Transplantation and horse-riding

Question

Can one pursue horse-riding after lung transplantation ?

Answer

Hello,
Thank you for your question!
Horse-riding is a sport practiced nowadays by an always broader public and which brings physical as well as emotional benefits.

It is true, nonetheless, that the contact with horses and/or the work in a barn can lead to aeroallergen and/or pathogenic exposure. Especially after lung transplantation, when patients are immunocompromised, this has to be taken into account.

First of all, the contact with horses can trigger off allergies. A protein secreted by the horse's sudoriparous (sweat) glands is responsible for this allergy. The protein can be found on the horse's fur, its skin, in its urine and will mix itself with the dust in suspension in the air. It is therefore an ‘aeroallergen’, which penetrates into the human organism through contact and the respiratory tract. The organs targeted by the allergic reaction are understandably the nose, the eyes, the lungs and the skin. The allergy, thus, can manifest as a rhinitis characterized by sneezing, nasal drip and pruritus. It can manifest as watering eyes, eye redness and itching (especially of the inner corners of the eyes) and sometimes conjunctival oedema. At the respiratory level, a bronchial asthma (dry, irritative cough and respiratory difficulties) may be observed. After the transplantation, allergic reactions are generally reduced by the treatment with systemic corticosteroids. If an allergy was pre-existing before the transplantation, one has to evaluate if it still persist after transplantation and if necessarily the usually recommended measures have to be taken (take a shower and change clothing in order to get rid of fur and dust after horse-riding; wash the clothes worn during horse-riding; favour a well-ventilated place, if possible in the open air, if one grooms the horse; avoid activities likely to release a high concentration of allergen like grooming, scrape clean the horse’s stable, mulching, sweeping; consider to wear an anti-dust mask).

Animals may also pass on some diseases to human beings, a process which is called 'zoonosis'. It seems to be really uncommon as far as horses are concerned. Salmonellosis is among the most important diseases (some horses are healthy carriers and some have themselves symptoms in the form of diarrhoea; thus, their fodder, water supply, box, litter or grooming material can be contaminated). Horses can also harbor MRSA strains, which can be passed on to human beings. There is an important number of other pathogens, which can be transmitted (the famous Hendra virus), but the risk for this kind of transmission seems to be very low. An advice, which in fact is just ‘common sense’, is NOT to take care of a horse, which clearly is ill. Finally, it is especially the horse's environment – the barn, the straw, the hay,...- which, in my opinion, can cause problems to a transplanted (or even a not transplanted) cystic fibrosis patient. The atmosphere in barns indeed contains an important concentration of inorganic and organic particles, especially bacteria and fungus like the Aspergillus fumigatus, which can be a threat for immunodepressed patients.
To conclude: a word on tetanus. It is caused by an anaerobic bacteria, Clostridium tetani, which develops in horse manure and produces a toxin causing a generally mortal disease of the central nervous system. The handling of horse manure is particularly dangerous in case of a wound (it is noteworthy that this danger also exists for those who like gardening and cutting rose bushes). In our region, everybody is in principle vaccinated against tetanus. It should be made sure that the necessary booster vaccinations have been given, ideally before transplantation as vaccines are in general less immunogenic after the transplantation. For passionate horse-riders it is preferable thus to have their shots completed during the time while waiting for transplantation.

So, no life without risk !
However, I would like share our practical experience with you. We have at least
5 transplanted CF patients, who are passionate of horses(wo)-men; one of them is a blacksmith, who returned to his full-time activity after the transplantation. Until today, there have not been any incidents. So, I have enumerated every possible risk for you; however, with correct hygiene precautions the true risk of falling ill because of the horse-riding and grooming is in my opinion pretty low.
Best wishes,
Christiane Knoop

29.05.2013