(What’s Really BuggingYou?) By John M. Hollingsworth, PA-C, RRT
This report deals with allergy to insects, not with reactions to insect stings or bee venom. In actuality there is only one insect we are currently interested in that causes significant human allergic reactions. The infamous cockroach is the real subject of this report.
The cockroach dates it’s ancestry back at least 250 million years. There are about 4,000 species of cockroach and only about 25 to 30 have earned the title of pest to the human species. Here in the USA, only two species are really significant in causing human allergies, the German and American varieties.
Cockroaches cause allergic reactions to develop in humans because the particles from their waste, eggs and dead bodies are light enough to float up into the air and become inhaled, like dust mite particles and animal dander. Unfortunately, most people in the USA have been exposed to these particles at some time in their life, either at work, at home or while on vacation. Once exposed, allergic individuals may develop allergic reactions to the proteins associated with the inhaled particles.
These insects are extremely well suited to invading our living spaces, hiding out in dark crevices and picnicking on left over food particles.A single cookie crumb is like a wedding cake for a happy pair of these little pests. Most homes have more than enough tiny food particles around to keep many cockroach newlyweds well fed for life. They live about 2- 4 years, and a single female can produce about 1,000 offspring in a full life cycle. One can assume that if one roach is cited, at least 800 more are hiding nearby. An infested home may house as few as 900 or as many as 330,000.
Cockroaches are extremely common wherever food is prepared for the public, such as in restaurants, cafeterias, hotels and entertainment facilities. In addition they are found in grocery stores, food storage warehouses, and some non-food storage facilities, such as paper storage areas.
Inner city apartment buildings are frequently infested, but no house is immune, and upper level socioeconomic homes are also commonly infested. Cockroaches can easily travel from the grocery store to the home in the family car, riding in grocery bags, munching on their dinner all the way to their new home, without ever being seen.
Most people are not aware that cockroaches cause allergy. Very few people want to admit they might have these pesky critters in their homes. Even fewer wish to think that they could have allergic symptoms due to particles from cockroaches in the air they breathe. The fact is, studies have shown that cockroach allergy is as common as pollen allergy in many large cities, and seems to range in prevalence from 7.5 % up to 75% in allergic individuals, according to studies done in different U.S. cities. Although these studies in different areas of the USA have produced highly different results, in all cases, the number of individuals reactive to cockroach allergy tests is very significant.
Persistent allergic or asthmatic symptoms on a year round basis can be caused by cockroach allergy. Year round symptoms make it more difficult to identify the most responsible allergens and irritants. Common allergy symptoms attributed to inhaled cockroach particles include nasal congestion, skin rashes, irritated eyes and asthma. In addition, cockroach allergy probably contributes to chronic sinus infection and chronic ear infection, just as the other airborne allergens do.
Severe, persistent asthma symptoms are directly attributed to cockroach allergy at an unexpectedly high rate of occurrence, according to some studies. This may be related to findings that indicate inner city children often have more severe asthma.
Management of cockroach allergy must include the same basic ingredients as dust mite allergy, with somewhat different mechanisms. Avoidance, medication, and if symptoms persist, immunotherapy.
The first step is avoidance. Since cockroaches can be eliminated, a pest control program must be initiated. A professional exterminator should be consulted. They can help identify the source and offer options for removal. Many asthmatics and people with severe sinus symptoms are bothered by strong chemical odors, and this must be considered when exterminating pests. Sometimes a day or more away from the home after spraying should be automatically planned into the program.
The second step is appropriate medical treatment. This includes evaluation of symptoms during frequent visits to the medical provider until control with appropriate medicines is achieved. The medical care provider should work with the patient and family to develop commonly agreed upon goals that are realistic and achievable. Assessment mechanisms include, home symptom diaries and medication logs, physical exams and breathing tests if asthma is a problem. The patient and family need to work with the care provider, trying medications and maintaining home records.
The third step is allergen desensitization. If medications alone are not adequate, allergen desensitization (immunotherapy) may be the most useful treatment, especially when the source of the allergen cannot be completely eliminated. When the exposure is at work, school, or in an apartment or condominium complex, it may be impossible to institute an effective pest control program.
Continued efforts in all cases will be rewarding. The cockroach is a difficult insect to eliminate, and the symptoms associated with cockroach allergy may be just as difficult to control in some cases. Determination, and a carefully planned, scientific approach, will provide the best outcome.