Contamination of nebulizer equipment with cockroach allergen: There's a bug in the system!

Mary E. Bollinger, Brian Wolf, Christina Schwindt, Robert G. Hamilton

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)475-477
Number of pages3
JournalAnnals of Allergy, Asthma and Immunology
Issue number4
StatePublished - Apr 2004

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pulmonary and Respiratory Medicine


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