Carmine Sapio

Gennaro Liccardi

Luigino Calzetta

Paola Rogliani

International Journal of Occupational Medicine and Environmental Health

English

Liccardi, G

Calzetta, L

Sapio, C

ROGLIANI, PAOLA

Occupational allergy to horse allergens: More than exposure to horses!

Rogliani, P

Name not available

CALZETTA , LUIGINO

Open Access Repository

721L E T T E R  T O  E D I T O R SInternational Journal of Occupational Medicine and Environmental Health 2016;29(5):721 – 723http://dx.doi.org/10.13075/ijomeh.1896.00770LETTER TO EDITORS(AUGUST 17, 2015)OCCUPATIONAL ALLERGY  TO HORSE ALLERGENS:  MORE THAN EXPOSURE TO HORSES!Dear Editor,We read with interest the article from Moghtaderi et al. [1] showing that exposure to horses among individuals who ride enhances the risk of developing allergic sensitization to horse allergens in comparison to healthy controls.The topic is of high importance considering the popularity of a horse as a domestic animal for several reasons (work, leisure, pet therapy, etc.), and the relatively scarcity of data on horse-induced allergic sensitization. However, in our opinion, serious limitations to the conclusions of this research have not been included in the list of possible limi-tations already acknowledged by the authors.First of all, the authors don’t provide any information on the type of contact of horse-riders and healthy controls with common pets such as cats and dogs (Ownership? In-direct exposure? No apparent contact?). The frequency of ownership and the prevalence of allergic sensitization to cats/dogs vary in different countries according to cultural differences and environmental factors.Moreover, it has been widely recognized that cat and dog allergens should be considered as ubiquitous since they are found not only in indoor environments containing those an-imals but also in other indoor private/public places where cats/dogs have never been kept [2]. The consequence of pet allergen ubiquity is a persistent stimulation of airways similar to that induced by dust mite. This indirect modal-ity of exposure (through clothes or other items) [3,4] is likely to be involved also for other furry animals, including horses [5]. Another important aspect is that allergic sen-sitization to furry animals may be induced not only by di-rect/indirect exposure but also by a cross-reaction mecha-nism involving some families of allergenic proteins. Lipo-calins constitute the most important group of mammalian inhalant allergens because they are the major allergenic materials derived from a dog (Can f 1-2), cattle (Bos d 2), a horse (Equ c 1), a rat (Rat n 1), a mouse (Mus m 1), a guinea pig (Cav p 1), a rabbit (Ory c 1), and a ham-ster (Pho s 21) [6]. Some lipocalins show a very low amino acid identity whereas others – greater homologies and immunoglobulin E (IgE) cross-reactivity (47–67%), such as Fel d 4, Can f 6, Equ c 1, Ory c 4, Mus m 1, and Rat n 1.It has been shown that mammalian serum albumins are also involved in some clinical conditions, such as anaphylactic reactions after artificial insemination, episodes of food al-lergy and asthmatic reactions [7]. In our geographical area (Naples, Italy), only about 50% of atopic patients sensitized to common pets (cats/dogs) are directly exposed to those animals whereas the other half is indirectly exposed or not exposed. If we consider allergic sensitization and modalities of exposure to other furry animals, such as rabbits, ham-sters, rats, horses, cows, guinea pigs and mice, the percent-age rate of sensitized individuals exposed directly to those animals ranges between 0–33.3% whereas the percentage rate of the patients sensitized to the same animals with indi-rect or no contact ranges between 66.7–100% [8].Finally, we have shown, by using an in vivo model (skin prick test), that exposure and allergic sensitization to com-mon pets increase the risk of developing sensitization to other furry animals (including horses) by about 14-fold, suggesting a possible predisposition to develop multiple Nofer Institute of Occupational Medicine, Łódź, PolandL E T T E R  T O  E D I T O R S       G. LICCARDI ET AL.IJOMEH 2016;29(5)722(Bos d 6, Can f 3, Equ c 3, Fel d 2) might be very useful to evaluate the possibility of cross-reactions between aller-gens of different animals [13]. These suggestions might contribute to prevent allergic sensitization to a horse other than the measures indicated by authors for indi-viduals who have already become horse riders.Key words:Bronchial asthma, Horse, Horse allergy, Hypersensitivity, Occupational allergy, Occupational asthmaREFERENCES1. Moghtaderi M, Farjadiani S, Hosseini Z, Raayat A. Increased risk of horse sensitization in southwestern Iranian horse rid-ers. Int J Occup Med Environ Health. 2015;28:909–13, http://dx.doi.org/10.13075/ijomeh.1896.00471.2. Liccardi G, D’Amato G, Russo M, Canonica GW, D’Amato LM, Passalacqua G. Focus on cat allergen (Fel d 1): Immunologi-cal and aerodynamic characteristics, modality of airway sensi-tization and avoidance strategies. Int Arch Allergy Immunol. 2003;132:1–12, http://dx.doi.org/10.1159/000073259.3. D’Amato G, Liccardi G, Russo M, Barber D, D’Amato M, Carreira J. Clothing is a carrier of cat allergens. J Allergy Clin Immunol. 1997;99:577–8, http://dx.doi.org/10.1016/S0091- 6749(97)70088-5.4. Liccardi G, Barber D, Russo M, D’Amato M, D’Amato G. Human hair: An unexpected source of cat allergen exposure. Int Arch Allergy Immunol. 2005;137:141–4, http://dx.doi.org/10.1159/000085793.5. Liccardi G, Dente B, Senna GE, de Martino M, D’Amato M, D’Amato G. Sensitization to horse allergens without appar-ent exposure to horse. Report of two cases. Eur Ann Allergy Clin Immunol. 2005;37:350–2.6. Hentges F, Léonard C, Arumugan K, Hilger C. Immune responses to inhalant mammalian allergens. Front Immu-nol. 2014 May 21;5:234, http://dx.doi.org/10.3389/fimmu. 2014.00234.7. Liccardi G, Asero R, D’Amato M, D’Amato G. Role of sen-sitization to mammalian serum albumin in allergic disease. sensitization to animal allergens [9]. Recently, we have confirmed this finding also by using an in vitro model (the micro-array technique ImmunoCAP ISAC, Thermofisher Scientific – Immuno-Diagnostics, Sweden), in the case of 741 subjects sensitized or not to pet allergens, because of the presence of lipocalins [10]. Unfortunately, this last diagnostic approach has not been performed, in the study of Moghtaderi et al., at least among individuals with a sus-pected horse-induced occupational allergy.In conclusion:1. The lack of information about the exposure to common pets among examined patients does not allow to estab-lish the potential risk of developing allergic sensitiza-tion to a horse, also in the absence of horse contact. In other words, it is likely that a significant percentage rate of horse-rider patients could have developed allergic sensitization to horse allergens as the only consequence of lipocalin-cross reactivity but not as a consequence of an occupational allergy.2. The lack of using the Component Resolved Diagno-sis (ImmunoCAP ISAC) does not allow to evaluate the presence of specific IgE to some families of aller-genic animal proteins which share significant cross-re-activity. This finding is very useful to confirm the suspi-cion of occupational allergy to horse.3. The data discussed here suggests that several different factors may induce allergic sensitization to furry animals with or without previous contact. This aspect should be taken into account by susceptible individuals before any contact with any animal, including a horse for working/leisure activity purposes [11,12]. The skin prick test and/or evaluation of specific IgE antibodies to a horse should be recommended for individuals already sensitized to common pets to identify the occurrence of allergic sen-sitization and consequently to avoid any kind of contact with a horse. In this context an evaluation of specif-ic IgE by using the micro-array technique for lipocalins (Can f 1, Can f 2, Equ c 1, Fel d 4, Mus m 1) and albumins HORSE EXPOSURE AND ALLERGY      L E T T E R  T O  E D I T O R SIJOMEH 2016;29(5) 72311. Liccardi G, Salzillo A, Dente B, Piccolo A, Lobefalo G, Russo M, et al. Horse allergens: An underestimated risk for allergic sensitization in an urban atopic population without occupational exposure. Respir Med. 2009;103:414–20, http://dx.doi.org/10.1016/j.rmed.2008.09.017.12. Liccardi G, D’Amato G, Antonicelli L, Berra A, Billeri L, Canonica GW, et al. Sensitization to horse allergens in Italy: A multicentre study in urban atopic subjects without occupa-tional exposure. Int Arch Allergy Immunol. 2011;155:412–7, http://dx.doi.org/10.1159/000321414.13. Liccardi G, Bilò MB, Manzi F, Piccolo A, di Maro E, Sal-zillo A. What could be the role of molecular-based allergy diagnostics in detecting the risk of developing allergic sen-sitization to furry animals? Eur Ann Allergy Clin Immunol. 2015;47:163–7.Gennaro Liccardi1, Luigino Calzetta2, Carmine Sapio3, and Paola Rogliani21 High Speciality “A. Cardarelli” Hospital, Naples, ItalyDepartment of Chest Diseases Division of Pneumology and Allergology2 University of Rome “Tor Vergata”, Rome, ItalyDepartment of Systems Medicine3 Federico II University, Naples, ItalyCorresponding author: Gennaro LiccardiHigh Speciality “A. Cardarelli” HospitalDepartment of Chest DiseasesDivision of Pneumology and AllergologyPiazzetta Arenella 7, 80128 Naples, Italy(e-mail: gennaro.liccardi@tin.it)Curr Allergy Asthma Rep. 2011;11:421–6, http://dx.doi.org/10.1007/s11882-011-0214-7.8. Liccardi G, Salzillo A, Piccolo A, Russo M, D’Amato G. Sensitization to furry animals in an urban atopic population living in Naples, Italy. Allergy. 2011;66:1500–1, http://dx.doi.org/10.1111/j.1398-9995.2011.02675.x.9. Liccardi G, Passalacqua G, Salzillo A, Piccolo A, Falagiani P, Russo M, et al. Is sensitization to furry animals an indepen-dent allergic phenotype in nonoccupationally exposed indi-viduals? J Investig Allergol Clin Immunol. 2011;21:137–41.10. Liccardi G, Meriggi A, Russo M, Croce S, Salzillo A, Pig-natti P. The risk of sensitization to furry animals in patients already sensitized to cat/dog: A in vitro evaluation using molecular-based allergy diagnostics. J Allergy Clin Immunol. 2015;135:1664–6, http://dx.doi.org/10.1016/j.jaci.2015.03.021.This work is available in Open Access model and licensed under a Creative Commons Attribution-NonCommercial 3.0 Poland License – http://creativecommons.org/licenses/by-nc/3.0/pl/deed.en.

Occupational allergy to horse allergens: More than exposure to horses!

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Occupational allergy to horse allergens: More than exposure to horses!

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Full text

Available Versions

ART

Name not available

ART

Open Access Repository

Archivio della Ricerca - Università di Roma Tor vergata

Crossref

Directory of Open Access Journals

Archivio istituzionale della Ricerca - Università degli Studi di Parma

Biblioteka Nauki - repozytorium artykuÅÃ³w

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