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Contamination of nebulizer equipment with cockroach allergen: there's a bug in the system!
Mary E Bollinger1, Brian Wolf, Christina Schwindt
1Division of Pediatric Pulmonology/Allergy, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. mbolling@peds.umaryland.edu
Background:
Physicians often have anecdotal reports of patients describing increased asthma symptoms after the use of nebulizers; however, there are few published reports of nebulizer-associated exacerbations.
Objective:
To present 2 cases of asthmatic children who experienced a life-threatening exacerbation of their symptoms after nebulizer use.
Methods:
Case 2's nebulizer was tested for cockroach allergen by washing the medication reservoir with 2 mL of sterile filtered 1% phosphate-buffered saline, 0.05% bovine serum albumin, and Tween 20 overnight with rotation. The patient's sealed albuterol nebulizer medication was used as a control. The control albuterol and test solutions were analyzed for Blattella germanica 1 and 2 allergens using a monoclonal antibody-based immunoenzymetric assay.
Results:
The reservoir from case 2 was found to have measurable levels of both Bla g 1 and Bla g 2. The control albuterol solution had no measurable cockroach allergen. An insect found in the nebulizer box of case 2 was identified as an infantile German cockroach.
Conclusions:
Nebulizer use provides an opportunity for antigen exposure directly to small airways, which may lead to severe allergic reactions in patients using contaminated equipment.
