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Infection or allergy?



I work in a busy inner-city ED, where I see a lot of children experiencing asthma exacerbations. My colleague says antibiotics should be prescribed routinely for these patients because infections are the most common cause of asthma attacks. Is she correct?—K.W., ILL.

No. Although bacterial infections cause some acute asthma exacerbations, the most common cause is allergies. Research has shown antibiotics to be beneficial only when the exacerbation was caused by a bacterial infection such as bacterial sinusitis or pneumonia. As you know, antibiotics should never be prescribed indiscriminately.

A recent nationwide study involving 937 inner-city children with asthma showed that cockroach allergen is a more common asthma trigger than either dust-mite or pet allergens. Researchers found that most homes in northeastern cities had high levels of cockroach allergens, particularly in high-rise buildings. High levels of dust-mite allergens were more common in the South and Northwest.

Because cockroaches are attracted by water and food debris, you can help reduce a child's exposure to them by teaching parents to permit eating only in the kitchen or dining room, keeping food in the refrigerator or in secure containers, cleaning counters, removing garbage daily, vacuuming and mopping floors regularly, and repairing leaky faucets.

The study, which spanned 3 years, was published in the March issue of the Journal of Allergy and Clinical Immunology. You can find complete asthma care guidelines by searching for National Asthma Education and Prevention Program: Expert Panel Report at

Nursing2005, will seek professional advice on any reasonable question connected with nursing. Send queries to Advice Editor, Nursing2005, 323 Norristown Rd., Suite 200, Ambler, PA 19002, or e-mail to Put “Advice” in the subject line.

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