Cockroach allergies occur when an individual's immune system overreacts to proteins in the feces, saliva, and/or body of a cockroach.
Patients may develop a reaction after inhaling the cockroach allergens in the insect's feces or saliva or after the insect touches the skin. The allergens cannot be seen and they may become airborne, especially during vacuuming or sweeping. These allergens may persist in areas where the cockroach was present at one time. For instance, if cockroaches were eating from an open bag of chips on the kitchen counter, an allergic reaction may occur if the individual touches the counter.
During an allergic reaction to cockroaches, the patient's white blood cells mistake the cockroach allergens as harmful substances like bacteria. When the white blood cells attack the cockroach allergens, allergic symptoms develop.
Symptoms of cockroach allergy vary among patients. Common symptoms include itchy skin or nose and scratchy throat. Individuals with allergic asthma are the most likely to develop allergies to cockroaches. When these patients are exposed to cockroach allergens, they may have an asthma attack. The most severe allergic reaction, called anaphylaxis, may cause shortness of breath, low blood pressure, and shock, all of which are potentially life threatening.
Cockroaches are considered one of the most resilient insects on the planet. They can live up to a month without food and can survive up to 45 minutes without oxygen.
Cockroaches are found all over the world. Cockroach allergy is most prevalent in urban areas and inner cities where they reside in high numbers. In fact, researchers at the Asthma and Allergy Foundation of America (AAFA) estimate that 23-60% of asthmatics who live in urban areas are allergic to cockroaches. Studies suggest that 78-98% of all urban homes have cockroaches. Cockroaches will eat virtually any food or garbage that is left uncovered in the home. Since more people live in urban cities, the cockroaches are more likely to find a suitable home in these areas.
Studies have shown that cockroach allergy is most prevalent among poor African Americans and Latinos. Researchers believe that this is because disproportionately high numbers of African Americans and Latinos live in urban areas.
Once a home becomes infested, the roaches reproduce quickly. It is estimated that an infested home or building may contain anywhere from 900-330,000 insects.
Allergy treatments for cockroach allergies depend on the severity of symptoms. The best way to relieve symptoms is to avoid contact with cockroaches. These insects are difficult to destroy and usually require the help of a professional exterminator. However, individuals can also purchase cockroach traps and poisons. If exposure is unavoidable, antihistamines, nasal sprays, decongestants, leukotriene inhibitors, and allergen immunotherapy (allergy shots) may help relieve symptoms. Patients who have allergic asthma that is caused or triggered by cockroaches may benefit from inhaled corticosteroids or bronchodilators.
In allergic individuals, the immune system becomes hypersensitive and overreacts to cockroach allergens that are inhaled or that come in contact with the person's skin.
An allergic response is not usually triggered the first time the body encounters the allergen. In general, patients do not become sensitized until they have been exposed one or more times to the allergen. During this process of sensitization, the body's white blood cells develop immunoglobulin E (IgE) antibodies to the cockroach allergens. Once sensitized, the IgE antibodies quickly detect and bind to the cockroach allergens when the allergen enters the body. This triggers the release of chemicals (like histamine) that cause allergic symptoms, such as runny nose, watery eyes, and sneezing.
Common allergy symptoms to cockroaches include sneezing, runny nose, itchy and watery eyes, nasal congestion, postnasal drip (mucus that drips from the sinuses down the throat), cough, irritability, facial pressure and pain, swollen and blue-colored skin under the eyes, skin rash, hives, allergic rhinitis (inflammation of the nose), rhinoconjunctivitis (inflammation of the nose and eyes), sinusitis (inflammation of the sinuses), as well as itchy nose, throat, or roof of the mouth.
Individuals who have allergic asthma may experience a worsening of symptoms after exposure to cockroaches. Asthma causes the airways to become inflamed. Common symptoms of allergic asthma include coughing, wheezing, shortness of breath, difficulty breathing, and chest pain.
General: The National Heart, Lung, and Blood Institute recommends that all patients with chronic asthma are tested for cockroach allergies in addition to the other major allergens including dust mites, animal dander, and mold.
Skin test: A skin ("scratch") test is used to determine whether a patient is allergic to cockroaches. During the test, the skin is exposed to the cockroach allergens and observed for an allergic reaction. If the allergen triggers an allergic reaction, the patient will develop reddening, swelling, or a raised, itchy red wheal (bump) that looks similar to a mosquito bite. The healthcare provider will measure the size of the wheal and record the results. The larger the wheal, the more severe the allergy.
A skin test is typically conducted in a healthcare provider's office. Skin tests cause minimal, if any, discomfort. The needles used barely penetrate the skin's surface and will not cause bleeding.
Allergen-specific immunoglobulin (IgE) test: An allergen-specific immunoglobulin E (IgE) test, commonly referred to as radioallergosorbent test (RAST©), may also be used to determine whether the patient is allergic to cockroaches. However, this test is less accurate than a skin test. It is usually performed in patients who have coexisting severe skin diseases (such as eczema or psoriasis) that make it difficult to interpret a skin test.
During the procedure, a sample of blood is taken from the patient. The blood is then sent to a laboratory that performs specific IgE blood tests. The cockroach allergen is bound to a paper disc called an allergosorbent. Then the patient's blood is added. If the blood contains immunoglobulin antibodies (substances that identify and bind to foreign invaders in the body) to the cockroaches, the blood will bind to the allergen on the disc. A radiolabelled ANTI-IgE antibody is then added to the disc to measure the level of IgE present in the blood. The higher the radioactivity, the higher the level of IgE in the blood and the more severe the allergy.
A qualified healthcare provider will interpret the results of the test. In general, the sensitivity of these tests ranges from 50-90%, with the average being about 70-75%. The patient will receive test results in about seven to 14 days.
General: Allergy treatments for cockroach allergies depend on the severity of symptoms. The best way to relieve symptoms is to avoid contact with cockroaches. These insects are difficult to destroy and usually require the help of a professional exterminator. Antihistamines, nasal sprays, decongestants, leukotriene inhibitors, and allergen immunotherapy (allergy shots) may help relieve symptoms. Patients who have allergic asthma that is caused or triggered by cockroaches may benefit from inhaled corticosteroids or bronchodilators. Patients should tell their healthcare providers if they are taking any drugs (prescription or over-the-counter), herbs, or supplements because they may interact with treatment.
Allergen immunotherapy (allergy shots): Allergen immunotherapy, also known as allergy shots, is often used to treat patients who suffer from severe allergies, or for those who experience allergy symptoms for more than three months a year. Allergen immunotherapy involves injecting increasing amounts of a diluted allergen into a patient over several months.
There are two phases of immunotherapy:
the build-up phase and the maintenance phase. During the build-up phase, allergy shots are injected into the upper arm once or twice a week for several months (typically three to six months). The dose is gradually increased until the maintenance dose is reached. The maintenance phase begins once the effective therapeutic dose is reached. This dose is different for each patient because it depends on the patient's level of allergen sensitivity and their response to immunotherapy during the build-up phase. Once the maintenance dose is reached, the patient will continue therapy every two to four weeks for two to five years or more.
Bronchodilators: Bronchodilators are a quick-acting medication that is used to stop symptoms of an asthma attack. The most commonly used short-acting beta-2 agonist for asthma is albuterol (Proventil HFA© or Ventolin HFA©).
Cromolyn sodium: Cromolyn sodium is available as a nasal spray (Nasalcrom©) for treating allergy symptoms. Eye drop versions of cromolyn sodium are available for itchy, bloodshot eyes. This medication works by creating a protective lining of the nasal cavities and outer eye surfaces that block the entry of allergens into blood stream.
Decongestants: Decongestants like pseudoephedrine (Sudafed© Nasal Decongestant) may help relieve symptoms such as nasal congestion (stuffy nose). These drugs shrink the tissues and blood vessels in the eyes and nose that swell in response to contact with an allergen. Nasal decongestant sprays like oxymetazoline (Afrin©) should not be used more than twice daily for three consecutive days because rebound nasal congestion may result. Decongestants in pill form do not cause this effect.
Extermination: The most effective treatment for cockroach allergies is to avoid exposure to cockroaches. If cockroaches have infested the home, a professional exterminator is often necessary to completely eliminate the insects.
If professional extermination is not possible, individuals can purchase cockroach poison baits and boric acid traps. However, chemical agents should not be used because they may irritate allergies and asthma. Also, patients should make sure all food and garbage is sealed. The trash should be emptied regularly.
Inhaled corticosteroids: Patients who suffer from allergic asthma and experience symptoms more than twice a week may be treated with inhaled corticosteroids like fluticasone (Flovent©), beclomethasone (Qvar©), budesonide (Pulmicort Turbuhaler©), or mometasone (Asmanex©). Inhaled corticosteroids may also be combined with long-acting inhaled bronchodilators like fluticasone/salmeterol (Advair©).
Longer-acting antihistamines: Longer-acting antihistamines like fexofenadine (Allegra©) or cetirizine (Zyrtec©) are available by prescription for mild to moderate allergy symptoms. They cause less drowsiness than short-acting antihistamines and they are equally effective. Although these medications usually do not interfere with learning, they should be use cautiously in children.
Nasal corticosteroid sprays: Nasal corticosteroid sprays can effectively relieve allergy symptoms in patients who are not responding to antihistamines. Commonly prescribed corticosteroid sprays include fluticasone (Flonase©), mometasone (Nasonex©), and triamcinolone (Nasacort AQ©).
Short-acting antihistamines: Short-acting antihistamines like diphenhydramine (Benadryl©) have been used to relieve mild to moderate allergy symptoms. Most short-acting antihistamines are available over-the-counter. Use cautiously, especially in children because these medications often cause drowsiness and they have been shown to impair cognition (slow learning) in children, even in the absence of drowsiness. However, loratadine (Claritin©), another over-the-counter medication, does not cause drowsiness or affect learning in children.
Good scientific evidence
: Bromelain has been studied in various clinical studies for sinusitis with mixed results. Further research is necessary.
Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or members of the Bromeliaceae
family. Use cautiously with history of bleeding disorder, stomach ulcers, heart disease, liver or kidney disease. Use caution before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.
: Good scientific evidence suggests that butterbur may be effective for allergic rhinitis prevention in susceptible individuals. Comparisons of butterbur to prescription drugs, such as fexofenadine (Allegra©) and cetirizine (Zyrtec©), have reported similar efficacy. Additional studies are warranted before a firm conclusion can be made.
Avoid if allergic or hypersensitive to Petasites hybridus or other plants from the Asteraceae/Compositae family (such as ragweed, marigolds, daisies, and chrysanthemums). Raw, unprocessed butterbur plant should not be eaten due to the risk of liver or kidney damage or cancer. Avoid if pregnant or breastfeeding.
: There is good evidence from clinical studies to recommend the use of nasal irrigation in the treatment of allergic rhinitis. One study demonstrated that reflexology massage may be equally effective; however, the advantage of irrigation (i.e. inexpensive, performed at home, minimal adverse side effects) makes the technique beneficial. Methodological and statistical reporting are lacking in some of these trials. A well-conducted, randomized controlled trial, fully reporting data would make the case for allergic rhinitis stronger.
Early research suggests that nasal irrigation may help treat chronic sinusitis, with improvements in sinus-related quality of life, decreases in symptoms, and decreases in medication use. Further study is needed before a conclusion can be made.
Nasal irrigation is generally well tolerated. Use cautiously with history of frequent nosebleeds. If the irrigation liquid is hot, the nose may become irritated.
: Use of probiotic Enterococcus faecalis bacteria in hypertrophic sinusitis (sinus inflammation) may reduce frequency of relapses and the need for antibiotic therapy. Further research is necessary before a firm conclusion can be made.
Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
Unclear or conflicting scientific evidence
: There is currently insufficient available evidence on which to base recommendations for acupuncture in non-allergic rhinitis. However, studies suggest that it may offer possible benefits. Additionally, more studies are needed of stronger design to determine whether or not acupuncture offers benefit in sinusitis.
Acupuncture should be avoided in patients with heart disease, pulmonary disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Pregnant women, the elderly, diabetics, people with a history of seizures, and those receiving radiation therapy and/or taking drugs increasing bleeding risks should also avoid acupuncture.
: Despite widespread use in over-the-counter agents and vapors, there is not enough scientific evidence to recommend use of eucalyptus oil as a decongestant-expectorant (by mouth or inhaled form).
Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
: Studies in patients with allergies found that black seed decreased subjective measures of severity of allergies. The effect of black seed for allergies is still not clear and further study is required before a conclusion can be made.
Avoid with a known allergy/hypersensitivity to black seed, its constituents, black seed oil, or to members of the Ranunculaceae family. Allergic contact dermatitis has been reported after topical use of black seed or the oil from the seed.
: It has been suggested that cat's claw may help treat allergies and related respiratory diseases. However, there is currently limited scientific evidence to support this claim. More well-designed trials are needed to determine whether cat's claw is a beneficial treatment.
Avoid if allergic to cat's claw or Uncaria plants or plants in the Rubiaceae family, such as gardenia, coffee, or quinine. Avoid with history of conditions affecting the immune system (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, lupus). Use cautiously with bleeding disorders or with history of stroke, or if taking drugs that may increase the risk of bleeding. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding. Cat's claw may be contaminated with other Uncaria species. Reports exist of the potentially toxic Texan-grown plant Acacia gregii being substituted for cat's claw.
: Oral tricholine citrate (TRI) effectively relieved allergic rhinitis symptoms in limited available study. Further research is needed before a firm conclusion can be made. Choline is generally regarded as safe and appears to be well tolerated.
Avoid if allergic to choline, lecithin, or phosphatidylcholine.
: Preliminary study suggests that ephedrine nasal spray may help treat allergic rhinitis. Additional research is needed before a recommendation can be made.
Ephedra taken by mouth can cause serious side effects, including heart attack, seizure, and stroke. Therefore, ephedrine nasal sprays should only be used in the nose. The U.S. Food and Drug Administration (FDA) has collected thousands of reports of serious toxicity linked to ephedra (including over 100 deaths). Ephedra products are banned from dietary supplements because of serious health risks, including heart attack, heart damage, breathing difficulties, and fluid retention in the lungs. Avoid with history of high blood pressure, abnormal heart rate, heart attack, stroke, seizure, eating disorders, anxiety, prostate disease, mental illness, kidney disease, stomach ulcers, heart disease, eye disease, depression, diabetes, thyroid disease, or sleep problems. Avoid if pregnant or breastfeeding.
: There is currently insufficient available evidence to recommend either for or against eucalyptus oil as a decongestant-expectorant.
Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, lung disease, or the blood condition known as acute intermittent porphyria. Use caution if driving or operating machinery. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
: Currently, there is insufficient human evidence to recommend honey for the treatment of rhinoconjunctivitis. Avoid if allergic or hypersensitive to honey, pollen, celery or bees.
Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
: Several studies suggest that some horseradish constituents may offer antibiotic activity and may help treat sinusitis. Additional high-quality clinical studies are needed before a conclusion can be made.
Avoid if allergic or hypersensitive to horseradish (Armoracia rusticana), its constituents, or members of the Brassicaceae family. Large oral doses may provoke allergic reactions. Use cautiously with clotting disorders, hypotension (low blood pressure), thyroid disorders, kidney disorders and inflammation, gastrointestinal conditions, and ulcers. Use cautiously if taking anticoagulants or antiplatelets (blood thinning agents), antihypertensives (blood pressure-lowering agents), anti-inflammatory agents, or thyroid hormones. Use cautiously if undergoing treatment for cancer. Avoid medicinal amounts of horseradish if pregnant or breastfeeding; based on herbal textbooks and folkloric precedent, horseradish has been used to induce abortion.
: It has been suggested that hypnotherapy may be effective for allergies. However, further research is necessary.
Use cautiously with mental illnesses such as psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders. Use cautiously with seizure disorders
: According to preliminary clinical study, MSM reduces symptoms associated with seasonal allergic rhinitis (SAR). However, larger controlled trials are needed to confirm these findings.
Avoid if allergic or hypersensitive to MSM. Long-term effects of supplementation with MSM have not been examined. Avoid if pregnant or breastfeeding.
: Research shows that topical application of an alcoholic onion extract significantly reduced responses to allergies. Although intriguing, more research is needed in this area to establish the efficacy and dosing of topical onion extracts.
Avoid if allergic or hypersensitive to onion (Allium cepa), its constituents, or members of the Lilaceae family. Use cautiously with hematologic (blood) disorders, diabetes, hypoglycemia (low blood sugar), and hypotension (low blood pressure). Use cautiously if taking anticoagulants or antiplatelets (blood thinners). Avoid medicinal doses if pregnant or breastfeeding.
: Preliminary evidence suggests some benefit of perilla extract for seasonal allergies. Further clinical trials are required before conclusions can be made.
Avoid if allergic/hypersensitive to perilla or members of the Lamiaciae/Labiatae family. Use cautiously with cancer, low HDL-cholesterol, and immune disorders. Use cautiously if taking NSAIDS or barbiturates. Avoid if pregnant or breastfeeding.
: Only a few types and combinations of probiotics have been studied as a possible allergy treatment. They have been studied mostly in children, teenagers, and young adults. Further research is necessary before a firm conclusion can be made.
Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
: Research suggests that an herbal combination preparation containing sorrel, Sinupret©, may have beneficial effects in improving symptoms of sinusitis when used with antibiotics. It is not clear if these same effects would be seen with sorrel alone or what dose may be safe and effective. For allergic rhinitis, there is not enough evidence to make a conclusion at this time. More research of sorrel alone is needed.
Avoid sorrel with a known allergy to sorrel or any of its constituents. Avoid large doses of sorrel because there have been reports of toxicity and death. Many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. Sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl©) or disulfiram (Antabuse©). Avoid if pregnant or breastfeeding.
: Anti-inflammatory properties of spirulina may help improve symptoms of allergic rhinitis. However, further high-quality studies are needed to confirm these findings.
Avoid if allergic or hypersensitive to spirulina or blue-green algae. Use cautiously with phenylketonuria (a genetic disorder of a liver enzyme that disrupts normal body functions), autoimmune diseases, bleeding disorders, diabetes, and osteoporosis. Use cautiously with products containing the blue-green algae species Anabaena spp., Aphanizomenon spp., and Microcystis spp.; in underweight patients or in those taking antiobesity agents or appetite suppressants; of if consuming a high-protein diet. Avoid in children or if pregnant or breastfeeding.
: For many years, a freeze-dried preparation of Urtica dioica has been prescribed by physicians and sold over-the-counter for the treatment of allergic rhinitis. Clinical trials demonstrating statistical significance over placebo and/or equivalence with other available treatments are needed to support the use of nettle in the treatment of allergic rhinitis.
Avoid if allergic or hypersensitive to nettle, the Urticaceae family or any ingredient of nettle products. Use cautiously with diabetes, bleeding disorders, and/or low sodium levels in the blood. Use cautiously with diuretics and anti-inflammatory drugs. The elderly should also use nettle cautiously. Avoid if pregnant or breastfeeding.
: Thymus extract may reduce allergy symptoms due to its potential immune stimulating effects. More clinical trials are required before recommendations can be made involving thymus extract for this use.
Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
: Although thought to aid in reducing the nasal symptoms of allergic rhinitis, vitamin E intake may not be effective. Current evidence is limited, however, and more studies are needed before a firm conclusion can be drawn.
Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe at doses up to 1,000 milligrams per day. Avoid doses higher than 1,000 milligrams a day. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders. The recommended dose of vitamin E for pregnant women of any age is 15 milligrams; for breastfeeding women of any age, the recommended dose is 19 milligrams. Use beyond this level in pregnant women is not recommended.
Fair negative scientific evidence
: Grape seed has been used to treat immune system disorders due to its antioxidant effects. However, a well-designed human study of allergic rhinitis sufferers showed no improvement in allergy symptoms with administration of grape seed extract ingredients.
Avoid if allergic or hypersensitive to grapes or other grape compounds. Use cautiously if taking blood thinners such as warfarin, aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or anti-platelet agents. Use cautiously with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with drugs processed using the liver's "cytochrome P450" enzyme system. Use cautiously with blood pressure disorders or if taking ACE inhibitors. Avoid with disorders that increase the risk of bleeding or with active bleeding disorders (stomach ulcers, bleeding into the brain, etc.). Avoid if pregnant or breastfeeding.
The best way to relieve symptoms is to avoid contact with cockroaches. These insects are difficult to destroy and may require the help of a professional exterminator. In addition, poison baits and boric acid traps may help eliminate cockroaches. However, chemical agents should not be used because they may irritate allergies and asthma.
Patients should keep all food and garbage in the home sealed. Cockroaches will eat virtually any food or garbage that is accessible. The trash should also be emptied regularly.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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- Gore JC, Schal C. Cockroach allergen biology and mitigation in the indoor environment. Annu Rev Entomol. 2007;52:439-63.
- Guo YS, Xu YP. [The specific IgE responses to three cockroach strains antigens in patients with asthma]. [Article in Chinese]. Zhonghua Nei Ke Za Zhi. 2006 Jul;45(7):556-8.
- Lopes MI, Miranda PJ, Sarinho E. Use of the skin prick test and specific immunoglobulin E for the diagnosis of cockroach allergy. J Pediatr (Rio J). 2006 May-Jun;82(3):204-9. View Abstract
- Morgan MS, Arlian LG, Bernstein JA, et al. Allergenicity of the Madagascar hissing cockroach. Ann Allergy Asthma Immunol. 2007 Mar;98(3):258-61.
- Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Copyright © 2009. Accessed May 12, 2009.
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