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Press Releases New York Presbyterian Hospital Columbia-Presbyterian Campus 161 Fort Washington Avenue New York, NY 10032 Contact: Karin Eskenazi (212) 305-5587 Office of Public Affairs CAN PRENATAL EXPOSURE TO ALLERGENS AND OTHER ENVIRONMENTAL FACTORS INCREASE ASTHMA RISK IN CHILDREN? Columbia Presbyterian Center Will Examine If Prenatal and Early-Life Exposures to Allergens Increase Asthma Risk NEW YORK, NY, March 22, 1999 -- As asthma rates--as well as asthma-related deaths--continue to rise in inner city neighborhoods, research has focused on early identification of children at high risk for the condition. Babies & Children’s Hospital of the Columbia Presbyterian Center of New York Presbyterian Hospital and the Columbia Center for Children’s Environmental Health are taking this research one step further and asking the question, might prenatal exposure to allergens and environmental factors predispose children to developing asthma? While allergens (substances that cause an allergic reaction, which can frequently lead to asthma) such as dust mites, cockroaches, and rodents have been implicated as risk factors for asthma, little is known about their role in the onset of asthma as a result of exposure in early life. Indoor allergens are a special problem in urban communities and present a significant exposure, since Americans spend an estimated 93 percent of their time indoors. Understanding the relationship of early-life exposures to asthma is complicated by the fact that asthma will not be diagnosed with certainty until a later age, according to Rachel L. Miller, MD, assistant attending physician at the Columbia Presbyterian Center of New York Presbyterian Hospital and a study investigator. Dr. Miller is also assistant professor of clinical medicine at the Columbia University College of Physicians & Surgeons. “We’re hoping to gain insight into how very early (prenatal and very soon after birth) exposure to indoor allergens contributes to asthma development. If we can identify which children are at high risk, then we can focus on intervention efforts for these children, such as clean-up campaigns to rid the home of allergens,” says Dr. Miller. Four hundred nonsmoking, pregnant women who receive their prenatal care from the OB/GYN clinics of Harlem Hospital and the Columbia Presbyterian Center are being recruited for this asthma study. Jean Ford, MD, director of the Harlem Lung Center and chief of pulmonary and critical care medicine at Harlem Hospital Center, is leading the study. Assessments of various environmental exposures, including dust mite, cockroach, and mouse allergens, will be made using home vacuum samples collected during the women’s third trimester of pregnancy. Women will wear personal monitors to determine exposure to indoor and outdoor pollutants. Blood from the mother and from the umbilical cord will be collected at the time of delivery. The blood will be analyzed for the presence of antioxidant nutrients, particularly vitamins A, C, and E, as well as chemical fingerprints of urban air pollutants and tobacco smoke that may increase risk of sensitization. It’s thought that low antioxidant levels increase a child’s susceptibility to allergens and asthma, as the body is less able to defend itself from allergic reactions to environmental allergens. Studies have shown a link between low antioxidant levels and respiratory diseases, including asthma and bronchitis. Follow-up analysis will continue until the children reach age two, at which point additional tests are administered. “Our testing for allergen sensitization and antioxidant levels in these children will enable us to document such information in an inner-city population, which generally consumes few foods high in antioxidants because of economic hardship and young children’s food preferences,” notes Dr. Miller. Follow-up home vacuum samples will also be taken when the children reach age one. Ambient air contaminants, such as diesel exhaust particles, environmental tobacco smoke, and particulate matter 2.5 microns in diameter or less, will be evaluated to determine whether these contaminants are associated with increased asthma risk. Additional information will be drawn from detailed respiratory symptoms questionnaires completed by the mothers during their third trimester and every three months after the birth until the children reach age two. This questionnaire will identify childhood respiratory problems, particularly wheezing, which is a good predictor of later onset of asthma. “Through these measurements--both prenatal and postnatal--we hope to identify children most likely to develop asthma. We consider those at high risk to have both allergic sensitization and recurrent wheezing,” says Dr. Miller. Once high-risk children are identified, they will be enrolled in an intervention trial directed by David Evans, PhD, associate professor in the sociomedical sciences division at The Joseph L. Mailman School of Public Health at Columbia University. Targeted to address many asthma risk factors, the comprehensive intervention will consist of an extensive home cleanup, sealing of all household cracks (which serve as entry points for roaches and rodents), antioxidant supplementation for the child, and provision of plastic food containers and impermeable bed and pillow covers (to protect against dust mites). A health educator will instruct each family about the significance of exposure to allergens, as well as teaching ways to prevent or decrease exposures to known environmental risks, such as smoking and lead. The African-American and Dominican Republic populations in Harlem and Washington Heights have asthma morbidity rates that are among the highest in the country. The Harlem Health Survey, conducted by the Harlem Center for Health Promotion and Disease Prevention, has shown that the chance of a lifetime diagnosis of asthma among Harlem residents--almost 14 percent--is about three times higher than in the general African-American community and almost four times higher than in the general Caucasian community.