Cockroach Reduction Intervention for Childhood Asthma
(ARCHS Trial)
Recruiting in Palo Alto (17 mi)
Overseen byFelicia Rabito, PhD
Age: < 18
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Tulane University
Must be taking: Long-term asthma controllers
Must not be taking: Beta-blockers
Disqualifiers: Chronic respiratory infections, Cardiovascular disease, Smoker, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The Allergen Reduction and Child Health Study (ARCHS) is a 12-month, two group randomized control trial of children with asthma and who are exposed to cockroaches. Children ages 5 - 17 living in the Greater New Orleans area will be recruited from a variety of clinic and community settings. The overall goal of the study is to improve patient-centered asthma outcomes (asthma symptom days, health care utilization, asthma control and quality of life) by targeting one key allergen - cockroach exposure in the child's home. The investigators propose a simple intervention of insecticidal bait that is low cost, simple to implement, and which is lower toxicity than other forms of pest control. The reduction in the number of cockroaches in the home is an environmental outcome that is patient-centered and is likely to add to its acceptance by families of children with asthma.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. However, it mentions that children with asthma who are on long-term controller medication are eligible to participate, so it seems likely that continuing asthma medication is allowed.
What data supports the effectiveness of the treatment for reducing cockroach exposure in children with asthma?
Research shows that using a combination of education, insecticide bait, and professional cleaning can significantly reduce cockroach numbers and allergens in homes, which are known triggers for asthma in children. Additionally, tailored pest management approaches have been successful in reducing cockroach infestations in urban communities, making them a cost-effective solution.
12345Is the cockroach reduction intervention safe for humans?
The studies focus on reducing cockroach allergens to help with asthma, but they do not provide specific safety data for humans regarding the intervention methods like insecticidal bait or pest control bait.
12367How does the Cockroach Reduction Intervention for Childhood Asthma treatment differ from other treatments for asthma?
This treatment is unique because it focuses on reducing cockroach exposure, a known asthma trigger, through a tailored approach or insecticidal bait, rather than directly treating asthma symptoms. Unlike standard asthma treatments that often involve medication to manage symptoms, this intervention aims to address an environmental cause of asthma.
378910Eligibility Criteria
The ARCHS trial is for children aged 5-17 in the Greater New Orleans area with uncontrolled persistent asthma and exposure to cockroaches. They must have had recent hospital visits or symptoms due to asthma, sleep at the target home most of the week, and speak English or Spanish. Kids can't join if they smoke, take beta-blockers, have certain heart diseases (except hypertension), other serious illnesses requiring daily meds, are on immunotherapy, or plan to move soon.Inclusion Criteria
I have asthma and need daily medication or have frequent symptoms.
The child needs to sleep at least 4 nights per week at the specified home on average.
You have seen or caught cockroaches in your home recently.
+3 more
Exclusion Criteria
I take daily medication for a heart condition, not including high blood pressure.
I am currently taking a beta-blocker medication.
You are currently smoking.
+2 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
1 visit (in-person)
Baseline Assessment
Initial assessment of asthma symptoms, quality of life, and cockroach exposure
1 week
1 visit (in-person)
Treatment
Participants receive either a multi-component intervention or insecticidal bait for cockroach reduction
12 months
Monthly home visits
Follow-up
Participants are monitored for safety and effectiveness after treatment
4 weeks
1 visit (in-person)
Participant Groups
This study tests two ways to reduce cockroach allergens in homes of asthmatic kids: one group uses insecticidal bait while another follows a tailored approach. The goal is to see which method better improves asthma-related health outcomes like symptom days, control over asthma, healthcare use and overall quality of life over a year.
2Treatment groups
Active Control
Group I: Comparator 1 (tailored approach)Active Control1 Intervention
Multi-component intervention tailored to the participant's allergic profile.
Group II: Comparator 2 (insecticidal bait)Active Control1 Intervention
Insecticidal bait for cockroach reduction.
Comparator 1 (tailored approach) is already approved in United States for the following indications:
🇺🇸 Approved in United States as Environmental Intervention for:
- Asthma Management
- Allergy Prevention
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Tulane UniversityNew Orleans, LA
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Who Is Running the Clinical Trial?
Tulane UniversityLead Sponsor
Patient-Centered Outcomes Research InstituteCollaborator
References
Abatement of cockroach allergens (Bla g 1 and Bla g 2) in low-income, urban housing: month 12 continuation results. [2010]In the first 6 months of this previously published, randomized trial, the combined intervention of occupant education, insecticide bait application, and professional cleaning significantly reduced cockroach numbers and Bla g 1 allergen levels in inner-city homes.
Efficacy of integrated pest management in reducing cockroach allergen concentrations in urban public housing. [2021]The efficacy of residential interventions to reduce cockroach allergens in public housing developments was evaluated over months of follow-up. Repeated measurements were collected from 39 apartments, with longitudinal analyses used to evaluate changes over time. Bla g 1 kitchen concentrations were reduced 71% and bed concentrations 53% (86% and 70% for Bla g 2, respectively) by 6 months post-intervention, after which concentrations began to increase. Apartments with higher concentrations were usually in poorer condition and benefited most from pest management efforts. Intensive interventions can significantly reduce the allergen burden in public housing apartments, but intervention efforts must be sustained.
A single intervention for cockroach control reduces cockroach exposure and asthma morbidity in children. [2022]Exposure to cockroaches is an important asthma trigger, particularly for children with asthma living in inner cities. Integrated pest management is the recommended approach to cockroach abatement; however, it is costly and difficult to implement. The impact of reducing cockroach exposure on asthma outcomes is not known.
Abatement of cockroach allergen (Bla g 1) in low-income, urban housing: A randomized controlled trial. [2021]Clinically relevant reductions in exposure to cockroach allergen, an important risk factor for asthma in inner-city households, have proven difficult to achieve in intervention trials.
Integrated pest management in an urban community: a successful partnership for prevention. [2018]Pesticides, applied in large quantities in urban communities to control cockroaches, pose potential threats to health, especially to children, who have proportionately greater exposures and unique, developmentally determined vulnerabilities. Integrated pest management (IPM) relies on nonchemical tools--cleaning of food residues, removal of potential nutrients, and sealing cracks and crevices. Least toxic pesticides are used sparingly. To evaluate IPM's effectiveness, the Mount Sinai Children's Environmental Health and Disease Prevention Research Center, in partnership with two community health centers in East Harlem, New York City (NY, USA), undertook a prospective intervention trial. Families (n = 131) enrolled when mothers came to the centers for prenatal care. Household cockroach infestation was measured by glue traps at baseline and 6 months afterward. The intervention group received individually tailored IPM education, repairs, least-toxic pest control application, and supplies, with biweekly pest monitoring for 2 months and monthly for 4 months. The control group, residing in East Harlem and demographically and socioeconomically similar to the intervention group, received an injury prevention intervention. The proportion of intervention households with cockroaches declined significantly after 6 months (from 80.5 to 39.0%). Control group levels were essentially unchanged (from 78.1 to 81.3%). The cost, including repairs, of individually tailored IPM was equal to or lower than traditional chemically based pest control. These findings demonstrate that individually tailored IPM can be successful and cost-effective in an urban community.
Assessment of environmental cockroach allergen exposure. [2021]In the past, cockroach allergen exposure assessment mainly focused on settled dust in homes in low-income urban cities in the United States. That choice was not wrong; without measureable levels of cockroach allergen, it is difficult to show associations with any home characteristics, much less with health outcomes (e.g., allergy, asthma). However, recent studies in other suburban areas, schools, and other countries have elucidated the importance of cockroach allergen in these environments too. In addition, characterizing the underlying factors that give rise to cockroach allergen exposure (or protect against it) can lead to more targeted public health interventions. This review discusses different approaches to sampling indoor environments, interprets recent asthma and allergy studies, compares cockroach allergen levels from past studies with those of recent studies, and describes strategies for decreasing exposures.
Ecology and elimination of cockroaches and allergens in the home. [2019]Cockroach infestations have been indicated as a major contributor to asthma throughout the world. Several studies have shown that large numbers of asthmatic patients are sensitized to cockroach allergens. Eliminating this pest from homes, schools, and public buildings involves a long-term commitment to a rational extermination process. This article covers the characteristics of the major cockroach species that invade homes, assesses the role of environmental exposure to cockroaches in asthma, and provides an intervention program for their extermination.
There are more asthmatics in homes with high cockroach infestation. [2019]Although asthma has been commonly associated with sensitivity to cockroaches, a clear causal relationship between asthma, allergy to cockroaches and exposure levels has not been extensively investigated. The objective of the present study was to determine whether asthma occurs more frequently in children living in homes with high cockroach infestation. The intensity of household infestation was assessed by the number of dead insects after professional pesticide application. Children living in these houses in the metropolitan area of Recife, PE, were diagnosed as having asthma by means of a questionnaire based on the ISAAC study. All children had physician-diagnosed asthma and at least one acute exacerbation in the past year. Children of both sexes aged 4 to 12 years who had been living in the households for more than 2 years participated in this transverse study and had a good socioeconomic status. In the 172 houses studied, 79 children were considered to have been exposed to cockroaches and 93 not to have been exposed. Children living in residences with more than 5 dead cockroaches after pesticide application were considered to be at high infestation exposure. Asthma was diagnosed by the questionnaire in 31.6% (25/79) of the exposed group and in 11.8% (11/93) of the non-exposed group (P = 0.001), with a prevalence ratio of 3.45 (95%CI, 1.48-8.20). The present results indicate that exposure to cockroaches was significantly associated with asthma among the children studied and can be considered a risk factor for the disease. Blattella germanica and Periplaneta americana were the species found in 96% of the infested houses.
Educational intervention to control cockroach allergen exposure in the homes of hispanic children in Los Angeles: results of the La Casa study. [2021]Cockroach allergy is common among inner city children with asthma, and exposure to cockroach allergen is associated with more severe disease. However, there has been little evaluation of educational approaches for controlling cockroach infestations and reducing allergen exposure.
Cockroach counts and house dust allergen concentrations after professional cockroach control and cleaning. [2021]It is known that cockroach allergen exposure is both frequent in inner-city homes and associated with asthma severity in children living in those homes. However, there have been few studies of interventions to reduce exposures in this setting.