Sensitization to Allergen

• Requires sufficient exposure (concentration and time)

• Requires genetic predisposition

Natural History of Childhood Asthma

• Thus, the likely scenario is that allergen exposure over the first few years of life induces sensitization.

• Continuing exposure can induce and maintain inflammation in the nose and lungs.

Natural History of Childhood Asthma

• It remains unclear at what time the critical exposure occurs and what role allergen exposure has played to induce development and influence severity of asthma

• Objective evidence of an immune response to allergens is generally not present until after two years of age.

Major Indoor Allergens

• Cockroach• Dust mite• Animal Dander• Fungi

German Cockroach

Dust Mite

Cockroach and Asthma Morbidity

• Group1=No Allergy/Low Exposure

• Group2=No Allergy/High Exposure

• Group3=Allergy/Low Exposure

• Group4=Allergy/High Exposure

0

0.2

0.4

1 2 3 4

Development of Asthma

Exposure to cockroach allergen early in life may contribute to the development of asthma in susceptible children.

J Allergy Clin Immunol 2001;107:41-7

Conclusions/Observations

• Asthma deaths/morbidity have increased and disproportionately high in African Americans

• Genetics and environment contribute to development and probably asthma severity

• Good management necessitates- Access to high quality care- Control of exposure to allergens/irritants- Pharmacotherapy for pathophysiology