Inner-city environments and mitigation of cockroach allergen.

d a r e ( t d Exposure and sensitization to indoor allergens are important risk factors for asthma.While the role of indoor allergen exposure in the development of allergic sensitization and the onset of asthma remains a subject of controversy, there is strong evidence that indoor allergens play a key role in exacerbation of existing asthma, particularly in sensitized individuals. In this supplement to the American Journal of Preventive Medicine, Crocker and coworkers advocate for a multi-trigger, multicomponent, home-based environmental intervention for the reduction of morbidity in asthmatic children and adolescents. This is appropriate guidance when dealing with the general population; however, inner-city asthmatic children, especially those who are sensitive and exposed to cockroach allergen, may experience greater benefıt from a highly effective, single-component intervention that specifıcally targets cockroach allergen. Asthma morbidity is a signifıcant public health concern, especially in inner-city populations. The National Cooperative Inner-City Asthma Study (NCICAS) demonstrated that asthma morbidity was strongly associated with the presence of a positive skin test and high allergen exposure. In particular, sensitization and exposure to ockroach allergen was shown to be one of the major risk actors for severe asthma. Asthma morbidity was highest in children with both a positive skin-test response to cockroach and a high exposure (defıned as 8 units of cockroach allergen per gram of dust [U/g]) in the bedroom. Detectable levels of cockoach allergen were found in 85% of the bedrooms tested, nd 50% of the bedrooms had levels 2 U/g, the proosed threshold for allergic sensitization. Correspondngly, a study of children in Boston showed that cockoach allergen exposure in the family room was a redictor of two or more episodes of wheeze in the fırst ear of life. The risk of asthma from exposure to cockroach allergen is not limited to children. Indeed, a recent study showed that sensitization to cockroach allergenwas