Pruritic Skin Disease Research Articles

Clinical relevance of intradermal test results in atopic dogs

Canine atopic dermatitis (AD) is an inflammatory and pruritic skin disease and in most cases associated with IgE antibodies against environmental allergens. To date, the only causative therapeutic option is allergen immunotherapy (AIT). Offending allergens for AIT can be identified by intradermal testing (IDT) or serum allergen-specific IgE testing. The aim of the study was to evaluate positive IDT results considering the atopic dogs' clinical history. An IDT was performed on 48 atopic dogs and their owners completed a detailed questionnaire about the seasonal course of their pruritus. Results of IDT were correlated with the seasonal occurrence of pruritus. The most common positive IDT reactions were observed to mite allergens (33.3-62.5 %). Prevalence of positive reactions to individual tree, grass and weed pollen ranged between 8.3 % and 25 %. Moulds and epithelial allergens produced positive reactions in only 0-6.3 %. A correlation between positive IDT reactions and course of pruritus could neither be found for perennial nor for seasonal allergens. The evaluation of IDT reactions may not be an optimal method for identification of clinically relevant allergens in canine AD. The results of this study emphasise the importance of considering clinical history in addition to allergy test results in the formulation of an allergen extract for desensitisation.

A novel function of NLRP3 independent of inflammasome as a key transcription factor of IL-33 in epithelial cells of atopic dermatitis

Atopic dermatitis (AD) is a common chronic pruritic inflammatory skin disorder characterized by recurrent eczematous lesions. Interleukin (IL)−33, a cytokine of the IL-1 family, was found to play an important role in the pathogenesis of AD. As a key component of the inflammasome, NLRP3 has been mostly described in myeloid cells that to mediate inflammasome activation conducted proinflammatory cytokine production of the IL-1 family. However, the role of NLRP3 inflammasome in the pathogenesis of AD, as well as IL-33 processing are highly controversial. Whether NLRP3 can mediate IL-33 expression and secretion independently of the inflammasome in the epithelium of AD has remained unclear. In this article, we found the mRNA expression of Il33 and Nlrp3 were notably increased in the lesional skin of AD patients compared to healthy controls. We then found a significant positive correlation between the expression of Nlrp3 and Il33 in the epithelium of MC903-mediated AD mice model, but no changes were observed for Il36α, Il36γ, Il1β, or Il18 mRNA expression, as well as IL-1β or IL-18 production. Overexpression of NLRP3 in human immortalized epithelial cells increased IL-33 expression, whereas siRNA targeting NLRP3 abolished IL-33 expression. In addition, inhibition of NLRP3 inflammasome activation or caspase-1 activity with MCC950 or VX-765 showed no effect on the expression and secretion of IL-33 in AD mice. Unlike myeloid cells, NLRP3 predominantly located in the nucleus of epithelial cells, which could directly bind to Il33 specific-promoters and transactivate it through an interaction with transcription factor IRF4. Furthermore, NLRP3 deficient mice exhibited a significant alleviated epidermis inflammation and decreased mRNA expression and secretion of IL-33 in MC903-mediated AD mice without interfering with TSLP and IL-1β production. Our results demonstrate a novel ability of NLRP3 to function as a crucial transcription factor of IL-33 in epithelium independently of inflammasome that to mediate the pathological process of AD.

A novel therapeutic diet can significantly reduce the medication score and pruritus of dogs with atopic dermatitis during a nine‐month controlled study

BackgroundCanine atopic dermatitis (cAD) is a common chronic relapsing pruritic skin disease for which management commonly relies on life‐long use of immunomodulatory drugs. A number of the medications used are associated with adverse effects and the potential for complications during long‐term use.HypothesisThe goal of the study was to determine if a complete and balanced diet formulated for therapeutic benefit could contribute towards management of cAD. We hypothesised that the diet would reduce pruritus while also reducing the requirement for medication during the study period.Animals, materials and methodsForty privately owned dogs, having undergone a comprehensive diagnosis for cAD, were randomly allocated to two groups, each group being fed one of two diets (test or control) for up to nine months. We assessed pruritus, Canine Atopic Dermatitis Extent and Severity Index‐(4th iteration) and medication score, the latter reflecting the medication required to maintain a satisfactory quality of life for the animal.ResultsBoth diets were well‐accepted and ‐tolerated. There was a significant improvement in the pruritus score after three months of feeding the therapeutic diet (P = 0.0001). No such improvement was observed at any time point in the group of dogs given the control diet. There was a reduced drug requirement for dogs receiving the therapeutic diet after three months (P = 0.058), and that decrease was significant at six months (P = 0.021) and nine months (P = 0.018). No improvement was seen at any time point in the control group.ConclusionThe results suggest that a novel therapeutic diet can assist in the management of cAD by helping to control pruritus and reducing reliance on medication.

Pruritus, Pain, and Depression Associated with the Most Common Skin Diseases: Data from the French Study “Objectifs Peau”

Background: The prevalence and impact of pruritus, pain, and other sensory symptoms in skin diseases are poorly known. Objective: To assess the frequency of these symptoms with dermatoses and their association with depression using data from the “Objectifs Peau” survey. Methods: A representative sample of 20,012 French individuals was created using the usual quota method. Results: When patients suffered from both pruritus and skin pain, they had a higher relative risk of psychological suffering (2.9) than those who suffered only from pruritus (1.4) or skin pain (1.2). Pruritus was reported in 48.55% of patients with acne, 43.24% with mycoses, 44.35% with warts, and 36.51% with rosacea. For skin pain, the results were 11.22%, 27.59%, and 16.13% for atopic dermatitis, acne, and warts, respectively. Other unpleasant sensations, such as tingling or burning, were also frequently reported. Conclusion: Pruritus, pain, or other sensory symptoms were found to be common not only in classic pruritic skin diseases but also in acne, rosacea, or warts. The association of pruritus and pain dramatically increased psychological suffering. These symptoms must be systematically searched for in patients, especially since new therapeutic possibilities are emerging for the symptomatic treatment of pruritus.

Evaluation of quality of life in dogs with atopic dermatitis and their owners after lokivetmab therapy

Canine atopic dermatitis is an inflammatory and pruritic skin disease, with clinical characteristics associated with IgE antibodies, most commonly directed against environmental allergens which impact the quality of life in affected animals and their owners. Treatment is multifaceted and must be adapted to each patient individually. Currently, a medication based on caninized monoclonal antibody (mAb), called lokivetmab, has shown promise for controlling the signs of the disease, as it neutralizes interleukin IL-31, a cytokine that plays an important role in the pathogenesis of atopy. The impact of dermatological diseases in the life of the dog and its owner has only been studied in recent years through validated questionnaires. This additional measurement tool is important for evaluating the therapeutic success of interventions in atopic dermatitis, as clinical improvement may not correlate with an increased quality of life. This study aimed to evaluate the quality of life in dogs with atopic dermatitis and their owners after lokivetmab therapy. Ten atopic dogs treated at the dermatology service of the Veterinary Hospital of the Veterinary School from UFMG were selected. Quality of life was assessed using a validated questionnaire, before and after lokivetmab therapy. It concludes that treatment with lokivetmab significantly improved the quality of life of dogs with atopic dermatitis and their owners.

A review on atopic dermatits

(AD) is common, chronic skin disorders that can significantly quality of life of affected individuals as well as their families. Although the pathogenesis of the disorder is not completely understood, it appears to result from the complex interplay between defects in skin barrier function, environmental & infectious agents, & immune deregulation. There are no diagnostic tests for AD; therefore, the diagnosis is based on specific clinical criteria that corticosteroids, Topical calcineurin inhibitors Atopic dermatitis(AD) is a chronic, highly pruritic(itchy) inflammatory skin disease, & is one of the most common skin disorders in children. The disorder results in significant morbidity & adversely affects quality of life.Not only are patients affected by the social stigma of a visible skin condition, but the intense itching characteristic of the disease often leads to skin trauma & significant sleep disturbances. In addition, management of the condition necessitates the frequent application of emollients (agents that soothe, moisturize take into account the patient’s history & clinical manifestations. Successful management of the disorder requires a multifaceted approach that involves education, optimal skin care practices, anti-inflammatory treatment with topical corticosteroids and/or topical calcineurin inhibitors, the management of pruritus, & the treatment of skin infections. Systemic immunosuppressive agents may also be used, but are generally reserved for severe flare-ups or more difficult-to-control disease. Topical corticosteroids are the first-line pharmacologic treatments for AD, & evidence suggests that these agents may also be beneficial for the prophylaxis of disease flare-ups. Although the prognosis for patients with AD is generally favourable, those patients with severe, widespread disease & concomitant atopic conditions, such as asthma & allergic rhinitis, are likely to experience poorer outcomes. Keywords: Atopic dermatitis, Diagnosis & management, Emollients, Skin care practices, Topical & soften the skin) & topical medications, as well as physician visits. AD also poses a significant economic burden with an estimated annual cost in Canada of $1.4 billion. Current evidence suggests that AD is a primary skin barrier defect that facilitates the development of other atopic conditions., In fact, AD is often the initial step in the “atopic march” (the sequential development of allergic disease manifestations during early childhood), which leads to asthma and/or allergic rhinitis in the majority of afflicted patients.Early AD may also be a causative factor in the development of food allergy. Newer insights into AD suggest that both structural abnormalities of the skin & immune dyregulation play important roles in the pathophysiology of the disease. Therefore, optimal management of AD requires a multifaceted approach aimed at healing & protecting the skin barrier & addressing the complex immune pathogenesis of the disease., This article provides an overview of current literature related to the epidemiology, pathophysiology, diagnosis, & appropriate management of AD

27284 The effect of combined therapy of topical anesthesia and capsaicin ointment in prurigo nodularis management

Introduction: Prurigo nodularis is a pruritic skin disorder that requires multifaceted approach. Capsaicin ointment has been reported to play a role in eliminating the severe itching of prurigo by limiting neural transmission of TRPV1 (transient receptor potential vanilloid 1) over time despite its transit burning sensation.

26884 Ruxolitinib cream rapidly decreases pruritus in atopic dermatitis: Pooled results from two phase 3 studies

Ruxolitinib cream is a Janus kinase (JAK) 1/JAK2 inhibitor in development for atopic dermatitis (AD), a highly pruritic inflammatory skin disease. Two phase 3 randomized controlled trials (TRuE-AD1 [NCT03745638]; TRuE-AD2 [NCT03745651]) enrolled patients aged ≥12 years with AD for ≥2 years, an Investigator’s Global Assessment score of 2 or 3, and 3%–20% affected body surface area. Patients (N = 1249 in both studies combined; median age, 32 years; mean ± SD itch numerical rating scale [NRS] score, 5.1 ± 2.5) were randomized (2:2:1) to 0.75% ruxolitinib, 1.5% ruxolitinib, or vehicle cream (all twice daily) for 8 weeks of double-blinded treatment.

27633 Efficacy and safety of ruxolitinib cream among adolescents with atopic dermatitis: Pooled Results from two phase 3 studies

Atopic dermatitis (AD) is a highly pruritic inflammatory skin disease that most often begins in childhood and can persist into adolescence and adulthood. Ruxolitinib cream is a Janus kinase (JAK) 1/JAK2 inhibitor in development for the treatment of AD. Two phase 3 randomized studies (TRuE-AD1 [NCT03745638]; TRuE-AD2 [NCT03745651]) enrolled patients aged ≥12 years with AD for ≥2 years with an Investigator’s Global Assessment (IGA) score of 2 or 3 and 3%–20% affected body surface area. A total of 1249 patients were randomized (2:2:1) to twice daily 0.75% ruxolitinib, 1.5% ruxolitinib, or vehicle cream for 8 weeks of double-blind treatment.

27620 Effects of ruxolitinib cream in patients with atopic dermatitis with baseline body surface area ≥10% and Eczema Area and Severity Index score ≥16: Pooled results from two phase 3 studies

Atopic dermatitis (AD), a highly pruritic inflammatory skin disease, is often stratified using objective (Investigator’s Global Assessment [IGA], Eczema Area and Severity Index [EASI], body surface area [BSA]) and subjective (eg, itch numerical rating scale [NRS]) assessment tools. Efficacy and safety of ruxolitinib cream, a Janus kinase (JAK) 1/JAK2 inhibitor, was investigated in two phase 3 randomized studies (TRuE-AD1 [NCT03745638]; TRuE-AD2 [NCT03745651]) that enrolled patients aged ≥12 years with AD for ≥2 years, an IGA score of 2 or 3, and 3%–20% affected BSA.

Effects of topical application of a tri-herb formula on inflammatory dry-skin condition in mice with oxazolone-induced atopic dermatitis

BackgroundAtopic dermatitis (AD) is a chronic relapsing inflammatory and pruritic skin disease, affecting 10-20% of the population worldwide. Paeonia suffruticosa Andrews (Paeoniaceae) (Cortex Moutan) and Mentha haplocalyx Briq. (Labiatae) (Herba Menthae) have shown beneficial effects on AD. Calendula officinalis L. (Asteraceae) is commonly used for treating skin rashes and wounds. PurposeIn the present study, a three-herbs formula including Cortex Moutan and Herba Menthae, together with C. officinalis at 1:1:1 weight ratio was used as a topical agent and its therapeutic effects on AD was investigated. MethodsIn vitro effects of individual herbs and three-herbs formula (0.125–1 mg/ml) were examined using cytokine release assay on human mast HMC-1 cells, inflammation test on murine macrophage RAW cells and human keratinocyte (HaCaT) cells, and migration scratch assay on human umbilical vein endothelial cells (HUVEC). The contributing functional pathway of three-herbs formula in AD was explored using Western Blot assay in HMC-1 cells. Oxazolone-induced AD-like mice model was also used to investigate the in vivo therapeutic effect of the topical application of the three-herbs formula. ResultsHerba Menthae, Cortex Moutan, and three-herbs formula significantly reduced the production of IL-6 and tumor necrosis factor (TNF)-α in HMC-1 cells, inhibited the expression of IL-6, IL-8 and CCL2 in TNF-α/IFN-γ stimulated HaCaT cells, and suppressed the lipopolysaccharide (LPS)-induced nitric oxide (NO) production in RAW 264.7 cells. Moreover, Herba Menthae and three-herbs formula significantly suppressed CCL2 and TNF-α production in LPS-induced RAW 264.7 cells. C. officinalis and three-herbs formula promoted wound healing in HUVEC. For intracellular mechanisms, three-herbs formula inhibited the expressions of molecules in STAT1 and STAT3-dependent pathways. In vivo model showed that topical application of three-herbs formula on challenged ear reduced ear swelling and mice scratching frequencies. H&E and toluidine blue staining of the challenged ear tissue demonstrated that three-herbs formula reduced the epidermal thickness and mast cell infiltration, respectively. ConclusionThe three-herbs formula of Cortex Moutan, Herba Menthae and C. officinalis at 1:1:1 (w/w) exhibited anti-inflammatory effect and promotion of cell migration in vitro. It also alleviated ear redness, swelling, epidermal thickness and inflammation of the OXA-induced AD mice. These findings suggest a potential beneficial role of the topical application of the three-herbs formula for treatment of AD.

Association of sleep disturbances with geriatric age in atopic dermatitis patients

Association of sleep disturbances with geriatric age in atopic dermatitis patients

Congenital Deficiency of Conventional Dendritic Cells Promotes the Development of Atopic Dermatitis-Like Inflammation.

Atopic dermatitis (AD) is a common pruritic inflammatory skin disease characterized by impaired epidermal barrier function and dysregulation of Thelper-2 (TH2)-biased immune responses. While the lineage of conventional dendritic cells (cDCs) are implicated to play decisive roles in T-cell immune responses, their requirement for the development of AD remains elusive. Here, we describe the impact of the constitutive loss of cDCs on the progression of AD-like inflammation by using binary transgenic (Tg) mice that constitutively lacked CD11chi cDCs. Unexpectedly, the congenital deficiency of cDCs not only exacerbates the pathogenesis of AD-like inflammation but also elicits immune abnormalities with the increased composition and function of granulocytes and group 2 innate lymphoid cells (ILC2) as well as B cells possibly mediated through the breakdown of the Fms-related tyrosine kinase 3 ligand (Flt3L)-mediated homeostatic feedback loop. Furthermore, the constitutive loss of cDCs accelerates skin colonization of Staphylococcus aureus (S. aureus), that associated with disease flare. Thus, cDCs maintains immune homeostasis to prevent the occurrence of immune abnormalities to maintain the functional skin barrier for mitigating AD flare.

Lack of Significant Association between Sex Hormone Concentrations and Atopic Dermatitis in Adolescents and Adults in Two Population-Based Studies

Atopic dermatitis (AD) is a chronic, pruritic skin disease with increasing incidence (Mathiesen and Thomsen, 2019). Although AD is classically thought of as a pediatric disease, recent studies have shown high rates of disease in adults as well, with a prevalence in Europe between 2.2% and 17.6% (Kowalska-Olędzka et al., 2019). There is a growing body of evidence that sex hormones play a role in the complex interplay of ADs pathophysiology, influencing immunological pathways and the skin (Kanda et al., 2019).

Characterisation of the serum cytokine profile in feline atopic skin syndrome.

Feline atopic skin syndrome (FASS) is a pruritic and inflammatory skin disease commonly encountered in cats. Three previous reports evaluated cytokine immune activation in cats diagnosed with feline allergic dermatitis. However, no significant upregulations were observed in allergic cats compared to healthy controls. To evaluate differences in the serum cytokine profile of cats diagnosed with FASS compared to healthy cats, and correlate serum markers with the extent of FASS skin disease using clinical scoring systems. Thirteen client-owned FASS cats and 12 healthy control cats. Thirteen cytokine and chemokines from the serum of FASS cats and healthy controls were analysed using a commercially available feline-specific multiplex assay. Patients with FASS had a significant increase in serum concentrations of interferon-gamma (IFN-γ), interleukin (IL)-2, IL-13 and IL-18. In addition, cytokine/chemokines involved in inflammation and chemotaxis [IL-8, C-C Motif Chemokine Ligand (CCL)5, CCL2 and CXCL12], as well as growth factors, stem cell factor and Fms-related tyrosine kinase 3 ligand (Flt3L), also were significantly elevated. A significant positive correlation (r=0.64) between the serum levels of Flt3L and Scoring Feline Allergic Dermatitis (SCORFAD) score was observed. These results demonstrate the activation of a broad array of immune secretory cytokines in the serum of cats with FASS, which are largely associated with a mixed Th1 and Th2 inflammatory response along with specific growth factors. Further larger-sample studies are needed to assess the modulation of serum biomarkers in FASS by pharmacological/therapeutic interventions.

Health-related quality of life and economic burden of prurigo nodularis

Prurigo nodularis (PN) is an understudied, pruritic inflammatory skin disease. Little is known about the effect of PN on quality of life and its associated economic burden. To quantify the impact of PN on quality of life and its economic implications. A cohort study of PN patients (n=36) was conducted using the Health Utilities Index Mark 3 questionnaire. Control data from US adults (n=4187) were obtained from the 2002-2003 Joint Canada/United States Survey of Health. Quality-adjusted life year loss and economic costs were estimated by comparing the Health Utilities Index Mark 3 scores of the PN patients with those of the controls. The PN patients had lower overall health performance compared to the controls, (mean±SE, 0.52±0.06 vs 0.86±0.003, respectively, P<.001). In multivariable regression, PN was found to be associated with worse health performance (coefficient -0.34, 95% CI [-0.46 to -0.23]), most prominent in the pain subdomain (coefficient -0.24, 95% CI [-0.35 to -0.13]). This correlated to an average of 6.5 lifetime quality-adjusted life years lost per patient, translating to an individual lifetime economic burden of $323,292 and a societal burden of $38.8 billion. These results demonstrate that PN is associated with significant quality-of-life impairment, similar to the level of other chronic systemic conditions. PN is also associated with a substantial individual economic burden, emphasizing the necessity of research on effective treatment options.

Central, but not peripheral, nervous system ERK2 is essential for itch signals in murine allergic skin inflammation.

Itch is a common cutaneous symptom in a variety of dermatological diseases, but detailed neuropathological mechanisms remain to be fully elucidated. This study aimed to assess in vivo ERK2 functions in the nervous system for itch responses. We generated conditional knockout mice deficient in ERK2 of the central nervous system (CNS) or peripheral nervous system (PNS), respectively, and assessed chemical and mechanical itch responses in vivo. Chemical itch responses to histamine, but not to BAM8-22, were alleviated in CNS Erk2-deficient mice. In contrast, both histamine- and BAM8-22-induced mechanical itch (alloknesis) were alleviated in CNS Erk2-deficient mice. Neither chemical itch nor mechanical itch induced by these pruritogens was affected by PNS ERK2 deficiency. Spontaneous scratching behaviors during acute and chronic contact hypersensitivity were impaired in CNS Erk2-deficient mice, but not PNS Erk2-deficient mice. In addition, CNS ERK2 deficiency attenuated mechanical itch responses during chronic contact hypersensitivity. Again, PNS Erk2-deficient mice showed comparable responses of mechanical itch to control mice. In addition, alleviated mechanical itch in CNS Erk2-deficient mice was observed in IgE-mediated prurigo-like allergic skin inflammation. Mechanical itch induced by IL-31 was also alleviated by CNS ERK2 deficiency. Phosphorylated ERK1/2 was detected in neurokinin B-expressing cells of the spinal dorsal horn of control mice; these cells accumulated during the induction of chronic contact hypersensitivity. Notably, phosphorylated ERK1/2 was also localized in spinal urocortin3-expressing neurons that are known to transmit mechanical itch. Spinal cord ERK2 could be a potential therapeutic target for intractable itch in pruritic skin diseases.

Interleukin-31 as a Clinical Target for Pruritus Treatment

In recent years, the published literature has suggested the key involvement of the cytokine interleukin-31 (IL-31) in the symptomatology of pruritus, and both IL-31 and its receptor have become potential therapeutic targets for a range of pruritic diseases. Elevated levels of IL-31 or its receptor have been reported in the tissue or serum of patients with pruritic skin diseases, such as atopic dermatitis, prurigo nodularis, and psoriasis. Pruritus places a heavy burden on patients, and can have a negative impact on daily life, sleep, and mental health. Since current anti-pruritic treatments are often ineffective, affected patients are in urgent need of new therapies. As a result, drug development targeting the IL-31 pathway is evolving rapidly. To date, only nemolizumab, a humanized monoclonal antibody targeting the IL-31 receptor, has successfully completed late-stage clinical studies. This article will highlight our current clinical understanding of the role of IL-31 in pruritic disease, and explore recent progress in drug development as well as the anticipated future advances in this field.

Evaluation of sensitization to the crude extract of Dermatophagoides farinae and its derived allergens, Der f 2 and Zen 1, in dogs with atopic dermatitis in Southern Brazil

BackgroundAtopic dermatitis is associated with the production of IgE antibodies against environmental allergens and allergens of the house dust miteDermatophagoides farinae are frequently implicated in the disease. ObjectivesWe aimed to observe the allergen-specific IgE against crudeD. farinae, Der f 2 and Zen 1 in dogs with atopic dermatitis and report if these dogs are in contact with material that could shelter mite allergens. Methods100 dogs with clinical diagnosis of atopic dermatitis were included after exclusion of other forms of pruritic skin disease and dogs that already received specific or non-specific immunotherapy. These dogs were of different breeds and ages and they were presented at a veterinary teaching hospital and a private service of veterinary dermatology, both located in Curitiba, Southern Brazil. At the time of anamnesis, some questions were applied to know the possibility of these dogs having had contact with furniture and textile material which could shelter house dust mites. Sera samples were obtained and further analyzed by ELISA assay to measure serum IgE levels against these allergens with an established cut-off of 0.200 IgE optical density. ResultsThe allergen-specific IgE positivity against crudeD. farinae (92 %) and Zen 1 (77 %) was higher than Der f 2 (56 %). There was a correlation in sensitization to crude D. farinae and Zen 1 that was not observed between crude D. farinae and Der f 2 and Der f 2 and Zen 1. The sensitization to D. farinae and its allergens was associated with an unrestricted exposition to furniture and textile material. Conclusion & clinical relevancedogs with atopic dermatitis are frequently sensitized to D. farinae and its allergens, Der f 2 and Zen 1, may be considered major allergens in these dogs. Zen 1 may be the main allergen responsible for the sensitization to crude D. farinae.

Detection of Serum Allergen-Specific IgE in Atopic Dogs Tested in Northern Italy: Preliminary Study.

Simple SummaryCanine atopic dermatitis (CAD) is a genetically predisposed allergic skin disease associated to IgE-mediated hypersensitivity. Serum Allergen-Specific IgE test (SAT) is used to detect allergen-specific IgE antibodies and to set-up a specific immunotherapy. The present study aims to identify the most relevant environmental allergens in a population of atopic dogs living in Northern Italy by using SAT, due to the absence of data in this area. Out of 117 selected client-owned dogs, 69 were included in the study. A screening test was used to identify indoor and outdoor allergens positivity and a specific serum allergy test was performed to detect an extended panel of allergens. Among the 49 positives to the screening test, 53% were positive for both indoor and outdoor, 38.8% only for indoor, and 8.2% only for outdoor allergens. Mites and pollen of Rumex acetosa, and grasses were the most represented allergens. This is the first study to collect data on the frequency of specific allergens involved in CAD in Italy by using SAT. In accordance with the result of this study, specific panels for geographical areas should be considered and re-evaluated at time intervals since numerous factors affect the prevalence of IgE positivity in atopic dogs.Canine atopic dermatitis (CAD) is a pruritic allergic skin disease associated with IgE-mediated hypersensitivity. IgE is detected using Serum Allergen-Specific IgE test (SAT) in order to identify allergens. The present study aims to identify the environmental allergens in atopic dogs living in Northern Italy using SAT. The screening SAT (sSAT), using a monoclonal antibody cocktail-based ELISA to identify indoor and outdoor allergens, was performed. In all positive samples, an anti-IgE monoclonal antibody ELISA test was performed to extend panel of allergens. Out of 117 selected dogs, 69 were included in the study; 71% were positive and 29% were negative to sSAT. Among the 49 positive sSAT, 53% were positive for both indoor and outdoor, 38.8% only for indoor, and 8.2% only for outdoor allergens. This is the first study on the frequency of allergens involved in CAD in Italy using SAT. IgE hypersensitivity in atopic dogs of Northern Italy is usually associated with indoor allergens, primarily house dust mites. Among the outdoor allergens, an important role was played by Rumex acetosa. Polysensitization also commonly occurs. Therefore, since the numerous factors affect the IgE positivity in CAD, specific panels for geographical areas should be considered and re-evaluated at time intervals.