Cockroaches: Are They The Cause Of Increasing Asthma In The Inner-City?
Over the past years, asthma has been increasing among children, and it is now the most common chronic disease in childhood. For reasons that are not completely understood, children in the inner-city are particularly affected by asthma, both in terms of its frequency and its severity. Public health experts have tried to find the reasons for this trend, and one factor that has been considered is allergy to cockroaches, which are so common in older houses and apartments. As part of a recently publicized research project called the National Cooperative Inner-City Asthma Study, scientists studied 476 asthmatic children (ages 4 to 9 years) from eight innercity areas in the U.S.
When the researchers examined dust taken from the children's bedrooms, they found that cockroach allergen (the material from cockroaches that causes allergic reactions) was more common than allergic products related to dust or cats. Furthermore, testing determined that a large proportion of the children were indeed allergic to cockroach antigen. A key finding was that children who were allergic to cockroach allergen and were exposed to high levels of it in their homes had more than three times as many hospitalizations per year than the other children, and had more than twice the number of unscheduled medical visits for asthma. These children also had significantly more days of wheezing, missed school days, and other evidence of asthma. By contrast, similar patterns were not found for the combination of allergy to dust mites or cat dander and high levels of these allergens.
The authors conclude that "the combination of cockroach allergy and exposure to high levels of this allergen may help explain the frequency of asthma-related health problems in inner-city children." (Rosenstreich DL et al. New England Journal of Medicine, May 8,1997, pp. 1356-1363)
COMMENT: While asthma attacks can be triggered by viral infections and other conditions, asthma in children is usually caused by various kinds of allergies. With the heavy concentration of cockroaches in inner-city housing, it's not surprising to see this allergen strongly associated with the problem. (Readers might be interested to know that it was almost exactly 20 years ago that Dr. Twarog, a member of the CHILD HEALTHALERT Editorial Advisory Board, reported that cockroaches could indeed lead to allergic reactions.)
An editorial that accompanied this report points out that cockroach allergen alone is unlikely to explain the epidemic of asthma in the inner-city. Though efforts to limit exposure to this allergen may be appropriate, measures for decreasing exposure aren't well developed. The writers note that current recommendations for limiting the problem of cockroaches center on controlling sources of food and water, routine cleaning, and regular use of insecticides. (Platts-Mills TAE & Carter MC: New England Journal of Medicine, May 8, 1997, pp. 1382-1384)
COMMENT: This national study provides strong evidence to suggest that cockroaches play a potentially major role in provoking asthma among inner-city children. However this evidence is still indirect, and it is important for doctors to see if keeping children away from cockroach allergens actually reduces their asthma. If that happens, the next step will be to determine how cockroaches can be removed--not an easy job, since ridding one apartment doe little good unless the whole building is cleared, and even then these insects can quickly re-infest the premises. If cockroaches do indeed cause as much asthma in the innercity as studies suggest, it will require a massive public health campaign to improve the situation, but such a campaign could produce tremendous lifelong health benefits for children in the inner-city.
... And A Warning To Asthmatics About Sulfites In Tuna
While on the subject of asthma, we want to alert readers to the fact that several popular brands of tuna in the U.S. may contain sulfites that are not mentioned on the label. Sulfites can trigger severe allergic reactions, including asthma, in people who are particularly sensitive to these chemicals. The problem apparently occurred when a food supplier, contrary to industry regulations, added sulfites to the vegetable broth that is found in all tuna products.
Among the brands thought to contain sulfites are Bumble Bee, Coral, Royal Reef, Chicken of the Sea, Star Kist (albacore white only), Three Diamonds, and Geisha. Though no recall is planned, the tuna industry has promised to change the labels on cans in stores and warehouses. One manufacturer pointed out that tuna from Thailand and Malaysia is not included in the warning, so sensitive asthmatics can check labels to see where the tuna originated. (Connolly P Infectious Diseases in Children, April, 1997, pp. 14 & 22)
In the past 15 years, one particular strain of E. coli bacteria has become an important cause of serious diarrhea and complications that can rarely lead to death. Called E. coli 0157:H7, these bacteria are probably best known as the cause of illness and deaths associated with undercooked hamburgers at the Jack-inthe-Box fast food chain and in the unpasteurized apple juice distributed by Odwalla (see CHILD HEALTH ALERT October 1994 & February 1997). Though most of these infections are acquired through eating contaminated foods, they can also spread by contact from person-to-person, a problem that has occurred in schools and day-care facilities.
A recent commentary in the British medical journal Lancet points out that children who have become ill from this form of E. coli can shed the bacteria in their feces for 3 or more weeks, and younger children tend to shed them longer than older children and adults. As for the practical question of how transmission in childcare centers can be limited, the authors point out that "Many persons infected with 0157 do not come to the attention of public health authorities; they may have had mild symptoms or non-bloody diarrhea and not have sought care, may not have had a stool cultured, or the specimen may not have been tested for 0 157. "
For this reason, they conclude that "Routine handwashing before snacks and meals and after diaper changes and toileting is the best way to prevent the spread of infection in child-care centers. Handwashing upon arrival would provide additional protection." (Swerdlow DL & Griffin PM, Lancet, March 15, 199 7, pp. 745- 746)
COMMENT: With all the media attention focused on E. coli infections resulting from fast food and unpasteurized apple juice, we tend to think that the only way to get this infection is from eating or drinking contaminated foods. Although illness due to E. coli 0157:H7 is believed to be far less common than many of the other diarrheal illnesses that spread through child-care settings, it's also important to recognize that this illness is not necessarily your average case of diarrhea. The diarrhea can be severe, and the complications can be very serious and even fatal. On the other hand, not all cases may be severe, and children with diarrhea may be shedding E. coli 0157:H7 without anyone knowing it, placing other children at considerable risk. The commentary in the Lancet offers good guidance, and it adds yet another example to the list of both mild and serious illnesses that can be limited by implementing a policy of routine and consistent handwashing.
Bee stings are a common problem, and most people realize that in order to reduce the severity of the reaction, it's important to quickly remove the stinger to stop the injection of venom. It has been widely believed that the best way to remove the stinger was to scrape it off--with a knife blade, credit card, or fingernail--but never to pull it out by squeezing it with fingers or a tweezers. The reason for that concern was that the stinger continues to inject venom after it has been left behind by the bee, and squeezing the stinger and venom sac would only pump more venom into the sting.
Because experts found that the venom sac didn't seem to be affected by squeezing, they tested the theory by measuring the amount of venom injected into a volunteer's arm under different removal methods. They report that, as would be expected, the hive-like reaction was bigger the longer the stinger was left in; however, there was no difference in reactions when the stinger was scraped off or pulled off.
They conclude that the common belief about how to remove the stinger may actually be counterproductive, because while someone is looking, for the "right kind" of tool to remove the stinger, it's continuing to inject more venom. "The advice", they stress, "should be simply to emphasize that a bee sting should be removed as quickly as possible." (Visseher PK et al: Lancet, August 3, 1996, pp. 301-302)
COMMENT: This sounds quit reasonable. Children who have been stung by bees often find that the pain of the sting is minor compared to the anxiety they pick up from the panicky adults who are their caretakers. The vast majority of stings produce no more than local pain and swelling, and it is most helpful to the child if their care providers are calm; it's easier to be calm if all you have to do is remove the stinger with your fingers, a tweezers, credit card, or whatever happens to be available.
Summer for most of us means spending more time outdoors, which can mean being out in the sun for many hours of the day. Unfortunately, prolonged sun exposure can lead to serious skin damage, skin cancer. cataracts, and other health problems. While these conditions are rare in children, it is now clear that intense sun exposure in childhood increases the risks for problems in adult life.
As a result, doctors and other public health experts have been educating adults and children about the importance of avoiding prolonged and intense sun exposure. They point out that
1) Sunlight is strongest between 10 AM and 3 PM.
2) Water, sand and snow make the sun's rays stronger.3) Clouds don't stop the sun's rays.
4) Babies under 6 months old should stay out of the sun.
When children (and adults) are in the sun, they should
1) Use a sunscreen (with SPF of 15 or more).
2) Wear sunglasses.3) Put on a hat.
4) Wear clothing for sun protection.
5) Take breaks in the shade.
To help readers follow these recommendations, we've provided on page 5 an attractive full-page flyer/poster entitled "Sun Protection Is For Everyone!". This page was specially prepared by Judith DuFour Love for CHILD HEALTH ALERT subscribers. It is designed to be posted on bulletin boards and to be copied and sent home with children to color and share with their families. We welcome your comments and suggestions.
Gold Bug, of Denver, Colorado, is recalling over 5,400 Carter's infant carriers because the adjustable shoulder strap can become unfastened or separate from the buckles. resulting in an infant falling from the carrier. The model being recalled is style no. 89000; it is made of light blue quilted fabric with a waist belt, padded shoulder strap, zippered leg openings with padding, and padded back and head supports. The padded fabric is light blue, white, green, and pink. The Carter's brand label is sewn into a seam on the carrier, which is intended for children from birth to 24 months of age. J.C. Penney sold these products (for about $30) in some of its stores across the country beginning in June, 1996. Models with style no. 89200 are not being recalled. Consumers who have model 89000 should call Gold Bug at 1-800 942-9442 to receive a free replacement; they may also write Gold Bug at P.O. Box 390488, Denver, Co. 80239.
... Flammable Sweat Shirts...
Target Stores of Minneapolis, MN, is recalling about 106,000 fleece sweat shirts for men and boys sold under the brand name "Utility". The fabric may ignite easily and presents a serious risk of burn injuries. The fleecy texture of the fabric resembles that of an inside-out sweat shirt (it's often called sherpa). Two styles are affected: crew neck (with "Utility" embroidered on the left chest) and zippered polo (with collar and a zipper closure at the neck). The sweat shirts come in various sizes and colors and have two sewn-in labels, one reading "Wear anywhere Utility Quality Clothing" and the other "Made in China ... RN17730". Target Stores sold the items nationwide from June, 1996, through February, 1997 for about $18 to $22.
Consumers should return them to the store where purchased for a full refund; for more information, call Target Stores at (612) 304-6000.
... And Children's Rompers
About 30,000 Little Miracles rompers for infant boys are being recalled by the Wear Me Apparel Corp., of New York. The rompers, sold for $4.44 at Kmart stores throughout the U.S. since October, 1996, have red or orange snaps, and the paint on the snaps violates the government's ban on lead. Only the outfits with red or orange snaps are being recalled; those with white, cream, pink, yellow, or blue snaps are considered safe. The affected garments have style numbers 9448 or 9449 imprinted on the reverse side of the care label. Consumers can return the items for a full refund to any Kmart store, and can call the manufacturer (1-800 223-0777) for more information.
(All reports above come from the U.S. Consumer Product Safety Commission, Washington, D.C.; telephone 1-800 638-2772)
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