Association between allergen exposure in inner-city schools and asthma morbidity among students
Open accessAbstract
Importance: Home aeroallergen exposure is associated with increased asthma morbidity in children, yet little is known about the contribution of school aeroallergen exposures to such morbidity. Objective: To evaluate the effect of school-specific aeroallergen exposures on asthma morbidity among students, adjusting for home exposures. Design, Setting, and Participants: The School Inner-City Asthma Study was a prospective cohort study evaluating 284 students aged 4 to 13 years with asthma who were enrolled from 37 inner-city elementary schools in the northeastern United States between March 1, 2008, and August 31, 2013. Enrolled students underwent baseline clinical evaluations before the school year started and were then observed clinically for 1 year. During that same school year, classroom and home dust samples linked to the students were collected and analyzed for common indoor aeroallergens. Associations between school aeroallergen exposure and asthma outcomes during the school year were assessed, adjusting for home exposures. Exposures: Indoor aeroallergens, including rat, mouse, cockroach, cat, dog, and dust mites, measured in dust samples collected from inner-city schools. Main Outcomes and Measures: The primary outcome was maximum days in the past 2 weeks with asthma symptoms. Secondary outcomes included well-established markers of asthma morbidity, including asthma-associated health care use and lung function, measured by forced expiratory volume in 1 second. Results: Among 284 students (median age, 8 years [interquartile range, 6-9 years]; 148 boys and 136 girls), exposure to mouse allergen was detected in 441 (99.5%) of 443 school dust samples, cat allergen in 420 samples (94.8%), and dog allergen in 366 samples (82.6%). Levels of mouse allergen in schools were significantly higher than in students' homes (median settled dust level, 0.90 vs 0.14 µg/g; P < .001). Exposure to higher levels of mouse allergen in school (comparing 75th with 25th percentile) was associated with increased odds of having an asthma symptom day (odds ratio, 1.27; 95% CI, 1.05-1.54; P = .02) and 4.0 percentage points lower predicted forced expiratory volume in 1 second (95% CI, -6.6 to -1.5; P = .002). This effect was independent of allergic sensitization. None of the other indoor aeroallergens were associated with worsening asthma outcomes. Conclusions and Relevance: In this study of inner-city students with asthma, exposure to mouse allergen in schools was associated with increased asthma symptoms and decreased lung function. These findings demonstrate that the school environment is an important contributor to childhood asthma morbidity. Future school-based environmental interventions may be beneficial for this important public health problem.
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Mouse allergen exposure is more common in low-income urban environments, with high concentrations often found in homes and schools.
“Mouse allergen exposure, much like that of cockroaches, is more prevalent in low-income urban environments, with high concentrations frequently detected in homes and schools (40,41,42).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [41]
The Results (page unavailable) report mouse allergen in 99.5% of school samples and 96.0% of home samples from this inner-city study, with high levels in schools. They do not establish that exposure is more prevalent in low-income urban environments than elsewhere, and home concentrations were substantially lower than school concentrations (medians 0.14 versus 0.90 μg/g). (LLM, conf=0.87)
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Indoor Allergen Interventions in Homes and Schools for Managing Asthma
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Perceived Versus Actual Aeroallergen Sensitization in Urban Children
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Use of a School-Based Survey to Screen Students for Symptoms Concerning for Asthma
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Self-citationAdvancing Use of Key Integrated Pest Management Practices in Schools
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Social and environmental determinants of health inequities in childhood asthma
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Self-citationMouse allergen levels in schools over the decade
Akar-Ghibril, N., Petty, C. R., Cunningham, A., Permaul, P., Gaffin, J. M., Phipatanakul, W., & Sheehan, W. J. (2022) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2022.07.025 · Cited by 4 · see citing works
Self-citationGeospatial data in pediatric asthma in the United States: a scoping review protocol
Cushing, A. M., Khan, M. A., Kysh, L., Brakefield, W. S., Ammar, N., Liberman, D. B., Wilson, J. P., Shaban‐Nejad, A., & Espinoza, J. (2022) · JBI Evidence Synthesis · doi:10.11124/jbies-21-00284 · Cited by 4 · see citing works
- Authors
- Sheehan, W. J., Permaul, P., Petty, C. R., Coull, B. A., Baxi, S. N., Gaffin, J. M., Lai, P. S., Gold, D. R., & Phipatanakul, W.
- Affiliations
- Boston Children's Hospital (US)
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Phipatanakul, Wanda
- ORCID
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2017-01-01
- Volume
- 171
- Issue
- 1
- Pages
- 31
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC5349325
- OpenAlex
- W2552850038
- Cited by
- 146
- References
- 36
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 10 · 2023: 14 · 2022: 22 · 2021: 12 · 2020: 14 · 2019: 20 · 2018: 17 · 2017: 13 · 2015: 1
- FWCI
- 13.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (KL2TR001100, UL1TR000170)
- National Heart, Lung, and Blood Institute (U10HL098102)
- National Institute of Allergy and Infectious Diseases (L40 AI107923, K23AI106945, U01AI126614, U01AI110397, R01AI073964, K24AI106822, K23AI104780)
- National Institute of Environmental Health Sciences (P30ES000002, K23ES023700)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Keywords
- indoor allergens, asthma morbidity, children, urban schools, mouse allergen, cat allergen, dog allergen, cockroach allergens, dust mites, settled dust, asthma symptoms, lung function, allergen exposure reduction, elementary school students
- MeSH terms
- Allergens, Animals, Asthma, Cats, Child, Cockroaches, Dogs, Environmental Exposure, Female, Humans, Male, Mites, Respiratory Function Tests, Schools, United States, Urban Population, Mice, Rats
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