Clinical Reviews in Allergy & Immunology

, Volume 57, Issue 3, pp 415–426 | Cite as

Asthma and Allergies in the School Environment

  • Brittany Esty
  • Perdita Permaul
  • Kristie DeLoreto
  • Sachin N. Baxi
  • Wanda PhipatanakulEmail author


The school is a complex microenvironment of indoor allergens, pollutants, and other exposures. The school represents an occupational model for children and exposures in this environment have a significant health effect. Current research establishes an association between school exposure and asthma morbidity in children. This review will focus on common school environmental exposures (cockroach, rodents, cat, dog, classroom pets, dust mite, fungus, and pollution) and their impact on children with allergies and asthma. Understanding and evaluation of school-based environments is needed to help guide school-based interventions. School-based interventions have the potential for substantial benefit to the individual, school, community, and public health. However, there is a paucity data on school-based environmental interventions and health outcomes. The studies performed to date are small and cross-sectional with no control for home exposures. Randomized controlled school-based environmental intervention trials are needed to assess health outcomes and the cost-effectiveness of these interventions. The School Inner-City Asthma Intervention Study (SICAS 2), a NIH/NIAID randomized controlled clinical trial using environmental interventions modeled from successful home-based interventions, is currently underway with health outcome results pending. If efficacious, these interventions could potentially help further guide school-based interventions potentially with policy implications. In the meanwhile, the allergist/immunologist can continue to play a vital role in improving the quality of life in children with allergies and asthma at school through the use of the ADA policy and Section 504 of the Rehabilitation Act as well as encouraging adoption of toolkits to build successful school-based asthma programs and asthma-friendly schools.


Asthma Allergen Environment Pediatric asthma Pollutant School School exposure School-based intervention 



School Inner-City Asthma Study


National Institutes of Health


National Institute of Allergy and Infectious Disease


Integrated pest management


High efficiency particulate arrestance


Particulate matter 2.5


Black carbon


Nitrogen dioxide


Carbon monoxide




School Inner-City Asthma Intervention Study



This work was conducted with support from Harvard Catalyst—The Harvard Clinical and Translational Science Center—(National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University, and its affiliated academic healthcare centers or the National Institutes of Health.


This work was supported by grants: K24 AI 106822, U01 AI 110397, R01 HL 137192 (PI: Dr. Phipatanakul) from the National Institutes of Health, and the Allergy and Asthma Awareness Initiative and K23 AI 123517 and LRP #L40 AI113791 (PI: Dr. Permaul) from the National Institutes of Health. Dr. Esty was supported by the Harvard Medical School Fellowship in Patient Safety and Quality (Boston, MA).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of ImmunologyBoston Children’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Division of Pediatric Allergy and ImmunologyWeil Cornell Medical CollegeNew YorkUSA
  4. 4.Allergy and Asthma Awareness Initiative, Inc.PeabodyUSA

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