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.

The attack quickly escalated to the level that would normally land Silver in the emergency room, and she pushed the button for the flight attendant. “As she got to me, she looked at the man beside me and said, ‘Sir, you can’t have your cat on your lap like that,’” she recounts.

Silver had no idea she’d been seated next to a cat owner and his pet. “He had snuck the cat out of the carrier and had it on his lap under his jacket. And I said, ‘I can’t sit here – I can’t breathe.’”

Silver was immediately moved away from the cat, but it was too late: by then the asthma attack was in full swing, and her inhalers were barely keeping her any relief as she suffered through the flight. “When we arrived, my dad took one look at me and said, ‘What happened?’ He could see I couldn’t breathe.”

Silver’s travel tale could become far more common. As of July, Canada’s largest airline similarly began allowing owners to fly with cats or small dogs. In a policy reversal, Air Canada dropped a  2½-year ban on animals in the cabin – a move that has outraged pet-allergic travelers and asthma and allergy organizations, alarmed medical practitioners and spurred the Canadian Lung Association to launch a write-in campaign to bring the issue to the federal government.

Cash-strapped Air Canada says the decision to drop the ban on pets came after customers complained they were unable to travel with their small pets, as they could on WestJet and other carriers. “We looked for the best way of balancing the needs of all of our customers,” says Air Canada spokesperson Angela Mah. “By doing this, we are aligning our policies with the vast majority of international airlines as well as our major domestic competitor.”

At least three million Canadians suffer from asthma and allergies, and with some of the most potentially dangerous allergens being allowed on board, travel options for hundreds of thousands of passengers are becoming more limited.

Mah stresses that pets are limited to either two or four per flight (depending on the size of the aircraft), and that animals must be kept in their pet carriers under the seats. If an allergy sufferer ends up sitting near a pet, the airline will make “all reasonable efforts” to move one or the other to a different seat or flight.

Pet Hair on Clothes

Even when the pets ban was in effect, Mah adds, the airline could not guarantee a “dander-free cabin”, because many passengers have pet hair on their clothes, and because the airline must allow service animals for passengers with disabilities. Most planes are equipped with high-efficiency HEPA filters, and she says the cabin air quality “compares favourably” to that in other indoor environments.

Dr. Donald Stark is not convinced. The Vancouver allergist lobbied to have animals removed from airline cabins so that people with pet allergies – roughly 10 per cent of the population – could breathe more easily when they travel. Having a pet in the cabin is far worse than having a pet owner with a little hair on the clothes, he says, because the levels of allergen being released into the air are much higher.

Stark adds that air filters can only do so much – especially if they’re not changed frequently – and air moving through the cabin can affect allergic flyers before it even gets to the filter.

While the air quality in some cabins may be similar to other indoor environments, there is one key difference: on the ground, an allergic person can walk out the door.

Who Reacts

Even our understanding of the prevalence of pet allergies is fuzzy. Although an estimated 20 to 30 per cent of young adults will react to at least one airborne allergen, studies have shown early exposure to animals (which researchers now suggest can have a protective effect), where you live, and whether you experience asthma, hay fever or both can all influence the development of allergies to animals.

New research from the U.S. National Institutes of Health shows that cats are the single biggest trigger for asthma, causing reactions in 29.3 per cent of asthmatics. A Swedish study, meantime, found 40 per cent of kids with asthma reacted to cats, 34 per cent to dogs, and 28 per cent to horses.

For the kids who got runny noses and itchy eyes, 49 per cent reacted to cats, 33 per cent to dogs, and 37 per cent to horses.

Dr. Jeffrey Davidson, an allergist in San Francisco and a clinical professor at the University of California San Francisco, says it’s fair to expect that as the incidence of allergic disease grows, so does the number of people reacting to animals. And while cat allergies are by far the most prevalent, people can be sensitized to any animals with feathers and fur, including dogs, guinea pigs, mice, birds, and ferrets.

The Symptoms

The range and severity of symptoms is vast, and includes itchy, runny nose and sneezing, irritated, watering eyes, wheezing and shortness of breath, eczema and hives. “Some people say they don’t have a problem unless they touch the pet and touch their eyes,” Davidson said. “And there are other people who walk into a room where there is a cat, or there has been one, and they will have an asthma attack.”

The Allergens

The culprits setting of these reactions are a series of proteins found in concentrated amounts in dander (flakes of dead skin), saliva and oil called sebum that hair follicles secrete to protect fur and skin. In some animals, allergenic proteins that originate in the blood are released through urine. The cat’s most prominent allergenic protein is called Fel d1, and its counterpart in dogs is Can f1.

Dr. James Ransom, an allergist in Topeka, Kansas and clinical instructor at The University of Kansas Medical Center, says cats’ constant grooming and indoor litter boxes mean these allergens are continuously evaporating into indoor air. A pet lover might reason a hairless cat or a short-haired dog should be fine. Not necessarily. Ransom says that, regardless of their fur, pets still emit the allergy-causing proteins from their skin, glands, dander, urine and saliva.

Plan B Solution

Ransom says if a patient has a severe reaction to animals or develops asthma, he’ll advise that the pet has to go. But “getting people to get rid of pets is very difficult.”

His Plan B is to tell the family to minimize the exposure. First, someone not allergic to the animal should wash it once a week. Next, the pet should never be allowed into the allergy sufferer’s bedroom. The pet’s roaming area in the house should be reduced to exclude areas where the allergic person spends much of his or her time. Finally, cloth-covered furniture and carpeting (which Ransom calls the “reservoir of allergens”) must be replaced with leather or vinyl furniture and hard floors such as linoleum or tile.

Although some shampoos and sprays claim to reduce how much allergenic protein your pet totes around, Davidson says washing a pet with water alone is probably just as effective. Wipe down a cat with a damp cloth instead of bathing him, the specialist advises, to avoid “losing your forearms.”

Next Page: The Cat Comes Back

Situation: There’s a friend at work you’ve often had lunch with. Lately, he’s decided it’s funny to tell the waiter “just bring her some water – she’s allergic to everything else.”

How to handle: Before your next midday meal with Don Rickles, prepare a sarcastic retort along the lines of “while my incredibly sensitive friend finds the idea of me doing a faceplant in my soup hilarious, I think I’ll just tell you about my life-threatening allergies instead.” If that doesn’t get the point across, ditch buddy boy and find a new lunchmate; preferably one who doesn’t find your serious health condition such a thigh-slapper.

Situation: Your new in-laws are desperate to have you two over for dinner, but you’re highly allergic to cats, and their beloved Mr. Tinkles is definitely the lord of the manor.

How to handle: You might as well be honest. Tell them about your allergy, and suggest that a meal in their beautiful garden would be a better option. (Hey, kissing up to the in-laws early is a good idea, especially if you’re planning to have kids.) It doesn’t hurt to lay some ground rules early either, in preparation for all those years and years of visits ahead. Ask if Mr. Tinkles could be confined to one room while you’re there, and suggest that, while you know your mother-in-law’s house is always spotless, maybe running the vacuum quickly before you arrive would, however, help your breathing. Bring a treat for the ball of allergenic fluff to show you don’t hate cats, really. And get your husband to agree to a late arrival and early departure, lest he bear the brunt of your coughing, snoring and wheezing all night.

Situation: A close friend asks you to be in her wedding party, but option two on the reception dinner menu is salmon – and you’re at risk of anaphylaxis to fish.

How to handle: Tell her that you’re willing to wear the seafoam green taffeta bridesmaid dress, but you’ll have to put your foot down when it comes to your ability to breathe unassisted. Speak
to the caterer ahead of time: can he assure that if you pick one of the other options, there will be no cross-contamination in the kitchen? If in doubt, bring your own meal and ask the caterer to have it served along with the others. Give a trusted friend the task of overseeing the handling of your food in the kitchen.If even a good whiff of fish has you reaching for the Epi or Twinject, tell the bride that, while you will be thrilled to precede her down the aisle, you’ll have to arrive at the reception after all fishy scraps have been cleared.

Situation: You’re out at a restaurant on a first date with an attractive, interesting fellow, who orders something you’re allergic to. Later, he leans in for a goodnight kiss.

How to handle: First of all, a kiss on the first date? OK, I’m old- fashioned, but a handshake or a hug should suffice. If your heart is already aflutter, best to be upfront. Calmly tell Dreamboat that he’s eaten something you’re allergic to, and that it’s just not safe for you to lock lips so soon after he’s eaten. Thank him for a wonderful evening and suggest getting together soon for a non-food date.

First published in Allergic Living magazine.
(c) Copyright AGW Publishing Inc.

To subscribe or order a back issue, click here.

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.

The check-in attendant told the St. John’s resident that WestJet is a pet-friendly airline – small animals are allowed in the cabin in an enclosed kennel. In fact, there were two other cats on the flight. “I told her, ‘I cannot get on that plane. If I do, I could die,’” recalls Callahan.

He was offered a seat near the back. He explained that moving would make no difference since the air is re-circulated: “I can’t get away from a cat at 30,000 feet.” Callahan was told he could have a seat on the next flight, but turned that down since the airline could not guarantee there would be no cats on that plane.

“So I had two options, get on a WestJet plane and put my life in jeopardy or stay behind.” Instead, Callahan bought a last-minute ticket on the next Air Canada flight, which cost him $1,900 one way. Air Canada does not allow animals to travel in the passenger cabin.

“We’ve made the decision as an airline that we will continue to take them (pets) on board,” explains Richard Bartrem, vice-president of culture and communications at WestJet. “While we empathize with this gentleman’s situation, we will continue to offer this service as a benefit to our guests.”

The risk of a severe reaction for passengers with asthma is relatively low with air travel, according to Dr. Antony Ham Pong, an Ottawa allergist. Dander takes time to accumulate, so the level of dander would depend on how long the cat has been on the plane. “The risk is certainly lower than walking into a house where someone lives with a cat,” he says.

The level of reaction would also depend on a person’s asthma control. “If someone has uncontrolled asthma and he or she is sitting beside a cat, it can lead to big-time trouble,” says Dr. Ham Pong. “It could be fatal. But if his or her asthma is under control, it shouldn’t be a big issue. Just don’t sit next to the cat.”

Travelers should check ahead for pet policies on planes, trains and buses to reduce the risk of an asthma attack, the allergist says, adding that they should always carry their asthma and allergy medication on board, just in case.

Callahan is not content with WestJet’s policy, describing the airline’s attitude toward passengers with severe pet allergies as “terrible.” Although WestJet does post its pet-friendly policy on its website, it’s not easy to find. Callahan would like to see it on the homepage, so others with pet allergies will be well warned. However, Bartem says WestJet has no plans to post a warning on its homepage. So unless that policy changes, at least for this airline, it’s “flyer beware.”

To provide feedback, visit www.westjet.com, click on “contact us” and then select “e-mail guest relations”.

First published in Breathing Space, a supplement of Allergic Living magazine.
To contact the Lung Association in your region, click here.

The Toronto Star featured a woman with asthma who flew from Paris to Toronto with a cat as a fellow passenger – and struggled to breathe the entire trip. She used her reliever inhaler, but wasn’t able to get her asthma under control during the flight she describes as “eight hours of distress.”

Meanwhile, Maclean’s spoke to a man whose dog died in the cargo section of plane (note: this larger lab mix dog would have been too large to be allowed in the cabin under the new rules). The article addresses the concerns of those with serious allergies, but stresses the happiness of pet owners with the news. The executive director of the Humane Society of Canada is quoted as saying:

“As a veteran air traveller, I would find [pets] much less objectionable than some of the people who’ve sat next to me on a flight.”

The Toronto Star also published a Q&A with Air Canada, which explains what the airline will do to accommodate those with allergies. It includes this quote from the airline: “We will make reasonable efforts to move you or the pet and pet owner. Where feasible, it may even be possible to allow passengers to change flights at the last minute at no extra charge if you prefer not to be on a particular flight with an animal.” Read the rest of The Star’s Q&A here.

What do you think? Have your say on our Talking Allergies Forum.

See Also:
• Survey: 80% want Pet-free Flights
• Forum: Food Allergies And Airlines
• Airlines and Allergies: Chart comparing allergy policies of 11 airlines (Note: doesn’t include new Air Canada rules.)
• Tips on Flying with Food Allergies

Discuss this issue on the Forum.