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

By Gwen Smith and Dory Cerny
Allergic Living magazine

If you have a child with peanut allergies, other parents will say to you: “Nobody was allergic to peanut butter when I was a kid.” If a cat swishing through a room starts you wheezing, you’ll get asked: “How come so many people have asthma?” Both are reasonable questions, variants on the broader million-dollar one: “Why do so many people have allergies today?”

If you want an easy answer, allergy experts will simply say they don’t know. But what they mean is – they don’t know entirely. The fact is that scientists understand a lot more about allergic disease than they did a decade ago. There are still gaping holes in their knowledge, but as they continue to fill in the pieces to the puzzle, what they are finding is fascinating and often surprising. In the following investigation, Allergic Living examines what science knows so far about why allergies occur.

In the Beginning

When a baby is born, its immune system is a work in progress. “You’re born with a naïve, allergic-skewed immune system,” explains Dr. Michael Cyr, an allergist and immunologist at McMaster University in Hamilton, Ontario. This is what scientists call the Th2 mode.

During the first days, weeks and months of life, as the baby comes into contact with various germs, bacteria, viruses and infection, the system is supposed to start learning to distinguish between what is harmful and what is benign.

Some allergists liken the emerging immune system to a toggle switch or a reset button: we’re all born in that Th2 mode and then that first bout of sniffles at eight weeks or the ear infection at four months begins to “switch” the immune system over from Th2 to Th1 mode or fighting bacterial infection mode.

But in the person with a genetic inclination to allergy, something misfires and the switchover doesn’t happen properly. Cyr, who’s a researcher with AllerGen (the Allergy, Genes and Environment Network), says that why this process happens easily for some people but not for others remains unclear, and may depend on a confluence of factors.

The young child who doesn’t get switched over is now atopic – predisposed to developing an allergic response to a trigger such as cat dander or ragweed pollen or peanuts. After breathing in or consuming one of those, the child’s immune system creates allergy antibodies – specifically Immunoglobulin E or IgE antibodies – to guard against offending trigger. The next time the immune system encounters it, the IgE will go on the defensive, setting off a cascade of allergic symptoms.

Though genetics are a large contributing factor to whether a person becomes allergic, scientists haven’t found one specific allergy gene. “It’s becoming clear that it’s not a gene, it’s a whole series of genes,” says Cyr. Something has changed to increase the number of us who are developing allergies, says Dr. Dennis Ownby, a professor of pediatrics and the head of allergy and immunology at the Medical College of Georgia in Augusta.

“What seems to have happened over the last three decades, at least in developed countries, is that genetic ability [to be allergic] has become more prominent,” he says.

Just how much have allergies and asthma grown? Figures from the World Allergy Organization reveal the global prevalence of asthma has increased by an astounding 50 per cent every decade for the past 40 years. In North America today, leading allergy organizations estimate that about three million Canadians and 20 million Americans have asthma.

In the past decade alone, the prevalence of food allergy, once an uncommon condition, has skyrocketed. The Food Allergy & Anaphylaxis Network, the U.S. education group, estimates that about 12 million Americans – 4 per cent of the population – now contend with the disease. The Canadian rate of food allergy is estimated to be comparable. Peanut allergy alone has doubled in young American kids.

In our modern world, allergy has spread like wildfire. Scientists are certain that genes alone can’t be the whole reason why. “The genetic pool does not dramatically change over decades,” notes Cyr. “So it’s obvious there’s something else going on.” And that something appears to be our environment.

Getting to the Dirt

While references to asthma date back to ancient Chinese medical texts, the real story of our modern understanding of allergy begins in earnest in 1989. It was a heady year, with the fall of Berlin Wall and the beginning of the opening up of the former East bloc. A team of German scientists decided this presented a great opportunity to compare the prevalence of asthma in Leipzig (former East Germany) and Munich (former West Germany).

Here were two highly similar gene pools of people who had been living in very different societies and conditions. “At that stage, everyone, including us, believed that air pollution was causing asthma and allergies,” says Dr. Erika von Mutius, who was then a young pediatrician and team leader, and who today is a professor and head of the asthma and allergy department of Munich University’s Children’s Hospital.

When the findings began coming back showing that there was considerably more asthma in modern, Western, hygienic Munich than among the study group living in Leipzig with its billowing factory smokestacks, the researchers were incredulous.

“It was so opposite what we’d anticipated,” recalls von Mutius on the phone from Munich. “We didn’t believe it, so we thought it was a mistake in data entry and re-entered all the data.” But the data were right, and the results were published in 1992.

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.

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.

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.