Cat allergy represents one of the most challenging aspects to an allergist’s practice. From the fact that so many families have indoor cats one can easily understand why cat allergy symptoms are so commonly seen in clinical practice. And the fact that the cat allergen itself is one of the most potent allergens on the face of the earth, it follows that the number of individuals sensitized to the allergen and who subsequently developed cat allergy symptoms has increased dramatically and will continue to increase.
The challenge to the allergist is even more acute when one recognizes the fact that, in so many cases, cats become bona fide and loved family members, and the suggestion to the cat allergy individual of removing one’s pets from the home is often met with a negative and nonnegotiable response. From a patient’s perspective, the realization that their allergy or asthma symptoms or their child’s symptoms are being caused by their cat can be devastating. The emotional impact of this realization is often met with denial, and subsequent avoidance of sound medical advice. A caring allergist will recognize these strong emotions and will work with the patient and family to design an environmental control program with which the patient suffering from cat allergy symptoms can take charge of improving his or her care.
It is the nature of the cat allergen itself which makes management and treatment of cat allergy so difficult to deal with. Cat allergen is extremely potent and in a highly allergic individual, it does not take much exposure to induce very bothersome, and sometimes severe, cat allergy symptoms. Besides the potency issue, cat allergen is extremely light and becomes airborne, therefore readily accessible to the eyes, nose and lungs of the allergic patient. The allergen is also very sticky, and therefore can be found just about anywhere that a cat resides; on the furniture, walls, carpeting, floors, bed, etc. Needless to say, the amount of cat allergen in homes where cats reside is plentiful and often problematic, but cat allergen is virtually everywhere! It can be found in very significant concentrations in school classrooms where children bring the allergen on their clothes, in places of business, in homes where a cat does not reside, and even in allergists’ offices!
Contrary to popular belief, the sole source of the allergen on cats is not the hair or fur. It is also present in the dander (skin scales), the urine, and the saliva. Also false is the notion that there are hypo-allergenic cats. Although some species have been reported to be less allergenic than others, all cats have the potential of inducing allergy symptoms in the highly sensitized individual.
Environmental control is the most important treatment modality in dealing with cat allergy symptoms, which can be as mild and inconsequential as minimal nasal and eye symptoms, or as severe as life threatening cat induced asthma, and everything in between. It is the severity of these cat allergy symptoms which will likely guide your allergist when making recommendations to the patient and family of the cat allergic individual.
When cat allergies are present in children or adults, they can experience chronic asthma symptoms. If the asthmatic has recurrent or persistent symptoms, or has evidence of chronic airway inflammation and airway obstruction as measured by spirometry (lung function studies), the necessary, albeit sometimes emotionally painful step, is the removal of the cat(s) from the home. The home should then undergo a thorough cleaning. Compromise approaches, such as keeping the cat out of the bedroom and avoiding direct contact, are likely not to be helpful. Not to remove the cat(s) from the homes will likely result in the patients needing to take multiple asthma medications on a daily basis just to maintain an acceptable level of lung function, and the frequent or chronic use of corticosteroid (prednisone, methyprednisolone) medication.
For less severe symptoms which do not involve asthma, compromise approaches can be helpful. These suggestions would likely include the recommendation that the cat(s) never go in the bedroom, avoiding direct contact, thorough and frequent cleaning of the home and the cat, use of medications, and possibly immunotherapy or desensitization.
It is extremely important that one create an allergy-free zone for the cat allergy patient. Since one spends approximately one third of their life in one’s bedroom, it is obvious the the allergy-free area should be the bedroom. Specific recommendations might include: