Mouse Allergen and Asthma Intervention Trial

描述（由申请人提供）哮喘是最常见的慢性疾病之一，它不成比例地影响居住在城市地区的弱势群体。特别是小鼠过敏原暴露，似乎在城市哮喘流行中起关键作用，原因如下：（1）小鼠m1，主要的小鼠过敏原，在95%的市中心家庭中发现，并且在市中心家庭中的浓度比郊区家庭高100倍;（2）在城市地区，多达25-50%的哮喘儿童对小鼠有IgE致敏的证据，使他们容易出现小鼠过敏原引发的哮喘症状;和（3）在IgE致敏的哮喘儿童中，家鼠变应原暴露与更多的症状天数、更多的急救药物使用和更多的哮喘相关医疗保健使用相关。虽然这些是令人信服的观察结果，但证明小鼠过敏原暴露的减少导致小鼠致敏哮喘儿童的哮喘健康改善对于建立小鼠过敏原暴露的因果关系至关重要。初步证据表明，小鼠过敏原靶向环境干预（MA-EI）是有效的，在减少沉降灰尘Mus m 1水平的>75%，提供了最后一块背景数据，以支持这一假设，即MA-EI将减少小鼠致敏哮喘个体的哮喘发病率。为了验证这一假设，我们建议在美国东北部两个主要城市中心进行多中心，随机临床试验的MA-EI哮喘和小鼠致敏和高家庭小鼠m 1水平的患病率高。目标1是：确定该MA-IE在以下方面的疗效：（a）减少哮喘症状和急救药物的使用，（B）减少哮喘相关的医疗保健利用，以及（c）改善小鼠致敏哮喘儿童中哮喘疾病活动的生理和炎症标志物。目的二：探讨小鼠特异性IgG和IgE作为过敏原暴露和哮喘临床状态的生物标志物。临床试验的结果将为家庭小鼠过敏原暴露对城市哮喘人群的影响提供重要见解，并直接为公共卫生策略提供信息，以减少市中心哮喘负担。

DESCRIPTION (provided by applicant) Asthma is one of the most common chronic illnesses and it disproportionately affects disadvantaged populations residing in urban areas. Mouse allergen exposure, in particular, appears to play a critical role in the urban asthma epidemic for several reasons: (1) Mus m 1, the major mouse allergen, is found in 95% of inner-city homes, and is found in 100-fold higher concentrations in inner-city homes than in suburban homes; (2) As many as 25-50% of children with asthma living in urban areas have evidence of IgE-sensitization to mouse, making them susceptible to mouse allergen-triggered asthma symptoms; and (3) Home mouse allergen exposure is associated with more symptoms days, more rescue medication use, and more asthma related health care use among IgE-sensitized children with asthma. Although these are compelling observations, demonstrating that a reduction of mouse allergen exposure results in Improved asthma health in mouse-sensitized children with asthma is critical for establishing a causal role for mouse allergen exposure. Preliminary evidence indicating that a mouse allergen-targeted environmental intervention (MA-EI) is efficacious in reducing settled dust Mus m 1 levels by >75% provides the final piece of background data to support the hypothesis that a MA-EI will reduce asthma morbidity in mouse-sensitized individuals with asthma. To test this hypothesis, we propose conducting a multi-center, randomized clinical trial of MA-EI at two major Northeastern US urban centers with high prevalence of asthma and mouse sensitization and high home Mus m 1 levels. Aim 1 is: To determine the efficacy of this MA-IE to: (a) Reduce asthma symptoms and rescue medication use, (b) Reduce asthma-related health care utilization, and (c) Improve physiologic and inflammatory markers of asthma disease activity among mouse-sensitized children with asthma. Aim 2 is: To evaluate mouse-specific IgG and IgE as biomarkers of allergen exposure and asthma clinical status. The findings from the clinical trial will lend critical insight into the impact of home mouse allergen exposure on urban populations with asthma, and directly inform public health strategies to reduce the inner-city asthma burden.