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Focus Questions
What is the extent and burden of pet allergies?
How has the diagnosis of cat and dog allergies evolved in recent years?
How does a diagnosis of pet allergy in paediatric patients impact on disease development and severity in later life?
How are patients identified as needing pharmacologic therapy versus allergen avoidance and environmental control measures?
What are the pros and cons of available pharmacotherapies and immunotherapy for the treatment of furry pet allergies?
How may novel approaches help to support personalized medicine?
What other approaches are being considered to help manage people affected by furry pet allergies?
How should healthcare professionals consider patient preferences and goals in managing their pet allergy over time?
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Addressing the diagnosis and management of pet allergies in primary care and beyond

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Dr Ann-Marie Schoos is a research associate professor at the University of Copenhagen in Denmark, where she leads the allergy group at Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) and supervises several medical and PhD students. She also works part-time in the paediatric department at Slagelse Hospital in Copenhagen. read more

Dr Schoos joined the COPSAC research team in 2009. In 2013–2014 she worked for 1 year during her PhD as a visiting scientist in Professor Hugh Sampson’s laboratory at Mount Sinai Hospital, New York, USA; in 2022–2023 she worked for 17 months as a visiting associate professor at British Columbia’s Children’s Hospital in Vancouver, BC, Canada with Professor Edmond Chan – both are world renowned for their expertise in allergy research.

Using data from the clinical birth cohorts at COPSAC, her research focuses on understanding the mechanisms of allergic disease inception to improve primary prevention of disease. Her research areas include diagnostic tools to interpret allergic sensitization and multiple biomarkers to better understand the mechanisms of atopic diseases.

Dr Schoos has received several prestigious awards for her research: the Grethe Stampes Award for outstanding allergy research in 2017 and 2020, the Birgit and Svend Igor Pock-Steen Award for paediatric allergy research in 2016, and the Fulbright Scholarship for Danish researchers in 2013. She serves as an editorial member of two international journals, and she has been a board member of the Danish Society of Allergology from 2016–2022.

Dr Ann-Marie Schoos discloses: Advisory board or panel fees from ALK. Consultancy fees from Thermo Fisher (relationship terminated). 

Learning Objectives

After watching this activity, participants should be better able to:

  • Interpret advances in the diagnosis of pet allergies and how these fit into the current diagnostic paradigm
  • Summarize optimal strategies for the management of pet allergies, including effective control measures and treatments
Overview

In this interview, Dr Ann-Marie Schoos answers a series of questions on the diagnosis and management of pet allergies, including the role of component-resolved diagnostics in providing a detailed analysis of patients’ sensitization profiles to allow for a more personalized approach to management.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of allergists, immunologists, paediatricians, primary care physicians and nurse practitioners involved in the management of pet allergy.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Ann-Marie Schoos discloses: Advisory board or panel fees from ALK. Consultancy fees from Thermo Fisher (relationship terminated). 

Content reviewer

Danielle Walker, DNP, APRN, AGNP-C has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Contributors

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.5 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category [category of credit ] CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.5 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 15 February 2024. Date credits expire: 15 February 2025

If you have any questions regarding credit please contact cpdsupport@usf.edu

This activity is CE/CME accredited

To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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Topics covered in this activity

Asthma / Allergy
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Addressing the diagnosis and management of pet allergies in primary care and beyond
0.5 CE/CME credit

Question 1/5
You are reviewing your 6-year-old patient with suspected allergy. Skin prick test extracts contain mainly Fel d 1 allergen, confirming a cat allergy. Allergen component test results show additional sensitization to Fel d 2 and Fel d 4 allergens. How may you interpret these findings based on the latest research in terms of risk for future atopic disease?

Allergy to cats and dogs has been recognized for many years as a major risk factor for the development of asthma and allergic rhinitis.1 Fel d 1 is the most important allergen in cat allergy.2 Studies have shown that high levels of IgE antibodies to Fel d 2 and Fel d 4 have been associated with atopic dermatitis in children with cat allergy.1–3 Component-resolved diagnostics can help to identify specific IgE responses to specific molecular targets, and allows detailed analysis of patients’ sensitization profiles.1

Abbreviation
IgE, immunoglobulin E.

References

  1. Schoos AM, et al. J Allergy Clin Immunol. 2021;147:1164–73.
  2. Popescu F-D, et al. World J Methodol. 2021;11:46–60.
  3. Wisniewski J, et al. Clin Experimental Allergy. 2013;43:1160–70.
Question 2/5
You are discussing the latest advances in allergy testing with your colleagues in the clinic. When asked about the role of allergen component testing within the current diagnostic pathway for pet allergies, how might you respond to your colleagues?

Although molecular diagnostics are gaining traction in allergology, guidelines continue to include a diagnostic workup for suspected IgE-mediated allergies that includes a comprehensive history, followed by sensitization tests and optional challenge tests.1,2 Guidelines highlight the utility of component-resolved diagnostics in profiling polysensitized patients, and assessing allergens of low abundance and/or low stability.1

Abbreviation
IgE, immunoglobulin E.

References

  1. Dramberg C, et al. Pediatr Allergy Immunol. 2023;34:e13854.
  2. Davila I, et al. Allergy. 2018;73:1206–22.
Question 3/5
In addition to guideline recommendations for allergy avoidance and environmental control measures, which of the following statements best reflects the current consensus regarding the real-world use of pharmacotherapies in the management of allergic rhinitis symptoms that can occur in patients with furry animal allergy?

The American Academy of Allergy, Asthma & Immunology and the European Academy of Allergy and Clinical Immunology guidelines outline the optimal management of animal allergies, consisting of allergen avoidance and environmental control measures, pharmacological therapy and immunotherapy.1,2 In a recent Delphi consensus panel of international experts on pharmacotherapy management of allergic rhinitis, the majority of respondents (n/N=10/18) said they recommended pharmacotherapy ‘as needed’ in moderate-to-severe allergic rhinitis; the majority of experts that recommended ‘as needed’ pharmacotherapy (n/N=7/10) said they would feel comfortable prescribing oral antihistamines or nasal steroids ‘as needed’.3  

References

  1. AAAAI. Available at: www.aaaai.org/conditions-treatments/allergies/pet-allergy (accessed January 2024).
  2. Dramburg S, et al. Pediatr Allergy Immunol. 2023;34:e13854.
  3. Larenas-Linnemann DES, et al. World Allergy Org J. 2023;16:100800.
Question 4/5
Your 24-year-old patient has a history of mild rhinitis on prolonged contact with furry animals. Your patient explains that since they have moved out of the family home, their parents and younger siblings have decided to keep a pet cat. Your patient asks for your advice on what steps they could take to manage their allergies when visiting their family at the weekend. Which of the following might you consider suggesting to your patient?

Physicians are encouraged to advise patients with cat allergy to take symptomatic treatment (e.g. antihistamines or mast cell stabilizers) before visiting cat owners if the visits cannot be avoided.1 Oral antihistamines can be used for any symptom classification in allergic rhinitis, and some patients report satisfactory symptom with antihistamine monotherapy.2 In clinical practice, intranasal corticosteroids may take a few days to be fully effective; they are most effective when used regularly, as their onset of action is 7–12 hours, reaching maximum benefit within 2 weeks.2,3

References

  1. Jensen-Jarolim E, et al. Allergo J Int. 2023;32:130–7.
  2. May JR, Dolen WK. Clin Ther. 2017;39:2410–9.
  3. Bousquet J, et al. J Allergy Clin Immunol. 2016;138:367–74.
Question 5/5
Your 5-year-old patient has a history of rhinitis and pruritus following contact with cats, but no wheezing or other respiratory symptoms to date. Skin prick tests to furry animal crude extracts yield a positive result to cat dander. Component-resolved serology tests show elevated titres of IgE antibodies against Fel d 1, Fel d 2, Fel d 4 and Fel d 8 allergens. Other furry animal allergen testing results show the patient is monosensitized to Can f 5. The parents ask if this means the family should avoid having a household pet as the family would like to own a cat or dog in the future. How might you counsel these parents?

IgE, immunoglobulin E.

Children monosensitized to Can f 5 (an allergen produced in the dog prostate gland) show different reactions to male and female dog extract provocation using both the skin prick test and conjunctival allergen provocation test, suggesting tolerance to female dogs and potential for ownership of a female dog as a household pet.1,2 

References

  1. Schoos AM, et al. J Allergy Clin Immunol. 2020;8:1592–7.
  2. Liccardi G, et al. J Allergy Clin Immunol. 2019;143:1657–8.
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