Contamination of nebulizers with environmental allergens

Abstract

Rationale A previous report described detectable cockroach allergen in the nebulizer reservoir of a cockroach sensitive asthmatic patient who experienced an acute life-threatening exacerbation after use of his nebulizer. In this study, we examined whether common indoor allergens could be measured in nebulizer reservoirs from the homes of children with asthma. Methods As part of a large study examining nebulizer use in inner city children with asthma, visiting nurses replaced nebulizer delivery equipment in subjects' homes as part of an intervention. Twenty reservoirs were randomly selected from the study group. The nebulizer sets were not linked to any clinical or environmental data from the subject's home. The nebulizer reservoirs were extracted with 2 ml of PBS-1%, BSA-0.05% Tween 20, after overnight rotation. Extraction buffer and unused albuterol nebulizer medication were used as negative controls. The solutions were tested for cockroach-(Bla g-1 and 2), cat-(Fel d-1), dog-(Can f-1) and mouse-(Mus m-1) allergens using a standard ELISA (Indoor Biotechnologies). Results Of the 17 reservoirs where adequate specimen was available for allergen detection, 29.4% had measurable allergen levels for at least one of the 5 allergen specificities tested. One had measurable Can f 1 (7.3 ng/ml), 2 had Bla g 1 and 2 (range 0.15-0.99 U/ml), 3 had Mus m 1 (range 0.45-2.6 ng/ml) and none had measurable Fel d 1. Conclusions Measurable levels of common indoor allergens can be found in nebulizer equipment of children with asthma with the potential for adverse consequences.