The report from NIAID's National Cooperative Inner-City
Asthma Study (NCICAS), and an accompanying editorial, appear in
the May 8, 1997, issue of The New England Journal of Medicine.
"Some of the most vulnerable of our citizens, children in the
poorest neighborhoods of our large cities, suffer disproportionately
from asthma," says Anthony S. Fauci, M.D., NIAID director. "Allergy
and exposure to cockroach allergen clearly play an important role in
the alarming rates of asthma-related sickness among these children."
"Reducing exposure to cockroach allergen, as part of a multi-
faceted approach to asthma management, may be a cost-effective
way of reducing the burden of this serious disease," says Daniel
Rotrosen, M.D., acting director of NIAID's Division of Allergy,
Immunology and Transplantation. "Simple and relatively low-cost
interventions that have been explored in the NCICAS, such as patient
education, roach traps and child-safe insecticides, are potentially
important adjuncts to previously established medical therapies that
can help asthmatic patients."
The first five-year phase of the NCICAS, recently completed,
enrolled more than 1,500 children with asthma, ages 4 to 11, living in
eight major metropolitan areas: The Bronx, N.Y.; East Harlem, N.Y.;
St.Louis, Mo.; Washington, D.C.; Baltimore, Md.; Chicago, Ill.;
Cleveland, Ohio; and Detroit, Mich.
In the current analysis, David L. Rosenstreich, M.D., of the
Albert Einstein College of Medicine in the Bronx, N.Y., and his
NCICAS colleagues studied 476 of these children. Most of the
children were either African-American (78 percent) or Hispanic (16
percent). The researchers measured levels of cockroach, dust mite
and cat allergens in the children's homes, and determined with allergy
skin tests that 37 percent of the children were allergic to cockroaches,
35 percent to dust mites, and 23 percent to cats. The investigators
then assessed the severity of the children's asthma over 12 months.
They found that children who were both allergic to cockroaches
and exposed to high cockroach allergen levels were hospitalized
for their asthma 3.3 times more often than children who were
allergic but not exposed to high levels of cockroach allergen, or
children who were exposed to high levels of cockroach allergen but
who were not allergic.
Children who were both allergic and heavily exposed to
cockroach allergen also missed school more often, needed nearly
twice as many unscheduled asthma-related medical visits, and
suffered through more nights with lost sleep. In addition, the
activities of the adults who cared for these children were
In contrast, neither the combination of allergy to dust mites
and high exposure to mites, nor the combination of allergy to cats
and high exposure to cats was associated with more severe asthma
among the 476 children in the study sample.
Despite the availability of effective asthma therapies, asthma-
related deaths among individuals younger than 25 in the
United States increased 118 percent between 1980 and 1993.
"These disturbing trends, which are especially pronounced in
minority populations, underscore the importance of the Institute's
research into understanding, preventing and treating asthma," says
Platts-Mills TA and Carter MC. Asthma and indoor exposure to
allergens. New Engl J Med 1997;336:1382-1384.
Rosenstreich DL, et al. The role of cockroach allergy and exposure to
cockroach allergen in causing morbidity among inner-city children
with asthma. New Engl J Med 1997;336;1356-63.
NIAID, a component of the National Institutes of Health (NIH),
conducts and supports research aimed at preventing, diagnosing and
treating illnesses such as AIDS and other sexually transmitted
diseases, tuberculosis, asthma and allergies. NIH is an agency of the
U.S. Department of Health and Human Services.
NIAID press releases, fact sheets and other materials are
available on the Internet via the NIAID home page at