Today's Veterinary Practice

MAY-JUN 2018

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53 MAY/JUNE 2018 ● TVPJOURNAL.COM FEATURES dust, and dust-creating cat litter, from the household whenever possible. Additionally, it is important to ensure that cats are receiving adequate parasite control—heartworm and other parasite exposure can also induce lung disease, as briefly mentioned above. Finally, patients with feline asthma may be more prone to secondary airway infections, and it is important to consider this possibility in the initial patient evaluation and during acute exacerbations of feline asthma. When airway samples are collected as part of the diagnostic workup, appropriate airway cultures should be submitted to evaluate for this possibility. EXPERIMENTAL THERAPIES Many therapies have been investigated in feline experimental models, and this section briefly describes pertinent therapies that have demonstrated some efficacy and/or are promising future therapies. Omega-3 Fatty Acids Supplementation with a long-chain omega-3 polyunsaturated fatty acid (PUFA) and antioxidant (luteolin) combination resulted in decreased airway hyper-responsiveness in cats with experimentally induced allergy. 18 However, airway inflammation did not significantly decrease. Therefore, supplementation may have some clinical benefit, and this could potentially be used as an adjunctive to mainstay therapy. Further research is needed to determine whether these effects apply to other omega-3 PUFA supplements and, in particular, whether there is an effect in patients with naturally occurring asthma. Allergen-Specific Immunotherapy Allergic asthma in human medicine is often managed by identifying allergens to which individuals are sensitized, avoiding the allergens (when possible), and/ or immunotherapy. Identification of allergens to which a cat is sensitized can be challenging. Although intradermal skin testing (IDST) is possible in cats, interpretation of the results is difficult. Evaluation of allergen-specific IgE concentrations is another option for allergy testing that requires only a blood sample. In a study evaluating IDST and serum allergen-specific IgE testing in cats, both IDST and an FcεR1α-based enzyme-linked immunosorbent assay (ELISA) were specific enough for selection of allergens for immunotherapy. 19 A separate ELISA (enzymoimmunometric assay) evaluated in this study was unreliable; 19 therefore, reliability of available ELISAs for detection of serum allergen- specific IgE may vary. Once allergens are identified, avoidance of allergens can be considered. However, this is unlikely to be successful in feline patients. A feline experimental allergic model evaluated allergen-specific immunotherapy. Several studies conducted expedited immunotherapy ("rush" immunotherapy) using various protocols and found it reduced eosinophilic airway inflammation. 20,21 Although this therapy appears to be effective in the experimental model, data in clinical patients are lacking. Future studies in clinical patients are needed to determine clinical usefulness. Stem Cell Therapy In studies evaluating the efficacy of mesenchymal stem cell (MSC) therapy for feline allergic asthma, potential benefits appear to be primarily directed at reduction of airway remodeling. Airway remodeling is a consequence of long-standing airway inflammation, and although MSC therapy did not result in decreased eosinophilic inflammation or airway hyper-responsiveness, positive effects on computed tomography indices were noted. Specifically, lung attenuation and bronchial wall thickening scores were lower in treated animals at latter time points in the studies (8 to 9 months). 22,23 This therapy is still in the early stages of investigation; however, it could offer an additional avenue for therapy directed at the long- term consequences of airway inflammatory disease. CONCLUSION Feline allergic asthma is an inflammatory airway condition that results in eosinophilic airway inflammation and bronchoconstriction. Therapy Clients should be counseled on eliminating or reducing airway irritants, such as cigarette smoke, dust, and dust- creating cat litter, from the household whenever possible.

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