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. 2024 Dec;154(6):1434-1441.
doi: 10.1016/j.jaci.2024.08.006. Epub 2024 Aug 19.

Indoor allergen exposure and its association to upper respiratory infections and pulmonary outcomes among children with asthma

Darlene Bhavnani  1 , Travis Lilley  2 , Paul J Rathouz  3 , Sylvie Beaudenon-Huibregtse  4 , Meghan F Davis  5 , Meredith C McCormack  6 , Corinne A Keet  7 , Susan Balcer-Whaley  3 , Michelle Newman  8 , Elizabeth C Matsui  3
Affiliations

Indoor allergen exposure and its association to upper respiratory infections and pulmonary outcomes among children with asthma

Darlene Bhavnani et al. J Allergy Clin Immunol. 2024 Dec.

Abstract

Background: Certain environmental allergen exposures are more common in disadvantaged communities and may contribute to differences in susceptibility to upper respiratory infections (URIs).

Objectives: We examined associations between indoor allergens and: (1) URI; (2) URI + cold symptoms; (3) URI + cold symptoms + pulmonary eosinophilic inflammation (fraction of exhaled nitric oxide ≥20 ppb); and (4) URI + cold symptoms + reduced lung function (percent predicted forced expiratory volume in 1 second of <80%).

Methods: We used data from the Environmental Control as Add-on Therapy for Childhood Asthma (ECATCh) study. Allergen concentrations were measured in air (mouse) and settled dust (mouse, cockroach, dog, and cat). URI was determined by testing nasal mucus for upper respiratory viruses. We evaluated associations between allergen concentrations and URI-associated outcomes accounting for age, sex, study month, season, health insurance, and household size.

Results: Ninety participants (92% Black, 92% public insurance) with 192 observations were included; 52 (27%) of observations were positive for URI. A doubling in cockroach allergen concentration increased the odds of a URI with cold symptoms by 18% (odds ratio [OR] = 1.18, 95% confidence interval [CI], 0.99-1.40), the odds of a URI + cold symptoms + pulmonary eosinophilic inflammation by 31% (OR = 1.31, 95% CI, 1.10-1.57), and the odds of a URI + cold symptoms + reduced lung function by 45% (OR = 1.45, 95% CI, 1.13-1.85). Mouse allergen concentrations were positively associated with all outcomes. Associations were suggestively stronger among children sensitized to pest allergens.

Conclusions: Cockroach and mouse, but not dog or cat, allergen exposure may predispose children with asthma to URIs with colds and lower respiratory outcomes.

Keywords: Allergen; asthma; atopy; cockroach; cold; disparities; eosinophilic inflammation; exacerbations; lung function; mouse; pest; rhinovirus; symptoms; upper respiratory infection; viral; virus.

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Conflict of interest statement

Disclosure statement Supported by core funds of the Dell Medical School at the University of Texas at Austin (to D.B. and P.J.R.) and the US Environmental Protection Agency (assistance agreement 83615201 to M.C.M.). Research was also supported by the National Institutes of Health (NIH) (grants K24AI114769, R01ES023447, and R01ES026170 to E.C.M., grant P50ES018176 to M.C.M., grant U01AI125290 to C.A.K., grant K01OD019918 to M.F.D., and grant KL2 TR002646 to D.B.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

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