J ALLERGY CLIN IMMUNOL

VOLUME 131, NUMBER 2

Abstracts AB55

SATURDAY

198 Association Between Asthma-Related Emergency Department

Visits and Pollen Concentration in the Bronx, 2001-2008Sayantani B. Sindher, MD1, Sunit Jariwala, MD2, Gabriele De

Vos, MD3, Jennifer Toh4, Anna Tavdi, BA5, David L. Rosenstreich,

MD, FAAAAI6; 1Albert Einstein/Montefiore Medical Center, 2Albert Ein-

stein/Montefiore Medical Center, New York, NY, 3Albert Einstein College

of Medicine, Bronx, NY, 4Montefiore Medical Center, New York, NY,5Albert Einstein College of Medicine, Division of Allergy/Immunology,6Albert Einstein / Montefiore Medical Center, NY.

RATIONALE: To examine the relationship between asthma-related

emergency department visits (AREDV) and the effect of pollen and

mold concentrations in a high asthma prevalence area, Bronx, NY.

METHODS: The numbers of daily adult and pediatric AREDV from

2001-2008 were obtained from two Bronx hospitals (Montefiore-Moses

and Montefiore-Weiler). AREDV data were acquired through the Clinical

Looking Glass data analysis software, which allowed a retrospective

search of asthma-related patients by ICD-9 code. Daily counts for tree,

grass and weed pollen along with mold (fungal spore) from 3/2001 to 10/

2008 were obtained from the Armonk counting station located in close

proximity to the Bronx.

RESULTS: From 2001-2008, there were a total of 42,065 AREDV. In a

prior analysis, a large spring increase in AREDV significantly correlated

with high tree pollen counts.When theweed, grass and tree pollen datawas

combined, therewas a significant positive correlation betweenAREDVand

total pollen counts (rho50.3, p<0.001). An average of a 50% increase in

AREDVwas found (frommean 10.4 +/- SD 6.1 to 15.8 +/- SD 8.1) if pollen

counts exceeded 100 grains/mm3 (p<0.001).CONCLUSIONS: Our data demonstrates a significant positive correla-

tion between AREDVand total pollen counts in the Bronx. This may have

prognostic value in anticipating increased asthma exacerbations. Early

warning of pollen peaks based on ongoing surveillance could potentially

guide clinical practice and minimize asthma-related emergency depart-

ment visits in the Bronx.

199 Report of Exercise-Induced Wheeze Predicts Urgent MedicalVisits for Asthma Among Inner-City Children

Matthew S. Perzanowski, PhD1, Timothy Mainardi, MD2, Kathleen

Donohue, MD3, Lori Hoepner4, Inge Goldstein5, Frederica P.

Perera, PhD6, Rachel L. Miller, MD, FAAAAI7; 1Department of Environ-

mental Health Sciences, Columbia University, New York, NY, 2Division

of Pulmonary, Allergy and Critical Care Medicine, Columbia University,3Division of General Medicine, Columbia University, 4Data Coordinating

Center, Columbia University, 5Department of Epidemiology, Columbia

University, 6Columbia’s Center for Children’s Environmental Health, Co-

lumbia University, 7Division of Pulmonary, Allergy and Critical Care

Medicine, Columbia University, New York, NY.

RATIONALE: Among middle-income asthmatic children in NYC, we

observed that report of exercise-induced wheeze (EIW) was associated

with urgent medical visits for asthma, independent of asthma severity, and

was more common among asthmatics living in neighborhoods with high

asthma prevalence. Here, we hypothesized that among lower-income

asthmatic children, report of EIWalso would predict future urgent medical

visits for asthma.

METHODS: With Columbia’s Center for Children’s Environmental

Health’s birth cohort study, children of African-American and

Dominican mothers living in high asthma prevalence NYC neighborhoods

were followed prospectively to age 11 years. Current asthmawas defined at

ages 5, 7, 9, and 11 by symptoms and medication use in the previous year.

Associations between EIW and urgent medical visits were tested in

repeated measures models including the covariate/confounders sex, race/

ethnicity, pre/postnatal environmental tobacco smoke, maternal asthma,

reported household income and frequent wheeze symptoms.

RESULTS: Among childrenwith current asthma participating at ages 5, 7,

9 and 11 (n5197, 160, 144 and 68, respectively), the frequency of EIW in

the past year increased with age (26%, 36%, 43%, 44%). In a cross-

sectional multivariable repeated measures model (n5480 subject/time

points), EIW was associated with urgent medical visits (prevalence

ratio51.78, P<0.001) and the magnitude of the association increased

with age. In longitudinal analyses (n5304), EIW predicted urgent medical

visits 2 years later (relative risk51.57, P50.040), including after adjust-

ment for urgent medical visits at the age of EIW.

CONCLUSIONS: Among asthmatic children in low-income, urban

communities, report of EIW can identify children at risk for future urgent

medical visits.

200 Allergen Exposure Influences the Relationship BetweenCommunity Violence and Asthma Morbidity: The Inner CityAsthma Study

Michelle L. Sever, PhD1,2, James Thomas, PhD2, Agustin Calatroni3,

Karin Yeatts, PhD2, Cynthia Visness, PhD3, Herman Mitchell, PhD3,

Darryl C. Zeldin, MD1; 1NIEHS, Research Triangle Park, NC, 2Depart-

ment of Epidemiology, Gillings School of Global Public Health, Univer-

sity of North Carolina at Chapel Hill, Chapel Hill, NC, 3Rho, Inc., Chapel

Hill, NC.

RATIONALE: In the Inner City Asthma Study (ICAS), children exposed

to high levels of violence in their neighborhood had higher asthma

morbidity at baseline. The relationship between violence and asthma is

thought to be mediated by either the physiologic response to violence or by

increased exposure to indoor allergens due to increased time spent indoors.

METHODS: We examined the interactions between cockroach allergen

exposure and sensitization, community violence exposure and asthma

morbidity in the ICAS population using linear mixed models.

RESULTS: At baseline, children exposed to high levels of community

violence had more asthma symptom days, but only if they were also both

exposed and sensitized to cockroach allergen. Similar results were seen

when number of assaults in a census tract were considered instead of

violence score. Children with the highest violence exposure who were

sensitized to cockroach allergen had the greatest reduction in asthma

morbidity following a decrease in cockroach allergen. The children not

sensitized to cockroach allergen also had a decrease in their asthma

morbidity with a decrease in cockroach allergen exposure, but the decrease

did not vary by violence exposure.

CONCLUSIONS: Asthmatic children exposed to high levels of violence

in their communities and cockroach allergen in their homes have more

symptoms, and also respond better to home-based environmental inter-

ventions to reduce allergen exposure. These findings support the hypoth-

esis that higher asthma morbidity in children exposed to violence in their

neighborhoods could be due, in part, to spendingmore time indoors and the

resultant higher exposure to the inner-city predominant cockroach

allergen.