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Are Curly Horses an Alternative for Horse-Allergic Riders? a Pilot Observational Case Study

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Are Curly Horses an Alternative for Horse-Allergic Riders? a Pilot Observational Case Study Original Article Original Allergy against horses: Are curly horses an alternative for horse-allergic riders? A pilot observational case study WOLFGANG MITLEHNER Private Medical Practice for Pneumology, Internal Medicine, Allergology, Klappholz; Former Private Medical Practice for Pneumology, Internal Medicine, Allergology, Hospital Moabit, Berlin Summary Pferdeallergie: Objective: To test the hypothesis that Curly horses while measuring lung function during and after Sind Curly possess hypoallergenic properties making them horse contact. Horses (Locken- suitable for horse-allergic riders. Results: The prestudy phase data show comparable re- pferde) eine Methods: The feasibility of a standard horse prick sults between the standard horse prick test and the Alternative für test, compared with the Curly horse scratch test, scratch test using material of a German riding pony pferde allergi- was first studied on 4 prestudy phase patients. Sub- and a defined Curly horse mare (ABC 2563). In the sche Reiter? sequently, ten horse-allergic riders, who had previ- main test phase, the skin test with Curly horses result- Eine Pilot-Fall- ously stopped riding because of horse allergy with ed in mostly reduced reactions compared to the stan- Beobachtungs- resulting bronchial asthma and/or allergic rhino- dard horse prick test. The ten horse-allergic riders did Studie conjunctivitis, underwent basic lung function diag- not react significantly to exposure to the horses or re- nostics: allergy testing (standard horse, Curly hors- acted very slightly. Nine of 10 patients were found not es) and spirometry (or body plethysmography). In- to react significantly after brushing Curly horses. Key words dependently of the allergy test result, an escalated Conclusion: We conclude that Curly horses seem to Horse allergy – Curly horse contact program was conducted begin- be suitable for horse-allergic riders who want or Curly horses – Hy- ning with riding and later on brushing Curly horses need to continue riding. poallergenicity – Lung function – Curly horse scratch test Zusammenfassung Ziel: Die sogenannten Curly Horses sollen eine hy- striegelt wurden. Während dessen wurde die Lun- poallergene Eigenschaft besitzen, die es pferdealler- genfunktion beim und nach dem Pferdekontakt gischen Reitern erlaubt, mit ihnen Umgang zu ha- gemessen. Schlüsselwörter ben. Dies sollte untersucht werden. Ergebnisse: Die Vorphasen-Testergebnisse zeigen Pferdeallergie, Methodik: Um zu testen, ob ein Standard-Pferde- vergleichbare Reaktionen zwischen dem Standard- Curly Horses (Lo- Pricktest vergleichbare Ergebnisse zu einem Cur- Pricktest Pferd und dem Scratchtest, getestet mit ei- ckenpferde), Hy- ly-Horse-Scratchtest liefert, wurden diese Metho- nem Deutschen Reitpony und einer definierten poallergenität, den zunächst in einer Vorphase an vier Patienten Curly-Horse-Stute (ABC 2563). In der Haupttest- Lungenfunktions- getestet. Im Anschluss wurden zehn pferdealler- phase zeigten die Curly Horses im Hauttest am Pa- messung beim gische Reiter, die aufgrund ihrer Allergie mit sym- tienten meist schwächere Reaktionen als im Stan- Reiten, Curly Hor- ptomatischen Beschwerden beim Reiten, wie dard Pricktest Pferd. Die zehn pferdeallergischen se Scratch Test Asthma bronchiale und/oder allergischer Rhino- Reiter reagierten nicht signifikant oder nur in ge- konjunktivitis, das Reiten aufgegeben hatten, lun- ringem Umfang auf Pferdekontakt (Reiten). Neun genfunktionell untersucht: Allergietestung (Stan- der zehn Reiter reagierten beim Putzen der Pferde dard Pferd – Curly Horse), Spirometrie oder nicht signifikant. Eingang/Submitted Ganzkörperplethysmographie. Unabhängig vom Schlussfolgerung: Der Verfasser kommt zu dem 9. Juli 2012 allergologischen Test ergebnis wurde ein eskalie- Schluss, dass Curly Horses für pferdeallergische Annahme/Accepted rendes Kontaktprogramm gestartet, in dem zu- Reiter, die ihren Sport weiter ausüben wollen, geeig- 15. März 2013 nächst die Pferde nur geritten und später auch ge- net sind. 244 Allergo J 2013; 22 (4) 244–51 Introduction Horse allergy is a sensitization that occurs frequent- Abbreviations ly in humans, mostly following contact with these Pat nr. patient number animals [1–3]. Possible reactions are symptoms of allergic rhinoconjunctivitis, bronchial asthma and nr. number allergic exanthema. The 16 proteins identified from WHO World Health Organization horses are located in skin dander, on hairs, in urine IUIS International Union of Immunological and in the saliva. Four allergens have been charac- Societies terized (Equ c 1–Equ c 4) [4]. Enthusiasts of Curly FEV1 forced expiratory volume 1 second horses report that the hypoallergenic properties of American Bashkir Curly horses render them suit- PEF peak expiratory flow able for patients with horse allergy to carry on with Pred predicted sport riding. SD standard deviation Serious scientific clinical studies on this issue are ABC American Bashkir Registry not available. The objective of this first study was to test the hypothesis of the hypoallergenicity of Curly kDa kilo Dalton horses under reference conditions. pI isoelectric point (SDS page) Methods Step 1: Prestudy phase (Berlin, Germany) Four patients with allergy against horses were iden- two mentioned mares followed. The same assistant tified in a pneumological private practice. These -pa always carried out, assessed, and documented by tients underwent a prick test (horse, Bencard®, Mu- photography the prick and scratch tests in the same nich, Germany) and a scratch test. Samples of Curly manner. The test material was obtained from brush- horses for testing were prepared with: mixed hairs es of the mares and prepared according to a previ- and dander scales from a breed of Curly horses in ously published method [5, 6]: a fingertip of the cut- Tønder, Denmark (C I) and Berlin, Germany (C II) up Curly hair and dander sample, suspended in 1 as well as from a Curly mare (ABC register nr. ml 0.9 % sodium chloride solution, was used. After P 2563; C III) and a German riding pony (D) [5, 6] scarification of the forearm skin of 1 cm in diame- to clarify whether these tests may be used to dem- ter the mixed hair/dander solution was applied on onstrate differences in reaction. the scarification region. This procedure was repeat- ed for every test. Two young, healthy, female riders Step 2: Pilot study (Klappholz, Germany) served as reference riders. For each case of allergy Following the prestudy phase, the author founded testing (step 1+2), the influence of concomitant a Curly farm (www.curlyfarm.de). To start, two medication was excluded (antihistamines, steroids, ABC (American Bashkir Curly Horse Registry) leukotriene synthesis inhibitors). mares formed the core of the farm: mare “Scoria’s Subsequently, the patients came into contact with Dee Lite” (ABC register nr. P 2563) and mare the horses, comprising 1-h riding without brushing. “Hawks Hiawatha” (ABC register nr. 3975). The use Later, the contact was intensified: 1-h riding fol- of a comparatively pure breeding line seemed to be lowed by 15 min of horse brushing. necessary to avoid contamination with horses of Initially, peak-flow measurements were per- nonpure breeding lines. No other horses were pres- formed in 15-min steps after the first horse contact ent in the stable. (Vitalograph 2110 electronic PEF/FEV1 diary) and Patients with anamnestic known allergy against documented. Other possible symptoms were also horses, who had given up riding because of symp- assessed (skin, nose, eyes, and respiration). The end- tomatic allergy, volunteered for the study following of-test criterion was a peak flow decrease of more media coverage of the research. Patients gave writ- than 20 % of the initial value. If this event occurred, ten consent for the horse contact and data collection. treatment with Salbutamol was planned to follow The patients were clinically investigated concerning immediately. The test was also repeated with these their lung function prior to horse contact: anamne- patients on the following day. sis, spirometry, or – if spirometry could not be All patients were rechecked 15 min after horse clearly interpreted owing to cooperation problems – contact. body plethysmography. During the first hours of horse contact, the pa- Subsequently, a standard prick test was carried tients were not allowed to enter the horse stable. out (horse Bencard®, Munich, Germany) using his- This was done to avoid bringing the patients into tamine and saline as control. A scratch test with contact with any other possible influence on their mixtures of the dander and the horse hairs of the allergy. Allergo J 2013; 22 (4) 244–51 245 Original Article Allergy against horses Original | Table 1 Prestudy test phase (Berlin): prick and scratch test results Pat nr. Disease Pollen allergy Mould allergy House dust Prick Scratch Scratch Scratch Scratch allergy horse D C I C II C III 1 A; R +++ +++ ++++ +++ +++ +++ +++ + 2 A; R +++ +++ + ++ + ++ + - 3 A +++ - ++ ++ +++ + ++ + 4 A + - - +++ 0 - - 0 A, bronchial asthma; R, allergic rhinoconjunctivitis Scratch D German riding pony; CI, Curly mixed hairs Tønder; C II, Curly mixed hairs Berlin, C III, Curly mare Dee Lite (ABC Register nr: P 2563 ); 0, not carried out Allergy test: - = negative (+) = < 3 mm ø;+ = > 3–4 mm ø; ++ = > 4–5 mm ø; +++ = > 5–6 mm ø; ++++ = > 6 mm ø. Pollen test material: grass, rye, mugwort, nettle, plantain, alder, hazel, birch, beech, oak, ragweed Mould test material: alternaria, cladosporium, aspergillus, penicilium House dust test material:
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