Cutaneous Adverse Food Reactions Research Articles

Ctrl-X, Ctrl-C and Ctrl-V in Veterinary Dermatology: Skin microbiota transplantation as a promising approach for dogs with cutaneous adverse food reactions

The probability of influencing the skin microbiome for addressing skin disorders opens a novel aisle of therapy. This study aimed to evaluate the efficacy of skin microbiota transplantation (sMt) for cutaneous adverse food reactions (caFr) in dogs. Ten client-owned dogs with caFr were included in the study. Unenriched heterologous sMt was performed using Nivea Skin Refining Clear-Up Strips (N-cUs). The bacterial microbiota of skin samples was analysed by next-generation sequencing of the 16S rRNA gene. Other relevant biomarkers were involved in VAS (visual analogue scale of pruritus score), CADESI-04 (canine atopic dermatitis extent and severity index) and epidermal corneometric analysis. Increased Faecalibacterium (0 to 1.9 %), Peptoclostridium (5.49 % to 9.11 %) and Collinsella (0.65 % to 8.91 %), and decreased Fusobacterium (19.16 % to 9.06 %), Porphyromona (8.75 % to 0.13 %), Streptococcus (1.63 % to 0.14 %) and Staphylococcus (1.09 % to 0.49 %) was evidenced before and after sMt, respectively. Treatment with sMt effectively controlled clinical signs and drastically reduced median VAS pruritus (6.5 vs. 2) and CADESI-04 scores (74.50±22.62 to 19.30±11.30) (p<0,001). In addition, skin pH and hydration values were improved (p<0,001) after sMt. The heterologous and unenriched sMt with N-cUs could be responsible for the clinical recovery observed in this study.

An open-label clinical trial to evaluate the efficacy of an elemental diet for the diagnosis of adverse food reactions in dogs.

The diagnosis of cutaneous adverse food reactions (CAFR) in dogs is dependent on a diet trial and provocative challenge. To evaluate the efficacy of an elemental diet for the diagnosis of CAFR in dogs. Sixty-two client-owned nonseasonally pruritic dogs. A prospective, uncontrolled, observational elimination diet trial study. Dogs were fed a commercially available elemental canine diet (Pro Plan Veterinary Diets EL Elemental Canine Formula, Nestlé Purina PetCare Company) for up to eight weeks. Pruritus was assessed using a validated Visual Analog Scale (PVAS), lesions with the Canine Atopic Dermatitis and Severity Index, 4th iteration (CADESI-04) and gastrointestinal (GI) signs with a client questionnaire. All dogs were challenged with their previous diet for up to 14 days. Treats were added from Day (D)7 to D14. Forty-five dogs completed the study. Eighteen (40%) of these were diagnosed with CAFR and 27 (60%) were diet-nonresponsive (NR). Dogs with CAFR flared on provocative challenges within 14 days. The smallest volume of previous diet that induced a CAFR flare was one teaspoon in two dogs (11.1%). The mean number of days leading to a provocation of clinical signs was 4.88 days. Gastrointestinal signs improved in both groups. Eight of the dogs with CAFR (44.4%) were subsequently maintained on the elemental diet alone. Pro Plan Veterinary Diets EL Elemental Canine Formula is efficacious for the diagnosis of canine CAFR. One teaspoon of the offending diet may induce clinical signs in some dogs with CAFR.

Intestinal Permeability Targeted Rectal Enema Nutraceutical Intervention in Dogs with Cutaneous Adverse Food Reactions: Gut-Brain-Skin Axis Directed Pro-active Treatment

Intestinal Permeability Targeted Rectal Enema Nutraceutical Intervention in Dogs with Cutaneous Adverse Food Reactions: Gut-Brain-Skin Axis Directed Pro-active Treatment

Diet in canine dermatology part 2: management of cutaneous adverse food reactions

The second in this two part series on nutritional management of dermatological conditions in dogs focuses on the role of diet in cutaneous adverse food reactions (both food allergies and intolerances). It reviews the most common causes of food allergies, how to diagnose them via an elimination diet trial and potentially appropriate diets for the trial. It also explores the most common reasons for failure of a diet trial, the role of the veterinary nurse in providing support and education for caregivers, and a number of ‘top tips’ to increase the likelihood of success of the trial. Finally, longer-term management of patients diagnosed with an adverse food reaction is discussed.

Evaluation of a hydrolysed salmon and pea hypoallergenic diet application in dogs and cats with cutaneous adverse food reaction.

Cutaneous adverse food reaction (CAFR) is a common disease, affecting about 1-2% of dogs and cats. Diagnosis of the CAFR is made through elimination diet coupled with diet challenge, as methods like skin tests, patch tests, basophil degranulation tests and assessment of IgG and IgE serum levels are not sensitive enough. A partially hydrolysed salmon and pea hypoallergenic diet was evaluated in the diagnosis and treatment of CAFR in dogs and cats. The diet was used in the treatment of 13 dogs and 12 cats for 10 weeks. The Pruritus Visual Analog Scale (PVAS; dogs and cats), Canine Atopic Dermatitis Extent and Severity Index (CADESI-04; dogs) and the Scoring Feline Allergic Dermatitis (SCORFAD; cats) were used for effectiveness evaluation. In dogs, a significant decrease was reported in both CADESI-04 (from 17.3±7.5 to 10.15±7.4; p=0.028) and PVAS (from 7±1.3 to 4.76±1.8; p=0.003) after four weeks of treatment. Also in cats, both the PVAS (from 6.75±1.8 to 4±2.3; p=0.006) and SCORFAD (from 4.16±1.9 to 2.58±1.2; p=0.029) decreased significantly after four weeks. After eight weeks, a significant improvement was observed in almost all the animals. Evaluated diet was useful in the treatment of the CAFR in dogs and cats.

Clinical application of insect-based diet in canine allergic dermatitis

The objective of this study was to evaluate the beneficial effects of the short-term application of insect-based diet in canine allergic dermatitis. Total 19 atopic dogs with concurrent cutaneous adverse food reactions were enrolled and classified into 3 groups. The treatment group (n = 7) was fed insect-based diet, the positive control group (n = 6) was fed salmon-based diet, and the negative control group (n = 6) was fed commercial or homemade diet for 12 weeks. The degree of skin lesions was evaluated based on canine atopic dermatitis extent and severity index (CADESI-4). Additionally, transepidermal water loss (TEWL) and pruritus visual analog scale were evaluated. All indices were evaluated every 4 weeks after the initial administration of hypoallergenic diets. In the treatment group, significant decrease in the CADESI-4 score was observed at 8 weeks compared to the baseline score (p = 0.031). There were significant differences in the CADESI-4 score between the groups at 8 weeks (p = 0.008), 12 weeks (p = 0.012), and TEWL at 12 weeks (p = 0.022). This preliminary result demonstrates the potential hypoallergenicity of an insect-based diet through features that diminish cutaneous lesions and skin barrier dysfunction.

Cutaneous adverse food reactions

Dietary-induced skin problems of cats and dogs can include food intolerances, primary and secondary nutrient deficiencies and nutrient toxicities. A full dietary history needs to be taken and owners should include specific commercial foods, all snacks and treats, supplements, chewable/palatable medications and vitamins, chew toys, human foods and any food that the animal may have access to. Actively encourage owners to keep a food diary, as with obese animals and diabetics. The classification and diagnosis of nutritional-related skin disorders are initially based on a detailed dietary history and food evaluation. Veterinary nurses are in an ideal position to help owners make an accurate representation of what the pet consumes.

Cutaneous adverse food reactions in the dog and cat – what's new?

Cutaneous adverse food reactions are common in both dogs and cats, as well as humans. Reactions can be severe and, in some cases, life-threatening. Strategies to manage cutaneous adverse food reactions are important and include ways to prevent the development of allergy and effective methods of diagnosing the problem, together with a range of effective therapies. This paper discusses recent advances in human medicine towards preventing the development of cutaneous adverse food reactions and considers how that knowledge could be applied to dogs and cats. New therapeutic strategies involving immunotherapy are also discussed. Information on the best diagnostic tests for cutaneous adverse food reactions is highlighted, alongside the advantages and disadvantages of different exclusion diets.

Results of food challenge in dogs with cutaneous adverse food reactions.

Elimination diet trials and food challenge tests remain the gold standard for diagnosing cutaneous adverse food reaction (CAFR) in dogs. However, food challenge tests are difficult to perform owing to a lack of definite information on expected clinical signs and the time frame within which they develop after challenge. To report the results of the food challenge test carried out in client-owned dogs under observation. A retrospective evaluation of the medical records of dogs presenting with pruritus was performed. Skin infections and/or parasites were treated before inclusion in the study. Dogs that underwent an elimination diet with clinical improvement and relapse with food challenge tests were included in this study. A pruritus Visual Analog scale score was recorded as an index of pruritus before and at the end of the elimination diet trial before challenge. The onset of time to relapse of clinical signs and the body sites affected after food challenge testing were recorded by the owners. We examined the medical records of 310 dogs with pruritus. Of these, 46 dogs with a diagnosis of CAFR were enrolled in this study. Significant clinical improvement was observed after the elimination diet trial (P<0.0001). All dogs exhibited pruritus, and none exhibited anaphylaxis after food challenge testing. Among these dogs, 60.9% developed pruritus within 12h of food challenge. Notably, 23.9% of the dogs developed pruritus within 3-6h. The limbs exhibited the highest frequency of pruritus (56.5%), followed by the face (26.1%). This study is the first to report details of the time to onset of clinical signs and body site affected after food challenge testing in dogs. These results will assist veterinarians and dog owners in the decision-making process regarding food challenge testing.

IgE reactivity to milk components in dogs with cutaneous adverse food reactions.

We investigated the IgE reactivity to crude and purified milk antigens in the sera of 112 dogs with cutaneous adverse food reactions (CAFRs). Of the 112 dogs, 33 (29%) had specific IgE for crude milk antigens. In the dogs with milk-specific IgE, IgE reactivity to casein, bovine serum albumin (BSA), α-lactalbumin, β-lactoglobulin, and bovine IgG were 81%, 85%, 39%, 27%, and 35%, respectively. Casein and BSA may be important allergens in dogs with CAFRs. Some canine vaccines contain casein hydrolysate as a stabilizer and the pooled serum with anti-casein IgE showed IgE reactivity to the vaccines containing it. Information about IgE reactivity to casein in dogs with CAFRs could be useful for predicting adverse reactions to the vaccines including casein hydrolysate.

Canine diet and cutaneous adverse food reactions

The veterinary nurse can play an important role in providing nutritional advice to dog owners. With the wide range of commercial diets that are available, it is important to tailor the diet to each individual animal. Selection of a diet to investigate a cutaneous adverse food reaction (CAFR) should be made after taking a thorough dietary history from the owner and a conversation to decide which diet is most appropriate for each individual. Selection of a diet should involve the use of a novel or hydrolysed protein source for that dog, but other factors such as palatability, convenience, nutritional content and cost need also to be considered. If a diet is carefully matched to owner and pet requirements, the chances of good owner compliance and a response to the diet can be maximised.

Use of the Health Belief Model to identify factors associated with owner adherence to elimination diet trial recommendations in dogs

To use the Health Belief Model to identify factors associated with owner adherence to elimination diet trial (EDT) recommendations by veterinarians for dogs with suspected cutaneous adverse food reactions (CAFRs). 192 owners of dogs prescribed an EDT between April 1, 2012, and April 1, 2017. Owners of dogs prescribed an EDT to diagnose CAFRs were identified through review of medical records from a single veterinary dermatology specialty practice. Identified owners were invited to participate in an anonymous online survey that was developed on the basis of the Health Belief Model. Multivariable logistic regression was used to evaluate associations between potential predictor variables and 100% adherence to EDT recommendations. 665 owners were invited to participate, and 192 (28.9%) completed the survey. Of the 192 respondents, 77 (40.1%) reported 100% adherence to EDT recommendations, and 115 (59.9%) reported < 100% adherence. Results indicated that the odds of owners reporting 100% adherence to EDT recommendations were significantly decreased by owner perception of barriers (adjusted OR [ORa] = 0.86) and were significantly increased by owner knowledge regarding diets and CAFRs in dogs (ORa = 1.30) and by self-efficacy or confidence in performing an EDT as directed (ORa = 1.18). Findings indicated that most prescribed EDTs were not followed strictly. Interventions to help owners reduce perceived barriers, increase self-efficacy, and improve related knowledge could improve adherence to EDT recommendations and, thereby, increase the diagnostic utility of EDTs.

Critically appraised topic on adverse food reactions of companion animals (7): signalment and cutaneous manifestations of dogs and cats with adverse food reactions

BackgroundOutside of pruritus, there is no clear consensus on the nature and prevalence of cutaneous manifestations of adverse food reactions (AFRs) in dogs and cats.ResultsWe searched two databases on August 7, 2018, for articles reporting detailed data on the signalment and clinical signs of at least one dog or cat with a cutaneous AFR (CAFR). We identified 233 and 407 citations from which were selected 32 articles reporting original information. Twenty-two articles included data on 825 dogs with CAFRs. The reported age of onset varied from less than one to 13 years of age; a beginning of signs by 6 or 12 months of age was noted in 22 to 38% of dogs, respectively. The female-to-male ratio also varied considerably. Four breeds (German shepherd dogs, West Highland white terriers, Labrador and golden retrievers) accounted for about 40% of affected dogs. Most dogs diagnosed with a CAFR were pruritic, most often in a generalized pattern, with the ears, feet, and abdomen also being frequently affected; the perineum was uncommonly targeted, however. Canine CAFRs presented mainly as recurrent bacterial skin infections, otitis externa and atopic dermatitis. Twelve articles reported novel information on 210 cats with this syndrome. There was no apparent breed and gender predisposition for feline CAFRs, but cats appeared to develop signs later than dogs with the same syndrome. Most cats with a CAFR were pruritic, especially on the head/face and neck, with the abdomen and ears also commonly involved. Symmetric self-induced alopecia, a head-and-neck self-traumatic dermatitis, miliary dermatitis and variants of eosinophilic diseases were the most common manifestations of feline CAFRs.ConclusionsCAFRs affect dogs and cats of any age, any breed, and both genders, with the proportion of juvenile dogs diagnosed about twice that of cats. There are no reliable breed predisposition data. Most patients are pruritic, with half the dogs having generalized pruritus and half the cats scratching their face/head or neck. Canine CAFRs most often manifest as bacterial skin infections, otitis externa or atopic dermatitis; cats with CAFRs will exhibit the expected clinical phenotypes associated with feline hypersensitivity dermatitides.

The role of the dermatologist in the immune-mediated/allergic diseases - position statement of the EADV task force on contact dermatitis, EADV task force on occupational skin diseases, UEMS-EBDV subcommission allergology and European Dermatology Forum.

The members of the Task Force on Contact Dermatitis and the Task Force on Occupational Dermatoses of the European Academy of Dermatology and Venereology (EADV), of the European Dermatology Forum (EDF), and the members of the UEMS Sectionof Dermatology-Venereology (UEMS-EBDV) we want to vindicate the fundamental role that the specialist in Dermatology has in the diagnosis and management of Immuno-mediated /allergic Diseases. In disagreement with the blueprint paper of the UEMS section of Allergology (2013), in which dermatologists are excluded from one of their core activities it was decided to write this consensus paper. The skin occupies a crucial place in the broad spectrum of allergic diseases; there is no other organ with such a multitude of different clinical conditions mediated by so many pathogenetic immune mechanisms. Subsequently, dermatologists play a fundamental role in the management of immune-mediated diseases including among others contact dermatitis, atopic dermatitis, urticaria and angioedema or cutaneous adverse drug, food and arthropod reactions. The essential role of dermatology in the diagnostic, therapeutic and preventive management of immune mediated /allergic diseases which is crucial for patient management is justified from both the academic and professional point of view. Based on the best care of the patient with cutaneous immune allergic disease a multidisciplinary approach is desirable and the dermatologist has a pivotal role in patient management. Be so good and no one will not ignore you, dermatologist. Ideally Dermatology should be governed according the following Henry Ford statement: "Arriving together is the beginning; keeping together is progress; working together is success."

Atopic dermatitis

Canine atopic dermatitis (CAD) is a common genetically predisposed inflammatory and pruritic disease. CAD is a diagnosis made by the exclusion of other pruritic skin diseases such as ectoparasites, and other allergies such as flea bite hypersensitivity, and cutaneous adverse food reaction. Nurses can play an important part in helping to investigate the underlying causes of pruritus in dogs, it is therefore important they have a good working knowledge of the clinical presentation of this common disease and the appropriate diagnostic tests that are routinely used to help rule out other causes of pruritus. Therapy can include systemic medication such as essential fatty acids, antihistamines, glucocorticoids, ciclosporine, Janus kinase inhibitors, monoclonal antibodies to IL31 and allergen specific immunotherapy.

An assessment of a Western blot method for the investigation of canine cutaneous adverse food reactions.

Adverse food reaction (AFR) is diagnosed with a two month elimination diet (ED), followed by challenge with the original food. To evaluate reactivity of selected EDs and performance of a Western blot serological test for the diagnosis of AFR. Twenty five food reactive (FR) and 13 non food reactive (NFR) privately owned dogs. Sera were tested for antibodies against hydrolyzed poultry feather (RCA), hydrolyzed soy (PHA), hydrolyzed fish (FUH), limited antigen horse and potato (THP), fresh horse meat and the offending food for each FR dog as documented by provocative challenge. Fourteen sera were negative and two positive to all foods. Sera from five of 13 NFR and three of 25 FR dogs were reactive to hydrolyzed foods. The RCA diet was recognized by four of 38, FUH by six of 38 and PHA by one of 28 samples. THP was recognized by 14 of 33 and fresh horse by one of ten dogs that had never eaten horse meat. The test correctly identified one of 15 dogs allergic to FUH. Twenty of 25 FR sera were negative for the dogs' respective offending foods (20% sensitivity), whereas four of 13 NFR sera were positive to the dogs' usual diets (69% specificity). Western blot analysis cannot be considered as a valid tool for the diagnosis of AFR; it may serve as an aid in selecting an ED.

Allergic otitis externa in the dog

Otitis externa is a common presenting sign in primary care practice. Up to 75% of all cases have allergy as an underlying cause. The veterinary nurse can play a valuable role in helping to investigate disease by cytology of aural discharge to identify parasites and infection; by the institution of a hypoallergenic diet to help rule out cutaneous adverse food reaction as a primary cause and by owner education on the best ways to clean ears and the most appropriate products to use.

Clinical efficacy of nutraceutical diet for cats with clinical signs of cutaneus adverse food reaction (CAFR).

Food allergies and food intolerances are clinically difficult to discriminate. Most often, along with cutaneous adverse food reactions or CAFR, they are classified as adverse food reactions, whose causes are numerous, including toxic compounds. Eighteen indoor-housed domestic cats with evident clinical symptoms related to CAFR (drooling, back and neck intense itching, neck eczema, chronic conjunctivitis and stomatitis) involving skin lesions were studied. Cytological evaluations of ear, skin and gingival swabs revealed an increased turnover of keratinocytes while the oxytetracycline ELISA determination showed an unexpected high amount of oxytetracycline in all cats at the first visit. All cats were then randomly assigned to receive a standard (SD group) or a nutraceutical diet (ND group) for 60 days. In the ND group a significant reduction of the mean serum concentration of oxytetracycline, pruritus intensity and skin lesion severity (**p<0.01, ***p<0.001, and ***p<0.001, respectively) was observed after 60 days, and associated with a significant improvement in the clinical picture. Although a direct correlation between oxytetracycline presence within cat sera and CAFR-related symptoms has never been described, this study highlights the benefit of a specific nutraceutical diet supplementation in improving clinical symptoms and skin lesions in cats with CARF.

Measurement of allergen-specific IgG in serum is of limited value for the management of dogs diagnosed with cutaneous adverse food reactions

Conflicting results have been reported in the literature in terms of the usefulness of serological testing for IgG against food allergens in dogs with cutaneous adverse food reaction (CAFR). The aim of the present study was to evaluate the suitability of a commercially available IgG ELISA for identifying food allergens in dogs, by challenging dogs with specific food ingredients, selected on the basis of IgG reactivity in serum samples. A total of 24 adult dogs with CAFR were enrolled into the study and 16 healthy dogs were included as a control group. Blood samples were obtained for measurement of specific IgG antibodies against 39 commonly used pet food ingredients by ELISA. Participating owners were surveyed to obtain information on their pet's dietary history. Eleven healthy control dogs and 12 dogs with CAFR were subsequently challenged in a blinded cross-over design experiment with both positive and negative food ingredients, selected on the basis of the ELISA test results.There was substantial individual variation in ELISA test results to the various food allergens, but no significant difference in IgG reactivity comparing the CAFR and control groups. None of the control dogs developed any clinical signs of an allergic reaction during the dietary challenge study. In the CAFR group, six of 12 dogs developed clinical signs after the negative challenge, and two of nine dogs developed clinical signs after the positive challenge. It was concluded that the ELISA test for dietary allergen-specific IgG is of limited value in the management of dogs with CAFR.

Critically appraised topic on adverse food reactions of companion animals (3): prevalence of cutaneous adverse food reactions in dogs and cats.

BackgroundThe prevalence of cutaneous adverse food reactions (CAFRs) in dogs and cats is not precisely known. This imprecision is likely due to the various populations that had been studied. Our objectives were to systematically review the literature to determine the prevalence of CAFRs among dogs and cats with pruritus and skin diseases.ResultsWe searched two databases for pertinent references on August 18, 2016. Among 490 and 220 articles respectively found in the Web of Science (Science Citation Index Expanded) and CAB databases, we selected 22 and nine articles that reported data usable for CAFR prevalence determination in dogs and cats, respectively. The prevalence of CAFR in dogs and cats was found to vary depending upon the type of diagnoses made. Among dogs presented to their veterinarian for any diagnosis, the prevalence was 1 to 2% and among those with skin diseases, it ranged between 0 and 24%. The range of CAFR prevalence was similar in dogs with pruritus (9 to 40%), those with any type of allergic skin disease (8 to 62%) and in dogs diagnosed with atopic dermatitis (9 to 50%). In cats presented to a university hospital, the prevalence of CAFR was less than 1% (0.2%), while it was fairly homogeneous in cats with skin diseases (range: 3 to 6%), but higher in cats with pruritus (12 to 21%) than in cats with allergic skin disease (5 to 13%).ConclusionsAmong dogs and cats with pruritus and those suspected of allergic skin disease, the prevalence of CAFR is high enough to justify this syndrome to be ruled-out with a restriction (elimination)-provocation dietary trial. This must especially be considered in companion animals with nonseasonal pruritus or signs of allergic dermatitis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12917-017-0973-z) contains supplementary material, which is available to authorized users.