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Current Allergy and Asthma Reports

Erschienen in:

01.02.2018 | Occupational Allergies (JA Poole, Section Editor)

Occupational Animal Allergy

verfasst von: Gregg M. Stave

Erschienen in: Current Allergy and Asthma Reports | Ausgabe 2/2018

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Abstract

Purpose of Review

This review explores animal allergen exposure in research laboratories and other work settings, focusing on causes and prevention.

Recent Findings

(1) Consistent with the hygiene hypothesis, there is new evidence that early childhood exposure to pets produces changes in the gut microbiome that likely lead to a lower risk of allergy. (2) Anaphylaxis from laboratory animal bites occurs more frequently than suggested by prior literature. (3) Animal allergens represent an occupational hazard in a wide variety of work settings ranging from fields that work with animals to public settings like schools and public transportation where allergens are brought into or are present in the workplace.

Summary

Exposure to animal allergens can result in allergy, asthma, and anaphylaxis. Animal allergy has been most studied in the research laboratory setting, where exposure reduction can prevent the development of allergy. Similar prevention approaches need to be considered for other animal work environments and in all settings where animal allergens are present.

• Hilger C, Kuehn A, Hentges F. Animal lipocalin allergens. Curr Allergy Asthma Rep. 2012;12(5):438–47. https://doi.org/10.1007/s11882-012-0283-2. Excellent review of animal lipocalin allergens.CrossRefPubMed

Tegoni M, Pelosi P, Vincent F, Spinelli S, Campanacci V, Grolli S, et al. Mammalian odorant binding proteins. Biochim Biophys Acta Protein Struct Mol Enzymol. 2000;1482(1-2):229–40. https://doi.org/10.1016/S0167-4838(00)00167-9.CrossRef

Santiago ML, Hafalla JCR, Kurtis JD, Aligui GL, Wiest PM, Olveda RM, et al. Identification of the Schistosoma Japonicum 22.6-kDa antigen as a major target of the human IgE response: similarity of IgE-binding epitopes to allergen peptides. Int Arch Allergy Immunol. 1998;117(2):94–104. https://doi.org/10.1159/000023995.CrossRefPubMed

Grönlund H, Saarne T, Gafvelin G, Van Hage M. The major cat allergen, Fel d 1, in diagnosis and therapy. Int Arch Allergy Immunol. 2010;151(4):265–74. https://doi.org/10.1159/000250435.CrossRefPubMed

Mattsson L, Lundgren T, Everberg H, Larsson H, Lidholm J. Prostatic kallikrein: a new major dog allergen. J Allergy Clin Immunol. 2009;123(2):362–368.e3. https://doi.org/10.1016/j.jaci.2008.11.021.CrossRefPubMed

•• Zahradnik E, Raulf M. Respiratory allergens from furred mammals: environmental and occupational exposure. Vet Sci. 2017;4(3):38. https://doi.org/10.3390/vetsci4030038. Comprehensive review of animal allergens and their presence in work and public settings, including schools and public transportation.CrossRefPubMedCentral

Jeal H, Harris J, Draper A, Taylor AN, Cullinan P, Jones M. Dual sensitization to rat and mouse urinary allergens reflects cross-reactive molecules rather than atopy. Allergy. 2009;64(6):855–61. https://doi.org/10.1111/j.1398-9995.2008.01899.x.CrossRefPubMed

Nilsson OB, Binnmyr J, Zoltowska A, Saarne T, van Hage M, Grönlund H. Characterization of the dog lipocalin allergen can f 6: the role in cross-reactivity with cat and horse. Allergy. 2012;67(6):751–7. https://doi.org/10.1111/j.1398-9995.2012.02826.x.CrossRefPubMed

• Virtanen T, Kinnunen T. Rytkonen–Nissinen M. Mammalian lipocalin allergens–insights into their enigmatic allergenicity. Clin Exp Allergy. 2012;42(4):494–504. https://doi.org/10.1111/j.1365-2222.2011.03903.x. Excellent review of the possible mechanisms underlying lipocalin allergies.CrossRefPubMed

10.

Oxelius VA, Sjöstedt L, Willers S, Löw B. Development of allergy to laboratory animals is associated with particular Gm and HLA genes. Int Arch Allergy Immunol. 1996;110(1):73–8. https://doi.org/10.1159/000237314.CrossRefPubMed

11.

Jeal H, Draper A, Jones M, Harris J, Welsh K, Taylor AN, et al. HLA associations with occupational sensitization to rat lipocalin allergens: a model for other animal allergies? J Allergy Clin Immunol. 2003;111(4):795–9. https://doi.org/10.1067/mai.2003.176.CrossRefPubMed

12.

Bush RK, Stave GM. Laboratory animal allergy: an update. ILAR J. 2003;44(1):28–51. https://doi.org/10.1093/ilar.44.1.28.CrossRefPubMed

13.

Virtanen T, Zeiler T, Mäntyjärvi R. Important animal allergens are lipocalin proteins: why are they allergenic? Int Arch Allergy Immunol. 1999;120(4):247–58. https://doi.org/10.1159/000024277.CrossRefPubMed

14.

Matsui EC, Diette GB, Krop EJ, Aalberse RC, Smith AL, Curtin-Brosnan J, et al. Mouse allergen-specific immunoglobulin G and immunoglobulin G4 and allergic symptoms in immunoglobulin E-sensitized laboratory animal workers. Clin Exp Allergy. 2005;35(10):1347–53. https://doi.org/10.1111/j.1365-2222.2005.02331.x.CrossRefPubMed

15.

Jones M, Jeal H, Schofield S, Harris JM, Shamji MH, Francis JN, et al. Rat-specific IgG and IgG4 antibodies associated with inhibition of IgE-allergen complex binding in laboratory animal workers. Occup Environ Med. 2014;71(9):619–23. https://doi.org/10.1136/oemed-2014-102119.CrossRefPubMed

16.

Krop EJM, Doekes G, Heederik DJJ, Aalberse RC, van der Zee JS. IgG4 antibodies against rodents in laboratory animal workers do not protect against allergic sensitization. Allergy. 2011;66(4):517–22. https://doi.org/10.1111/j.1398-9995.2010.02508.x.CrossRefPubMed

17.

Douwes J, Pearce N, Heederik D. Does environmental endotoxin exposure prevent asthma? Thorax. 2002;57(1):86–90. https://doi.org/10.1136/thorax.57.1.86.CrossRefPubMedPubMedCentral

18.

Pacheco KA, McCammon C, Liu AH, Thorne PS, O'Neill ME, Martyny J, et al. Airborne endotoxin predicts symptoms in non-mouse-sensitized technicians and research scientists exposed to laboratory mice. Am J Respir Crit Care Med. 2003;167(7):983–90. https://doi.org/10.1164/rccm.2112062.CrossRefPubMed

19.

Pacheco KA, McCammon C, Thorne PS, O'Neill ME, Liu AH, Martyny JW, et al. Characterization of endotoxin and mouse allergen exposures in mouse facilities and research laboratories. Ann Occup Hyg. 2006;50(6):563–72. https://doi.org/10.1093/annhyg/mel019.PubMed

20.

Newton AN, Davis M, Koehler K, Shreffler W, Ahluwalia S, Metwali N, et al. Atopy as a modifier of the relationships between endotoxin exposure and symptoms among laboratory animal workers. Ann Work Expo Health. 2017;61(8):1024–8. https://doi.org/10.1093/annweh/wxx061.CrossRefPubMed

21.

Freitas AS, Simoneti CS, Ferraz E, Bagatin E, Brandão IT, Silva CL, et al. Exposure to high endotoxin concentration increases wheezing prevalence among laboratory animal workers: a cross-sectional study. BMC Pulm Med. 2016;16(1):69. https://doi.org/10.1186/s12890-016-0233-1.CrossRefPubMedPubMedCentral

22.

Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299(6710):1259–60. https://doi.org/10.1136/bmj.299.6710.1259.CrossRefPubMedPubMedCentral

23.

Wold AE. The hygiene hypothesis revised: is the rising frequency of allergy due to changes in the intestinal flora? Allergy. 1998;53(46 Suppl):20–5. https://doi.org/10.1111/j.1398-9995.1998.tb04953.x.CrossRefPubMed

24.

Stiemsma L, Reynolds L, Turvey S, Finlay B. The hygiene hypothesis: current perspectives and future therapies. Immunotargets Ther. 2015;4:143–57. https://doi.org/10.2147/ITT.S61528.CrossRefPubMedPubMedCentral

25.

Legatzki A, Rösler B, von Mutius E. Microbiome diversity and asthma and allergy risk. Curr Allergy Asthma Rep. 2014;14(10):466. https://doi.org/10.1007/s11882-014-0466-0.CrossRefPubMed

26.

Stiemsma LT, Turvey SE. Asthma and the microbiome: defining the critical window in early life. Allergy Asthma Clin Immunol. 2017;13(1):3. https://doi.org/10.1186/s13223-016-0173-6.CrossRefPubMedPubMedCentral

27.

Ownby DR, Johnson CC, Peterson EL. Exposure to dogs and cats in the first year of life and risk of allergic sensitization at 6 to 7 years of age. JAMA. 2002;288(8):963–72. https://doi.org/10.1001/jama.288.8.963.CrossRefPubMed

28.

•• Fujimura KE, Demoor T, Rauch M, Faruqi AA, Jang S, Johnson CC, et al. House dust exposure mediates gut microbiome lactobacillus enrichment and airway immune defense against allergens and virus infection. Proc Natl Acad Sci U S A. 2014;111(2):805–10. https://doi.org/10.1073/pnas.1310750111. Demonstrates how house dust from houses with dogs as pets may alter the gut microbiome and reduce the risk of allergy in an experimental model. CrossRefPubMed

29.

•• Tun HM, Konya T, Takaro TK, Brook JR, Chari R, Field CJ, et al. Exposure to household furry pets influences the gut microbiota of infants at 3–4 months following various birth scenarios. Microbiome. 2017;5(1):40. https://doi.org/10.1186/s40168-017-0254-x. Demonstrates that exposure to 2 or more pets in early childhood was associated with changes in the gut microbiome with increases of two bacteria, Ruminococcus and Oscillospira, which have been negatively associated with childhood atopy (and obesity).CrossRefPubMedPubMedCentral

30.

Siracusa A, Folletti I, Gerth van Wijk R, Jeebhay MF, Moscato G, Quirce S, et al. Occupational anaphylaxis—an EAACI task force consensus statement. Allergy. 2015;70(2):141–52. https://doi.org/10.1111/all.12541.CrossRefPubMed

31.

Teasdale EL, Davies GE, Slovak A. Anaphylaxis after bites by rodents. Br Med J (Clin Res Ed). 1983;286(6376):1480. https://doi.org/10.1136/bmj.286.6376.1480.CrossRef

32.

Hesford JD, Platts-Mills TA, Edlich RF. Anaphylaxis after laboratory rat bite: an occupational hazard. J Emerg Med. 1995;13(6):765–8. https://doi.org/10.1016/0736-4679(95)02016-0.CrossRefPubMed

33.

Rankin TJ, Hill RJ, Overton D. Anaphylactic reaction after a laboratory rat bite. Am J Emerg Med. 2007;25:985.e981–2. https://doi.org/10.1016/j.ajem.2007.02.025.CrossRef

34.

Leng K, Wiedemeyer K, Hartmann M. Anaphylaxis after mouse bite. J Dtsch Dermatol Ges. 2008;6(9):741–3. https://doi.org/10.1111/j.1610-0387.2008.06616.x.CrossRefPubMed

35.

Bunyavanich S, Donovan MA, Sherry JM, Diamond DV. Immunotherapy for mouse bite anaphylaxis and allergy. Ann Allergy Asthma Immunol. 2013;111(3):223–4. https://doi.org/10.1016/j.anai.2013.06.010.CrossRefPubMedPubMedCentral

36.

Kampitak T, Betschel SD. Anaphylaxis in laboratory workers because of rodent handling: two case reports. J Occup Health. 2016;58(4):381–3. https://doi.org/10.1539/joh.16-0053-CS.CrossRefPubMedPubMedCentral

37.

•• Stave GM, Lee EH, Darcey DJ. Laboratory animal bite anaphylaxis: a National Survey: part 1: case series and review of the literature. J Occup Environ Med. 2017;59(8):728–38. https://doi.org/10.1097/JOM.0000000000001005. Case series revealing that laboratory animal bite anaphylaxis occurs more frequently than previously indicated in the literature. CrossRefPubMed

38.

Watt AD, McSharry CP. Laboratory animal allergy: anaphylaxis from a needle injury. Occup Environ Med. 1996;53(8):573–4. https://doi.org/10.1136/oem.53.8.573.CrossRefPubMedPubMedCentral

39.

Thewes M, Rakoski J, Ring J. Anaphylactic reaction after a mouse bite in a 9-year-old girl. Br J Dermatol. 1999;141(1):179. https://doi.org/10.1046/j.1365-2133.1999.02949.x.CrossRefPubMed

40.

Tomitaka A, Suzuki K, Akamatsu H, Matsunaga K. Anaphylaxis after hamster bites: a rare case? Contact Dermatitis. 2002;46(2):113. https://doi.org/10.1034/j.1600-0536.2002.460213.x.CrossRefPubMed

41.

Niitsuma T, Tsuji A, Nukaga M, Izawa A, Okita M, Maruoka N, et al. Two cases of anaphylaxis after dwarf hamster bites. Allergy. 2003;58(10):1081. https://doi.org/10.1034/j.1398-9995.2003.00242.x.CrossRefPubMed

42.

Lim DL, Chan RM, Wen H, Van Bever HP, Chua KY. Anaphylaxis after hamster bites—identification of a novel allergen. Clin Exp Allergy. 2004;34(7):1122–3. https://doi.org/10.1111/j.1365-2222.2004.01992.x.CrossRefPubMed

43.

Trummer M, Komericki P, Kranke B, Aberer W. Anaphylaxis after a Mongolian gerbil bite. J Eur Acad Dermatol Venereol. 2004;18(5):634–5. https://doi.org/10.1111/j.1468-3083.2004.00985.x.CrossRefPubMed

44.

Wilkes D. Father in fight for life after being bitten by a hamster. DailyMail.com. 2007.

45.

Torres JA, Pastor-Vargas C, de las Heras M, Vivanco F, Cuesta J, Sastre J. An odorant-binding protein as a new allergen from Siberian hamster (Phodopus sungorus). Int Arch Allergy Immunol. 2012;157(1):109–12. https://doi.org/10.1159/000324956.CrossRefPubMed

46.

Hudson TW. Lab animal bite anaphylaxis: underappreciated, serious; not rare; needs more attention. J Occup Environ Med. 2017;59(8):727. https://doi.org/10.1097/JOM.0000000000001103.CrossRefPubMed

47.

Bush RK, Wood RA, Eggleston PA. Laboratory animal allergy. J Allergy Clin Immunol. 1998;102(1):99–112. https://doi.org/10.1016/S0091-6749(98)70060-0.CrossRefPubMed

48.

Lieberman P, Nicklas RA, Oppenheimer J, Kemp SF, Lang DM, Bernstein DI, et al. The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol. 2010;126(3):477–80.e1-42. https://doi.org/10.1016/j.jaci.2010.06.022.CrossRefPubMed

49.

Stave GM, Lee EH, Darcey DJ. Laboratory animal bite anaphylaxis: a national survey: part 2: treatment protocols. J Occup Environ Med. 2017;59(8):739–41. https://doi.org/10.1097/JOM.0000000000001063.CrossRefPubMed

50.

Gordon S, Tee RD, Nieuwenhuijsen MJ, Lowson D, Harris J, Newman Taylor AJ. Measurement of airborne rat urinary allergen in an epidemiological study. Clin Exp Allergy. 1994;24(11):1070–7. https://doi.org/10.1111/j.1365-2222.1994.tb02745.x.CrossRefPubMed

51.

Eggleston PA, Newill CA, Ansari AA, Pustelnik A, Lou SR, Evans R 3rd, et al. Task-related variation in airborne concentrations of laboratory animal allergens: studies with rat n I. J Allergy Clin Immunol. 1989;84(3):347–52. https://doi.org/10.1016/0091-6749(89)90419-3.CrossRefPubMed

52.

Thulin H, Björkdahl M, Karlsson AS, Renström A. Reduction of exposure to laboratory animal allergens in a research laboratory. Ann Occup Hyg. 2002;46(1):61–8.PubMed

53.

Heederik D, Venables KM, Malmberg P, Hollander A, Karlsson AS, Renström A, et al. Exposure-response relationship for work-related sensitization in workers exposed to rat urinary allergens: results from a pooled study. J Allergy Clin Immunol. 1999;103(4):678–84. https://doi.org/10.1016/S0091-6749(99)70242-3.CrossRefPubMed

54.

Peng RD, Paigen B, Eggleston PA, Hagberg KA, Krevans M, Curtin-Brosnan J, et al. Both the variability and level of mouse allergen exposure influence the phenotype of the immune response in workers at a mouse facility. J Allergy Clin Immunol. 2011;128(2):390–396.e7. https://doi.org/10.1016/j.jaci.2011.04.050.CrossRefPubMedPubMedCentral

55.

Goodno LE, Stave GM. Primary and secondary allergies to laboratory animals. J Occup Environ Med. 2002;44(12):1143–52. https://doi.org/10.1097/00043764-200212000-00008.CrossRefPubMed

56.

Feistenauer S, Sander I, Schmidt J, Zahradnik E, Raulf M, Brielmeier M. Influence of 5 different caging types and the use of cage-changing stations on mouse allergen exposure. J Am Assoc Lab Anim Sci. 2014;53(4):356–63.PubMedPubMedCentral

57.

Gordon S, Fisher SW, Raymond RH. Elimination of mouse allergens in the working environment: assessment of individually ventilated cage systems and ventilated cabinets in the containment of mouse allergens. J Allergy Clin Immunol. 2001;108(2):288–94. https://doi.org/10.1067/mai.2001.117258.CrossRefPubMed

58.

York JM, McDaniel AW, Blevins NA, Guillet RR, Allison SO, Cengel KA, et al. Individually ventilated cages cause chronic low-grade hypoxia impacting mice hematologically and behaviorally. Brain Behav Immun. 2012;26(6):951–8. https://doi.org/10.1016/j.bbi.2012.04.008.CrossRefPubMedPubMedCentral

59.

• Jones M, Schofield S, Jeal H, Cullinan P. Respiratory protective equipment reduces occurrence of sensitization to laboratory animals. Occup Med (Lond). 2014;64(2):104–8. https://doi.org/10.1093/occmed/kqt144. Provides additional support for the use of respirators as a control strategy in the laboratory animal research setting. CrossRef

60.

Fisher R, Saunders WB, Murray SJ, Stave GM. Prevention of laboratory animal allergy. J Occup Environ Med. 1998;40(7):609–13. https://doi.org/10.1097/00043764-199807000-00005.CrossRefPubMed

61.

Westall L, Graham IR, Bussell J. A risk-based approach to reducing exposure of staff to laboratory animal allergens. Lab Anim (NY). 2015;44(1):32–8. https://doi.org/10.1038/laban.603.CrossRef

62.

Curtin-Brosnan J, Paigen B, Hagberg KA, Langley S, O'Neil EA, Krevans M, et al. Occupational mouse allergen exposure among non-mouse handlers. J Occup Environ Hyg. 2010;7(12):726–34. https://doi.org/10.1080/15459624.2010.530906.CrossRefPubMedPubMedCentral

63.

Krop EJ, Doekes G, Stone MJ, Aalberse RC, van der Zee JS. Spreading of occupational allergens: laboratory animal allergens on hair-covering caps and in mattress dust of laboratory animal workers. Occup Environ Med. 2007;64(4):267–72. https://doi.org/10.1136/oem.2006.028845.CrossRefPubMed

64.

Stave GM, Darcey DJ. Prevention of laboratory animal allergy in the United States: a national survey. J Occup Environ Med. 2012;54(5):558–63. https://doi.org/10.1097/JOM.0b013e318247a44a.CrossRefPubMed

65.

Renström A, Olsson M, Hedrén M, Johansson SG, van Hage M. Pet shop workers: exposure, sensitization, and work-related symptoms. Allergy. 2011;66(8):1081–7. https://doi.org/10.1111/j.1398-9995.2011.02591.x.CrossRefPubMed

66.

Yilmaz I, Oner Erkekol F, Secil D, Misirligil Z, Mungan D. Cat and dog sensitization in pet shop workers. Occup Med (Lond). 2013;63(8):563–7. https://doi.org/10.1093/occmed/kqt116.CrossRef

67.

Samadi S, Heederik DJ, Krop EJ, Jamshidifard AR, Willemse T, Wouters IM. Allergen and endotoxin exposure in a companion animal hospital. Occup Environ Med. 2010;67(7):486–92. https://doi.org/10.1136/oem.2009.051342.CrossRefPubMed

68.

Moghtaderi M, Farjadian S, Abbaszadeh HM. Animal allergen sensitization in veterinarians and laboratory animal workers. Occup Med (Lond). 2014;64(7):516–20. https://doi.org/10.1093/occmed/kqu097.CrossRef

69.

Schlünssen V, Basinas I, Zahradnik E, Elholm G, Wouters IM, Kromhout H, et al. Exposure levels, determinants and IgE mediated sensitization to bovine allergens among Danish farmers and non-farmers. Int J Hyg Environ Health. 2015;218(2):265–72. https://doi.org/10.1016/j.ijheh.2014.12.002.CrossRefPubMed

70.

Elfman L, Brannstrom J, Smedje G. Detection of horse allergen around a stable. Int Arch Allergy Immunol. 2008;145(4):269–76. https://doi.org/10.1159/000110885.CrossRefPubMed

71.

• Sheehan WJ, Permaul P, Petty CR, Coull BA, Baxi SN, Gaffin JM, et al. Association between allergen exposure in Inner-City schools and asthma morbidity among students. JAMA Pediatr. 2017;171(1):31–8. https://doi.org/10.1001/jamapediatrics.2016.2543. Demonstrates high levels of mouse allergens in schools associated with increased asthma symptoms in students that could also represent a hazard for teachers and others working in these schools. CrossRefPubMedPubMedCentral

72.

Munir AK, Einarsson R, Schou C, Dreborg SK. Allergens in school dust. I. The amount of the major cat (Fel d I) and dog (Can f I) allergens in dust from Swedish schools is high enough to probably cause perennial symptoms in most children with asthma who are sensitized to cat and dog. J Allergy Clin Immunol. 1993;91(5):1067–74. https://doi.org/10.1016/0091-6749(93)90221-Z.CrossRefPubMed

73.

De Lucca SD, O’Meara TJ, Tovey ER. Exposure to mite and cat allergens on a range of clothing items at home and the transfer of cat allergen in the workplace. J Allergy Clin Immunol. 2000;106(5):874–9. https://doi.org/10.1067/mai.2000.110804.CrossRefPubMed

74.

Salo PM, Sever ML, Zeldin DC. Indoor allergens in school and day care environments. J Allergy Clin Immunol. 2009;124(2):185–92, 192.e1-9; quiz 193-4. https://doi.org/10.1016/j.jaci.2009.05.012.CrossRefPubMedPubMedCentral

75.

Fu X, Lindgren T, Guo M, Cai GH, Lundgren H, Norbäck D. Furry pet allergens, fungal DNA and microbial volatile organic compounds (MVOCs) in the commercial aircraft cabin environment. Environ Sci Process Impacts. 2013;15(6):1228–34. https://doi.org/10.1039/c3em30928b.CrossRefPubMed

Titel: Occupational Animal Allergy
verfasst von: Gregg M. Stave
Publikationsdatum: 01.02.2018
Verlag: Springer US
Erschienen in: Current Allergy and Asthma Reports / Ausgabe 2/2018
Print ISSN: 1529-7322
Elektronische ISSN: 1534-6315
DOI: https://doi.org/10.1007/s11882-018-0755-0

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Occupational Animal Allergy

Abstract

Purpose of Review

Recent Findings

Summary

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Purpose of Review

Recent Findings

Summary

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