Indoor Allergen Control Measures: A Practical Summary

By Peter B. Boggs, MD

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The Five Common Indoor Allergens:
Effective Remediation Measures

Cockroach

Although there are some 3,500 identifiable species of cockroach, four commonly infest our homes: German, American, Oriental, and brown-banded.³²

Cockroaches prefer dark, snug places close to water and food, and they venture forth to scavenge at night. It is because of the latter that many people do not realize their homes are infested. A daytime sighting is unusual and reflects significant overcrowding of the reservoir with inadequate food and water supplies.

Multiple allergens have been identified as sensitizers for humans (Bla g 1, etc.). Allergen sources include cast skins, dead bodies, fecal material, saliva, and secretions. Cockroach feces and saliva are common calling cards. Although cockroach allergen is highest in kitchens, it is also found in beds, bedding, and sofas. Work and school environments are not immune to cockroach infestation.³²

Cockroach allergen requires a significant physical disturbance to become airborne. Like house dust mite and mold allergens, cockroach allergens are carried into the air primarily on large (> 10 mm) particles, most of which settle rapidly. However, recent studies have shown that some allergen is dispersed on smaller particles and can remain in the air for longer periods.²⁵ Additional studies are required to define the aerodynamics of cockroach allergen particles.

Effective remediation of cockroach allergens include professional extermination (initial and at least one follow-up in about 2 weeks) and aggressive cleaning before and after extermination to reduce allergen and food sources, including thorough vacuuming (Table 4).32 Encasements impermeable to house dust mite and cat allergen are impermeable to cockroach allergen as well. Secondary measures are common sense and include the daily washing of dishes and removal of garbage; storing food in sealed containers (plastic or glass); sealing plumbing openings, cracks, and crevices; and the placement of bait traps. HEPA filters may help with elimination of the smaller airborne allergens.

Threshold cockroach allergen studies suggest that levels > 2 mg/g of dust are sufficient for sensitization in a genetically susceptible person and levels > 8 mg/g of dust can trigger asthma symptoms.²⁵

Caveats. Cockroach allergens may remain in settled dust for many months after successful extermination and will require repeated cleaning for removal.32,33 Successful extermination and allergen elimination are not the same thing: allergens can persist indoors for months after successful extermination. The best one can hope for is a 95% reduction in cockroach allergens. Hence, it is more difficult to achieve clinical control of cockroach allergy with heavy infestations. Successful cockroach extermination generally requires the participation of professional exterminators.

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