Up to 1,200 patients are enrolling in an international study to evaluate a new form of allergy immunotherapy which, if successful, will require as few as four allergy shots, given monthly, to rid a patient of an allergy to cat dander.

Current immunotherapy for cats takes about three years and often more than a hundred shots to complete.

“Use of immunotherapy has always been limited by the long treatment required,” said allergist Dr. Harold Nelson of National Jewish Health in Denver, who is heading the project. “If the current study confirms earlier findings, it could be a major step forward for allergy treatment,” he said in a news release.

With traditional allergy immunotherapy, multiple injections of protein triggers like cat dander or pollen are given in small then increasing amounts over a long period of time. The idea is to gradually build tolerance and, ultimately, to desensitize the patient to the allergen. While this type of vaccination is currently the only way to treat the underlying allergic disease (rather than just allergy symptoms), it is a fairly invasive, costly and time-consuming, since patients must make numerous visits to the doctor.

Cat allergy is one of the most common allergic disorders, and a frequent trigger for asthma. The protein in cat dander that causes almost all symptoms is “fel d 1”, and the new vaccination therapy, called ToleroMune, works by injecting seven tiny protein fragments or “peptides” of this cat protein, as opposed to the whole protein.

By using the fragments, which aren’t large enough to provoke an allergic reaction, studies to date show that patients can become desensitized to cat much more rapidly and with far few side effects. Unlike the proteins used in traditional immunotherapy, as the protein fragments are not large enough to cause a reaction.

The study is expected to involve about 1,200 participants at National Jewish Health as well as at more than 100 centers in the United States, Canada, and Europe. Researchers hope to confirm earlier findings which showed that after four shots of ToleroMune, which has been developed by the British firm Circassia Ltd., many patients became desensitized and remained so a year later.

DECORATING

1. Scented Candles
The thought of cinnamon or vanilla wafting through the house may appeal, but scented candles smell of big trouble for those with allergies or chemical sensitivities.

“People who have environmental allergies such as to pollen or pets develop very sensitive inflamed nasal tissue which is hyper-reactive,” explains Ottawa allergist Dr. Antony Ham Pong. “These tissues then react more strongly to scents, and act as if they are allergens and mimic an allergic reaction.”

Plus, consider whether soy-allergic guests will be visiting before you light up that soy wax candle. While most are made from hydrogenated oil, which won’t cause an inhalant reaction, your soy-allergic guest or her child may feel uncomfortable knowing that a soy product is wafting through the air.

Advice: Use unscented, beeswax candles or opt instead for trendy fairy light strings for table décor or wreaths.

2. Festive Spores
If you have environmental allergies, a pine or cedar dominating the living room can bring you to sneezes and tears (or worse). Allergists warn at this time of year about “Rudolph the Reindeer Syndrome,” literally a reaction to the Christmas tree.

“Allergic reactions can occur to any pollen from the pine cones, or to mold in the bark of the tree,” Dr. Ham Pong notes. He says the tree’s resin can also cause “either eczema from contact with the skin, or nasal symptoms due to the scent.”

Mold is the biggest issue – some studies suggest household mold counts can increase as much as 10 times with a cut tree in the home. But an artificial tree can also harbor mold if it was stored in a damp basement.

Advice: Reduce the allergen load of a fresh-cut tree with a good blow-out – either taking it home on the roof of your car or subjecting it to a leaf blower on your front lawn. This gets rid of pollen grains and some mold. If mold is an asthma trigger, the Asthma and Allergy Foundation of America additionally suggests wiping around the tree’s trunk with a solution of 1 part bleach to 20 parts of lukewarm water. Also, wear gloves when moving a tree or boughs to avoid contact with the sap.

Or: Opt instead for a nice faux tree. Just be sure to enclose it plastic post-season, and store it in a dry spot.

3. Up in Smoke
Watch out for a roaring wood fire when visiting. As Certified Asthma Educator Jo-Anne St. Vincent has explained in Allergic Living magazine, that can expose those with asthma or allergies to a variety of environmental triggers, including smoke and mold.

If visiting friends in a home with a trendy enclosed gas fireplace, that’s a safer bet. But even then don’t linger close by. Vincent says gas-burning fireplaces still emit nitrogen oxide, which can increase inflammation of the airways.

While manufactured fireplace logs used to be infamous for off-gassing toxic chemicals (since industrial waste was part of their composition), today these logs are much more environmentally friendly. There are still two problems though from an allergy/asthma perspective:

a) smoke, no matter how “green” still irritates sensitive airways.
b) Nut allergy concerns. Several brands make “crackling” fire logs, and they use walnut or other nut shells to achieve the sound while burning. It’s wise to avoid putting such proteins into the air around a nut-allergic individual.

Advice: Best of all is to ask close family to forego the fire in the living room, if that’s to be the main party room.

Next: Gift Giving, Food and Drink Tips

After one of his patients broke out in hives and had trouble breathing after drinking marijuana tea, Dr. Gordon Sussman began asking his patients about their marijuana use, and recruited 17 people for a study. Sussman, acting division director of allergy and immunology at the University of Toronto, tested each patient with a skin-prick test using marijuana extracts.

All 17 developed skin reactions and other allergy symptoms; 15 experienced rhinitis and wheezing and 13 developed hives. “People have thought reactions were due to contaminants like mold, but I think marijuana itself is an allergen,” says Sussman.

He is writing up his study for publication; next, he’ll head to the lab in the hopes of isolating the allergen in the plant.

“With the use of medical marijuana, and with marijuana use just generally more widespread, I think people should be aware of this allergen,” says Sussman. “It’s not as uncommon as people think.”

Hives triggered by cold caused me years of itching and embarrassment.
How I finally made peace with winter.

I vividly remember the first time it happened. I was 9 years old, and walking to school in Calgary on a chilly October morning. Although my mother had set out my winter coat and hat, I sneaked out of the house wearing only a light jacket. I was cold, and soon my face started to feel funny.

I felt bumps on my cheeks, but didn’t think too much of this until I reached the playground. “What’s wrong with your face?” a boy in my class demanded loudly.

Suddenly, kids crowded around staring and questioning. I buried my face in my hands. This, it would turn out, was my first outbreak of cold-induced urticaria – or hives and swelling brought on by exposure to cold conditions.

From then on, chilly weather came to mean anxiety and restrictions. While I had no formal diagnosis, the family doctor’s orders were simply to avoid the cold. My parents’ over-protectiveness kicked into high gear, and my winter activities became slim pickings. No more ice skating or tobogganing and, even with the Rocky Mountains a stone’s throw away, I could forget about skiing.

Things didn’t improve with teendom. The gawking and ridicule I had to endure when I broke out in hives during outdoor gym class or a fire drill were horrifying to an adolescent.

And we’re not talking little dot hives; I got big welts all over my body. I spent hours concocting excuses for not going out in the cold or developing escape routes and backup plans in case it turned cold.

It wasn’t until I was an adult, and with the advent of the Internet, that I was able to find some answers, and have another doctor make a firm diagnosis. Following years of suffering and avoidance, finding a management plan that worked for me was a complete revelation.

Identifying the Culprit

Part of the problem with getting a diagnosis is that cold-induced urticaria is a relatively rare condition. Experts say it accounts for only 3 per cent of chronic urticaria cases.

There are two forms of cold-induced urticaria; the first is “familial”, a disorder that runs in a family’s genes and emerges in infancy. The second, more common form is “acquired”. It is not genetic, and cases have occurred in babies as well as senior citizens.

Acquired is further divided into primary or idiopathic – the latter literally meaning “unknown cause”. Dr. Martin Ostro, a professor with the division of allergy and inflammation at Harvard University’s Beth Israel Deaconess Medical Center in Boston, explains that in “90 per cent of cases, there is no underlying cause demonstrated.”

In other words, while the experts know that cold triggers these reactions, they can’t say why people like me develop the condition.

I had assumed I was simply “allergic to the cold”. But cold-induced urticaria is not a typical allergy in that there is no specific IgE, the allergic antibody, which responds to a particular substance.

People with allergies, whether it’s to food, stinging insects, or medications, can be at risk of severe symptoms. Not all people will have all symptoms, and they will vary based on what you’re allergic to. Additionally, each exposure could bring on different symptoms.

The Range of Symptoms
-Tingling in the mouth
-Swelling of the tongue and throat / feeling of throat tightness
-Itchy skin, hives or skin redness
-Abdominal cramps
-Vomiting or diarrhea
-Breathing difficulty, wheezing
-Faintness due to a sudden drop in blood pressure

Symptoms reviewed by Dr. Susan Waserman

Anaphylaxis

Anaphylaxis is the severe form of allergic reaction. It involves one or more of the body’s symptoms; for example, the gastrointestinal tract, the respiratory tract, the skin and the cardiovascular system. A person experiencing anaphylaxis often has difficulty breathing, and the person could lose consciousness. Anaphylaxis puts a person at risk of death.

Anaphylactic reactions can come on quickly, and it’s impossible to know when a reaction will become severe. It’s important that people with food allergies are prepared for a reaction by always carrying an epinephrine auto-injector (either EpiPen or Twinject).

Experts recommend using epinephrine early if a person known to be at risk of anaphylaxis begins to show signs of allergy symptoms – don’t wait until the symptoms worsen, as it may become to difficult put a halt to the reaction once it’s in progress.

Idea: Hypoallergenic Cat

What’s Involved: Genetically engineering a cat that doesn’t have the gene that makes Fel d 1 protein, which causes the majority of allergic reaction. Once a colony of hypoallergenic cats is established, kittens could be bred using “traditional” methods.

Where We Stand: In 2006 a company called Allerca Inc. claimed to have bred the world’s first hypoallergenic kittens and Time magazine hailed them as one of the best inventions of the year.

But the company and its founder have been the subject of controversy, with the media and a dedicated website questioning whether the firm, now called Lifestyle Pets, really has sneeze-free cats.

But this is not the only company in the hunt for the hypoallergenic kitty. Dr. David Avner, an emergency room physician in Denver, has been working with molecular biologists on silencing the Fel d 1 gene for years, and so far has come up empty-handed.

This past summer his team thought they had successfully knocked out the gene, which could lead to the breakthrough they’ve hoped for.

While Avner admits to being “optimistic” in predicting when his company, Felix Pets, will have cats on the market, he says there’s little doubt that in 10 years, a hypoallergenic cat will be in people’s homes.

“Without question, someone is going to do it. It’s too obvious an application of the technology, and the desire for people to have allergen-free cats is too high for it to go unrealized.”

Idea: Herbal Tablets for Asthma

What’s Involved: The Antiasthma Herbal Formula (ASHMI) is a tablet containing three traditional Chinese herbs. A study of patients in China shows it improves lung function and reduces use of bronchodilators.

Where We Stand: Dr. Xiu-Min Li at the Mount Sinai School of Medicine and her colleagues continue to study ASHMI in mice and people, comparing it to using corticosteroids. New, unpublished data show that eight weeks after mice stop taking the corticosteroids, their asthma symptoms return when they are exposed to triggers.

However, the mice on the herbal formula are still protected eight weeks later. Safety studies in humans have been completed, and Phase 2 efficacy studies are continuing.

One of the benefits to using ASHMI, instead of a steroid, is that there are fewer side effects, such as weight gain. However, Li says corticosteroids will be the standard treatment for asthma for years to come.

“The practical protocol will be to have a herbal remedy that will reduce the steroid’s side effects and help to maintain the protective effect,” she says.

Idea: Quick-Acting Allergy Shots

What’s Involved: Currently, immunotherapy to environmental allergies such as trees, grass, ragweed and cats, sometimes called allergy shots, requires numerous needles over several years. The shots also carry the risk of anaphylaxis in some individuals. Now, a few companies are developing therapies to make the treatment process far shorter and also safer.

In 2006, two men in Fairbanks, Alaska died of anaphylaxis after being stung by yellow jacket wasps. It was the first time anyone had died from an allergic reaction to an insect sting in Fairbanks, let alone two people. That year had already been a particularly bad one for yellow jackets: there were 10 times more wasps than normal, causing school outings to be canceled.

The sudden abundance of wasps represented an increase in the survivability of the queens over the winter,” explains Dr. Jeffrey Demain, the director of the Allergy, Asthma & Immunology Center of Alaska. He wondered: could global warming be responsible for all these wasps and ultimately, the deaths?

Demain began studying data from his own clinic, the local hospital’s emergency room visits, and the state’s Medicaid program database. He found increases in the number of people seeking medical attention for insect stings in all three databases. When he looked at the Medicaid database broken down by region, he found significant increases in the number of people seeking care for insect stings in all but one region: the gulf coast.

“We then started looking at climate-related variables. And what seemed to fit very closely with this puzzle was a change in temperature,” says Demain. The five regions that saw many more patients looking for medical attention for insect stings also had at least a 6.1 degree Fahrenheit increase in winter minimal temperature over the past 50 years; the gulf region only had a 1.5 degree increase. And it turns out the gulf coast also already had the highest number of stings per capita and the highest temperature. It was the proof he needed to put the blame squarely on his state’s rising temperatures.

There are plenty of ways in which a warmer Earth can affect allergies and asthma. Allergenic insects move farther afield and thrive in suddenly hospitable climes; CO2, the gas primarily to blame for heating up the atmosphere, causes weeds to flourish and boosts pollen counts in longer growing seasons. Ground level pollution gets worse on hot days, making it difficult for asthmatics to breathe. Not to mention wild swings in weather patterns leading to drought and wildfires in some places, and floods and mold in others.

“All of these are going to affect air quality in ways that can be synergistic and may be contributing to this tremendous increase in allergies and asthma that we’re seeing,” says Dr. Paul Epstein, associate director of the Center for Health and the Global Environment at the Harvard Medical School in Boston.

Dr. Gina Solomon, a senior scientist at the Natural Resources Defense Council and a doctor of internal medicine in San Francisco, notes that “climate change is overall going to have a substantial adverse impact on allergies and asthma. But it will tend to be gradual, and affect different areas differently.”

Evidence of that is already in. From Alaska to Europe, Louisiana to British Columbia, scientists are discovering ways in which climate change is giving our allergy-causing foes a boost. The question is: are we ready to confront these effects of climate change?

Pollen Proliferation
People who say they are feeling hay fever symptoms sooner in the year and sneezing longer than they used to may be feeling first-hand the effects of global warming. “In the U.S., we’re seeing an early arrival [of spring] of about one week, and persistence of fall another week,” says Epstein. “We see this measured in the flowering of plants and the arrival of birds, and how the trees are responding to the climate.”

An early spring and a late autumn can affect when pollens peak. Dr. Donald Stark, a Vancouver allergist, has been monitoring the pollen counts of trees in his city for more than a decade. In spring, “there has been a two-week shift earlier over 13 years,” he says.

Warmer temperatures in some areas also allow new plants and trees to flourish. Ragweed, which is a fairly recent arrival to Europe, is now a major health concern as it moves into more northern countries on that continent. A study from the Global Allergy and Asthma European Network, which was published in the journal Allergy in April, found that Hungarians are the most affected by ragweed, with about 60 per cent of people there sensitized to the weed. In Denmark, 20 per cent test positive to it.

But it is the north of the northern hemisphere where the consequences of climate change are most dramatic and apparent. “Our temperature change in Alaska is four times that of the global average,” says Demain, who is an adviser to the governor’s sub-cabinet on climate change. “We’re seeing impacts now that others are predicted to see [in the future].”

Simulations performed by the University of Alaska Fairbanks foresee a shift from a forest dominated by conifers to one in which deciduous trees are twice as prevalent as conifers by 2050. “It’s also projected that 90 per cent of the historic tundra in Alaska, over the next century, will be forested because of melting permafrost,” says Demain. “We’re going to start sustaining an ecosystem that’s going to support trees and grasslands that’s not there now.”

Excerpted from the Summer 2009 issue of Allergic Living magazine.
To order that issue or to subscribe, click here.

© Copyright AGW Publishing Inc.

Related Articles:

• See Outdoor Allergies: Ragweed’s Rule – Investigating how this allergy weed became so potent and so wide spread.
• See Breathless – Essay on why we need a revolution for air and for asthma.
• See Asthma: The Link to Smog – Article on traffic pollution and the effects on asthma.

Troublemakers

The insects that cause the majority of life-threatening reactions in North America are: the honeybee, the yellow jacket, the yellow hornet, the white-face hornet, the paper wasp and the fire ant. “Those are the six that we have very good skin-test reagents for, and also the six that we have very good desensitization protocols for,” says Vadas, the director of Allergy and Clinical Immunology at St. Michael’s Hospital in Toronto.

Yellow jackets are the most aggressive, and in the same family as hornets and wasps. This means that if you’re allergic to one, you may be allergic to the others.

The honeybee is a distant relative, with distinct venom proteins, so if that’s your allergen, you aren’t likely to react to the others. Fire ants are native to Florida and Central America, but aren’t a risk farther north.

Reactions

The first time you’re stung by one of the pesky insects, you won’t have a life-threatening allergic reaction. Your body needs to be exposed to the venom before it recognizes the protein, and begins to create IgE antibodies against it. In fact, you may be stung many times without anaphylaxing, says Vadas.

Those who have the most exposure to the insects are more likely to be stung and therefore more likely to experience sting reactions.

How big is the risk?

The risk in the general population of a sting being life-threatening is about 2 per cent. If you’re having a large reaction at the site of a sting on your body, Vadas says the risk increases slightly, to 5 per cent. With systemic symptoms remote from the sting, such as breathing difficulties or fainting, the risk jumps to 20 to 60 per cent.

When to worry?

The point at which a person becomes at risk of having a life-threatening reaction is different for kids and adults.

If a person younger than 16 years old gets stung and feels the reaction in either his airway (difficulty breathing, chest tightness) or with his blood pressure (dizziness, fainting), he is at risk of having a life-threatening reaction the next time he is stung.

Next: Adults at Risk

On a frigid winter’s night, Lise Kavanagh doesn’t bury herself under blankets. When she wakes up to a chilly morning, she doesn’t take a hot shower. Nor will she dress in super warm clothes to head out for the day.

Is this 39-year-old superwoman immune to cold? Nope.

Instead, she’s hyper-sensitive to heat. In fact, when her body temperature rises, she develops an itchy rash all over her body. Kavanagh has what’s known as cholinergic urticaria or hives. Her body reacts with hives to the physical stimulus of heat.

Sometimes at the gym, you’ll hear dubious tales of a runner who’s “allergic to their own sweat”. Chances are, it’s not the perspiration – it’s the heating up of the body through exercise that’s causing the person to break out in a rash.

Cholinergic urticaria can be triggered by several heat-raising activities: jogging or aerobic workouts are obvious, but also hot baths or showers, eating spicy foods, and even emotional stress can bring on the hives.

For Kavanagh, “some of my worst attacks happen when I’m sleeping. Even if I have no blankets at all, when I stir in the night and end up on my back, the heat accumulates between the mattress and my skin, and I’ll wake up with a rash all over my back.”

While a relatively rare condition, experts say that 5 per cent of people who have chronic urticaria also experience the cholinergic symptoms. In the United States, it’s estimated that one in five people will experience chronic urticaria in their lifetime.

Spotting the Condition

With cholinergic urticaria or CU, the hives are tiny, about the size of a ball point pen tip. The rash comes on rapidly, usually within a few minutes of perspiring, and can last from 30 minutes to an hour or more before receding once the body returns to normal temperature.

The hives or “wheals” are very itchy, and can be preceded by a burning, tingling and/or warm sensation.

The wheals may join to form a large mass of swelling, and some people also experience headaches, salivation, palpitations, fainting, shortness of breath, abdominal cramps and diarrhea.

“CU appears when the affected individual’s body is heated by exertion or a situation that raises the core temperature of the body 2.7 degrees F or more,” says Dr. Martin Ostro, staff physician with the division of allergy and immunology at Massachusetts General Hospital in Boston.

Technically, it’s not an actual allergy since cholingeric urticaria has no specific IgE, the allergic antibody, created to respond to a particular substance. But the mechanism of the reaction is similar to allergy.

Next: How to Treat