RATIONALE: Urban children with asthma are commonly skin test positive to indoor allergens. We evaluated the relationship between home exposures and skin test sensitivity of children with asthma or asthma-like symptoms attending two Dallas Independent School District elementary schools. METHODS: Students, ages 6-12, with asthma or asthma symptoms were skin tested to cockroach, dust mite, cat, dog, and rodent (rat, mouse) allergens. Students who were skin positive to at least one indoor allergen were invited to participate. We evaluated study participants' homes for environmental exposures thought to be related to indoor allergen levels. RESULTS: Seventy-eight students entered the study. The skin test sensitivity profiles were similar for children attending either school. Dust mite, either Dermatophagoides farinae or D. pteronyssinus, mouse and cockroach were the most prevalent skin test sensitivities (67.9%, 50% and 46.2% respectively). Fifty-three percent reported problems with cockroaches but only fourteen percent reported problems with mice during the previous year. Apartment living significantly increased the likelihood of cockroach sensitivity (odds ratio 3.824, 95%CI: 1.472 -9.933; p=.006), as well as leaks in the home in the previous 12 months (odds ratio 2.857, 95%CI: 1.119 -7.293; p=.037). While most children had wall-to-wall carpeting in their bedroom (88%), it was not significantly associated with dust mite skin sensitivity (p>.05), nor were reported problems with mice significantly associated with mouse skin test sensitivity (p>.05). CONCLUSIONS: Our study indicates that apartment living and leaks in the home increase the risk of cockroach sensitivity in school-age children with asthma or asthma-like symptoms attending Dallas schools. Funding: ExxonMobil
RATIONALE: To investigate the safety, efficacy, and immunologic effects of peanut sublingual immunotherapy (SLIT). METHODS: After a baseline oral food challenge (OFC) of up to 2gm (median tolerated dose 46mg), 40 subjects, aged 12-37 (median 15) years, were randomized 1:1 across 5 sites to receive daily peanut (escalating from .00017mcg to 1386mcg) or placebo SLIT. A 5gm OFC was performed after 44 weeks. Placebo subjects then crossed-over to peanut SLIT to a maximum of 3696mcg, followed by a week-44 5gm OFC. Week-44 OFC was compared to baseline OFC; subjects successfully consuming 5gm or at least 10-fold more peanut than baseline OFC threshold were considered ''responders.'' RESULTS: 14/20 (70%) subjects receiving peanut SLIT were responders compared to 3/20 (15%) receiving placebo (p50.001). In peanut-SLIT responders, median successfully consumed dose increased from 3.5mg to 496mg; none tolerated the entire 5gm OFC. Of 10,701 peanut doses through week-44 OFCs, 61.6% were symptom-free; excluding oral/pharyngeal symptoms, 95.2% were symptom-free. Basophil activation did not decline significantly from baseline to 44 weeks; median peanut-IgE levels significantly declined from weeks 29 to 44 in the peanut group compared to placebo (p50.01). 6/15 crossover subjects with week-44 OFC assessment to date were responders; median successfully consumed dose increased from 11mg to 496mg. Three subjects (2 peanut,1 placebo) withdrew during the blinded phase prior to week-44 OFCs; 9 subsequently withdrew (3 peanut,6 original placebo). CONCLUSIONS: Initial results demonstrate that peanut SLIT can safely induce significant, low-level desensitization in a majority of subjects. Maintenance dosing is ongoing for 3 years to determine further efficacy.
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