Results of the National Cooperative Inner-City Asthma Study (NCICAS) environmental intervention to reduce cockroach allergen exposure in inner-city homes

Background: Cockroach allergen is important in asthma. Practical methods to reduce exposure are needed. Objective: We sought to evaluate the effectiveness of house cleaning and pr ofessional extermination on lowering cockroach antigen Levels in inner-city dwellings. Methods: As part of the National Cooperative Inner-City Asthma Study interv ention, 265 of 331 families with asthmatic children who had positive skin t est responses to cockroach allergen consented to a professional home exterm ination with 2 applications of a cockroach insecticide (Abamectin, Avert) c ombined with directed education on cockroach allergen removal. On a random subset of 48 homes undergoing cockroach extermination in the intervention g roup, Bla g 1 was measured in settled dust from the kitchen, bedroom, and T V/living room. The first sample was collected 1 week before extermination, with additional samples after the exterminations at approximately 2, 6, and 12 months after the first sample. Self-reported problems with cockroaches were collected at baseline and after 12 months of follow-up in both the int ervention and control group. Results: The geometric mean kitchen lever of Bla g 1 decreased at 2 months (33.6 U/g) relative to preextermination levels (68.7 U/g, P < .05). The per cent of kitchens with over 8 U/g of Bla 1 followed a similar pattern, but o nly the decrease from preextermination to 6-month levels was significant (8 6.8% vs 64.3%, P < .05). By the 12-month visit, the allergen burden had ret urned to or exceeded baseline levels. Except for an increase in the bedroom at 2 months (8.9 U/g vs 11.1 U/g, P < .05), no other significant change wa s seen. Only about 50% of the families followed the cleaning instructions; no greater effect was found in these homes. Self-reported problems with coc kroaches showed no difference between the intervention and control group af ter I year of follow-up. Conclusions: Despite a significant, but short-lived, decrease the cockroach allergen burden remained well above levels previously found to be clinical ly significant.