as shown in Table 2. Homes located in the pg/g, and the Fel d 1 lower limit was 0.0125 Household race/ethnicity was assigned areas high-poverty were also more to likely be When an adequate amount of based on the pg/g. living race/ethnicity in designation of the multiapartment or buildings (three more room sample was available, we also per- parents. If either of the parents considered in a apartments single building). formed an assay for dog allergen (Can f 1); him- or herself black, the household was des- levels. Of Allergen the homes assayed, when an adequate amount of kitchen ignated as sample black. In the absence of a 42% black (213) had dust mite allergen levels in was available, we also measured a second parent, if either parent considered him- or the highest category (Der p 1 or Der f 1, Volume 108, Number 4, April 2000 * Environmental Health Perspectives Articles * Socioeconomic predictors of allergen levels 24% of the homes in the low-poverty area Socioeconomic predictors of dust mite > 10 and 13% (66) had cockroach pg/g) g 1 had levels in the highest category, as com- and cockroach allergen, adjusting for home allergen levels in the highest category (Bla . 2 Results are shown in pared to 11 % in the high-poverty area. characteristics. Chew et al. (22) reported or Bla g 2, U/g). 3 and Figure 1. Nearly 50% of Asian households and 27% that the type of home, the type of floor cov- Table 1 levels in the and the season of sampling are asso- Der f 1 was more commonly present at of white households had Fel d ering, than Der 1. Der f 1 levels were highest category, as compared to 8% of the ciated with dust mite levels in our study high levels p homes. As compared to apartments, houses in the highest category in 40% of the homes, black households (p < 0.05). 1 levels were in the highest High levels of dog allergen were more were twice as likely to have high levels of whereas Der p in of the homes. Overall, evenly distributed between the poverty level dust mite allergen. Homes with carpeted category only 11% 18% of the high- floors or those that were sampled in the sum- 67% of the homes had Der f 1 or Der p 1 areas than cat allergen; . 2 67% had Fel d 1 levels . 1.0 area, 18% of the mid-poverty area, mer were also more likely to have high levels levels poverty pg/g, pg/g, and 60% had Bla g 1 or Bla g 2 levels and 23% of the low-poverty area homes had of dust mite whether 2 2 pg/g or 2 10 pg/g as the cut point, although homes > 0.05 U/g. Can f 1 levels . 10 i'g/g. Levels of dog aller- was used these characteristics frequently had Poverty area, socioeconomic, and gen varied substantially by race/ethnicity, without homes, 9% of high levels (22). racial/ethnic risk factors for moderate or however; 4% of Hispanic area of Asian homes, and 23% In the present analysis, these home char- high allergen levels. Poverty (Figure 2) black homes, 17% associated with the type and level of of white homes had levels 2 10 acteristics only partially accounted for the was pg/g. between the various SES indica- allergen exposure (Figure 1 and Tables 4 and Consistent with the associations noted associations in high-poverty region of the for allergen levels, having a cat or dog in the tors of disadvantage and lower dust mite lev- 5). Living the Boston area was associated with an increased home was less common among those living els. Frequency of room vacuuming, a weak in areas, in black or of mite levels, did risk of moderate or high levels of cockroach the high-poverty univariate predictor dust a decreased risk of Hispanic households, or in those with the not influence associations between SES and allergen and, conversely, more cats type of moderate or high levels of dust mite allergen. lowest family income. One or dust mite allergens. Similarly, the were in each of were allowed in the homes of 4% (2 of 45) home and the season of sampling only par- These associations present at two cut for of those who lived in the high-poverty area, tially explained the associations between SES the rooms sampled and points both An exception to these associa- as compared to 16% (31 of 195) of those and cockroach allergens, which remained allergens. in were home tions was dust mite allergen in the kitchen; living the low-poverty area. Dogs significant after controlling for these or less common in high-poverty areas characteristics. For example, the odds ratio there was a low prevalence of moderate slightly levels of in the kitchen in all of than in low-poverty areas (13 vs. 19%). As for dust mite . 10 for homes in the high allergen pg/g the areas. In univariate logistic shown elsewhere (22), nearly all (96 of 98, areas with high-poverty rates versus the areas poverty mite and cockroach or of those homes in which a cat was regression analysis, dust 98%) levels also varied income allowed inside the home had an Fel d 1 level allergen by family Table 2. Relationship between family income, and race/ethnicity (Tables 4 and 5). . 8 pg/g, as compared to 35 of 399 (8.7%) race/ethnicity, and poverty area. of the homes in A Overall, although 53% of those without a cat. similar relationship Poverty area the areas had dust mite allergen between the presence of an animal and a low-poverty Low Medium High in levels . 10 only 16% of the homes in the high level of allergen the home was seen Characteristic no. (%) no. (%) no. 1%) pg, areas had levels . 10 jig (p- for 64 of of those with a high-poverty dogs; 67 (95.5%) Family income value < 0.001). Approximately 50% of white allowed in the home had Can Fl levels dog > $50,000 11 (25) 173(90) 164(63) households and about 20% of the black . 10 as compared to 18 of 354 (5.2%) of to < 50,000 17 60 11 $30,000 (9) (23) (25) in without. 1 26(10) 21 (48) households had mite allergen levels the those <$30,000 (1) Race/ethnicity 10 dust highest category (> Similarly, pg). White 170 190 (73) 10 (22) (87) levels in the moderate or highest cate- mite 1. of cohort Table General characteristics family Black 35(14) 28(62) 11<1) n = gories were more common among those (total 499). Hispanic 6 (3) 17 (7) 7 (16) with incomes and those with higher family Asian 13 15 Percent (7) (6) (0) Characteristic No. greater maternal education. Other 5 2 0 (3) (1) (0) Area of residence in Conversely, homes the high-poverty Low poverty 195 39 were more to have cockroach area likely high Medium poverty 259 52 2 than homes in the levels max- allergen (. U/g) Table 3. Overall prevalence of allergens by High poverty 45 9 area vs. imum allergen level in the home. low-poverty (51 3%; p-value Maternal education of the black Post college 231 46 < 52% 0.001). Approximately Allergen No. Percent 159 32 College of the homes had homes and 40% Hispanic school or less 109 22 Der p 1 or Der f 1 498 High (pg/g) levels in the (. 2 cockroach highest category income .10 213 42 Family white and as to of the U/g), compared 5% 348 70 2 to < 10 120 24 2 $50,000 of the Asian homes. Family income and 7% < 88 18 166 33 to <2 $30,000 50,000 maternal both of which were asso- < 48 1 0 Bla 1 or Bla g 2 499 education, $30,000 g (U/g) .2 66 13 and location in our Insurance ciated with race/ethnicity 463 93 0.05 to < 2 232 47 Private showed the same those population, pattern: 26 5 < 0.05 201 40 Medicaid lower income and households with family No insurance 9 2 Fel d 1 498 (pg/g) were also at less maternal education greater 131 26 Race/ethnicity cockroach levels. risk for high allergen 204 41 White 370 74 1 to <8 areas <1 163 33 Living in the low- or mid-poverty Black 64 13 Can f 1 412 Hispanic 30 6 classification as white or Asian were each (pg/g) and 28 6 .10 82 20 Asian associated with increased risk of cat allergen 7 1 < 1 0 330 80 Other levels in the Approximately high category. * Volume Number 2000 Environmental Health Perspectives 108, 4, April * Kitch et al. Articles for home character- variables, although race/ethnicity appeared to with low-poverty rates changed from 0.2 to allergen after adjustment associations with dust mite cockroach allergen 2 2 istics and race/ethnicity, and was therefore have significant 0.3; the odds ratio for in final model for dust mite. and cockroach levels that were independent for homes in the areas with high-pover- not included the U/g areas were at lower risk of of the other SES and home characteristics ty rates versus the areas with low-poverty High-poverty for both cut variables considered. from to 18. dust mite exposure points, rates changed 33 association was not significant In multivariable models adjusting for although the Discussion when we used a cut point of . 2 ,ug/g. Area other SES variables as well as home character- homes in the high-poverty of area appears to poverty was the most important risk factor We found that istics, the level poverty of a large metropolitan area were differences in both dust for having any detectable cockroach allergen, regions explain some of the family income was more strongly more likely to have high levels of cockroach allergen levels, although whereas mite and cockroach levels of allergen and, conversely, less likely to have for both allergens the significance of the associated with the risk of high mite or cat allergens. Colinearity issues and high levels of dust relationships varies with the cut point used cockroach allergen. in levels was also associated 4 income was not a size limit interpretation of models Variation allergen (Tables and 5). Family sample SES and home characteristics with family income and race/ethnicity. predictor of dust mite containing all significant independent our study include the The strengths of measurement of multiple allergens, the col- _8 .... _ 80 ::::: .......i.. 780 lection of dust from multiple sites in all of JS70A and the of a large num- 60 .. the homes, sampling cp 50 ..... o .... ........ .. : . ber of homes. We also sampled homes from ::.i.: ,.5 5: ... .:~~~~~~~~~~~~~~~~.. ... .. 50 ... y °o:J different residential areas or regions (which j40 B~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.. .:. within a sin- we designated as poverty areas) u 30 ..3 .::. .... .... ~~~~~~~~~~~~~~~~~~~~... ..0........... metropolitan area, and the homes of ;. ..: gle g 10 :~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~. .......... -.s ............ ..: families with different racial and socioeco- nomic backgrounds, allowing us to study the Bia.0.5 Bia 2 Ulg Ulg Der?t2jigg Der2A0pgIg determinants of within-city between-group in allergen type and level. variation _ 80 Other studies have shown that cockroach - 70 be in inner- allergen levels tend to highest O 60 R in certain minority, and in lower city, m 50 hous- income homes (10-12). Substandard *S 40 multiunit which are gen- ing and buildings, erally more common in the inner city, are ' 20 infestation thought to promote cockroach io o 0 the lev- and thus contribute to high allergen o0 Bla.0.5U/g Bia"2Ufg Der.>lO0iglg els In our those who k2uig ueralugg/g (23). study population, Der>2z[gig Derk2gg/g Allergen Allergen lived in high-poverty areas were considerably in build- more likely to live multiapartment of moderate or levels of dust mite or cockroach allergen for (A) child's bedroom Figure 1. Prevalence high more in a single and area. Low poverty was defined as < 5% of ings (three or apartments floor, (B) child's bed, (C) living room, (D) kitchen, by poverty level based on 1990 U.S. Census mid was defined as > 5-20% individuals below the poverty data; poverty than those who lived in low-pover- building) the and was defined as > 20% of individuals below the of individuals below poverty level; high poverty area vs. ty areas (58% of the high-poverty poverty level. of the 4% low-poverty area). Other studies have also demonstrated that location within a cat allergen levels vary by race/ethnicity, and by socioeconomic city, by In our those who status (10,11). population, lived in the high-poverty areas were less likely that to keep cats as pets, and it follows they would be less to have cat allergen levels likely in the category. Although Fel d 1 has highest been found in dust samples of homes both with and without cats, the presence of aller- > with gen levels 8 is strongly associated pg/g the of a cat presence (22). Significantly, in our Boston cohort we found that dust mite levels also vary within a poverty area, by race/ethnicity, single city by and by income variables. Previous studies of dust mite levels in the urban setting have The National Inner produced varied results. a lower City Asthma Study (13) reported prevalence of high levels of dust mite among homes than in our study (10% of inner-city in homes had levels 2 2 vs. 42% our 2. of the Boston area showing the distribution of poverty areas in our cohort. Scale: 1 inch upg/g, Figure Map 4.5 miles. A study of 57 homes in Atlanta by equals approximately study). Number 2000 Health Perspectives 304 Volume 108, 4, April * Environmental * Articles Socioeconomic of predictors allergen levels Call et al. (10) and a of study 186 homes in levels. Unmeasured In our allergen characteristics Der f 1 was more cohort, Wilmington, Delaware, by Gelber et al. winter (11) (e.g., indoor better mea- than Der which temperature, was 1, prevalent p expected reported much higher prevalences of high sures of indoor humidity, or additional because other studies have shown that the levels of dust mite allergen in inner-city details on home dust condition) may account for mite is species Dermatophagoidesfarinae homes (- 25% had levels 2 10 than the unexplained of the observed more common in the aspect dif- less humid pg/g) cooler, either our study or the National Inner ferences. For City example, other northern climates than investigators Dermatophagoides Asthma Study (13). Of these have other studies suggested that certain homes may have pteronyssinus (8). the only Wilmington study examined both air rates higher exchange and may therefore Some researchers have that postulated urban and suburban be homes; levels were simi- drier we did the (26,27). Although not find a increased burden of asthma experienced lar between the two areas. The difference absence of a in humidity between and different low-income is at by inner-city groups difference in dust mite levels between home our pover- types, measurements were made least attributable to a burden partly greater ty areas in which Wilmington, contrasts a home of during single visit, and may not allergen exposure among poor inner-city with our results, may be a function reflect of the household averages or microenviron- this minority populations (2,28). Although geographic location of the cities mental relative studied still humidity. our showed that may prove true, study and/or a function of differences in We also found that heating black and Hispanic not all levels are in the allergen higher high- systems and indoor humidity. race/ethnicity are independently associated areas. homes in poverty Though high-pover- We believe that differences in home char- with reduced dust mite levels. Sarpong et al. areas were more have levels ty to likely high acteristics and housing stock are responsible (12) showed that African American race is of cockroach were less to allergen, they likely for the within-metropolitan-area an socioeco- independent predictor of cockroach have expo- dust mite and cat high allergen levels. nomic and race/ethnicity gradients in dust sure. As has been suggested for cockroach As a the risk of at least one result, having mite and cockroach levels that we observed allergens, it seems likely that differences in level in the did not allergen highest category (8,22,24,25). The home home characteristics, characteristics and housing stock area of residence vary significantly by (69% which we measured and reported elsewhere explain the differences in dust mite of the area allergen vs. 71% of the low- high-poverty (22) as predictors of dust mite allergens (the levels attributable to race/ethnicity. The area We did find that those poverty homes). of type building, the type of floor of covering, inability home characteristics to in the lowest fully income all of group, whom and the season) and cockroach account for the allergens (the effect of race/ethnicity in our lived in had a high-poverty areas, greater risk type of and the building season), only partial- multivariate analysis suggests important of at least one level in the having allergen ly explained these socioeconomic gradients in unmeasured characteristics. highest category. Table 4. Estimates of associations between socioeconomic factors and maximum level of Der p 1 or Der f 1 in the home, shown as OR (95% confidence limit). .2 Der or Derf 1 pg/g p1 orDerfi .lOpglgDerpl Variable Model la Model 2 Model 3 18 Model Model Model 2 Model 3 Model a 4b Family income 2 $50,000 1 - - - - 1.0 - $30,000 to < 50,000 0.7 (0.4, - 1.1) - - 0.8 - (0.5,1.3) - $30,000 0.3 - - - (0.2, 0.5) - - 0.3 (0.1, 0.6) - Area poverty Low - - 1.0 - - 1.0 1.0 1.0 - - Medium - - 0.4 0.6) (0.3, 0.6 (0.4, 1.0) 0.6 (0.4, 0.8) 0.7 (0.5,1.1) - - High - - 0.2 (0.1, 0.4) 0.6 (0.3,1.5) 0.2 (0.1, 0.4) 0.4 (0.1,1.0) Race/ethnicity White - - 1.0 - 1.0 1.0 1.0 Asian - - - 0.7 (0.3, 1.6) 0.9 (0.4, 2.1) 0.8 (0.4, 1.7) 0.9 (0.4,1.9) - - Black - - 0.2 (0.1, 0.4) 0.4 0.7) (0.2, 0.3 (0.1, 0.5) 0.5 (0.2,1.1) - - Hispanic - - 0.1 (0.1, 0.3) 0.2 (0.1, 0.5) 0.1 (0.1, 0.4) 0.2 (0.1,0.6) aModels 1-3 are univariate logistic regression with the variables analyses for family area and income, poverty, race/ethnicity as the independent variables, bModel 4 is a respectively. multivariate model containing the variables for home characteristics (season of and sampling house/duplex vs. area and apartment), poverty, race/ethnicity. Table 5. Estimates of associations between socioeconomic factors and maximum level of 1 or 2 in Bla g Bla the shown as OR g home, (95% confidence limit). 20.05U/gBlag orBlag2 o2rU/Blag orBlag2 Variable Model Model 2 la Model 3 Model 4b 1a Model Model 2 3 Model 4b Model Family income 2 1.0 - $50,000 - 1.0 1.0 - 1.0 to < 1.2 - $30,000 50,000 - (0.8, 2.0) 0.9 3.4 (0.5, 1.5) - - (1.6, 6.9) 1.5 (0.7, 3.5) < - - $30,000 3.5 (1.6, 7.4) 1.8 21.1 (0.7, - - 4.5) (10.2, 43.6) 4.9 (1.9,12.9) Area poverty Low - 1.0 1.0 - 1.0 - 1.0 Medium - 1.2 (0.8, 1.7) 1.0 5.3 (0.6, 1.5) - 1.9 (2.2, 12.7) (0.7, 5.3) High 8.6 4.2 - (3.0, 25) - 32.9 (1.3, 14.0) 2.3 (12.1, 89.6) (0.6, 8.9) Race/ethnicity - - White - 1.0 1.0 1.0 1.0 Asian - - 1.3 1.4 1.4 1.4 (0.6, 2.8) (0.6, 3.2) 6.4) 6.7) (0.3, (0.3, Black - 5.0 3.7 - (2.4, 10.6) 19.7 7.7 (1.6, 8.8) (10, 38.6) (3.2, 18.4) Hispanic 1.7 0.9 - (0.8, 12.3 3.7) (0.3, 2.3) 5.6 (5.2, 29.2) (1.9, 16.6) aModels 1-3 are univariate logistic with the variables for regression analyses area and as the family income, poverty, bModel 4 is a race/ethnicity independent variables, respectively. multivariable model the variables for home characteristics of and vs. containing (season area and sampling house/duplex income, apartment), family poverty, race/ethnicity. Environmental Health Volume Perspectives * Number 2000 305 108, 4, April Articles * Kitch et al. risk is dust mite allergen levels tended to be lower Whether equivalent imposed by 3. Gergen PJ, Mullally DI, Evans R Ill. National survey of prevalence of asthma among children in the United each of these allergens is not known, and this and cockroach levels higher in the lower SES States, 1976 to 1980. Pediatrics 81:1-7 (1988). in comparing the bur- (high-poverty) areas. The only exception was should lead to caution 4. Weiss KB, Wagener DK. Changing patterns of asthma den of allergen exposure across groups. the kitchen, where dust mite levels were low mortality: identifying target populations at high risk. JAMA 264:1683-1687 (1990). to cock- in most homes. A separate but important Asthmatic patients who are sensitive 5. Sporik R, Holgate ST, Platts-Mills TAE, Cogswell JJ. roach allergens may have particularly high question is whether exposure in the home is Exposure to house-dust mite allergen (Der p 1) and the levels of IgE, more chronic and perennial best characterized by the allergen level in the in N Med development of asthma childhood. Engl J 323:502-507 (1990). in the symptoms, and greater disease severity child's bedroom, the highest level 6. Sporik R, Chapman MD, Platts-Mills TAE. House dust allergen plays a home, or some average of all of the rooms. Whether cockroach (13,29). mite exposure as a cause of asthma. Clin Exp Allergy greater role than dust mite or cat allergens in The answer to this question is likely to vary 22:897-906 (1992). the development of asthma remains to be with age and activity patterns of the child Arlian LG, Bernstein D, Bernstein IL, Friedman S, Grant A, Lieberman P, Lopez M, Metzger J, Platts-Mills T, determined. Additionally, indoor allergens and family. These issues have been explored M. Prevalence of dust mites in the homes of Schatz peo- such as in more detail in analyses of allergen levels as that are not yet routinely measured, ple with asthma living in eight different geographic those derived from rat or mouse, may be predictors of health outcomes (30). areas of the United States. J Allergy Clin Immunol 90:292-300 (1992). of to important in the development or morbidity The levels allergen necessary 8. Arlian LG. Biology and ecology of house dust mites, of the disease. Nearly 21% of our cohort induce sensitization are uncertain for each Dermatophagoides spp. and Euroglyphus spp. Immunol reported having seen signs of rats or mice in of the allergens studied. Although one Allergy Clin North Am 9:(2)339-356 (1989). 9. Becker Lam Dimich-Ward Chan-Yeung M, A, J, H, the over the prospective study of dust mite exposure home past year. Ferguson A, Warren P, Simons E, Broder I, Manfreda J. Just as dust mite levels were lower but found a substantially increased risk for asth- House dust mite levels in two cities in Canada: allergen to . 10 not undetectable in poorer homes, cock- ma among children exposed effects of and home characteris- season, humidity, city, pg/g tics. Clin Exp Allergy 25:240-246 (1995). not undetectable Der p 1 (5), other studies showed that sensi- roach levels were lower but 10. Call RS, Smith TF, Morris E, Chapman MD, Platts-Mills in homes. Although a low pro- tization may occur with exposure to consid- more affluent TAE. Risk factors for asthma in inner city children. J in portion of high-income homes had cock- erably lower levels (20,21). With this Pediatr 121:862-866 (1992). 11. Gelber LE, Seltzer LH, Bouzoukis JK, Pollart we examined two cut for both SM, roach antigen levels 2 2 U/g, 50% of those mind points TAE. Chapman MD, Platts-Mills Sensitization and expo- incomes 2 $50,000 had cockroach dust mite and cockroach allergens and with sure to indoor allergens as risk factors for asthma levels . 0.05 but < 2 U/g. demonstrated a relationship between SES among patients presenting to hospital. Am Rev Respir and level at both moderate and Dis 147:573-578 (1993). Our study has several limitations. First, allergen 12. Sarpong SB, Hamilton RG, Eggleston PA, Adkinson NF. we measured allergen levels in settled rather high levels. Socioeconomic status and race as risk factors for cock- Finally, our study was not designed to be than airborne dust samples. Allergen expo- roach allergen exposure and sensitization in children will for a settled a random of the in the with asthma. J Allergy Clin Immunol 97:1393-1401 sure itself likely vary given sample population (1996). 13. Rosenstreich DL, Eggleston P, Kattan M, Baker D, Slavin we for a stable dust concentration with the activity level of greater Boston area; selected RG, Gergen P, Mitchell H, McNiff-Mortimer K, Lynn H, of the with a of asthma subjects, air exchange characteristics population parental history et al. The role of cockroach and Ownby D, allergy expo- of in settled or and an interest in a sure to cockroach in home, etc. The amount allergen allergy longitudinal allergen causing morbidity among with N inner-city children asthma. EngI J Med dust, however, is a substantial determinant study. Our findings of socioeconomic gradi- 336:1356-1363 (1997). is in levels have the most rele- of exposure, and when sampling of levels ents allergen 14. Chapman M, Aalberse RC, Brown MJ, Platts-Mills TA. settled dust concentration is con- vance to the Northeastern U.S. pediatric infrequent, Monoclonal antibodies to the major feline allergen Fel d 1. Il: Single step affinity purification of Fel d 1, N-terminal for asthma. a better index of concentration than populations most at risk They ceivably and of a sensitive two- sequence analysis, development This is the have internal relevance as our aerosolized levels. particularly longitudinal site to assess Fel d 1 J Immunol immunoassay exposure. case for dust mite and cockroach to examine whether allergens, study begins allergen 140:812-818 (1988). 15. Arruda Platts-Mills Miller burden is of Luczynska CM, LK, TA, JD, Lopez which are only transiently airborne. type or total allergen predictive M, Chapman MD. A two site monoclonal antibody ELISA the of airborne aller- asthma incidence in children at risk for asth- Moreover, availability for the quantification of the major Dermatophagoides spp. measurements is unlikely to have ma because of family history. Assessment of gen allergens, Der p 1 and Der f 1. J Immunol Methods in terms the distribution of SES in a 1 18(2):227-235 (1989). changed the ranking of households allergens by gen- 16. de Groot Goei Van Swicter Aalberse RC. H, KG, P, Affinity of level or the relationship between eral population would require a different allergen of a purification major and minor allergen from dog in the home. based on both SES and SES and the level of allergen sampling strategy extract: serologic activity of affinity-purified Can f 1 and our variables for race/ethnicity, housing stock. Second, Can f 1-depleted extract. J Allergy Clin Immunol 87:1056-1061 In we have shown that (1991). indicators of SES, and poverty were summary, 17. Pollart Smith Morris SM, TF, EC, Gelber LE, Platts-Mills TA, associated with one and levels another, potentially allergen types vary substantially Chapman MD. Environmental exposure to cockroach aller- interfering with multivariate analysis. In the by area of residence, family income, and with monoclonal gens: analysis antibody-based enzyme multivariate model dust mite J Clin Immunol 87:505-510 predicting race/ethnicity. However, the net allergen immunoassays. Allergy (1991). 18. Platts-Mills TA, Thomas W, Aalberse R, Vervioet D, allergens, we now include only area poverty burden faced by inner-city and suburban M. Chapman Dust mite allergens and asthma: report of a and excluding income, which is not a residents may be more similar than race, second international workshop. J Allergy Clin Immunol significant predictor of dust mite after previously suspected. The implications of 89:1046-1060 (1992). 19. Ingram JM, Sporik R, Rose G, Honsinger R, Chapman MD, adjusting for race and family income. The these findings for asthma risk in vulnerable Platts-Mills TA. Quantitative assessment of exposure to confidence intervals in the adjusted analyses such as the children in populations our f and cat (Fel d dog (Can 1) 1) allergens: relation to sensi- are widened as those in the compared to cohort is as yet unknown. tization and asthma among children living in Los Alamos, crude analyses, and although this may partly New Mexico. J Allergy Clin Immunol 96:449-456 (1995). Warner AM, Bjorksten B, Munir AK, Moller C, Schou C, represent the effects of correlation, it also REFERENCES AND NOTES Kjellman NI. Childhood asthma and exposure to indoor in our reflects the relatively small numbers allergens: low mite levels are associated with sensitivity. lower SES categories. 1. Gottlieb DJ, Beiser AS, O'Connor GT. Poverty, race, and Pediatr Allergy Immunol 7:61-67 (1996). We as have medication use are correlates of asthma hospitalization 21. Wahn Lau found, others, that allergen U, S, Bergmann R, Kulig M, Forster J, rates. Chest 108:28-35 (1995). Bauer I. Indoor Bergmann K, CP, Guggenmoos-Holdzman levels varied substantially from room to 2. Marder D, Targonski P, Orris P. Persky V. Addington W. is a risk factor allergen exposure for sensitization during room within given home (10,11,1/). Effect of racial and socioeconomic factors on asthma the first three years of life. J Allergy Clin Immunol Regardless of the room sampled, however, mortality in Chicago. Chest 101(6):426S-429S (1992). 99:763-769 (1997). Volume 108, Number 4, April 2000 * Environmental Health Perspectives * Socioeconomic of levels Articles allergen predictors Evans R. Asthma among minority children: a growing Chew GL, Burge HA, Dockery DW, Muillenberg MS, 25. Brandt RL, Arlian LG. Mortality of house dust mites, 28. Chest 101:(6)368S-371S (1992). Weiss ST, Gold DR. Limitations of a home characteristics Dermatophagoides farinae and D. pteronyssinus, problem. BC, Johnson J, Veres-Thorner C. Atopic profile of questionnaire as a predictor of indoor allergen levels: exposed to dehydrating conditions or selected pesti- 29. Kang asthma with a comparative analysis on the and epidemiologic implications. Am J Respir Crit cides. J Med Entomol 13:(3)327-331 (1976). inner-city clinical Care Med 157:1536-1541 11998). 26. Korsgaard HH, Dahl J. House-dust mites and associated cockroach sensitive and ragweed sensitive subgroups. J Immunol 92:802-811 (1993). 23. Koehler PG, Patterson RS, Brewer RJR. German environmental conditions in Danish homes. Allergy Allergy Clin 48:106-109 (1993). 30. Gold DR, Carey V, Milton DK, Platts-Mills T, Weiss ST, cockroach infestations in low income apartments. J HA. Predictors of repeated wheeze in the first Entomol 80:446-450 (1987). 27. Wickman M, Perhagen G, Nordvall SL, Schwartz B. Burge Econ AK, Einarsson R, Dreborg SK. Vacuum cleaning House dust mite sensitization in children and residential year of life: the relative roles of cockroach, birth weight, 24. Munir illness, and maternal smoking. characteristics in a temperate region. J Allergy Clin acute lower respiratory decreases the levels of mite allergens in house dust. Immunol 4:136-143 (1993). Immunol 88:89-95 (1991). Am J Respir Crit Care Med 160(1):227-236 (1999). Pediatr Allergy For as little as $ 3.09* user, per year per have your students can full Internet access to the Environmental Health Information Service (EHIS)! The EHIS offers online, searchable access to: * Environmental Health Perspectives Health Environmental Perspectives Supplements * National Toxicology Program Technical and Toxicity Reports on Report Carcinogens * Chemical Health and Safety Database J* Rodent Histon'cal Control Database on For more information call 1-800-315-3010. ordering I r] is bsdo ulip Ue Interne Accss *Price is based on User Internet Access. 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