Abstract
Allergic pruritus and urticaria in the horse are challenging for veterinarians and owners; little is known about their long-term management. To summarize intradermal allergen test results (IDT), and to assess owners' perceptions of skin disease and the effects of medical treatment and management changes in their atopic horses over time. Eighty two horses with atopic dermatitis in southeastern England between 2006 and 2011. The IDT results were reviewed retrospectively. Owners completed telephone questionnaires on skin changes, medication, effect of allergen-specific immunotherapy (ASIT) and management. Sixty one owners (74.4%) could be contacted, an average of 5.9 years (range 28-88 months) after IDT; of those, three could not be enrolled. Of the 58 remaining horses, eleven (19%) were deceased at the time of owner interview, including four (6.9%) euthanized due to uncontrollable skin disease. The remaining 47 owners reported that the signs of skin disease had not been seen for at least two years in 18 horses (38.3%), including two that only flared with known triggers. Twenty nine horses (61.7%) still required medication to control skin disease although 25 (53.2%) required less since testing. Owners reported benefit from ASIT in nine of 14 horses (64.3%) from glucocorticoids in 33 of 35 (94.3%) and from antihistamines in 17 of 28 (60.7%). Specific management changes were implemented for 22 horses and reported as beneficial in nine of 22 (40.9%). Equine atopic dermatitis may not always be chronic, but severe cases appear difficult to control. IDT may help to formulate ASIT and can help to guide management changes.
Highlights
The management of pruritus and urticaria due to allergic skin disease in the horse is challenging for veterinary surgeons and owners, and little is known about the longterm treatment requirements and progression of disease over time
Atopic dermatitis, as a hypersensitivity reaction to environmental allergens and food, presents with pruritus or urticaria or both. 1-8 It is typically described as a lifelong condition requiring ongoing treatment interventions, but signs may be seasonal or perennial, depending on the causal allergens
As for other veterinary species, the diagnosis of equine atopic dermatitis is a clinical diagnosis based on compatible history, clinical signs and exclusion of other differential diagnoses such as ectoparasite infestations, Culicoides hypersensitivity and other insect bite hypersensitivities (IBH), and if possible adverse food reactions
Summary
The management of pruritus and urticaria due to allergic skin disease in the horse is challenging for veterinary surgeons and owners, and little is known about the longterm treatment requirements and progression of disease over time.In the horse, atopic dermatitis, as a hypersensitivity reaction to environmental allergens and food, presents with pruritus or urticaria or both. 1-8 It is typically described as a lifelong condition requiring ongoing treatment interventions, but signs may be seasonal or perennial, depending on the causal allergens. 9 Allergens commonly implicated in many reports include house dust and storage mites, insects, pollens and epithelia.[6]. 9 Allergens commonly implicated in many reports include house dust and storage mites, insects, pollens and epithelia.[6] As for other veterinary species, the diagnosis of equine atopic dermatitis is a clinical diagnosis based on compatible history, clinical signs and exclusion of other differential diagnoses such as ectoparasite infestations, Culicoides hypersensitivity and other insect bite hypersensitivities (IBH), and if possible adverse food reactions. 9. Dust and moulds can be found in high concentrations in various feeds and bedding materials[10] and implementation of allergen reduction measures has been shown to be beneficial in some equine patients with recurrent airway disease[11,12] and in 18 of horses with non-summer seasonal and perennial pruritus with or without urticaria.[13] Many topical therapies are likely used but there is little published evidence regarding their use or efficacy.
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