Parrot feathers

 
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Code: e213
Latin name: Ara spp.
Source material: Feathers
Family: Psittacidae
Common names: Parrot, Macaws. Also see below.
Direct or indirect contact with bird allergens may cause sensitisation.
 
Bird allergens may be major components of house dust.

Allergen Exposure

Geographical distribution
The Parrot is one of the most common domestic birds, together with Budgerigars and Canaries. In 1994, Parrots were estimated at 25 million in US households, and more than 8 millions in German ones (1).
 
Parrot is the common name for members of the order Psittaciformes, comprising 315 species of colorful birds, pantropical in distribution, including such divergent types as the small Parakeet and the large, crested Cockatoo. Parrots have large heads and short necks, strong feet with two toes in front and two in back (facilitating climbing and grasping), and strong, thick bills, with the larger hooked upper mandible hinged to the bones of the head. They are prized worldwide as pets and zoo animals for their beautiful, bright plumage, their sociability, and their ability as mimics.
 
Environment
See above.
 
Unexpected exposure
Cockatoos have a down powder beneath their feathers, which provides insulation to keep them warm. The down also sheds a thick powder, which the birds use to waterproof and clean their outer feathers.
 
Allergens
Well-defined major allergenic bands with molecular mass of 20-30 kDa and 67 kDa have been detected and identified in IgE immunoblots with feather extracts as well as with serum proteins of Budgerigar, Parrot, Pigeon, Canary, and Hen. Inhalable feather dust was shown to contain several allergenic components which cross-react with serum allergens/antigens of the same as well as of other bird species (1). The allergens have not been fully characterised yet.

Potential Cross-Reactivity

As noted above, inhalable feather dust contains several allergenic components which cross-react with serum allergens/antigens of the same as well as of other bird species (1).
 
Cross-reactivity between Parrot and other phylogenetically related bird species may be expected, and in Parrot-allergic patients, significant IgE antibody titers to Canary, Budgerigar, Chicken, Pigeon, Goose and Duck have been reported (2-3), even in patients without known exposure (1). Moreover, cross-reactivity to Hen's egg, Bird-Egg Syndrome, should be considered. Here the livetins present in egg yolk have been suggested as the major cross-reacting allergen (4-5).

Clinical Experience

IgE mediated reactions
Asthma, allergic rhinitis and allergic conjunctivitis may result following exposure to Canary feathers, epithelial cells or droppings (6, 7). The allergic manifestations may present as Bird Fancier´s Asthma and as the so-called Bird-Egg Syndrome, with symptoms such as rhinitis, urticaria and angioedema (2), and also as gastro-intestinal problems (3).
 
Specific IgE has been found in patients exposed to Parrots (1-3). In two case reports (2, 5), adult patients, both having developed allergy after acquiring a Parrot, experienced urticaria, angioedema and asthma after eating egg.
 
Previously, they had never had allergy to egg. They had specific IgE to egg, but in these cases it seems that the egg yolk was the trigger, not the egg white, which is the common causative allergen in childhood egg allergy.
 
Extrinsic allergic alveolitis, also known as Hypersensitivity pneumonitis, Bird Fancier's Lung and Farmer's Lung, is a disease of inflammation of the lung parenchyma in the terminal bronchioles and alveoli. Symptoms may start soon after exposure to bird allergens or after many years, and may include breathlessness, cough, occasional chills, and fever. Death may also result.
 
The disease occurs after exposure to organic dust, especially after close contact with Pigeons or other birds such as Budgerigars, Parrots, Canaries, Parakeets, Cockatiels, Doves or Finches. Exposure results in the development of immunoglobulin antibodies including IgE (1), IgM (8), IgA and various IgG subclasses (9-11). The antibodies may be found in the sera and saliva of patients (12) as well as in the sera of asymptomatic but exposed subjects (13).
 
The allergenic proteins may be found in bird serum, droppings, skin scales, feathers and, in the case of Pigeons, Pigeon bloom (a waxy fine dust which coats the feathers of Pigeons). Contact may result from handling birds, cleaning their lofts, or exposure to the organic dust drifting down from a ceiling or roof where birds nest.
 
Diagnosis is based on a characteristic clinical picture and a typical x-ray pattern, accompanied by the presence of specific IgG antibodies (14).
 
The measurement of specific IgG using IgG tracer technology has been shown to be a sensitive and specific assay for the routine diagnostic testing of extrinsic allergic alveolitis (15).
 
Hypersensitivity pneumonitis has also been reported following contact with a wild Moluccan Cockatoo (16).
 
Other reactions
Bird Breeder's Lung has also been described as caused by Parrot droppings (17).
 
Compiled by Dr Harris Steinman, harris@zingsolutions.com

References

  1. Tauer-Reich I, Fruhmann G, Czuppon AB, Baur X. Allergens causing bird fancier's asthma. Allergy 1994;49(6):448-53
  2. de Maat-Bleeker F, van Dijk AG, Berrens L. Allergy to egg yolk possibly induced by sensitization to bird serum antigens. Ann Allergy 1985;54(3):245-8.
  3. van Toorenenbergen AW, Huijskes-Heins MI, Gerth van Wijk R. Different pattern of IgE binding to chicken egg yolk between patients with inhalant allergy to birds and food-allergic children. Int Arch Allergy Immunol 1994;104(2):199-203.
  4. Mandallaz MM, de Weck AL, Dahinden CA. Bird-egg syndrome. Cross-reactivity between bird antigens and egg-yolk livetins in IgE-mediated hypersensitivity. International Archives of Allergy & Applied Immunology 1988;87(2):143-50.
  5. de Blay F, Hoyet C, Candolfi E, Thierry R, Pauli G. Identification of alpha livetin as a cross reacting allergen in a bird- egg syndrome. Allergy Proc 1994;15(2):77-8.
  6. van Toorenenbergen AW, Gerth van Wijk R, van Dooremalen G, Dieges PH. Immunoglobulin E antibodies against budgerigar and canary feathers. Int Arch Allergy Appl Immunol 1985;77(4):433-7
  7. Gerth Van Wijk R, Van Toorenenbergen AW, Dieges PH. Nasal allergy to avian antigens. Clin Allergy 1987;17(6):515-21
  8. Martinez-Cordero E, Aquilar Leon DE, Retana VN. IgM antiavian antibodies in sera from patients with pigeon breeder’s disease. J Clin Lab Anal 2000:14(5):201-7
  9. Yoshizawa Y, Miyashita Y, Inoue T, Sumi Y, Miyazaki Y, Sato T, et al. Sequential evaluation of clinical and immunological findings in hypersensitivity pneumonitis: serial subclass distribution of antibodies. Clin immunol Immunopathol 1994;73(3):330-7
  10. Todd A, Coan R, Allen A. Pigeon breeder’s lung; IgG subclasses to pigeon Intestinal mucin and IgA antigens. Clin Exp Immunol 1993;92(3):494-9
  11. Baldwin CI, Todd A, Bourke SJ, Allen A, Calvert JE. IgG subclass responses to pigeon intestinal mucin are related to development of pigeon fancier’s lung. Clin Exp Allergy 1998;28(3):349-57
  12. McSharry C, Macleod K, McGregor S, Speekenbrink AB, Sriram S, Boyd F, et al. Mucosal immunity in extrinsic allergic alveolitis: salivary immunoglobulins and antibody against inhaled avian antigens among pigeon breeders. Clin Exp Allergy 1999;29(7):957-64
  13. Rodrigo MJ, Benavent MI, Cruz MJ, Rosell M, Murio C, Pascual C, et al. Detection of specific antibodies to pigeon serum and bloom antigens by enzyme linked immunosorbent assay in pigeon breeder’s disease. Occup Environ Med 2000;57(3):159-64
  14. Rodriguez de Castro F, Carrillo T, Castillo R, Blanco C, Diaz F, Cuevas M. Relationship between characteristics of exposure to pigeon antigens. Clinical manifestations and humoral immune response. Chest 1993;103(4):1059-63
  15. Lopata A, Schinkel M, Andersson C, Johansson G, van Hage-Hamsten M. Quantification of IgG antibodies to bird antigens in the diagnosis of extrinsic allergic alveolitis (EAA) using the UniCAP system. (Manuscript in preparation)
  16. Choy AC, Patterson R, Ray AH, Roberts M. Hypersensitivity pneumonitis in a raptor handler and a wild bird fancier. Ann Allergy Asthma Immunol 1995;74(5):437-41
  17. Tokojima M, Ihi T, Kyoraku Y, Hiratsuka T, Matsumoto K, Matsumoto N, Katoh S, Mukae H, Matsukura S. A case of Bird Fanciers' Disease caused by parrot droppings. [Japanese] Nihon Kokyuki Gakkai Zasshi 2001;39(10):739-43

 

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.