I have a patient who works as a veterinarian and has many pets at home as well. She has ImmuoCAP results which are positive to various pollens, cat dander, and dog dander. She also has rabbits at home and ImmunoCAP is also positive for allergen specific IgE to rabbit epithelium. What would be the therapeutic dose range for immunotherapy for rabbit or does one exist? Is immunotherapy for rabbit dander even effective?
Thank you for your question.
Like laboratory animal workers, veterinarians and staff have significant exposure to animals. It has been approximated that one third of laboratory animal workers have occupational allergy to animal danders, and a third of these have symptomatic asthma. Sensitization generally occurs with the first 3 years of employment, and risk factors include atopic background, as well as job description as it relates to the intensity of exposure. (1)
Rabbit allergy is seen in pet owners as well as those with occupational exposures. Various allergens, such as Ory c 1, Ory c 2, Ory c 3 and Ory c 4 have been identified in rabbit’s saliva, hair, urine, dander. Ory c 3 and Ory c 4 has been shown to cross react with cat Fel d 4 and dog Can f 6. (2, 3) Rabbit saliva is the most potent allergen source of allergen. Rabbit allergen extract is sourced from rabbit epithelium, which contains all four major allergens.
Rabbit epithelium extract, like many extracts, is not standardized. It is available for both testing and treatment (both glycerin and aqueous). Rabbit epithelium extract for testing and treatment is available through most allergen extract companies.
In our mixing lab we add 0.5mL in 5mL vial or 1mL in 10mL vial. In our practice, we find rabbit immunotherapy effective. I have treated several veterinarians as well patients that have rabbits as pets. Anecdotally, I find that most patients with rabbit allergy are also cat allergic.
1) Bush RK, Wood RA, Eggleston PA. Laboratory animal allergy. J Allergy Clin Immunol. 1998 Jul;102(1):99-112.
2) M. Curin CH. Allergy to pets and new allergies to uncommon pets. Allergol Select 2017;1(2):214-221. 2017;1:214-21.
3) Hilger C, Kler S, Arumugam K, Revets D, Muller CP, Charpentier C, Lehners C, Morisset M, Hentges F. Identification and isolation of a Fel d 1-like molecule as a major rabbit allergen. J Allergy Clin Immunol. 2014 Mar;133(3):759-66.
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Jeffrey G Demain, MD, FAAAAI