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Cockroach Allergy

Ear, Nose, & Throat (ENT)
Contributed byKrish Tangella MD, MBAJun 12, 2019

What are the other Names of this Condition? (Also known as/Synonyms)

  • Allergy to Cockroaches

What is Cockroach Allergy? (Definition/Background Information)

  • Cockroach Allergy is a common condition that manifests as an abnormal immune reaction/response, frequently due to inhaled cockroach dead parts, saliva, and fecal wastes that are present in home environments
  • Cockroaches are common insects found all over the world; some of the species share their habitat with humans. They are considered as household pests and can cause severe infestation, if left uncontrolled. In warm-humid spaces, cockroaches may be present year-round
  • A house may contain hundreds and thousands of cockroaches, frequently in the kitchens and bathrooms. Some individuals are allergic to the feces, saliva, and dead body parts of cockroaches (allergens) on inhalation. This can result in allergy and asthmatic symptoms
  • The respiratory system is mainly affected and the signs and symptoms of Cockroach Allergy may include runny nose, sneezing, and breathing difficulties. In some cases, it may lead to an anaphylactic shock, which is a medical emergency
  • Chronic exposure to cockroach waste matter can result in asthma and sinus infection. Cockroach Allergies are generally diagnosed by conducting a physical examination, assessing the symptoms, and via an antibody blood test or a skin-prick test
  • Anti-allergic medications form the first line of treatment for mild Cockroach Allergies. However, in the case of a severe allergic reaction (anaphylaxis), epinephrine or adrenaline injections are recommended
  • The prognosis of Cockroach Allergy is generally good with adequate treatment, although the condition can recur. Awareness of such allergies and taking steps to eliminate cockroaches from homes is the best form of prevention

Who gets Cockroach Allergy? (Age and Sex Distribution)

  • Cockroach Allergies can occur in both children and adults. Individuals of any age may be affected
  • No gender preference is noted and both males and females are affected
  • All racial and ethnic groups are equally vulnerable to the condition

What are the Risk Factors for Cockroach Allergy? (Predisposing Factors)

The risk factors for Cockroach Allergy include:

  • Regular exposure to saliva, fecal wastes, and dead cockroaches (also to parts that are shed)
  • Humid and poorly-ventilated kitchens and dining areas that are regularly kept unclean
  • Family history of an associated allergy including asthma and hay fever; it is estimated that about 40-60% of the individuals with asthma worldwide may be allergic to cockroach detritus
  • Infants and young growing children are more at risk
  • Having one form of allergy puts one at risk for other forms too

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Cockroach Allergy? (Etiology)

An allergic reaction occurs in an individual with Cockroach Allergy, because the immune system recognizes cockroach wastes as being dangerous and harmful to the body.

  • The cockroaches may shed body parts wherever they are present/travel. Along-with this, saliva, fecal material, and dead roaches mix with dust and trigger allergy symptoms, when inhaled
  • Exposure to cockroach wastes result in the production of antibodies, specifically immunoglobulin E (IgE). The next time the individual is exposed to the enzyme, the antibodies that are circulating in blood causes an antibody-antigen reaction
  • This results in the production of histamine and other chemical messengers, which cause the symptoms seen during an allergic reaction
  • The extent of exposure that triggers an allergy may not be significantly large. Sometimes, mild or minor contact with the allergen is sufficient to trigger Cockroach Allergy

In some cases, a severe allergic reaction termed as anaphylaxis may occur, which is a medical emergency that requires immediate medical attention.

What are the Signs and Symptoms of Cockroach Allergy?

The signs and symptoms of Cockroach Allergy may start to appear within a few minutes, to a couple of hours, after the individual has been exposed to cockroach waste matter. Depending on the level of sensitivity and quantum of exposure, the symptoms may be mild or severe. A severe allergic reaction is a medical emergency.

The signs and symptoms of Cockroach Allergy may include:

  • Sneezing is the most common symptom noted
  • Coughing that may be recurrent, chest tightness
  • Runny or stuffy nose
  • Watery eyes, redness, and irritation; conjunctivitis like symptoms including swollen eyes
  • Irritation of the throat
  • Ear infections
  • Shortness of breath (trouble breathing), wheezing
  • Asthma-like symptoms; in children (mainly) with asthma or other lung conditions, Cockroach Allergy can make it worse
  • Face pain due to sinus involvement
  • Skin can be itchy
  • Severe infestation can cause severe respiratory symptoms

Generally, not all episodes of allergy will be of the same severity. In some individuals, the most severe symptom caused by Cockroach Allergy is anaphylaxis.

  • Anaphylaxis (sometimes called an anaphylactic shock) is a life-threatening, whole-body allergic reaction
  • During anaphylaxis, tissues in various body parts release histamine and other messenger chemicals, which causes swelling of the throat and other symptoms
  • Swelling of the throat is especially dangerous as this can cause shortness of breath. If the swelling is not reduced soon, then there is a possibility that the individual could die from a lack of sufficient oxygen
  • It can also result in a bluish skin, weak pulse, and decreased blood pressure (hypotension)

How is Cockroach Allergy Diagnosed?

The diagnosis of Cockroach Allergy may involve the following:

  • Physical examination, assessment of symptoms, and medical history evaluation (history of allergies in the family)
  • Radioallergosorbent (RAS) test; to determine the specific allergy-causing substance
  • Skin-prick (allergy) test:
    • For this test, tiny amounts of certain substances are injected right underneath the skin (forearm, upper arm, or back)
    • After 15-20 minutes, if the spot where the chemical was injected swells, or if there is redness noticed, then this indicates that the individual may be allergic to the substance
  • Blood test to detect antibodies (IgE antibody test)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Cockroach Allergy?

The complication of Cockroach Allergy is associated with the allergic reaction itself and it depends on the severity of the reaction. It may include:

  • Anaphylactic shock/reaction that may be life-threatening
  • Severe asthma attacks
  • Development of chronic conditions including asthma and sinusitis, when the lungs are affected due to continued exposure. About two-thirds of the individuals, on continuous exposure to cockroach allergens, may get asthma
  • Aggravation of symptoms in those with underlying lung conditions/infections
  • Having one form of allergy can make the individual prone to other allergy types
  • In severe reactions, a tracheostomy may have to be performed during an emergency situation 

How is Cockroach Allergy Treated?

The treatment of Cockroach Allergy may be undertaken in the following manner:

  • To the extent possible, limit or reduce exposure to cockroaches
  • Anti-allergic medication for mild reactions; antihistamine therapy, that is prescribed by the allergy physician
  • Use of leukotriene modifiers (allergy medication)
  • Symptomatic treatment; use of decongestants, especially for nose block including steroid sprays
  • In the case of anaphylaxis (severe allergic reaction), epinephrine or adrenaline is immediately administered
  • Breathing support as necessary, control asthma symptoms and low blood pressure
  • Bronchodilators for respiratory conditions such as asthma, wheezing, etc.
  • Undertake appropriate treatment for any underlying lung infections or illnesses
  • Immunotherapy (allergy shots), in case of severe allergies, for long-term tolerance development

How can Cockroach Allergy be Prevented?

It may be possible to prevent Cockroach Allergy by eliminating them from home environments, by considering the following steps:

  • Keep house environment clean; clean kitchens (including sinks, preparation counters), toilets, and bathrooms regularly
  • While cleaning use suitable dust masks, else the symptoms may get worse
  • Avoid leaving food stuffs open, including food wastes and pet foods
  • Keep trash cans closed or sealed
  • Avoid clutter and piling up of materials/clothes (avoid dumping materials in the closet or garage)
  • Repair leaky pipes, broken drain covers/grates; replace damaged manhole covers
  • Use insect (roach) repellents, such as boric acid
  • Seek professional pest control help, if required
  • Wash hands thoroughly with soap and water, in case of contact with an allergen, especially before eating
  • Clean indoor spaces regularly for dust; use high-power vacuum cleaners on room carpets, mattresses, and sofas

Additionally, the following may be considered:

  • Studies have shown that breastfeeding children for 4-6 months or over, can help build their body immunity and make them less prone to allergies
  • Appropriate maternal diet during pregnancy can help build stronger resistance (against allergies) in children
  • Generating public awareness on various allergies

In case the child or adult is susceptible to an anaphylactic shock (high-risk individuals) from Cockroach Allergy, the following should be considered:

  • Being watchful of triggers and avoiding them
  • Wearing medical alert information bracelets or suitable devices
  • Carry auto-injector epinephrine or adrenaline medications such as EpiPen, Anapen, or Twinject. Since the condition may recur, it is advised to carry 2 doses (2 pens)
  • Supervise children on how to self-administer the injection, if required
  • If child is prone to anaphylactic reaction, then information (preferably written instructions) should be given to day care, school authorities accordingly
  • Adults should inform their spouses, colleagues, and friends, about the condition, in case of a future emergency

What is the Prognosis of Cockroach Allergy? (Outcomes/Resolutions)

  • The prognosis of Cockroach Allergy depends on the severity of the signs and symptoms, but it is generally good with appropriate treatment
  • However, the condition can recur, if cockroaches are not eliminated from homes. Also, chronic and regular exposure can result in severe lung infections and worsening of asthmatic symptoms, especially in children
  • In some cases, the allergic reaction may be severe, causing anaphylaxis. This is a medical emergency that can lead to a respiratory failure. It requires an immediate treatment of the condition. In such cases, the prognosis is guarded and it depends on whether immediate medical assistance is provided

Additional and Relevant Useful Information for Cockroach Allergy:

Sneezing due to house dust is common, but it need not lead to an allergic condition in all cases.

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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team


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