Clinical Signs Of Atopic Dermatitis Research Articles

OA01.24. A study of effect of neem oil on clinical signs of canine atopy

Purpose: Due to growing nuclear nature of urban families, pets like dogs are becoming popular companions. A skin disorder is common in dogs and is a concern for human coming in contact. Natural remedies need to be assessed for long term safety of dogs and humans. There is evidence that in dogs, Neem oil can help with fleas, ticks, intestinal parasites and mange mites. According to Ayurvedic medicine. Neem oil improves the clinical signs of skin disorders. To study its action in canines, further work was required on the efficacy of Neem oil in the treatment of canine atopy. Method: Effect of a preparation of Neem oil on canine atopy was assessed in a open, placebo-controlled trial. Privately owned dogs were used and the clinical signs of atopic dermatitis were evaluated by the owners. For a period of 3 weeks, the dogs daily received application with Neem oil (n = 9) or vehicle (n = 8). During the trial, all dogs were cleaned with the use of regular bathing shampoo in order to maintain hygiene. To assess the severity of atopic dermatitis, the clinical signs scored were itching, redness, scaling, thickening and stripping of skin. The severity of the signs of atopic dermatitis was scored by the owners by marking with a cross a 10-cm, horizontal line. Result: For all five clinical signs, the group-mean improvement, expressed as change of severity score over time, was greater in the test group than in the controls. Within each group, the changes for the five clinical signs were added up to arrive at an overall index of improvement of atopic dermatitis. The extra improvement caused by the application of Neem oil was significant. Conclusion: Neem oil can be considered as effective and is beneficial for dogs with atopic dermatitis.

Effectiveness of the Novel Herbal Medicine, KIOM-MA, and Its Bioconversion Product, KIOM-MA128, on the Treatment of Atopic Dermatitis

This study was conducted to determine if oral administration of the novel herbal medicine, KIOM-MA, and its Lactobacillus acidophilus-fermented product, KIOM-MA128, has therapeutic properties for the treatment of atopic dermatitis (AD). Using AD-induced BALB/c mice by Ovalbumin and aluminum hydroxide, the effectiveness of KIOM-MA and KIOM-MA128 on AD was evaluated. Oral administration of KIOM-MA and KIOM-MA128 reduced major clinical signs of AD including erythema/darkening, edema/papulation, excoriations, lichenification/prurigo, and dryness. Interestingly, KIOM-MA128 more significantly improved AD-related symptoms including decrease of IgE level in the plasma as well as reduction of scratching behavior, skin severity in the AD BALB/c model. HPLC analysis showed the significant changes in the constituent patterns between KIOM-MA and KIOM-MA128. Our results suggest that both KIOM-MA and KIOM-MA128 have potential for therapeutic reagent for the treatment of AD, and further, the efficacy is significantly enhanced by L. acidophilus fermentation via increases in its indicator molecule.

Dietary Beta-1,3/1,6-Glucans Reduce Clinical Signs of Canine Atopy

Problem statement: There was evidence that beta-1,3/1,6-glucans modulate inflammatory activity. In an open, non-controlled trial, purified beta-1,3/1,6-glucans were found to improve the clinical signs of dogs with undefined chronic skin disorders. Given the design of that study, further work was required on the efficacy of beta-1,3/1,6-glucans in the treatment of canine atopy. Approach: The influence of a purified preparation of beta-1,3/1,6-glucans (MacroGard®) on canine atopy was assessed in a double-blind, placebo-controlled trial. Privately owned dogs were used and the clinical signs of atopic dermatitis were evaluated by the owners. For a period of 8 weeks, the dogs daily received a complete dry food without (n = 16) or with 800 ppm beta-1,3/1,6-glucans (n = 15). During the trial, all dogs were treated three times with the use of a flea remedy in order to exclude any influence of flea-bite allergy. To assess the severity of atopic dermatitis, the clinical signs scored were itching, redness, scaling, thickening and stripping of skin. Results: For all five clinical signs, the group-mean improvement, expressed as change of severity score over time, was greater in the test group than in the controls. Within each group, the changes for the five clinical signs were added up to arrive at an overall index of improvement of atopic dermatitis. The extra improvement caused by the ingestion of beta-1,3/1,6-glucans was 63%. The difference between the pooled group-mean changes of the scores for the control and test dogs was statistically significant (P<0.001). To correct for the differences in baseline scores, dose equivalents required for the observed change between baseline and final scores were calculated. It was found that the dose equivalents for the combined placebo and treatment effects seen in the test group were much greater than those required for the placebo effect in the control group. Conclusion: Beta-1,3/1,6-glucans can be considered safe and it is put forward that a dose of 800 ppm in a dry food is beneficial for dogs with atopic dermatitis.

Evaluation of the atrophogenic potential of hydrocortisone 1% cream and pimecrolimus 1% cream in uninvolved forehead skin of patients with atopic dermatitis using optical coherence tomography

Topical corticosteroids are widely used to treat atopic dermatitis (AD), but their anti-inflammatory mode of action can be accompanied by several unwanted side effects including skin atrophy and telangiectasia. In this 8-week, investigator-blinded, intraindividual right-left comparison study with patients with mild-to-moderate AD, hydrocortisone 1% cream (HCT) was applied twice daily for 4 weeks on one side of forehead skin without clinical signs of AD and pimecrolimus 1% cream (PIM) on the other. Epidermal and dermal thickness were assessed by optical coherence tomography (OCT) and high-frequency ultrasound, respectively. Skin atrophy and telangiectasia were assessed by contact dermatoscopic photography (Dermaphot(®)). Treatment with HCT leads to a significant decrease in epidermal thickness after only 2 weeks of treatment, while the decrease in PIM-treated sites was less pronounced and was not statistically significant. By 4 weeks after the end of treatment, epidermal thickness returned to baseline values. No dermal thinning or development of telangiectasia could be observed by means of ultrasound or Dermaphot(®), respectively. In summary, this study indicates that a 2-week single course of topical treatment with a mildly potent steroid can cause transient epidermal thinning, an effect not seen in the PIM group. The slight decrease with PIM - although not significant - could be due to normalization of the increased skin thickness caused by a subclinical inflammation in AD. This study suggests that PIM may be safer for treatment of AD in sensitive skin areas like the face, especially when repeated application is required.

The study of canine atopic dermatitis involving the isolation of dogs

Twenty-seven pruritic dogs were used in this study. When a hypoallergenic diet was fed to these 27 dogs for six weeks, none of the dogs showed improvement of the pruritus. These dogs had a history and clinical signs of atopic dermatitis (AD) as defined by Prelaud's diagnostic criteria. Subsequently, the 27 dogs were isolated for observation for two weeks in the hospital. In the isolation room in the veterinary clinic, cages and tableware were all stainless steel, and carpet was not used. A hypoallergenic diet was continuously fed to the 27 dogs for two weeks, during which time they were kept in the isolation room. PVAS (Pruritus Visual Analog Scale) was performed prior to starting the isolation, at the start of the study and 2 weeks after starting the isolation. In 17 dogs (63%) the pruritus improved in the isolation room. A statistically significant reduction (p < 0.01) of PLS (Pruritus liners score) was recorded 2 weeks after isolation. It was hypothesized that the 17 dogs whose pruritus improved in the isolation room had AD caused by an environmental antigen that was not present in the isolation room. Pruritus of the remaining 10 dogs (37%) did not improve. For 6/10 dogs, the intradermal allergy testing was positive for an environmental antigen. For 4/10 dogs, the intradermal allergy testing was negative for all environmental antigens. Dogs for which sensitivity to an environmental antigen was not identified were thought to have atopic-like dermatitis.

Evaluation of Lactobacillus rhamnosus strain GG for the prevention of atopic dermatitis in dogs

To evaluate the efficacy of the probiotic Lactobacillus rhamnosus strain GG for the alleviation or prevention of clinical signs of atopic dermatitis (AD) in genetically predisposed dogs. 2 adult Beagles with severe AD and 16 puppies. The 2 adult Beagles were bred twice, with a year between breedings. Lactobacillus rhamnosus GG was administered to the bitch during the second pregnancy and to the puppies of the second litter from 3 weeks to 6 months of age. Both litters were epicutaneously sensitized to Dermatophagoides farinae. Blood samples were collected from puppies every 6 weeks to measure serum titers of allergen-specific IgE. At 6 months of age, all puppies underwent intradermal allergen testing and environmental challenge with D farinae. Clinical signs were scored. In the first litter, at 6 months of age, 7 of 7 puppies were strongly seropositive for IgE against D farinae, 6 had a positive reaction to intradermal testing, and 7 developed severe clinical signs of AD after the environmental challenge. In the second litter, 7 of 9 puppies were seropositive, 3 had a positive reaction to intradermal testing, and 6 developed dermatitis and pruritus after the challenge. The second litter had a significantly lower serum titer of allergen-specific IgE and milder reaction to intradermal testing, compared with the first litter. Clinical scores did not differ between litters. Administration of L rhamnosus GG to puppies appeared to reduce immunologic indicators of AD, although no significant decrease in clinical signs was detected.

Prevalence and features of canine atopic dermatitis in Hungary

Medical records of 600 dogs diagnosed with atopic dermatitis were reviewed and evaluated with reference to history, geographical distribution, breed predilection, clinical signs and positive reactions to allergens as determined by intradermal skin testing (IDT) manufactured by Artuvetrin Laboratories. In 66.6% of dogs, the age of onset of atopic dermatitis was between 4 months and 3 years. Dogs living in the garden suburb of Budapest were more sensitive to house dust mites, fleas and moulds, and dogs from the western part of Hungary were more sensitive to weeds than to other allergens (p < 0.01). Positive reactions were most common to Dermatophagoides farinae followed by human dander. The breed distribution found in the present study was consistent with that reported in the literature, except for the breeds Hungarian Vizsla, Pumi, French bulldog, Doberman Pinscher and Bobtail which were over-represented among atopic dogs compared to the breed distribution of the general dog population of a large city in Hungary. Breeds with verified adverse reaction to food were Cocker spaniels, French bulldogs, Bullmastiffs, Bull terriers, St. Bernards, Tervurens, West Highland White terriers and American Staffordshire terriers (p < 0.05). The clinical signs of atopic dermatitis and their occurrence are in accordance with the data described in the literature.

The challenge of diagnosing atopic diseases: outcomes in Cuban children depend on definition and methodology

Prevalences of childhood asthma and other atopic diseases are increasing worldwide, and so is the number of diagnostic methods and definitions used. We determined the occurrence of atopic diseases in Cuban children with a range of diagnostic approaches commonly used or proposed in epidemiological studies, and compared the different outcome measures. A total of 398 Cuban schoolchildren between 5 and 13 years of age were diagnosed by International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, clinical examination, pre- and post-exercise spirometry, and skin prick testing. All results were considered separately, as well as jointly by using scores and definitions as described in the literature. Using questionnaire-based approaches, 21-39% of the children were positive for asthma, 9-19% for atopic dermatitis, and 15-46% for rhinoconjunctivitis. With spirometry, 7% of the children had asthma. Definitions based on a combination of questionnaire and spirometry results yielded asthma rates of 5%. Of all children, 6% wheezed on clinical examination, and only one child showed clinical signs of atopic dermatitis. Eleven percent of the children had a positive skin prick test. In total, 254 children (64%) had an atopic disease as based on the ISAAC questionnaire, and 263 (66%) based on all approaches used. Diagnostic outcomes on atopic diseases vary considerably depending on definition and methodology. Our results clearly demonstrate the need for consensus on diagnosing asthma and other atopic diseases in epidemiological studies. Based on the most commonly used ISAAC questionnaire, our data suggest prevalences of atopic diseases in Cuban children that rival those found in some other Latin American countries and developed nations with the highest prevalences in the world.

NR4A Orphan Nuclear Receptor Family in Peripheral Blood Eosinophils from Patients with Atopic Dermatitis and Apoptotic Eosinophils in vitro

To identify novel genes related to the clinical signs of atopic dermatitis (AD), differentially expressed genes were sought in peripheral blood eosinophils from both AD patients and healthy volunteers. RNA was prepared from eosinophils, expression of various genes was monitored using the Affymetrix GeneChip, and expression was quantified by real-time RT-PCR. Two genes, Nur77 and NOR1, members of NR4A orphan nuclear receptor family, were expressed at a significantly higher level in AD patients than in healthy volunteers. Expression of another gene in the NR4A receptor family, Nurr1, was also higher in AD patients than in healthy volunteers. When peripheral blood leukocytes from healthy volunteers were fractionated, NOR1 expression was highest in eosinophils, but expression of Nur77 and Nurr1 genes was not eosinophil-specific. Extremely intense apoptosis was induced in both eosinophils and an eosinophil cell line, AML14.3D10, by treatment with antibody (Ab) to both CD30 and Fas. Rapid expression of the genes for the NR4A receptor family was observed with anti-CD30 Ab treatment but not with anti-Fas Ab. The NR4A orphan nuclear receptor family gene expression and the subsequent eosinophil apoptosis were downregulated by the MAPK inhibitor, U0126. These results suggest that the expression of the NR4A receptor family genes through CD30 signaling may regulate eosinophil apoptosis in allergic conditions such as AD.

Evaluation of a point‐of‐care immunodot assay for predicting results of allergen‐specific intradermal and immunoglobulin E serological tests

Immunotherapy to prevent recurrence of clinical signs of atopic dermatitis (AD) is based on intradermal or serological tests that assist in identifying allergen-specific immunoglobulin E hypersensitivities. Unfortunately, the results of such tests can be negatively influenced by several factors, which include the age of the patients, the season of testing and the administration of anti-allergic drugs. Screening to predict when these expensive tests will be useful would benefit owners of dogs with AD. The objectives of this study were to determine whether a point-of-care allergen-specific immunodot assay (Allercept E-Screen, Heska Corp., Ft Collins, CO, USA) could predict results of either intradermal or Allercept full panel serological tests in atopic dogs. Thirty dogs living in the south-eastern USA were diagnosed with AD in accordance with current standards. Allergen-specific intradermal, serological and E-Screen tests were performed in all subjects. For flea, house dust mite and pollen allergens altogether, results of the E-Screen assay agreed with those of intradermal and serological tests in 26/30 dogs (87%) and 25/30 dogs (83%), respectively. In this group of dogs, the probabilities of obtaining intradermal or serological tests positive for these allergens were 70 and 67%, respectively. If either skin or serum tests were performed only in dogs with positive E-Screen tests, the probability of obtaining positive results would be increased from 70 to 95% and from 67 to 90%, respectively. In this population of dogs with AD, results of the E-Screen point-of-care immunodot assay was found to often agree with those of allergen-specific intradermal or Allercept tests for selected allergen groups.

Safety and Efficacy of Topical Calcineurin Inhibitors in the Treatment of Childhood Atopic Dermatitis

Approximately 10-20% of infants in industrialized countries experience atopic dermatitis. In recent decades topical corticosteroids have been the first-choice therapy for treatment of flares. However, this form of therapy may induce skin atrophy, especially after application to facial lesions or with long-term use. Thus, development of new anti-inflammatory topical agents for the treatment of childhood atopic dermatitis was needed. The topical calcineurin inhibitors tacrolimus and pimecrolimus have an effect on various cells of the cutaneous immune system, specifically on T cells, by inhibiting the phosphatase calcineurin and preventing the transcription of proinflammatory cytokines. In several clinical studies of children and adults with atopic dermatitis, topical calcineurin inhibitors were found to be effective both on the face and the trunk and extremities, in both short- and long-term treatment regimens. Tachyphylaxis or rebound were not observed. In most patients an improvement of their eczema occurred during the first week of treatment, as measured by subjective and objective clinical signs of atopic dermatitis. Treatment significantly reduced the incidence of flares and the need for corticosteroids in children and adults. Treatment success, commonly defined as 'excellent improvement' or 'clearing of all lesions', was observed in more than one-third of all children treated with 0.03% or 0.1% tacrolimus or 1% pimecrolimus. Topical application of pimecrolimus and tacrolimus does not lead to significant blood concentrations of these agents in the majority of children with atopic dermatitis, and any increase in blood concentrations decreases after a few days of therapy. No changes in laboratory parameters were observed in short- and long-term studies in patients with atopic dermatitis. The most common adverse effect following the application of topical calcineurin inhibitors is mild to moderate symptoms of irritation such as burning, erythema and pruritus, which occurred in up to 20% of all children treated with tacrolimus and 10% of children treated with pimecrolimus, and usually faded after a few days. In contrast to topical corticosteroids, calcineurin inhibitors do not induce skin atrophy, even after long-term use. Topical calcineurin inhibitors have been proven to be effective and have a good safety profile during short-term and long-term use for up to 1 year with pimecrolimus and up to 4 years with tacrolimus. Given the lack of extensive experience with use of topical calcineurin inhibitors over longer periods, regular use of these agents, particularly in children, should be undertaken only after careful consideration of individual cases. Sun protection should also be advised.

Remission of the clinical signs of atopic dermatitis in dogs after cessation of treatment with cyclosporin A or methyiprednisolone

Seventy-eight dogs with atopic dermatitis were treated for four months with either cyclosporin A or methylprednisolone. During the two months after the treatment ceased, 87 per cent of the dogs...

The ACVD task force on canine atopic dermatitis (XV): fundamental concepts in clinical diagnosis

The clinical signs of atopic dermatitis (AD) in man and in dogs are variable, and there is no single physical or historical feature that, if present, indicates the presence of AD. The initial diagnosis of AD is made clinically with the fulfillment of a combination of criteria that are strongly associated with the disease. Several schemes have been proposed in an attempt to define uniform clinical criteria for diagnosing canine AD, but no system is perfect. Once AD is considered as a possible diagnosis, other important differential diagnoses must be methodically eliminated from consideration. As a final step, once the clinician is certain that AD is probable, “allergy” tests may be conducted to provide additional evidence to “substantiate” the diagnosis. It is important to understand that allergy testing, in whatever form, is not appropriately used early in the patient evaluation as a screening test. Rather, it should be reserved, after a firm clinical diagnosis of AD has been made, to implement allergen avoidance schemes or to select allergens to be incorporated in immunotherapy formulations.

Aero-allergens in canine atopic dermatitis in southeastern Australia based on 1000 intradermal skin tests.

To determine the most relevant aero-allergens involved in canine atopic dermatitis in southeastern Australia and provide information about these aero-allergens to the general practitioner. Dogs presented to the Animal Skin & Allergy Clinic with history and clinical signs of atopic dermatitis were injected intradermally with 38 different allergens and negative and positive control. Intradermal skin tests in 1000 dogs were retrospectively evaluated. One third of all patients reacted to the house dust mite Dermatophagoides farinae. Allergens reacting in more than 15% of the patients were wheat (Triticum aestivum), sweet vernal (Anthoxanthum odoratum), English couch (Agropyron repens), yellow dock (Rumex crispus), Mexican tea (Chenopodium ambrosioides), plantain (Plantago lanceolata), melaleuca (Melaleuca quinquenervia) and peppercorn (Schimus spp). House dust mites are the most common allergens in canine atopic dermatitis in southeastern Australia and D farinae is involved most frequently. However, a number of grass, weed and tree pollens also are involved regularly.

Serum immunoglobulin E concentrations in West Highland White Terrier puppies do not predict development of atopic dermatitis.

Sera from 154 West Highland White Terrier puppies between 6 and 12 weeks of age were assayed for total IgE using a sandwich ELISA method. Development of clinical signs of atopic dermatitis in these dogs was monitored by use of an annual owner questionnaire, until the dog reached 3 years of age. Of 114 evaluated dogs, skin disease severe enough to warrant veterinary examination was reported in 52 (46%) during the three study years. A diagnosis of atopic dermatitis was made by the attending veterinarian in 28 dogs (25%). Certain litters had an especially high prevalence of apparently atopic dogs, consistent with the genetic predisposition towards atopy in this breed, but clear evidence of consistent heritability was not present. The median IgE concentration in 154 puppies at 6-12 weeks of age was 0.9 units mL-1 , with a skewed distribution. Significant (P < 0.01) variation in serum IgE concentrations was observed between litters, with median serum IgE concentrations for a litter ranging from 0 to 27.7 units mL-1 . The median serum IgE concentration in puppies that later developed clinical signs of atopic dermatitis was not significantly different from that of puppies that remained healthy. There were no apparent correlations or significant differences found between serum IgE concentration as a puppy, parental history of skin disease, and subsequent emergence of clinical signs of atopic dermatitis. We conclude that early total serum IgE determinations seem to have little usefulness in predicting the later onset of atopic dermatitis in this breed.