Human allergy to cats: A review of the impact on cat ownership and relinquishment.

PRACTICAL RELEVANCE: Cats have become increasingly common as companion animals, and in many countries their popularity now exceeds that of dogs. At the same time, human allergies (including allergy to cats) have been increasing and it has been estimated that globally up to 10-20% of human adults are sensitised to cats. AIM: This review summarises the available published data on how human allergy to cats affects cat ownership and considers the implications of the findings on the wider human-cat bond and how adverse effects can be minimised. EVIDENCE BASE: Online databases were searched for all original studies up to December 2020 that had quantified the impact of human allergy to cats on ownership or relinquishment. Objective quantifiable data appeared to fall into three broad outcomes - (1) choosing to avoid cat ownership; (2) relinquishment of owned cats; and (3) return of cats after acquisition from a rehoming centre. The data retrieved on these topics are the focus of this review. In some studies, data from cats and dogs were combined and these have also been included in the review.

Human allergy to cats: A review for veterinarians on prevalence, causes, symptoms and control.

PRACTICAL RELEVANCE: Human allergy to cats affects a substantial and growing proportion of the global population, and cat allergy is regarded as the third most common cause of human respiratory allergies, and the second most common indoor cause. Veterinarians will frequently encounter owners who are cat-allergic, and having an understanding of this disease and the methods available to help control the allergy will assist them in giving appropriate advice, alongside human healthcare professionals. AIM: The aim of this review is to summarise currently available data on the prevalence, causes, symptoms and control of human allergy to cats. In terms of managing cat allergy, the emphasis is on reviewing current and emerging modalities to reduce environmental exposure to cat allergens rather than on pharmacotherapy or immunotherapy, as it is in these areas in particular that the veterinarian may be able to offer help and advice to complement that of human healthcare professionals. EVIDENCE BASE: The information in this review is drawn from the current and historical literature on human allergy to cats, and approaches to reduce exposure to cat allergens and manage symptoms of cat allergy.

Evaluation of benazepril in cats with heart disease in a prospective, randomized, blinded, placebo-controlled clinical trial.

BACKGROUND: Heart disease is an important cause of morbidity and mortality in cats, but there is limited evidence of the benefit of any medication. HYPOTHESIS: The angiotensin-converting enzyme inhibitor benazepril would delay the time to treatment failure in cats with heart disease of various etiologies. ANIMALS: One hundred fifty-one client-owned cats. METHODS: Cats with heart disease, confirmed by echocardiography, with or without clinical signs of congestive heart failure, were recruited between 2002 and 2005 and randomized to benazepril or placebo in a prospective, multicenter, parallel-group, blinded clinical trial. Benazepril (0.5-1.0 mg/kg) or placebo was administered PO once daily for up to 2 years. The primary endpoint was treatment failure. Analyses were conducted separately for all-cause treatment failure (main analysis) and heart disease-related treatment failure (supportive analysis). RESULTS: No benefit of benazepril versus placebo was detected for time to all-cause treatment failure (P = .42) or time to treatment failure related to heart disease (P = .21). Hazard ratios (95% confidence interval [CI]) from multivariate analysis for benazepril compared with placebo were 1.00 (0.57-1.74) for all-cause failure, and 0.99 (0.50-1.94) for forward selection and 0.93 (0.48-1.81) for bidirectional selection models for heart disease-related failure. There were no significant differences between groups over time after administration of the test articles in left atrium diameter, left ventricle wall thickness, quality of life scores, adverse events, or plasma biochemistry or hematology variables. CONCLUSIONS AND CLINICAL RELEVANCE: Benazepril was tolerated well in cats with heart disease, but no evidence of benefit was detected.

ISFM Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats.

Practical relevance: Feline hypertension is a common disease in older cats that is frequently diagnosed in association with other diseases such as chronic kidney disease and hyperthyroidism (so-called secondary hypertension), although some cases of apparent primary hypertension are also reported. The clinical consequences of hypertension can be severe, related to 'target organ damage' (eye, heart and vasculature, brain and kidneys), and early diagnosis followed by appropriate therapeutic management should help reduce the morbidity associated with this condition. Clinical challenges: Despite being a common disease, routine blood pressure (BP) monitoring is generally performed infrequently, probably leading to underdiagnosis of feline hypertension in clinical practice. There is a need to: (i) ensure BP is measured as accurately as possible with a reproducible technique; (ii) identify and monitor patients at risk of developing hypertension; (iii) establish appropriate criteria for therapeutic intervention; and (iv) establish appropriate therapeutic targets. Based on current data, amlodipine besylate is the treatment of choice to manage feline hypertension and is effective in the majority of cats, but the dose needed to successfully manage hypertension varies between individuals. Some cats require long-term adjuvant therapy and, occasionally, additional therapy is necessary for emergency management of hypertensive crises. Evidence base: These Guidelines from the International Society of Feline Medicine (ISFM) are based on a comprehensive review of the currently available literature, and are aimed at providing practical recommendations to address the challenges of feline hypertension for veterinarians. There are many areas where more data is required which, in the future, will serve to confirm or modify some of the recommendations in these Guidelines.

ISFM Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease.

PRACTICAL RELEVANCE: Chronic kidney disease (CKD) is one of the most commonly diagnosed diseases in older cats. In most cats, CKD is also a progressive disease and can be accompanied by a wide range of clinical and clinicopathological changes. These ISFM Consensus Guidelines have been developed by an independent panel of clinicians and academics to provide practical advice on the diagnosis and management of this complex disease. CLINICAL CHALLENGES: Although CKD is a common clinical problem in cats, the manifestations of disease vary between individuals. Thus there is a need for careful and repeat evaluation of cats with CKD and adjustment of therapy according to individual needs. In addition to addressing problems arising from CKD and improving quality of life (QoL) for the patient, therapy may also target slowing the underlying progression of disease and hence prolonging life. While maintaining QoL is of paramount importance in our patients, this can be challenging when multiple therapies are indicated. In some cases it is necessary to prioritise therapy, given an understanding of what is likely to most benefit the individual patient. EVIDENCE BASE: In preparing these Guidelines, the Panel has carefully reviewed the existing published literature, and has also graded the quality of evidence for different interventions to help to provide practical recommendations on the therapeutic options for feline CKD. This is a field of veterinary medicine that has benefited from some excellent published clinical research and further research findings will undoubtedly modify the recommendations contained in these Guidelines in the future.

ISFM consensus guidelines on the practical management of diabetes mellitus in cats.

PRACTICAL RELEVANCE: Diabetes mellitus (DM) is a common endocrinopathy in cats that appears to be increasing in prevalence. The prognosis for affected cats can be good when the disease is well managed, but clinical management presents challenges, both for the veterinary team and for the owner. These ISFM Guidelines have been developed by an independent, international expert panel of clinicians and academics to provide practical advice on the management of routine (uncomplicated) diabetic cats. CLINICAL CHALLENGES: Although the diagnosis of diabetes is usually straightforward, optimal management can be challenging. Clinical goals should be to limit or eliminate clinical signs of the disease using a treatment regimen suitable for the owner, and to avoid insulin-induced hypoglycaemia or other complications. Optimising bodyweight, feeding an appropriate diet and using a longer acting insulin preparation (eg, protamine zinc insulin, insulin glargine or insulin detemir) are all factors that are likely to result in improved glycaemic control in the majority of cats. There is also some evidence that improved glycaemic control and reversal of glucose toxicity may promote the chances of diabetic remission. Owner considerations and owner involvement are an important aspect of management. Provided adequate support is given, and owners are able to take an active role in monitoring blood glucose concentrations in the home environment, glycaemic control may be improved. Monitoring of other parameters is also vitally important in assessing the response to insulin. Insulin adjustments should always be made cautiously and not too frequently--unless hypoglycaemia is encountered. EVIDENCE BASE: The Panel has produced these Guidelines after careful review of the existing literature and of the quality of the published studies. They represent a consensus view on practical management of cats with DM based on available clinical data and experience. However, in many areas, substantial data are lacking and there is a need for better studies in the future to help inform and refine recommendations for the clinical management of this common disease.

Feline CKD: New horizons - where do we go from here?

PRACTICAL RELEVANCE: Chronic kidney disease (CKD) is common in humans as well as in cats, and is a significant human health problem. In feline medicine, despite recent research and improvements in our understanding of the condition, management remains limited by late diagnosis and an inadequate ability to prevent progression of disease. Investigation of future treatments that both delay the progression of CKD and manage clinical signs, and that are also easy and cost effective to administer, is desirable. To this end, we may learn from our colleagues in the medical profession. AUDIENCE: CKD is commonly encountered in general practice and so all practitioners dealing with cats will benefit from understanding future treatment possibilities and interventions in the management of CKD. EVIDENCE BASE: Large-scale medical studies have been performed to provide an evidence base for treatment decisions in human CKD. Several studies in cats have looked at various aspects of treatment and prognosis, but large-scale studies are needed to assess the benefits of treatments such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. CLINICAL CHALLENGES: Providing treatment that is effective, easy to administer and not cost-prohibitive is the challenge currently faced by clinicians in the management of feline CKD.

2013 AAFP Feline Vaccination Advisory Panel Report.

RATIONALE: This Report was developed by the Feline Vaccination Advisory Panel of the American Association of Feline Practitioners (AAFP) to provide practical recommendations to help clinicians select appropriate vaccination schedules for their feline patients based on risk assessment. The recommendations rely on published data as much as possible, as well as consensus of a multidisciplinary panel of experts in immunology, infectious disease, internal medicine and clinical practice.

ISFM guidelines on population management and welfare of unowned domestic cats (Felis catus).

UNLABELLED: GUIDELINES RATIONALE: Cats are among the most commonly kept domestic pets, and coexist with humans in a variety of different circumstances. Cats are sentient beings and, as such, humans have a responsibility for cat welfare where humans and cats coexist. Because cats reproduce efficiently, measures to control populations are frequently needed, but these should be based on ethical and humane approaches. FRAMEWORK: These consensus guidelines from the International Society of Feline Medicine's Welfare Advisory Panel provide a framework for the approach to welfare and population control measures, primarily among unowned cats and those going through a homing programme.

Feeding old cats--an update on new nutritional therapies.

Aging is associated with a wide variety of physiological changes that compromise the ability of the body to respond to stress or change, and ultimately contribute to morbidity and mortality. Much research has been done on the aging process in humans and experimental animals, and the impact of diet, but there is relatively little data from companion animal studies. However, although many of the aging changes are likely to be similar between different mammals, it is known that there are some differences with cats. In contrast to dogs and humans, elderly cats experience an increase in their maintenance energy requirements rather than a continued decline, which may be mediated partly through a better-maintained basal metabolic rate but also through progressive compromise in fat and protein digestion. Old age is also associated with a progressive loss of lean body mass that may be mitigated in part by feeding higher protein levels. Diets designed for healthy elderly cats should therefore concentrate on being energy dense, highly digestible and with an increase in the proportion of protein calories, and being fed with the aim of supporting optimal body weight. There is also strong evidence emerging that dietary manipulation in cats may be able to modify aspects of the aging process, with a long-term longitudinal study of cats demonstrating both survival and health benefits from feeding a diet supplemented with antioxidants, fatty acids, and a prebiotic source.

ISFM and AAFP consensus guidelines: long-term use of NSAIDs in cats.

UNLABELLED: NSAIDS AND CATS: Non-steroidal anti-inflammatory drugs (NSAIDs) are an important class of drug in feline medicine, having analgesic, anti-inflammatory and antipyretic activity. While most published data on their use in this species relate to short-term (often perioperative) therapy, there is increasing evidence of the value of these drugs in treating chronic pain in cats (for example, that associated with degenerative joint disease), and some NSAIDs have now become licensed for long-term use in cats in some geographies. Most of our knowledge of therapeutic mechanisms or adverse drug reactions associated with NSAIDs is extrapolated from work in other species, and there is a paucity of published data relating to cats. GUIDELINES: These guidelines have been drawn together by an expert panel, which have reviewed the current literature on long-term NSAID use in cats and other species, and developed guidance on their use based on this information. The aim is to provide practical information for veterinarians to encourage appropriate NSAID therapy whenever cats will benefit from the use of these drugs.

Infection of the subcutis of the nose in a cat caused by Mucor species: successful treatment using posaconazole.

A 14-year-old neutered female domestic shorthair cat was presented for investigation of a non-painful subcutaneous swelling of the nasal dorsum at the site of a scratch injury. Cytological evaluation demonstrated a granulomatous reaction and many variably shaped organisms consistent with yeasts/fungi. Subsequent biopsy and culture yielded a pure growth of a Mucor species. The cat was treated with the second-generation triazole antifungal agent posaconazole for 5 months. Complete resolution was seen with no recurrence 12 months after discontinuing treatment.

Eosinophilic fibrosing gastritis and toxoplasmosis in a cat.

A 3-year-old, neutered male Tiffany cat was presented to the Animal Health Trust for investigation of pyrexia and a gastric lesion. Radiography and ultrasound showed severe thickening of the gastric wall and regional lymphadenopathy. There was altered gastric wall layering, predominately due to muscularis thickening. Histopathology confirmed eosinophilic fibrosing gastritis. The cat also had evidence of generalised Toxoplasma gondii infection, which may have been responsible for the gastric changes.

The 2006 American Association of Feline Practitioners Feline Vaccine Advisory Panel report.

Vaccination is a medical procedure, and the decision to vaccinate should be based on a risk-based assessment for each cat and each vaccine.

Evaluation of a commercial in-house test kit for the semi-quantitative assessment of microalbuminuria in cats.

Proteinuria was assessed in 100 randomly selected sick cats and 22 healthy cats by means of the urine protein:creatinine ratio, a traditional urine "dipstick" and a commercial ELISA-based dipstick designed to detect microalbuminuria (MA) semi-quantitatively. In addition the repeatability and reproducibility of the MA test was assessed by comparing results of five replicate tests of 26 urine samples, interpreted by two different readers. Discrepancies existed in the replicate test result in 23 and 27% of the samples examined by reader 1 and 2, respectively, and on several occasions this discrepancy was between whether the sample was "positive" or "negative" for MA. The inter-reader agreement was good (kappa=0.75), but again discrepancies were noted and part of the reason for these problems appeared to be the necessary subjectivity in the interpretation of colour changes when reading test results. Proteinuria was significantly (P< or =0.014) more prevalent in the sick than the healthy cats with 36 and 9%, respectively, having detectable MA, 34 and 5%, respectively, having a urine protein to creatinine (UPC) ratio >0.5, and 84 and 9%, respectively, having positive urine protein dipstick analysis. There was a moderate significant correlation between UPC ratio and MA concentrations (r(s)=0.68, P<0.0001). While 13/87 cats with a UPC ratio < or =0.5 had positive MA results, 10/84 cats with negative MA results had a UPC ratio >0.5, and none of these had evidence of lower urinary tract disease. This study confirmed that MA and proteinuria are commonly seen in cats with a variety of diseases, but they are not necessarily both elevated, and the UPC ratio can be elevated without an increase in MA results. Furthermore, some repeatability problems were demonstrated with the semi-quantitative MA test. These findings demonstrate that the semi-quantitative MA test should not be relied on as the sole determinant of proteinuria.

A questionnaire-based study of gestation, parturition and neonatal mortality in pedigree breeding cats in the UK.

This study was based on a convenience-sampling questionnaire study of pedigree cat breeding in the UK. Data were collated for the births of 1,056 litters from 14 different pedigree breeds and 942 different households. Significant relationships between various outcomes and relevant predictors were assessed by multiple linear regression or logistic regression as appropriate. The overall mean gestation length of 65.1 days varied significantly between the breeds (P<0.0001), and larger litter sizes were associated with shorter gestation lengths (P=0.04). The mean litter size of 4.6 kittens also varied significantly according to breed (P<0.0001). The weight of kittens born alive (overall mean 93.5 g) increased with longer gestation lengths (P=0.0003), decreased with larger litter sizes (P<0.0001) and varied between the breeds (P<0.0001). A total of 8.0% of pregnancies resulted in a caesarean section, with a higher risk associated with smaller litter sizes (P=0.002). Although the frequency of caesarean sections varied from 0 to 18.5% between individual breeds, breed itself was not shown to have a significant independent effect on this likelihood. A mean of 7.2% of all the kittens were stillborn, which varied according to breed (P=0.0003), and the risk of a stillborn kitten increased with litter size (P=0.0001), and with the presence of congenital defects in the litter (P=0.0002). The mean kitten mortality between birth and 8 weeks of age was 9.1%, and the majority of these occurred in the first week of life. Parturition intervals varied widely. The duration of first stage of labour was less than 2h in 82.9% of cats. The interval between the birth of the first and last kitten was less than 6h in 85.7%, but more than 48 h in three cats. A maximum of 48 h was recorded between the births of individual kittens in unassisted deliveries.

MRI characteristics of suspected acute spinal cord infarction in two cats, and a review of the literature.

A 10-year-old neutered male Persian cat and a 4-year-old spayed female domestic shorthair (DSH) cat were evaluated for acute-onset severe lateralising tetraparesis and hemiplegia, respectively. Both cats also had left-sided Horner's syndrome. Neurological examination of the cats localised the lesion to cranial to C5 in the Persian and the left cervical intumescence (C6-T2) in the DSH. Physical examinations were otherwise generally unremarkable. Routine laboratory tests and spinal radiography were normal for the Persian cat and were not performed for the DSH cat. A cerebrospinal fluid (CSF) tap was attempted for the Persian cat but aborted because of gross blood contamination, and was not performed for the DSH cat. Magnetic resonance imaging (MRI) of the Persian cat revealed a lesion within the spinal parenchyma at segments C1 to C3 (slightly more left-sided) which was iso- to hypointense on T1-weighted scans and hyperintense on T2-weighted scans, and which enhanced slightly with gadolinium. MRI of the DSH cat revealed a lesion within the spinal parenchyma at segment C7 (predominantly left-sided) which was hypointense on T1-weighted scans and hyperintense on T2-weighted gradient echo scans. Contrast was not administered. The MRI findings in both cases were highly suggestive of acute spinal cord infarction, based upon comparison to human cases. Both cats made full neurological recoveries with supportive treatment only. This paper describes two cases of suspected acute spinal cord infarction in the cat, demonstrates the potential diagnostic value of MRI, and discusses the clinical syndrome of this condition with a brief review of published cases.

Exhaled breath condensate (EBC) collection in cats--description of a non-invasive technique to investigate airway disease.

Exhaled breath condensate has been collected in other species and used as a non-invasive method of evaluating airway disease by measurement of various markers in the fluid, including hydrogen peroxide, nitric oxide, leukotrienes and prostaglandins. We describe a novel technique for the collection of exhaled breath condensate from cats, which enabled collection of fluid and measurement of its hydrogen peroxide concentration. Further studies will be needed to establish the value of this technique in the investigation of feline respiratory disease.