"Asthma is a significant public health problem among Puerto Ricans, but the extent to which this population is affected by allergies is not completely understood," said the study's lead author Juan C. Celedón, MD, DrPH, FCCP, Department of Medicine, Brigham and Women's Hospital, Boston, MA. "Puerto Rican and African-American children are more likely to live in poor housing conditions and, consequently, have an increased risk of exposure to certain allergens. Not knowing a child is allergic to certain allergens may result in the child being continuously exposed to these allergens, which can ultimately make asthma management more difficult."
Researchers from Brigham and Women's Hospital, Connecticut Children's Medical Center, Hartford, CT, and University of Connecticut Health Center, Farmington, CT, examined the relationship between ethnicity, geographic residence and living conditions, and asthma severity on the prevalence and extent of indoor and outdoor allergens among children with mild to severe asthma living in Hartford, CT. Of the 791 children, ages 4-18, included in the study, 346 (43.7 percent) were white, 312 (39.5 percent) were Puerto Rican, 113 (14.3 percent) were African-American, and 20 (2.5 percent) belonged to other ethnic groups. Using a standard allergy skin test, children were monitored for skin test reactivity to indoor allergens (ie, cockroach, cat and dog dander, and dust mite) and outdoor allergens (ie, mixed tree and grass pollen, mold, ragweed, weed mix, and mugwort/sage). Results showed that Puerto Rican children with asthma were three times more likely to be allergic to cockroaches and twice as likely to be allergic to weed mix and mugwort/sage than white children with asthma. In addition, African-American children with asthma were two to three times more likely than white children with asthma to be allergic to mixed tree and grass pollens, weed mix, and mugwort/sage.
"The high frequency of positive allergy test results in Puerto Rican and African-American children with asthma suggests that these groups should be tested for allergies more often. However, historically, these minority groups have had limited access to skin testing," said Dr. Celedón. "Parents of Puerto Rican or African-American children with asthma should be aware that allergy skin testing may be helpful in managing their child's asthma, particularly if the child has asthma that is difficult to treat."
When compared with white children, Puerto Rican and African-American children were more likely to live in an urban area, to be insured by Medicaid, to have severe persistent asthma, to have eczema (dry skin condition), and to be exposed frequently to cockroaches and rodents in their homes. Overall findings showed that children with more severe asthma had more severe allergies. Eczema and frequent exposure to cockroaches in the home were associated with indoor allergies, and urban residency was associated with the prevalence of cockroach allergies.
"It is important for physicians and other medical professionals to recognize the impact asthma and allergies have on minorities, particularly in children," said Richard S. Irwin, MD, FCCP, President of the American College of Chest Physicians. "Increased knowledge of how specific allergens affect minorities can lead to more effective asthma management and better patient care."
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. ACCP represents more than 15,700 members who provide clinical, respiratory, and cardiothoracic patient care in the United States and throughout the world. ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication.