Indoor allergen exposure and its association to upper respiratory infections and pulmonary outcomes among children with asthma - 12/09/24

Doi : 10.1016/j.jaci.2024.08.006

Darlene Bhavnani, PhD, MPH ^a,^⁎ , Travis Lilley, MS ^b,^{^{†
Deceased.}}, Paul J. Rathouz, PhD ^a, Sylvie Beaudenon-Huibregtse, PhD ^c, Meghan F. Davis, DVM, MPH, PhD ^d,^e, Meredith C. McCormack, MD, MHS ^f, Corinne A. Keet, MD, PhD ^g, Susan Balcer-Whaley, MPH ^a, Michelle Newman, BSN ^h, Elizabeth C. Matsui, MD, MHS ^a
^a Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Tex
^b Department of Statistics and Data Sciences, College of Natural Sciences, University of Texas at Austin, Austin, Tex
^c High Throughput Testing Core, University of Texas at Austin, Austin, Tex
^d Department of Molecular and Comparative Pathobiology, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Md
^e Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
^f Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Md
^g Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
^h Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Md

^∗Corresponding author: Darlene Bhavnani, PhD, MPH, Department of Population Health, University of Texas at Austin, 1601 Trinity St, Austin, TX 78701.Department of Population HealthUniversity of Texas at Austin1601 Trinity StAustinTX78701

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 12 September 2024

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.

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Key words : Allergen, cockroach, mouse, pest, asthma, atopy, upper respiratory infection, viral, virus, rhinovirus, cold, symptoms, eosinophilic inflammation, lung function, exacerbations, disparities

Abbreviations used : TNA, PM₁₀, CI, ECATCh, Feno, FEV₁, GEE, IQR, OR, ppFEV₁, URI