Comprehensive home environmental intervention did not reduce allergen concentrations or controller medication requirements among children in Baltimore
Open accessAbstract
OBJECTIVE: To determine if the addition of home environmental control strategies (ECSs) to controller medication titration reduces asthma controller medication requirements and in-home allergen concentrations among children with persistent asthma in Baltimore City. METHODS: 155 children ages 5-17 with allergen-sensitized asthma were enrolled in a 6-month randomized clinical trial of multifaceted, individually-tailored ECS plus asthma controller medication titration compared to controller medication titration alone. Participants had to meet criteria for persistent asthma and have had an exacerbation in the previous 18 months. Allergen sensitization (mouse, cockroach, cat, dog, dust mite) was assessed at baseline and home dust allergen concentrations were measured at baseline, 3 and 6 months. ECS was delivered 3-4 times over the trial. Asthma controller medication was titrated using a guidelines-based algorithm at baseline, 2, 4, and 6 months. The primary outcome was controller medication treatment step at 6 months (0-6, as-needed albuterol to high-dose ICS + LABA). RESULTS: The population was predominately Black (90%), on public insurance (93%), and male (61%). The mean age was 10.1 years (SD 3.3). More than 70% were sensitized to a rodent, >50% to cockroach, and 70% were polysensitized. At 6 months, there were no differences in either treatment step (3.8 [SD 1.4] vs. 3.7 [SD 1.5]) or allergen concentrations between groups. CONCLUSION: Among this predominantly low-income, Black pediatric asthma population, the addition of ECS to controller medication titration reduced neither indoor allergen concentrations nor controller medication requirements compared to controller medication titration alone.
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In a 2017 randomized controlled trial of 286 mite-sensitized children with asthma aged 3-17, significantly fewer children in the active group (29.3%) returned to the hospital with an asthma exacerbation compared to the placebo group (41.5%) (p=0.047).
“At the end of the study, significantly fewer children in the active group (29.3%) had returned to the hospital with an asthma exacerbation compared to those in the placebo group (41.5%) (p=0.047) (55).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [55]
Split into 2 atoms — 0 confirmed, 0 partially supported, 2 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
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Experimental — accuracy not yet measuredThe 2017 trial concluded that mite-impermeable bedding effectively reduces hospital visits due to asthma exacerbations in mite-sensitized children but does not significantly reduce the need for oral corticosteroids.
“This study concluded that mite-impermeable bedding effectively reduces hospital visits due to asthma exacerbations in mite-sensitized children but does not significantly reduce the need for oral corticosteroids (55).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [55]
The Methods describe a six-month trial of a multifaceted home intervention, not a 2017 trial of mite-impermeable bedding alone. The Results (Primary and Secondary Clinical Outcomes; page unavailable) report fewer hospitalizations in the intervention group, but the difference was not statistically significant (2 versus 10; p = 0.07), contrary to the claimed effective reduction. The cited results do not establish the claim about oral corticosteroid need. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe mite-impermeable bedding intervention directly targeted and reduced dust mite exposure, even though specific allergen levels were not reported.
“While specific allergen levels were not reported, the intervention (mite-impermeable bedding) directly targeted and reduced dust mite exposure (55).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [55]
The Methods (page unavailable) describe a dust-mite intervention module and new bedding, so the intervention did target dust mites. But the Results say exposures other than mouse allergen did not significantly change from baseline, and the Discussion says allergen concentrations did not differ between groups. The paper therefore does not support the claimed reduction in dust-mite exposure. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn the same trial, multivariable analysis showed that the risk of emergency hospital visits was 45% lower in the active group (hazard ratio 0.55; 95% CI 0.36-0.85; p=0.006).
“Multivariable analysis showed that the risk of emergency hospital visits was 45% lower in the active group (hazard ratio: 0.55; 95% CI: 0.36–0.85; p=0.006) (55).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [55]
The Results (Primary and Secondary Clinical Outcomes; page unavailable) report no difference in asthma-related emergency room visits between groups (26 vs. 29; p=0.86), contrary to the claimed significant 45% reduction. The Methods (Statistical Analysis; page unavailable) describe Poisson regression for acute visit counts, not the reported hazard-ratio analysis. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe annual rate of hospital visits was 27% lower in the active group, but this difference was not statistically significant (p=0.18).
“However, while the annual rate of hospital visits was 27% lower in the active group, this difference was not statistically significant (p=0.18) (55).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [55]
The Results (Primary and Secondary Clinical Outcomes; page not provided) report fewer hospitalizations in the active ECS+MED group than in the MED ONLY group, and say the difference was not statistically significant. They report 2 versus 10 hospitalizations (p = 0.07), however, not an annual rate 27% lower (p = 0.18). The Methods (Statistical Analysis; page not provided) specify that visits were tracked over six months. (LLM, conf=0.88)
Experimental — accuracy not yet measured
There was no significant difference between the groups in the need for oral prednisolone to manage exacerbations (p=0.28).
“Additionally, there was no significant difference between the groups in the need for oral prednisolone to manage exacerbations (p=0.28) (55).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [55]
The Methods (Outcome Measures; page unavailable) list oral corticosteroid bursts as a measure of exacerbations, and the Results (Primary and Secondary Clinical Outcomes; page unavailable) report no differences between groups in any secondary clinical outcomes. Our copy does not identify prednisolone specifically or give p=0.28 for corticosteroid use, so those details are not supported. (LLM, conf=0.82)
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“Where are they now?” Catching up with the 2021 AAAAI Faculty Development awardees
Ballas, Z. K. (2026) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2026.05.010
- Authors
- Grant, T. L., McCormack, M. C., Peng, R. D., Keet, C. A., Rule, A. M., Davis, M. F., Newman, M., Balcer-Whaley, S., & Matsui, E. C.
- Affiliations
- Johns Hopkins University (US)
- University of North Carolina at Chapel Hill (US)
- University of Maryland, Baltimore (US)
- Corresponding author
- Grant, Torie L.
- ORCID
- Venue
- Journal of Asthma
- Publisher
- Informa UK Limited
- Published
- 2022-06-03
- Volume
- 60
- Issue
- 3
- Pages
- 625-634
- ISSN
- 0277-0903 (ISSN-L)
- 1532-4303
- PMC
- PMC10424504
- OpenAlex
- W4281917443
- Cited by
- 14
- References
- 33
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 3
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Asthma (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (K23AI159144)
- American Academy of Allergy, Asthma, and Immunology (AAAAI) Foundation Faculty Development Award; Meredith McCormack - NIH (P50ES018176)
- U.S. Environmental Protection Agency (83615201)
- Corrine Keet - NIH (U01AI125290)
- Meghan Davis - NIH (K01OD019918)
- Elizabeth Matsui - NIH (K24AI114769, R01ES023447, R01ES026170)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- childhood asthma, persistent asthma, allergen sensitization, asthma controller medications, dose titration, treatment phases, cockroach allergens, rodent allergens, dust mites, Baltimore
- MeSH terms
- Allergens, Animals, Asthma, Cockroaches, Dogs, Environmental Exposure, Humans, Male, Urban Population, Baltimore, Mice
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