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Pet Allergies Cat and Dog Allergens PowerPoint Presentation

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Dr. Sherry Dyer Adult and Pediatric Allergist & Immunologist Pet Allergies: Cat and Dog Allergens
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Cat and Dog Taxonomy
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Cat and Dog Taxonomy
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Cat and Dog Common Allergens
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Pomés A et al. Curr Allergy Asthma Rep. 2016;16:43 Cat and Dog – Indoor Allergens
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Fel d 1 is a 38 kD tetrameric glycoprotein with a structure similar to that of uteroglobulin. IgE from over 90 % of cat-sensitized individuals reacts with this major cat allergen. Fel d 1 is produced in sebaceous, anal, and salivary glands and transferred to the fur by grooming. Airborne Fel d 1 is mostly associated with larger particles (>9 μm) 23 % of airborne Fel d 1 is carried on small particles (<4.7 μm diameter) that stay suspended in the air for several days, favoring distribution of the allergen in the environment. Pomés A et al. Curr Allergy Asthma Rep. 2016;16:43 Pet Allergies: Cat Allergen
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Others relevant cat allergens Fel d 3: Cysteine protease inhibitor react with 10 % of IgE from cat-allergic patients. Fel d 6: Cat IgM is less well documented. Pomés A et al. Curr Allergy Asthma Rep 2016;16:43 Grönlund H et al. Int Arch Allergy Immunol 2010;151:265–274 Konradsen et al. J Allergy Clin Immunol 2015;135:616-25. Sarbjit S. Saini. Middleton's 8th edition. 90% 63% 37% 15-40% 40% High IgE levels to Fel d 1 could be a marker of increased asthma risk. High IgE levels to Fel d 4 have been associated with atopic dermatitis. Pet Allergies: Cat Allergen
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A proportion of the airborne allergen (10% to 40%) was being carried on smaller particles (less than 5 μm in diameter). The aerodynamic behavior of these particles and show that they are dynamically equivalent to spheres of 1 to 7 μm in diameter. It is important to realize that a flat “flake” of dander may potentially have an aerodynamic size smaller than its real size. Approximately 60% of airborne Fel d 1 settles out within 2 days of disturbance, leaving smaller particles that can remain airborne for up to 14 days or longer. J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Sarbjit S. Saini. Middleton's 8th edition. Pet Allergies: Airborne Cat Allergen
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The presence of a cat can increase airborne Fel d 1 within 30 minutes. Indeed, recent estimates suggest that the quantities of cat allergen inhaled are 10 to 50 times higher than mite allergen. The size of these particles has some important consequences. Small particles fall slowly and can be kept airborne by any movement in the house. Increased ventilation helps to remove small particles from a house. Air filtration with a room air cleaner may be a useful method of reducing exposure to allergen on small particles. J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Sarbjit S. Saini. Middleton's 8th edition. Pet Allergies: Airborne Cat Allergen
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More than 90% of all people who have respiratory tract symptoms related to cat exposure have IgE antibodies specific for Fel d 1. Measurements of Fel d 1 in the environment provide an excellent model for cat exposure relevant to asthma or rhinitis. Peptides derived from Fel d 1 have been proposed as an alternative to cat extract for immunotherapy. Fel d 1 itself has no important cross-reactivities and indeed has very little homology with any known allergens except Can f 4. Sarbjit S. Saini. Middleton's 8th edition. Pet Allergies: Clinical Significance of Specific Allergen Derived From the Cat
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Other allergens from cat are more important in relation to food allergy than to inhalant symptoms. Fel d 2, Cat albumin cross-reacts immunologically with several different mammalian albumins, including those of dog, pork, and beef  adult-onset allergic reactions to pork Pork-Cat Syndrome Patients with this syndrome sensitized to albumins from animal dander report symptoms after the consumption of pork because of the cross-reactivity of albumins from different species. Konradsen et al. J Allergy Clin Immunol 2015;135:616-25. Sarbjit S. Saini. Middleton's 8th edition. Pet Allergies: Clinical Significance of Specific Allergen Derived From the Cat
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Fel d 5w, cat IgA The alpha-gal–specific IgE antibodies were strongly associated with delayed anaphylaxis to red meat. IgE antibodies to alpha-gal will bind to cat IgA (Fel d 5w), beef thyroglobulin The presence of IgE antibodies to alpha-gal can lead to misleading results on IgE assays or skin tests using cat extracts. IgE antibodies to alpha-gal do not create a risk for asthma or other inhalant symptoms. Sarbjit S. Saini. Middleton's 8th edition. Pet Allergies: Clinical Significance of Specific Allergen Derived From the Cat
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Konradsen et al. J Allergy Clin Immunol 2015;135:616-25.
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Dogs can be a potent source of allergen, appears to be less common than cat allergy as a cause of asthma. Many dogs are kept outside and become dirty (actually, much worse), so washing dogs is a common practice. A common sources of dog allergens are dander and saliva. Four of six currently identified dog allergens are lipocalins. Can f 1, Can f 2, Can f 4, and Can f 6 Sarbjit S. Saini. Middleton's 8th edition. Pomés A et al. Curr Allergy Asthma Rep. 2016;16:43 Pet Allergies: Dog Allergen
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About ∼70 % of dog- allergic individuals have IgE antibodies specific to the major dog allergen Can f 1. Can f 1 is detectable in one third of homes without a dog. The size distribution of particles associated with Can f 1 is similar to that of Fel d 1. A wide variability in Can f 1 levels can be found between dog breeds, but there is no evidence for a hypoallergenic breed. Pomés A et al. Curr Allergy Asthma Rep. 2016;16:43 Pet Allergies: Dog Allergen
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Can f 5 (prostatic kallikrein, arginine esterase), derived from dog urine is also considered a major allergen, with up to 70% of dog- allergic patients having Can f 5-specific IgE. 38 % of dog-allergic patients were monosensitized to Can f 5. Other relevant dog allergens Can f 2 (lipocalin) react with 20–30% of IgE from dog- allergic patients. Can f 4 (lipocalin) react with 15–50% of IgE from dog- allergic patients. Can f 6 (lipocalin) react with 38% of IgE from dog- allergic patients. Can f 3 (dog albumin) react with 81 % of IgE from dog- allergic patients. Significant inhalant allergens Sarbjit S. Saini. Middleton's 8th edition. Mattsson et al. J Allergy Clin Immunol 2009;123:362-8. Pomés A et al. Curr Allergy Asthma Rep. 2016;16:43 Pet Allergies: Dog Allergen
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D.M. Smith and C.A. Coop. Ann Allergy Asthma Immunol 2016;116:188-193 Pet Allergies: Dog Allergen
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Konradsen et al. J Allergy Clin Immunol 2015;135:616-25. Pet Allergies: Cat and Dog Allergen
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Pet Allergies: Immune Response to Cat and Dog Allergen
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The immune response to domestic animal allergens includes T cells IgE antibodies different isotypes of antibodies. At present, both the significance of IgE antibodies and the techniques for measuring IgE antibody levels are better established than the techniques for describing any other aspect of the immune response. Konradsen et al. J Allergy Clin Immunol 2015;135:616-25. Pet Allergies: Immune Response to Furry Animal Allergens in Addition to IgE
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T-cell responses A wide range of studies have been carried out on T-cell responses to cat allergens using both the protein Fel d 1 and overlapping peptides derived from Fel d 1. These studies demonstrated that responses to Fel d 1 are, broadly speaking, of a TH2 type. Although it is possible that there are patients who have symptoms related to cat or dog allergen exposure on the basis of a T-cell response without an associated IgE antibody response, this has not been demonstrated. Konradsen et al. J Allergy Clin Immunol 2015;135:616-25. Pet Allergies: Immune Response to Furry Animal Allergens in Addition to IgE
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IgG antibody responses There are mixed data about the isotypes other than IgE and IgG4. Many publications report detectable IgG4 antibodies in most allergic and non-allergic subjects in contrast to extensive earlier data. Although the results might not be relevant to the clinical evaluation of patients, they are important to understanding the immune response to cat allergens in those atopic children who live in a house with a cat but do not become symptomatic on exposure to cat allergens. Konradsen et al. J Allergy Clin Immunol 2015;135:616-25. Pet Allergies: Immune Response to Furry Animal Allergens in Addition to IgE
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IgG antibody responses (Cont.) The dissociation of allergen-specific IgE and IgG responses to cat, dog, and horse was reported, indicating that nonsequential class-switch mechanisms are operative in patients with animal allergy and might explain why naturally occurring allergen-specific IgG is not always protective. Measurement of IgG antibodies might also be relevant to understanding why some subjects experience increased symptoms on entering a house with an animal after a period of decreased exposure. Konradsen et al. J Allergy Clin Immunol 2015;135:616-25. Pet Allergies: Immune Response to Furry Animal Allergens in Addition to IgE
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Study design: Prospective cohort study Participants: 97 college students who tolerated living in a house with a cat Intervention: Decrease exposure to cat allergen The primary outcome: The change in antibody titers over time. Measure: Skin prick test: at baseline Specific IgE to cat: at baseline, 8 months Specific IgE to Fel d 1: at baseline, 8 months IgG to Fel d 1  IgG4 to Fel d 1: at baseline, 8 months E.A. Erwin et al. Ann Allergy Asthma Immunol 2014;112:545-550
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Having IgG without evidence of sensitization was the most frequently observed immune response to cat (n = 32). None of the students who had IgG but were not sensitized to cat had wheezing. E.A. Erwin et al. Ann Allergy Asthma Immunol 2014;112:545-550
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Non-sensitized individuals with IgG to Fel d 1 experienced a significant decrease in IgG titers with decreased exposure to cat allergen (p=0.02). For those students (n = 21) who were followed up for a second year, levels of IgG antibody to Fel d 1 had decreased further. Non- sensitized individuals, IgG4 also decreased (P < .001) during 8 months of decreased cat exposure. None of the individuals having IgG to Fel d 1 without sensitization to cat developed a positive serum IgE antibody assay or a positive skin prick test result to cat during 1 year or 2 years. Changes in Antibody Titers to Fel d 1 in Non-sensitized Individuals E.A. Erwin et al. Ann Allergy Asthma Immunol 2014;112:545-550
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Specific IgE titers to cat did not decrease significantly during prolonged, decreased exposure to cat allergen. IgG antibody to Fel d 1 decreased significantly during the 8-month study period (P < .001) E.A. Erwin et al. Ann Allergy Asthma Immunol 2014;112:545-550
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There was a highly significant decrease in the ratio of IgG to IgE antibodies after 8 months, decreased exposure to cat allergen. E.A. Erwin et al. Ann Allergy Asthma Immunol 2014;112:545-550
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Conclusion: Under conditions of marked decrease in exposure, No participants developed new-onset sensitization. Among the individuals sensitized at study entry, there were major decreases in the ratio of IgG to IgE. E.A. Erwin et al. Ann Allergy Asthma Immunol 2014;112:545-550
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Pet Allergies: The Effects of Cats or Dogs in the Home
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The major cat allergen, Fel d 1, remains airborne for many hours after any disturbance. As a result, estimates of the quantities of cat (or dog) allergens inhaled in a house with an animal are much higher, at approximately 1 μg/day, than comparable estimates of Der p 1 inhaled of 10 ng/day. In addition, the particles of dander carrying cat allergens appear to be “sticky,” which means that they are consistently carried on clothing from houses with an animal to other buildings. Sarbjit S. Saini. Middleton's 8th edition. Pet Allergies: The Effects of Cats or Dogs in the Home and Passive Transfer of Allergens
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In a community where 20% or more of the families have animals, these allergens will be easily measurable in dust from schools or in homes without a cat. Sensitization to cats can occur without direct exposure to the animals. In some studies, 75% of the children who are allergic to cats have never lived in a house with a cat. Sarbjit S. Saini. Middleton's 8th edition. Pet Allergies: The Effects of Cats or Dogs in the Home and Passive Transfer of Allergens
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In 1998, Hesselmar and Bjorksten reported that children raised in a house with a cat were less likely to become allergic to cats. This result was greeted with astonishment; however, several other groups of investigators found strong evidence supporting that observation. Many of the “non-allergic” children who lived in a house with a cat had made IgG and IgG4 antibodies to Fel d 1. This response is of interest in that it has more of the features of a “modified Th2” response than of a shift to Th1. The effect of exposure to a cat in early life can be both allergen- specific and long-lasting. Sarbjit S. Saini. Middleton's 8th edition. Pet Allergies: The Effects of Cats or Dogs in the Home and Passive Transfer of Allergens
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Study design: Meta – analysis Objective: To examine the associations between pet keeping in early childhood and asthma and allergies in children aged 6–10 years. Participants: Data of 11 prospective European birth cohorts that recruited a total of over 22,000 children in the 1990s. Exposure definition: Ownership of only cats, dogs, birds, rodents, or cats/dogs combined during the first 2 years of life. Outcomes: Allergic asthma, Allergic rhinitis and Allergic sensitization during 6–10 years of age. Lodrup Carlsen KC et al. PLoS One 2012;7:e43214.
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Lodrup Carlsen KC et al. PLoS One 2012;7:e43214. OR= 1.09 OR= 0.79 Pet Allergies: Allergic Asthma
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OR= 0.91 Lodrup Carlsen KC et al. PLoS One 2012;7:e43214. Pet Allergies: Allergic Asthma
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OR= 0.65 OR= 0.87 Lodrup Carlsen KC et al. PLoS One 2012;7:e43214. Pet Allergies: Allergic Sensitization
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OR= 0.68 Lodrup Carlsen KC et al. PLoS One 2012;7:e43214. Pet Allergies: Allergic Sensitization
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Lodrup Carlsen KC et al. PLoS One 2012;7:e43214. OR= 1.02 OR= 0.77 Pet Allergies: Allergic Rhinitis
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OR= 0.79 Lodrup Carlsen KC et al. PLoS One 2012;7:e43214. Pet Allergies: Allergic Rhinitis
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Conclusion: Pet ownership in early life did not appear to either increase or reduce the risk of asthma or allergic rhinitis symptoms in children aged 6–10. Advice from health care practitioners to avoid or to specifically acquire pets for primary prevention of asthma or allergic rhinitis in children should not be given. Lodrup Carlsen KC et al. PLoS One 2012;7:e43214.
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An issue of some clinical importance is whether the effect of a dog in the house is the same as the effect of a cat. High levels of endotoxin in the home were inversely related to allergen sensitization. Several detailed studies have shown that a cat in the home does not increase endotoxin either in floor dust or in airborne form. The presence of one or more dogs in the house does increase airborne endotoxin, and in some studies, early exposure to dogs appeared to have an inhibitory effect on allergy in general. Sarbjit S. Saini. Middleton's 8th edition. Pet Allergies: The Effects of Cats or Dogs in the Home and Passive Transfer of Allergens
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Although undoubtedly individual differences will affect the response to animal exposure, two very different mechanisms may be involved. The first is the shift, induced by higher exposure, to germinal center production of B cells, which favors IgG4 production and may be a major component of the allergen-specific tolerance induced by early exposure to cat allergens. The second mechanism is increased endotoxin or increased bacterial diversity in the home, with consequent effects on the microbiome of the child during early development. The second mechanism would not be allergen- specific and is more likely with a dog than with a cat. Sarbjit S. Saini. Middleton's 8th edition. Pet Allergies: The Effects of Cats or Dogs in the Home and Passive Transfer of Allergens
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Pet Allergies: Environmental Assessment and Exposure Control
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Ann Allergy Asthma Immunol 108 (2012) 223.e1–223.e15 Contents lists available at SciVerse ScienceDirect Practice Parameter Environmental assessment and exposure control: a practice parameter—furry animals Chief Editors: Jay Portnoy, MD, Kevin Kennedy, MPH, James Sublett, MD A desire for companionship often override the medically prudent advice to avoid exposure to dogs and cats for a sensitized person. The bottom line is that patients love their pets. They are part of the family. Pet ownership is likely to persist. Allergists need to be able to advise their patients how to live with the pet while remaining as healthy as possible.
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Removal of cats is recommended to decrease overall exposure. However, complete removal of all cats is necessary to minimize cat allergen exposure in a home. (C) Cat characteristics, such as length of hair, sex, reproductive status, and time spent indoors, are not associated with levels of Fel d 1 in the environment. Therefore, interventions related to these factors cannot be recommended. (C) Data about the effect of neutering a dog or cat are inconsistent, No specific recommendations can be made at this time about performing such a procedure to reduce allergen exposure. (D) J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Pet Allergies: Exposure to Cat Allergen
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Because 1 or more cat allergens are present in all cats, patients should not be advised that it is safe to obtain a nonallergenic cat. (C) Measurement of cat allergens in settled dust should not be used as a surrogate for airborne exposure. (C) Carpets are the major reservoir for pet allergens in homes with pets Dust from living rooms contains significantly higher concentrations of both Fel d 1 and Can f 1 than dust from bathrooms, kitchens, and bedrooms, although the beds may contain even higher concentrations of Fel d 1. To reduce transport of cat allergen, people should consider changing their clothes when traveling from a high cat allergen environment to a low cat allergen environment. (C) J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Pet Allergies: Exposure to Cat Allergen
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Because 1 or more dog allergens are present in all dogs, patients should not be advised that it is safe to obtain a nonallergenic dog. (C) Dogs should be excluded from rooms in which reduced exposure is desired. (C) The number of dogs in the home is not related to dog allergen levels. Homes with outdoor dogs have higher dog allergen levels than homes without any dogs but lower levels than homes with indoor dogs. Upholstered chairs in hospitals are an important reservoir of cat and dog allergen. Special daycare centers with children who don’t have dogs or cats have lower concentrations of both dog and cat allergen than daycare centers with children who live with a dog or cat. J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Pet Allergies: Exposure to Dog Allergen
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Although exposure to elevated cat allergen Fel d 1 concentrations before 3 months of age may reduce the likelihood of developing cat sensitization, the risk reduction is not sufficient to justify a decision to get a cat to avoid IgE sensitization. (C) Although exposure to elevated dog allergen Can f 1 concentrations before 3 months of age may reduce the likelihood of developing dog sensitization, the risk reduction is not sufficient to justify a decision to get a dog to avoid IgE sensitization. (C) J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Pet Allergies: Primary Prevention to Avoid IgE Sensitization
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Cat exposure should be minimized in cat sensitized individuals to reduce the likelihood of developing asthma. (C) Dog exposure should be minimized in dog sensitized individuals to reduce the likelihood of developing asthma. (C) Exposure to cat allergens should be minimized to reduce the likelihood of an asthma exacerbation in cat sensitized schoolchildren and adults who already have asthma. (A) Exposure to dog allergens should be minimized to reduce the likelihood of an asthma exacerbation in dog sensitized schoolchildren and adults who already have asthma. (A) J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Pet Allergies: Secondary Prevention to Avoid Disease in IgE Sensitized Individuals Pet Allergies: Tertiary Prevention to Treat Furry Animal Allergy
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Patients should be asked whether there is a dog or cat in the house because an affirmative answer is associated with greater exposure to dog or cat allergens. (C) Patients with allergic disorders should be evaluated for sensitization to cat and dog allergens by skin prick testing or in vitro testing for cat and dog specific IgE. (C) J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Clinical Evaluation
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Patients should be advised to consider removing the cat or dog from the environment, if present, to improve respiratory health. (A) To reduce exposure to cat allergens with the cat still living in the house, a combination of measures, such as removing reservoirs, keeping the cat out of the bedroom, washing the cat, air cleaning with a HEPA room air cleaner, improving ventilation, and mattress and pillow covers, may be helpful. (C) J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Avoidance
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Chemical treatments, such as tannic acid, can be applied to carpet to give short-term reduction of cat allergen, but this is not sustained and there is no evidence that it improves respiratory health. (C) Use of hypochlorite bleach to denature indoor allergens can reduce allergen exposure, improve quality of life, and reduce the likelihood of developing atopy, but it can also lead to increased respiratory symptoms in individuals using it. (C) J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Avoidance
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Washing cats or dogs at least weekly can reduce airborne cat Fel d 1 or dog Can f 1; however, the clinical benefit is yet to be proven and the effect of washing is not sustained. (B) Some woven microfiber bed encasings, generally those with a mean pore size of 6 m or less, block cat allergen from penetrating the fabric though the respiratory health benefit from their use is unclear. (C) Nonwoven microfiber encasings collect allergen on their surface over time, including cat and mite allergens. Because they cannot be washed, they are unsuitable for allergen avoidance. (C) J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Avoidance
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Long-term regular use of high-efficiency or central vacuum cleaners is associated with reduced exposure to Fel d 1 and Can f 1 in homes with cats or dogs living in them, although the health effects are uncertain. (B) HEPA air cleaners run continuously over time can reduce exposure to dog and cat allergen concentrations, but the clinical benefits are unknown. (B) Dog and cat allergens are relatively stable to dry heat so dry heat should not be used specifically to reduce exposure. (C) J. Portnoy et al. Ann Allergy Asthma Immunol 2012;2018:223.e1–223.e15 Avoidance
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BOX 28-3 AVOIDANCE MEASURES FOR CAT ALLERGENS Removal of cat from the home* Measures to reduce allergen with cat in situ Reduce reservoirs for cat allergen (e.g., carpets, sofas). Use vacuum cleaners with effective filtration system. Increase ventilation or use high-efficiency particulate air (HEPA) filters to remove small airborne particles. Wash cat weekly, if possible. *Reducing allergen levels requires about 12 to 16 weeks after cat is removed. Sarbjit S. Saini. Middleton's 8th edition. Avoidance
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Pet Allergies Cat and Dog Immunotherapy
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Although the best treatment for animal allergy is avoidance. This is not always possible. Exposure to both dog and cat allergen has been shown to be ubiquitous and can occur even without an animal in the home. Making avoidance even more difficult. Because immunotherapy has been shown to be effective for cat and dog The decision to include dog or cat allergen in an allergen immunotherapy extract should be considered in those circumstances in which there is exposure. Cox et al. J Allergy Clin Immunol 2011;127:S1-55 Pet Allergies: Cat and Dog Immunotherapy
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The major allergen content of cat extracts is relatively low, requiring larger amounts to be given than for pollens or house dust mite. The major allergen content of most dog extracts is too low to allow effective dosing, even with undiluted manufacturers’ extracts. However, in one study using an extract containing approximately 161 mg/mL Can f 1 (Hollister-Stier Laboratories, Spokane, Wash), there was a significant dose response of immunologic parameters similar to that demonstrated with other allergens. Cox et al. J Allergy Clin Immunol 2011;127:S1-55 Pet Allergies: Cat and Dog Immunotherapy
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Cox et al. J Allergy Clin Immunol 2011;127:S1-55
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Fel d 1 is now available as an additional recombinant allergen and supplemental diagnostic tool for the diagnosis of cat allergy. This single major cat allergen has shown to be as good as cat dander extract in identifying patients. The IgE levels in rFel d 1 may be useful as increased levels in children seem to be a potential risk factor for allergic asthma. Grönlund H et al. Int Arch Allergy Immunol 2010;151:265–274 Pet Allergies: Cat Immunotherapy
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Fel d 1 is an ideal model allergen for the development of new strategies for allergen-specific treatment of allergy and asthma. Fel d 1 hypoallergens Peptide-based immunotherapy: T-cell epitope-containing peptides Engineered Fel d 1 proteins with immunomodulatory function: Formulations consisting of Fel d 1 coupled to an immunomodulatory protein or carrier. Results reported from studies evaluating these approaches in experimental in vitro and in vivo systems as well as in clinical trials with Fel d 1 peptides bear promise that safer, more specific and efficient ways to treat cat-allergic patients will be available in the future. Grönlund H et al. Int Arch Allergy Immunol 2010;151:265–274 Pet Allergies: Cat Immunotherapy
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Study design: Randomized, double-blind, placebo-controlled, parallel-group clinical trial Subjects: 18- 65 years, had a history of rhinoconjunctivitis on exposure to cats for at least 1 year Study medication: Cat-PAD: 6-nmol, 3 -nmol Cat-PAD: Cat-peptide antigen desensitization Peptide immunotherapy uses synthetic peptides consisting of T-cell epitopes derived from major allergens and autoantigens to induce antigen-specific tolerance. Delivery of T-cell epitopes intradermally is thought to lead to the induction of T cells with a regulatory phenotype, which results in downregulation of the response to antigen. Patel et al. J Allergy Clin Immunol 2013;131:103-9
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Intervention: 3 groups Primary efficacy measurement: the mean change in TRSSs at 50 to 54 weeks from 1 hour onward on days 2 to 4 of the posttreatment challenge (PTC) compared with baseline values Patel et al. J Allergy Clin Immunol 2013;131:103-9
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Patel et al. J Allergy Clin Immunol 2013;131:103-9
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Baseline 18-22 wks after treatment 50-54 wks after treatment Mean TRSSs score Patel et al. J Allergy Clin Immunol 2013;131:103-9
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Results: Greater efficacy with 4 administrations of a 6-nmol dose 4 weeks apart The treatment effect of 6 nmol persisted 1 year after the start of treatment and was significantly different from 3-nmol (P= 0.0342) and placebo (P= 0.0104) Conclusions: A short course of Cat-PAD improves the ocular and nasal components of rhinoconjunctivitis symptoms in subjects with cat allergy, with the treatment effect persisting 1 year after the start of treatment. Patel et al. J Allergy Clin Immunol 2013;131:103-9
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P. Couroux et al. Clinical & Experimental Allergy 2015;45:974–981
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D.M. Smith and C.A. Coop. Ann Allergy Asthma Immunol 2016;116:188-193
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Studies investigating dog allergen immunotherapy during the past 40 years have failed to demonstrate any clearly reproducible clinical evidence to confirm its effectiveness in ameliorating symptoms of rhinitis and asthma. Variability of Dog Extracts In 1996 report noted that Can f 1 levels in these extracts ranged from 3.8 to 170 mg/mL. The major dust mite allergens, Der p 1 and Der p 2, were detectable in all commercial dog extracts. The possibility of false positives with skin prick testing for dog allergy. In 2001 compared the newest AP dog extract to the traditional aqueous dog extract 48% tested positive to AP dog. Only 28%tested positive to conventional dog extracts. All patients who tested positive to conventional extracts also were positive to AP dog, with a significantly larger mean wheal diameter. 41% who tested positive to AP dog tested negative to conventional dog extracts. These data perpetuated questions about false negative. D.M. Smith and C.A. Coop. Ann Allergy Asthma Immunol 2016;116:188-193 Pet Allergies: Dog Immunotherapy
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Stability of Dog Extracts In 1998 showed that Can f 1 was relatively thermostable, with 50% of the allergen remaining after 60 minutes of 140 C dry heat. In 2009, the stability and compatibility of AP and conventional dog extracts were investigated Can f 1 levels remained at 94% to 119% and Can f 3 retained 79% to 94% potency for 3 days when kept between 21 C and 45 C, showing standard shipping methods without refrigeration are acceptable for extracts. The extracts with 50% glycerin retained their potency, whereas the extracts with no more than 10% glycerin showed significant degradation. D.M. Smith and C.A. Coop. Ann Allergy Asthma Immunol 2016;116:188-193 Pet Allergies: Dog Immunotherapy
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Current Prescribing Trends A nationwide survey in 2006 showed the perspective of how allergists across the United States were integrating these conflicting and confusing data and using them in daily practice. Responses showed the maintenance weight-to-volume ratio varied widely from 1:10 to 1:1,000 with the most common concentration being 1:100 (24.3%). Most allergists believe that dog immunotherapy will provide at least some relief from allergic rhinitis (91.9%) and asthma (89.6%) 86% would be willing to offer immunotherapy to treat occupational allergy. This rate decreases to 81% if the patient is unable to remove the dog for purely emotional reasons. To compare with 1987 when only 65% of board-certified allergists in private practice perceived improvement in allergic rhinitis or asthma symptoms with cat or dog immunotherapy. D.M. Smith and C.A. Coop. Ann Allergy Asthma Immunol 2016;116:188-193 Pet Allergies: Dog Immunotherapy
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Future research is necessary to produce more potent and complex extracts that could be tailored to an individual patient’s pattern of dog sensitization. The first step would be to produce a standardized extract for clinical use. Additional trials could be designed to evaluate the efficacy of dog allergen immunotherapy in improving clinical end points for patients. Properly powered studies with consistent allergen extracts also would facilitate identification of the optimal dose required to produce these effects. The current recommendation on immunotherapy dosing for nonstandardized dog extracts is 15 ug of Can f 1 per dose. 0.5-mL dose using full-strength (1:100 w/v) AP dog extract D.M. Smith and C.A. Coop. Ann Allergy Asthma Immunol 2016;116:188-193 Pet Allergies: Dog Immunotherapy
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sherry

About : Expert allergist with holistic and caring approach to care, specializing in immunotherapy, eczema, trigger point injections, hereditary angioedema, chronic sinus pain and severe asthma.
Occupation : Medical Professional
Specialty : MD
Country : United States of America
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