Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul;32(5):971-979.
doi: 10.1111/pai.13480. Epub 2021 Mar 20.

Development of nasal allergen challenge with cockroach in children with asthma

Amanda K Rudman Spergel  1 , Michelle L Sever  2 , Jacqueline Johnson  2 , Michelle A Gill  3 , Veronique Schulten  4 , April Frazier  4 , Carolyn M Kercsmar  5 , Stephanie Lovinsky-Desir  6 , Dan A Searing  7 , Alessandro Sette  4   8 , Baomei Shao  9 , Stephen J Teach  10 , James E Gern  11 , William W Busse  11 , Alkis Togias  1 , Robert A Wood  12 , Andrew H Liu  7 ; National Institute of Allergy and Infectious Diseases Inner City Asthma Consortium
Affiliations

Development of nasal allergen challenge with cockroach in children with asthma

Amanda K Rudman Spergel et al. Pediatr Allergy Immunol. 2021 Jul.

Abstract

Background: Nasal allergen challenge (NAC) could be a means to assess indication and/or an outcome of allergen-specific therapies, particularly for perennial allergens. NACs are not commonly conducted in children with asthma, and cockroach NACs are not well established. This study's objective was to identify a range of German cockroach extract doses that induce nasal symptoms and to assess the safety of cockroach NAC in children with asthma.

Methods: Ten adults (18-37 years) followed by 25 children (8-14 years) with well-controlled, persistent asthma and cockroach sensitization underwent NAC with diluent followed by up to 8 escalating doses of cockroach extract (0.00381-11.9 µg/mL Bla g 1). NAC outcome was determined by Total Nasal Symptom Score (TNSS) and/or sneeze score. Cockroach allergen-induced T-cell activation and IL-5 production were measured in peripheral blood mononuclear cells.

Results: 67% (6/9) of adults and 68% (17/25) of children had a positive NAC at a median response dose of 0.120 µg/mL [IQR 0.0380-0.379 µg/mL] of Bla g 1. Additionally, three children responded to diluent alone and did not receive any cockroach extract. Overall, 32% (11/34) were positive with sneezes alone, 15% (5/34) with TNSS alone, and 21% (7/34) with both criteria. At baseline, NAC responders had higher cockroach-specific IgE (P = .03), lower cockroach-specific IgG/IgE ratios (children, P = .002), and increased cockroach-specific IL-5-producing T lymphocytes (P = .045). The NAC was well tolerated.

Conclusion: We report the methodology of NAC development for children with persistent asthma and cockroach sensitization. This NAC could be considered a tool to confirm clinically relevant sensitization and to assess responses in therapeutic studies.

Trial registration: ClinicalTrials.gov NCT02710136.

Keywords: allergic rhinitis; asthma; children; cockroach allergy; inner city; nasal allergen challenge.

PubMed Disclaimer

Figures

Figure 1 –
Figure 1 –. Pediatric Response to Nasal Allergen Challenge with German Cockroach Extract.
Error bars represent 95% confidence limits.
Figure 2 –
Figure 2 –. German CR Skin Prick Test Wheal, CR-specific IgE, and Pediatric CR-specific IgG and IgG/IgE in NAC-positive versus NAC-negative Participants.
Bars show the geometric mean with 95% CI.
Figure 3 –
Figure 3 –. German Cockroach-Specific IL-5 (A) and T Cell (B) Activation for Combined Adult and Pediatric Populations.
Bars shown the geometric mean ± 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Scadding GW, Eifan A, Penagos M, et al. Local and systemic effects of cat allergen nasal provocation. Clin Exp Allergy 2015;45(3): 613–23. - PMC - PubMed
    1. Togias A, Corren J, Wagenmann M. Nasal Provocation Testing. In: Adkinson NF, Busse WW, Bochner BS, Holgate ST, Simons ER, Lemanske RFJ, eds. Middleton’s Textbook of Allergy. 7th ed: Elsevier; 2009:1281–94.
    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(19):1356–63. - PubMed
    1. Medsker BH, Forno E, Han Y, et al. Cockroach allergen exposure and plasma cytokines among children in a tropical environment. Ann Allergy Asthma Immunol 2017; 119(1): 65–70 - PMC - PubMed
    1. 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. - PubMed

Publication types

Associated data