NIAID-supported research has established that decreasing exposures to household allergens—such as those from dust mites and cockroaches—and implementing guidelines-based asthma therapy can reduce asthma symptoms and health care visits. Much of this research has been conducted in low-income urban areas, where asthma is more prevalent and severe. Since 1991, NIAID has sponsored a series of research programs to reduce the public health burden of asthma in low-income urban environments.
The National Cooperative Inner-City Asthma Study, conducted in the early 1990s, determined that cockroach allergen was directly related to asthma severity. Researchers found that counseling on how to reduce this allergen in the home helped lessen children’s asthma symptoms. Subsequently, the Inner-City Asthma Study, which took place from 1996 to 2001, showed that reducing environmental allergens, especially in the bedroom, decreased asthma symptoms in at-risk children.
NIH issued the first set of Guidelines for the Diagnosis and Management of Asthma in 1991. The guidelines are developed and updated by an expert panel commissioned by the National Asthma Education and Prevention Program (NAEPP) coordinated by NIH’s National Heart, Lung and Blood Institute. While treatment based on the NIH asthma guidelines is generally effective at controlling asthma, many people still experience asthma attacks that may require emergency room visits and hospitalizations. The NIAID-funded Inner-City Anti-IgE Therapy for Asthma (ICATA) study showed that adding year-round treatment with the drug omalizumab to guidelines-based asthma therapy nearly eliminated seasonal increases in asthma attacks and decreased asthma symptoms among young people. A follow-up study called Preventative Omalizumab or Step-Up Therapy for Severe Fall Exacerbations (PROSE) assessed a shorter course of omalizumab treatment. Adding omalizumab to ongoing guidelines-based therapy for a targeted four-month period beginning just before the start of school reduced the number of autumn asthma attacks and colds in urban children.
Omalizumab targets and reduces levels of an antibody called immunoglobulin E, which is central to the allergic response. The drug currently is approved in the United States for patients ages 6 years and older with moderate-to-severe persistent allergic asthma.