1. Sensitization to Allergen Requires sufficient exposure (concentration and time) Requires genetic predisposition

2. Natural History of Childhood Asthma Thus, the likely scenario is that allergen exposure over the first few years of life induces sensitization. Continuing exposure can induce and maintain inflammation in the nose and lungs.

3. Natural History of Childhood Asthma It remains unclear at what time the critical exposure occurs and what role allergen exposure has played to induce development and influence severity of asthma Objective evidence of an immune response to allergens is generally not present until after two years of age.

4. Major Indoor Allergens Cockroach Dust mite Animal Dander Fungi

5. German Cockroach

6. Dust Mite

10. Cockroach and Asthma Morbidity Group1=No Allergy/Low Exposure Group2=No Allergy/High Exposure Group3=Allergy/Low Exposure Group4=Allergy/High Exposure

12. Development of Asthma Exposure to cockroach allergen early in life may contribute to the development of asthma in susceptible children. J Allergy Clin Immunol 2001;107:41-7

13. Conclusions/Observations Asthma deaths/morbidity have increased and disproportionately high in African Americans Genetics and environment contribute to development and probably asthma severity Good management necessitates - Access to high quality care - Control of exposure to allergens/irritants - Pharmacotherapy for pathophysiology