Code: e1
Latin name: Felis domesticus
Source material: Dander
Family: Felidae
Common names: Cat, Domestic cat
Allergen Exposure
Sensitization to cat is strongly associated with asthma, especially in environments free of mite and cockroach (1). The presence of domestic pets increases the prevalence of respiratory symptoms in asthmatic children (2), and children sensitized to cat allergen are more likely to develop a more severe asthma than children with negative tests to cat (3).
Potential Cross-Reactivity
Cat-allergic patients with IgE antibodies to Fel d 1 have been shown also to react to the corresponding protein of ocelot, puma, serval, siberian tiger, lion, jaguar, and snow leopard (24).
A subgroup of cat-allergic patients also react to dogs and sometimes to other animals. Serum albumin is the main common component (25, 26). Extensive cross-reactivity even occurs between albumins of distantly related species (27) and subjects with IgE antibodies to cat albumin may also react to horse, cattle, pig, rodents (28), and fur animals like mink and fox (29). However, great variability exists between patients and selective sensitivity to limited numbers of species occurs, (28) indicating shared and specific epitopes.
Common and species-restricted epitopes have also been observed on the major cat and dog allergens Fel d 1 and Can f 1 (30).
Allergy to cat dander and pork meat, also referred to as the pork/cat syndrome (31), was shown to be mediated by IgE antibodies recognizing cat and pig serum albumin (32). In addition, other kinds of meat may be a risk for patients with this type of sensitivity, as indicated by a case with cat-specific IgE antibodies and exercise-induced anaphylaxis after eating pork or beef (33).
Clinical Experience
IgE-mediated reactions
IgE-mediated sensitization to cat is a risk factor for asthma attacks. Allergen exposure plays a causal role in the development of bronchial hyperreactivity and of the chronic inflammatory responses seen in patients with asthma (40). Infants exposed to cats developed skin prick test sensitivity about three times more often than those without such exposure (41).
Review
Tobacco smoke, prenatal and postnatal, has been shown to have an adjuvant effect on cat sensitization in exposed children (4).
Allergic reactivity to pollens may be aggravated by environmental priming with ubiquitous animal dander (5). Allergy to cats or dogs also seems to be an important risk factor for the development of laboratory animal allergy (6).
Data strongly suggest that those with a predisposition for allergy should avoid having pets in the home (2).
Cat allergens
Several cat-derived proteins are involved in allergy. An acidic glycoprotein and cat serum albumin are common sensitizers (7-9).
The glycoprotein, now called Fel d 1, is a major allergen, and more than 80% of cat-allergic patients have been reported to have IgE antibodies against this molecule (10).
Fel d 1 has an apparent molecular weight of about 36 kD and is a dimer of a polypeptide comprised of two covalently bound chains called 1 and 2, or a and b (11). Chains 1 and 2 contain 70 and 92 amino acid recidues respectively (12). The IgE binding epitopes appear to be primarily conformational and do not involve carbohydrate residues, although chain 2 carries an oligosaccharide (13-16).
Studies on recombinant chain 1 and chain 2 showed that both chains contain IgE-binding epitopes and contribute to the allergenicity of the protein (17).
Allergen localization
Fel d 1 is present on the skin surface and in the fur of the cat. The protein has been demonstrated in, and may be produced by, salivary glands and lacrimal glands (18), skin sebaceous glands (19, 20) and anal glands (21). The allergen production appears to be hormonally regulated and male cats produce more Fel d 1 than females and castrated males (22, 23)
Cat parasites
It is also worth mentioning that cats may carry exoparasites that could contribute allergens and possibly add confusion in the investigation of allergy related to animals.
The cat flea is an example. Carried by the cat and occasionally biting humans, it is also an allergenic insect among many, and may add to the allergen content of indoor dust (34-36).
Prevalence of cat allergy
Exposure to cat allergens is one of the most common causes of respiratory allergic disease and is of worldwide importance. The prevalence varies because of cultural differences and environmental factors. Keeping cats as pets in homes is an obvious risk leading to prevalences up to 80% or above in atopics (1, 37-39).
Cold climates may contribute to the risk in the sense that the cats spend more time indoors (38). Cat is the major cause of indoor asthma in dry, high altitude areas like Los Alamos, NM, USA, where mites and cockroaches are virtually absent (1) and it adds severely to the burden in more humid climates with high level mite exposure (39).
Fel d 1 exposure
IgE-mediated sensitization to cat is a risk factor for asthma attacks. Allergen exposure plays a causal role in the development of bronchial hyperreactivity and of the chronic inflammatory responses seen in patients with asthma (40). Infants exposed to cats developed skin prick test sensitivity about three times more often than those without such exposure (41).
The concentration of cat allergen Fel d 1 is highest in homes with a cat, but is usually also measurable in houses where cats were not kept (42- 45). In many cases, the Fel d 1 level exceeds proposed threshold levels for cat sensitization (46). Furthermore, the low level cat exposure that occurs in many homes without cats is capable of inducing symptoms in some patients who are sensitive to cats (47).
In dry climates, Fel d 1 is a major cause of indoor allergy, e.g. in northern Sweden, where mite and cockroach allergens are undetectable in homes (48). Even in Japanese homes, the airborne Fel d 1 concentration is much higher (160 times) than those of the major mite allergens (49).
Carpets, matresses and upholstered chairs are reservoirs of cat allergens (50-52).
Cat allergen is carried on human clothing into environments never visited by cats (53-55). Transport of Fel d 1 on clothing from the domestic to the school environment is in fact a major source of classroom cat allergen (56). The cat allergen concentration in classes with many cat owners may be higher than that found in the homes of non-cat owners (57).
Avoidance
Avoidance of cat allergens is an important measure to take in the treatment of sensitized asthmatics, decreasing symptoms and decreasing the need for drugs (58). The Fel d 1 concentration in dust is significantly lower in homes from which the cat has been removed than in homes keeping the pet (51, 59).
Encasing covers and hot washing of linen reduce cat allergens in matresses in the absence of cats (60). Washing the clothes of cat owners is an effective method for prevention of cat allergen dispersal (61).
Dry heat up to 140°C has little effect on the Fel d 1 content of house dust (62) and tannic acid treatment is not a reliable method for reduction of indoor cat allergen (63). The effect of air cleaners in homes with cat seems uncertain in terms of reducting symptoms (64-66). In addition, washing or spraying cats does not lead to significant reduction of Fel d 1 shedding.
Only removal of the cat leads to a lasting decrease of the allergen exposure (67-69).
Diagnostic efficiency of IgE antibody measurements
The aggreement between IgE antibody and in vivo tests is generally high. A study of optimization of skin testing showed 94% concordance between Phadebas RAST and SPT (70). Pharmacia CAP System showed 91% efficiency relative to SPT in one study (71) and was considered superior to skin testing in another (72).
A contributing factor to the variability of the degree of agreement may be the variability of the skin test extracts (73). Also, it has been shown that even low levels of naturally induced Fel d 1-specific IgG antibodies affect the skin reactivity (74).
Table 1
| Region |
|
Preval.
%
|
Study group |
n |
Procedure |
Ref |
| America |
|
|
|
|
|
|
| USA |
Chicago, Ill |
29 |
Child asthma |
138 |
SPT |
75 |
| 40 |
Asthma |
592 |
SPT |
76 |
| New York, NY |
38 |
Adult asthma |
73 |
SPT |
77 |
| Morgantown, WV |
14 |
Infantile asthma |
196 |
SPT |
78 |
| Los Alamos, NM |
62 |
Child asthma |
21 |
IgE Ab(PCS) |
1 |
|
San Diego, Cal
|
10
|
Child asthma
|
41
|
SPT
|
79
|
|
California
|
39
|
Asthma and/or rhinitis
|
141
|
SPT
|
80
|
|
Canada
|
Vancouver, BC
|
13
|
Asthma/asthma-like/bronchitis
|
504
|
SPT
|
81
|
|
Sainte-Foy, Quebec
|
77
|
Atopic
|
2698
|
SPT
|
82
|
|
Montreal, Quebec
|
84
|
Atopic
|
155
|
SPT
|
37
|
|
Mexico
|
Mexico Valley
|
13
|
Atopic children
|
247
|
SPT
|
83
|
|
Puerto Rico
|
Ponce
|
17
|
Asthma
|
576
|
SPT
|
84
|
|
Brasil
|
São Paulo
|
11
|
Child asthma
|
80
|
SPT
|
85
|
| Europe |
|
|
|
|
|
|
|
Sweden
|
Uppsala
|
14
|
Random adults (34% atopic)
|
527
|
SPT
|
86
|
|
15
|
|
472
|
IgE Ab(PCS)
|
|
|
Umeå (north)
|
73
|
Child asthma
|
41
|
IgE Ab(PCS)
|
38
|
|
Linköping (center)
|
62
|
|
37
|
|
|
|
Helsingborg (south)
|
39
|
|
46
|
|
|
|
United Kingdom
|
Birmingham
|
59
|
Asthma
|
54
|
SPT
|
87
|
|
Germany
|
Hamburg
|
12
|
Random adults
|
739 |
IgE Ab(PCS)
|
88
|
|
Erfurt
|
8
|
|
718
|
|
|
|
Freiburg
|
18
|
Child, general population
|
583
|
SPT
|
89
|
|
Austria
|
Vienna
|
20
|
Random adults
|
191
|
SPT
|
90
|
|
40
|
Adult asthma
|
70
|
|
|
|
44
|
Adult rhinitis
|
117
|
|
|
|
Spain
|
|
21
|
Adult asthma
|
136
|
IgE Ab(PCS)
|
91
|
|
Barcelona
|
16
|
Random adults
|
342
|
IgE Ab(PCS)
|
92
|
|
Albacete
|
4
|
|
170
|
|
|
| East Mediterran. |
|
|
|
|
|
|
|
Turkey
|
|
16
|
Asthma and/or rhinitis
|
614
|
SPT
|
93
|
|
Saudi Arabia
|
Dhahran
|
17
|
Atopic, Saudi Arabs
|
806
|
SPT
|
94
|
|
32
|
Atopic, Expatriates
|
241
|
|
|
| South Atlantic |
|
|
|
|
|
|
|
Tristan da Cunha
|
|
20
|
General population
|
282
|
SPT
|
95
|
|
13
|
Born >1y after cat extermination
|
51
|
|
|
| South East Asia |
|
|
|
|
|
|
|
Thailand
|
Bangkok
|
10
|
Child asthma
|
100
|
SPT
|
96
|
|
Bangkok
|
29
|
Adult rhinitis
|
100
|
SPT
|
97
|
|
Malaysia
|
Kuala Lumpur
|
73
|
Rhinitis
|
314
|
SPT
|
98
|
| Japan |
|
|
|
|
|
|
|
|
Sagamihara
|
78
|
Adult asthma
|
90
|
IgE Ab
|
99
|
|
Sagamihara
|
31
|
Asthma and/or rhinitis
|
458
|
SPT
|
100
|
|
Tokyo
|
70
|
Child asthma, cat at home
|
44
|
IgE Ab (PCS)
|
39
|
|
34
|
Child asthma, no cat at home
|
394
|
|
|
| Australia |
|
|
|
|
|
|
|
|
Sydney
|
4
|
Child, general population
|
1217
|
SPT
|
101
|
PCS = Pharmacia CAP System™
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