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 New, unpublished data show that eight weeks after mice stop taking the corticosteroids, their asthma symptoms return when they are exposed to triggers.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 June of 2005, the smog hanging over downtown Toronto was so thick you couldn’t see the CN Tower from the mid-town restaurant where Sara La Rocque was waiting tables at an outdoor patio. That was when Sara, a 21-year-old creative writing student, quit her job to go home and strip wallpaper.

One day later, she couldn’t breathe properly. Although she had experienced asthma briefly as a child, this was different. It was like breathing through a straw. For most of the rest of the summer, as Ontario lumbered through a record summer of smog advisories, Sara stayed indoors. She was miserable.

It wasn’t until six weeks later that she could even walk around the block with the family’s golden retriever (she is not allergic to dog dander) or the Burmese mountain dog.

Sara’s pretty sure what triggered her condition, and it wasn’t the wallpaper: “My asthma is smog-induced,” she says. “I think that’s what caused it.” A few years ago, most scientists would have doubted her analysis. The common wisdom was that air pollution could only exacerbate symptoms in people already living with asthma.

But now, a handful of mavericks in the scientific world are building a case to prove Sara’s point – that pollution might not just worsen asthma, but cause it. Not that these asthma researchers can yet say how this might happen. That’s still under study.

When it comes to asthma, theories abound as to why it develops, starting with the hygiene hypothesis. This suggests that our urban society is too germ- and virus-free, causing the underworked immune systems of those who inherit the allergic tendency to react to proteins – such as inhaled pollen or dust mites – that should be harmless. The immune system’s over-reaction results in airway inflammation and allergic asthma attacks.

There are also new indications that antibiotics in early life and obesity may be contributing factors. But some scientists keep coming back to the relationship between asthma and air pollution, particularly to that dense layer of smog that blights our cities all too often in the summer.

Somewhere in that haze of pollution, they believe, lies an answer to the mystery of why asthma gets switched on with such frequency in the urban world.

Over the past decade, scientists have found compelling evidence that air pollution irritates the lungs and triggers attacks in those who already have asthma. Some research indicates it can also worsen asthmatic flare-ups to allergens such as pollen, dust mites or pet dander.

“Air pollution remains one of the most under-appreciated contributors to asthma exacerbation,” wrote George Thurston, an associate professor of environmental medicine at New York University School of Medicine, in a 2005 article in the Journal of Allergy and Clinical Immunology.

A classic instance: When a strike closed a steel mill in the Utah Valley for the winter during the mid-1980s, researchers found that admissions of children to hospital for asthma and pneumonia were cut in half – and they climbed right back up the following winter after the steel mill had reopened. That’s a vivid example of pollution’s effect on asthma, and there are plenty more.

Next Page: Proof from California

Adrienne Smith has been battling with her asthma since she was diagnosed at the age of 13. For Smith, high school gym class was particulary difficult: she would often get a crushing feeling in her chest when she started to run, and it would take her 25 minutes to recover. “It was humiliating,” she says.

Now, at 30, Smith’s asthma is still a big part of her life. She doesn’t play competitive sports any more, something she used to enjoy. And when she works out, she tends to walk, rather than run. When her asthma is at its worst, it keeps her up at night. During these bouts, she finds ordinary household chores arduous, such as carrying laundry up the stairs.

Still, Smith, who lives in Victoria, B.C., feels she’s doing fairly well. “I haven’t been to the hospital this year,” she says. “So that’s a good sign.” While she finds her limitations frustrating, she accepts them as a part of who she is. “I don’t think I’m sickly. It’s just that sometimes I have these episodes.”

About three million Canadians have asthma – one of the highest incidences in the world – and the majority of those affected share Smith’s conception of the disease.

“They think it’s normal to be short of breath, waking up at night, or not being able to perform exercise,” says Dr. Louis-Philippe Boulet, a respirologist and asthma researcher at Laval University in Quebec City. “I saw a patient recently who had stopped exercising; he started playing chess. He almost couldn’t do anything. But it was normal for him.

“Research shows 28 per cent of Canadians with asthma have symptoms of their disease every day, while 67 per cent have symptoms every week. But the experts agree that this should not be the case; that asthma is completely controllable. In the right environment and with the right medications, even those with severe asthma should have relatively few symptoms.

That’s because the medications available today can prevent the inflammation of the lungs, and the resulting constriction of the bronchial tubes and mucus build-up.

It’s possible to develop an asthma action plan in which, by reducing bronchial inflammation with medication and avoiding asthma triggers, the patient should rarely have to stop to catch a breath. And that blue “rescue” inhaler that many asthmatics depend on to treat frequent symptoms? It should only be used occasionally.

However, this ideal is far from reality. Instead, the majority of Canadian asthmatics are living half-lives. They aren’t exercising, which can lead to a host of other health problems, like obesity, diabetes and heart disease. They are missing school and work, and giving up activities they enjoy.

They see their doctors, but these visits are often marked by poor communication. They end up in the hospital after days of worsening symptoms. They are Canada’s “walking wounded,” and they’re slipping through the cracks of our health-care system. Amazingly, most of them don’t even realize they have a problem.

The statistics show just how bad it is. Six years ago, the Asthma Society of Canada announced that 57 per cent of Canadians with asthma did not have their disease under control. The society’s latest research, released in September 2006, shows no sign of improvement; more than half of asthmatics are still living with symptoms above what are considered acceptable levels.

Earlier findings showed 10 per cent of them had landed in the emergency room at least once in the previous year because of an asthma attack, and 12 per cent reported missing school or work.

In Ontario alone, hospital statistics show that asthmatics made more than 73,000 emergency room visits in the past year. National statistics are not available, but the numbers are known to be uniformly high.

“Certainly for children, we know that it is one of the most common reasons for emergency visits,” says Jan Haffner, vice-president of health initiatives for the Lung Association of Saskatchewan.

Next page: How asthma medication works

The Lung Association has also asked Air Canada and WestJet to compromise by designating some flights as pet-free. “We’re worried that profit is taking a front seat and public health is taking a back seat,” says Cameron Bishop, director of government affairs for The Lung Association. “We want to help Canadians to express their views on the issue of pet-free flights.”

A poll released by the association found that 80 per cent of Canadians want Canada’s airlines to offer pet-free flights. In addition, 75 per cent of Canadians believe that the federal government has a responsibility to protect the health and safety of passengers and crew.

Bishop hopes the campaign will convince Parliament to hold hearings this fall to review the public health ramifications of the airlines’ policies. “We, of course, recognize the need for service animals or guide dogs to be allowed on flights,” he adds. “We just request that passengers be alerted to their presence.”

The campaign has received the support of thousands of Canadians like Monica Peterson, who has asthma and a severe allergy to cats. She was flying on a WestJet flight from Winnipeg to Victoria last year when her eyes started watering and her airways became congested. “When the plane was unloading, it turned out a cat was under the seat in front of me. Luckily it was a short flight; it was alarming that there wasn’t even a warning that pets were on board.”

When Traveling with Asthma, Pet Allergies or COPD:

• Check with the airline beforehand to try to get on a pet-free flight.
• Take your medications regularly and follow your asthma action plan.
• Use your rescue inhaler 20 minutes before boarding the plane.
• Speak to your doctor before traveling. You may need medications adjusted for the flight.
• Always have your medications with you – never keep them in checked baggage.

From the Fall 2009 issue of Allergic Living magazine.
To order that issue or to subscribe, click here.

© Copyright AGW Publishing Inc.

Since being diagnosed with asthma when he was 4 years old, Brett Favaro has suffered pneumonia and bronchitis, asthma attacks, and been to numerous doctors. Now 22, he still has a nebulizer, a machine that delivers asthma medication in a fine mist through a facemask, in his bedroom.

But if you’re picturing a skinny kid, wheezing on the sidelines, you’ve got the wrong guy. Favaro was a competitive swimmer for 13 years, culminating with a stint as captain of the varsity swim team at Simon Fraser University in Vancouver. He’s also competed in cross-country running, taken tae kwon do lessons, and played basketball. Plus, he’s an avid weightlifter. Favaro says that with the support of his doctor, “I was able to do everything that everyone else did. I just had to be more mindful of my ability to breathe than other people.”

Growing up, Favaro achieved what experts say is possible for all asthmatic kids. “If they have good control, they can be competitive to any level,” says Dr. Brian Lyttle, a pediatric respirologist in London, Ontario. Good control usually means taking a corticosteroid (such as Flovent or Pulmicort) every day to reduce inflammation, minimizing exposure to triggers such as cigarette smoke and allergens, and having a fast-acting reliever puffer on hand in case of an asthma attack.

While exercise is important for everyone, it plays a special role for people who have asthma. “The better shape you’re in, the better your lungs function,” says Dr. Michael Clarfield, a sports medicine specialist and former team physician for the Toronto Maple Leafs. “When you’re getting diminished function from your asthma, the more function you had to start with, the better off you will be.”

Dr. Alan Kaplan, a doctor in Richmond Hill, Ontario who chairs the Family Physician Airways Group of Canada, looks at it this way: “Exercising will teach your muscles to learn to work with what you’ve got. So even if you do have lung impairment, it’s still important to exercise and to teach your muscles to be able to exercise even at lower oxygen levels.”

It’s not that asthmatic kids should ignore their symptoms and push themselves into respiratory distress; rather, with the right combination of medications, and in a supportive environment with minimal triggers, all kids with the disease should be able to reach their athletic goals.

Katherine Smith, 14, a Canadian whose family lives in Phoenix, has certainly not let asthma deter her athletic pursuits. A bout with pneumonia at age 1 left her with diminished lung function, and she also has bad seasonal allergies. When she was about 9 years old, her parents noticed she had difficulty breathing when she ran or played sports at school. “If she had to do anything that required any endurance, all of a sudden she was gasping for air,” says her dad, Doug Smith.

With the right medications and a good attitude, Katherine has thrived. She pitches for a competitive softball team that placed ninth out of 70 teams at last year’s U.S. national championships. “She treats the asthma meds as something ‘I’ve just got to do to prepare,’ ” says Smith, “like going to conditioning class, or to her trainer.”