SCORing Feline Allergic Dermatitis Research Articles

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.

Efficacy of oclacitinib for the control of feline atopic skin syndrome: correlating plasma concentrations with clinical response.

The aim of this study was to assess the efficacy of a new therapeutic regimen of oclacitinib for the control of feline atopic skin syndrome (FASS) and to correlate plasma levels of this drug with clinical effects. Twenty-eight client-owned cats with a clinical diagnosis of FASS were recruited. Oclacitinib was administered at 1 mg/kg q12h for 2 weeks and then at 1 mg/kg q24h for a further 2 weeks. At the study outset (D0), and 7 (D7) and 28 (D28) days after starting treatment, clinical lesions were assessed using a validated scoring system (SCORing Feline Allergic Dermatitis [SCORFAD]) and pruritus was graded via an adapted visual analogue scale (PVAS). At the same time points, plasma oclacitinib levels and haematological variables were measured. Among 18 cats completing the study, PVAS and SCORFAD improved by ⩾50% in 61% and 88% of animals, respectively. Mean PVAS decreased significantly between D0 and D7 and between D0 and D28 (both P <0.001) but not between D7 and D28. Likewise, mean SCORFAD values decreased significantly between D0 and D7 and between D0 and D28 (both P <0.001) but not between D7 and D28. On D7 and D28, plasma oclacitinib concentrations varied widely from 0 to 1443.2 ng/ml and from from 0 to 1177.7 ng/ml, respectively. Oclacitinib concentrations showed no correlation with clinical effects (SCORFAD and PVAS). Oclacitinib emerged as being safe and effective to control clinical signs of FASS. A mean dose of 1 mg/kg, even without extending twice-daily treatment beyond the first 2 weeks, could be a suitable therapeutic regimen. Plasma drug levels did not seem useful to predict clinical response during treatment.

Interobserver reliability of Feline Dermatitis Extent and Severity Index (FEDESI) and Scoring Feline Allergic Dermatitis (SCORFAD) and the relationship between lesion scores and pruritus.

Feline Dermatitis Extent and Severity Index (FEDESI) and Scoring Feline Allergic Dermatitis (SCORFAD) are scales used to assess lesion severity in cats with allergic dermatitis. Interobserver reliability has not been assessed for either. To determine interobserver reliability for FEDESI and SCORFAD, and the relationship between lesion scores and pruritus. Thirty-eight cats presenting for pruritus. Each cat's lesions were scored by two observers at each visit using both FEDESI and SCORFAD (n=117 paired observations). Spearman's rho was calculated to assess correlation between scales and between each scale and the owner-reported pruritus Visual Analog Scale (pVAS). Concordance correlation coefficients were calculated between observers for each scale, and Bland-Altman plots were used to visually represent the relationship between paired scores. FEDESI and SCORFAD were strongly positively correlated with one another (rho=0.84, P<0.001). Each scale showed fair correlation with pVAS (rho=0.42, P<0.001; rho=0.38, P<0.001, respectively). There was good concordance between observers for both scales, with a correlation coefficient of 0.77 for FEDESI and 0.80 for SCORFAD [intraclass correlation coefficient (ICC) 95%, confidence interval (CI) 0.69-0.83; ICC 95%, CI 0.72-0.86, respectively]. Median lesion score was low (FEDESI 20; SCORFAD 4), which may improve interobserver reliability. There is good interobserver reliability for both FEDESI and SCORFAD. FEDESI and SCORFAD are positively correlated with one another and with pVAS. These findings support use of both scales in clinical research and assessment.

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.

Effect of dietary supplementation with ultramicronized palmitoylethanolamide in maintaining remission in cats with nonflea hypersensitivity dermatitis: a double-blind, multicentre, randomized, placebo-controlled study.

BackgroundFeline nonflea hypersensitivity dermatitis (NFHD) is a frequent cause of over‐grooming, scratching and skin lesions. Multimodal therapy often is necessary.Hypothesis/ObjectivesTo investigate the efficacy of ultramicronized palmitoylethanolamide (PEA‐um) in maintaining methylprednisolone‐induced remission in NFHD cats.AnimalsFifty‐seven NFHD cats with nonseasonal pruritus were enrolled originally, of which 25 completed all study requirements to be eligible for analysis.Methods and materialsCats were randomly assigned to PEA‐um (15 mg/kg per os, once daily; n = 29) or placebo (n = 28) while receiving a 28 day tapering methylprednisolone course. Cats responding favourably to methylprednisolone were then administered only PEA‐um (n = 21) or placebo (n = 23) for another eight weeks, followed by a four week long treatment‐free period. Cats were maintained in the study until relapse or study end, whichever came first. Primary outcome was time to relapse. Secondary outcomes were pruritus Visual Analog Scale (pVAS), SCORing Feline Allergic Dermatitis scale (SCORFAD) and owner Global Assessment Score (GAS).ResultsMean relapse time was 40.5 days (±7.8 SE) in PEA‐um treated cats (n = 13) and 22.2 days (±3.7 SE) for placebo (n = 12; P = 0.04). On Day 28, the severity of pruritus was lower in the PEA‐um treated cats compared to placebo (P = 0.03). Mean worsening of pruritus at the final study day was lower in the PEA‐um group compared to placebo (P = 0.04), whereas SCORFAD was not different between groups. Mean owner GAS at the final study day was better in the PEA‐um than the placebo‐treated group (P = 0.05).Conclusion and clinical importanceUltramicronized palmitoylethanolamide could represent an effective and safe option to delay relapse in NFHD cats.

Use of maropitant for the control of pruritus in non-flea, non-food-induced feline hypersensitivity dermatitis: an open-label, uncontrolled pilot study.

Non-flea, non-food-induced hypersensitivity dermatitis (NFNFIHD) is a common inflammatory and pruritic skin disease in cats. When avoidance and conventional systemic immunosuppressive treatments fail to control the clinical signs, there are limited treatment options. The aim of this study was to evaluate the efficacy and tolerability of maropitant in feline NFNFIHD. In an open-label, uncontrolled study, cats with proven non-seasonal NFNFIHD were treated with maropitant 2 mg/kg PO q24h for 4 weeks. Clinical lesions were evaluated with the Scoring Feline Allergic Dermatitis (SCORFAD) system and pruritus was evaluated with a 10 cm visual analogue scale (VAS) before and at the end of the study. Owners assessed global efficacy and tolerability with a 4-point scale at the end of the study. Adverse events and body weight changes were recorded. Twelve cats were treated with a mean initial maropitant dose of 2.22 mg/kg PO q24h. The treatment decreased both SCORFAD and pruritus VAS (pVAS) scores in all cats except one, in which only pruritus was reduced. The efficacy and the tolerability of the treatment were judged as excellent or good by 83.3% of owners. Treatment did not cause any side effects other than, in a few cases, short-time, self-limiting sialorrhoea. Maropitant seems to be an effective, well-tolerated therapeutic option to control pruritus in cats. Caution is needed in interpreting the results as the pVAS score system has not yet been validated in cats and the trial was uncontrolled. A further, controlled study is required to confirm our findings.

Evaluation of the correlation between Scoring Feline Allergic Dermatitis and Feline Extent and Severity Index and skin hydration in atopic cats.

Evaluation of the severity of clinical signs of cats with allergic skin diseases has used two scoring systems: Scoring Feline Allergic Dermatitis (SCORFAD) and the Feline Extent and Severity Index (FeDESI). The integrity of the cutaneous barrier can also be evaluated by measuring skin hydration. A correlation between the clinical score and skin hydration has been observed in humans and dogs with atopic dermatitis (AD). To demonstrate a correlation between the clinical score and skin hydration of cats affected with presumed AD. European short hair cats (n = 18): 11 females and seven males with a confirmed diagnosis of AD. SCORFAD and FeDESI scores were calculated and the measurements of skin hydration were assessed from seven body sites using corneometry. The correlation between the SCORFAD and FeDESI systems and skin hydration of each site, and the average skin hydration was calculated. There was a positive correlation between the SCORFAD score and skin hydration for the axilla, thorax and forelimb; for FeDESI and axilla and lumbar sites. There was a negative correlation between the FeDESI and skin hydration for the pinna (r = -0.47). Measurements of skin hydration could be a useful tool for the evaluation of allergic cats. There is limited evidence of any useful correlation between clinical scoring systems and measurements of hydration. The pinna may be a suitable region for the assessment of skin barrier function in normal and allergic cats.

Treatment of Neotrombicula species infestation in cats using a 10% (w/v) fipronil topical spot-on formulation: a pilot study.

ObjectivesFew data are available concerning therapeutic aspects of feline trombiculiasis. This study evaluated the efficacy of a 10% w/v fipronil-based spot-on solution in 15 cats with natural Neotrombicula species infestation.MethodsTen cats received 1 drop per affected site on day (D)0 and D14, with the rest of the 0.5 ml pipette applied on the skin between the shoulders. Five cats served as non-treated controls. Parasite score (0 = absent; 3 = severe, >10 parasites/zone) was assessed on D0, D14 and D28 on all animals. Skin lesions (SCORing Feline Allergic Dermatitis lesion severity scale [SCORFAD]) and investigator pruritus scale (IPS; 0 = cat comfortable, grooming like any normal cat; 4 = cat uncomfortable, pruritic all the time) were assessed on treated cats on the same days. Global assessment of efficacy, tolerance and ease of use (GAS; 1 = very poor; 5 = excellent) was assessed on D28.ResultsAll the cats completed the study. Parasite scores of the control cats were maintained throughout the trial (mean ± SD: D0 4 ± 0.7, D14 3.2 ± 1.1 and D28 3.2 ± 0.4). In treated cats, SCORFAD (D0 3.2 ± 5.4, D14 1.1 ± 2.1 [P <0.002] and D28 0.5 ± 1.3 [P <0.002]), parasite (D0 3.9 ± 1.3, D14 1.2 ± 0.8 [P <0.005] and D28 0.4 ± 0.5 [P <0.005]) and IPS (D0 1 ± 1.2, D14 0.5 ± 1.1 [P <0.05] and D28 0.3 ± 0.7 [P <0.05]) scores significantly decreased throughout the trial. On D28, the GAS was 4.2 ± 0.9. There were no adverse effects from treatment.Conclusions and relevanceThe 10% w/v fipronil preparation appeared to be effective, safe and practical in the treatment of localised Neotrombicula species infestation in these cats.

Development and validation of a questionnaire to evaluate the Quality of Life of cats with skin disease and their owners, and its use in 185 cats with skin disease

Skin disease can negatively affect the Quality of Life (QoL) of cats and of their owners. To develop and evaluate a questionnaire on QoL of cats with skin disease and their owners. Following interviews with owners of cats with severe skin disease and elaboration of a preliminary 19 item questionnaire, a final 15 item (score 0-3) questionnaire was developed. This was administered to owners of 45 cats with allergic dermatitis and 39 healthy cats, to assess its ability to differentiate between diseased and healthy subjects. In allergic cats, owners evaluated overall disease severity (S) and pruritus with a Visual Analog Scale (VAS); veterinarians evaluated skin lesions [SCORing Feline Allergic Dermatitis (SCORFAD) and Feline Dermatitis Extent and Severity Index (FeDESI)]. The correlation with QoL was analysed by Spearman's rank test. In 31 allergic cats, SCORFAD, FeDESI, pruritus VAS, S and QoL scores were obtained before and after therapy, and their improvement evaluated statistically. QoL scores in allergic cats were significantly higher than in healthy cats (P=<0.0001). Severity correlated well and significantly with both cat's and owner's QoL (r = 0.51 and 0.64, P = 0.0003 and <0.0001, respectively). Correlation of QoL with pruritus VAS was moderate and significant (r = 0.3, P = 0.03), whereas with SCORFAD and FeDESI it was low and not significant. With therapy all scores decreased significantly (P < 0.0001); however, QoL was not influenced by improvement of clinical scores. Questions related to the burden of therapy showed the smallest improvements. This QoL questionnaire could be a useful tool in evaluating cats with skin disease.

Comparison of FEDESI and SCORFAD scoring systems for the evaluation of skin lesions in allergic cats.

Feline Dermatitis Extent and Severity Index (FeDESI) and Scoring Feline Allergic Dermatitis (SCORFAD) are two different scoring systems for the evaluation of feline allergic dermatitis. To evaluate the correlation between FeDESI and SCORFAD and pruritus. The dermatological lesions of 32 cats affected by feline allergic dermatitis were evaluated with both FeDESI and SCORFAD before treatment and once monthly during treatment where ciclosporin was administered at 7 mg/kg orally once daily for 1 month then tapered, when possible, in the subsequent 2 months. Pruritus was scored by pet owners with a Visual Analog Scale (VAS). Correlation between scores at Visit 1, and between absolute and percentage score improvements at visits 1, 2 and 3, were analysed statistically using a nonparametric Spearman's rank correlation test. Correlation between FeDESI, SCORFAD and VAS pruritus scores at baseline was low and nonsignificant for all combinations. The correlation of absolute score improvement was moderate and significant only between FeDESI and VAS pruritus at Visit 3. Correlation of improvement percentage was moderate and significant between FeDESI and SCORFAD and between FeDESI and VAS pruritus at Visit 2, whereas at visits 3 and 4 it was high and significant for each combination. Only improvement percentage of FeDESI and SCORFAD scores seem to correlate well. SCORFAD is the only scoring system to have been validated, although it seems to correlate less with pruritus and may be more difficult to use than FeDESI. The latter could thus be more appropriate for use, but further studies are needed especially in regard to its validation.

Oclacitinib in feline nonflea-, nonfood-induced hypersensitivity dermatitis: results of a small prospective pilot study of client-owned cats.

Oclacitinib is a Janus kinase inhibitor that decreases pruritus and lesions in allergic dogs. In cats, it is able to inhibit interleukin-31-induced pruritus; no information is available on its clinical effectiveness. To evaluate the efficacy, ease of administration and tolerability of oclacitinib in feline nonflea-, nonfood-induced hypersensitivity dermatitis. Cats >12 months of age and >3 kg body weight with a diagnosis of nonflea-, nonfood-induced hypersensitivity dermatitis were treated with oclacitinib, 0.4-0.6 mg/kg orally (p.o.) twice daily for 2 weeks, then once daily for an additional 14 days. Clinical lesions were evaluated with the Scoring Feline Allergic Dermatitis (SCORFAD) system and pruritus was evaluated with a 10-cm-long visual analog scale (VAS) before and at the end of the study. Owners assessed global efficacy, ease of administration and tolerability with a four-point scale. Twelve cats were treated with a mean initial oclacitinib dose of 0.47 mg/kg p.o. twice daily. There was good improvement in SCORFAD and VAS pruritus scores in five of 12 cases, while the other cats were unchanged, deteriorated or dropped out due to treatment failure. Owners scored global efficacy as good/excellent in four of 12 cases and ease of administration and tolerability as good/excellent in 10 of 12. Oclacitinib at 0.4-0.6 mg/kg p.o. may be an effective and safe drug for some cats with nonflea-, nonfood-induced hypersensitivity dermatitis. Further studies are needed to identify the most effective dose range for this species.

Efficacy of spinosad tablets administered to a colony of 15 indoor cats naturally infested with fleas.

The aims of the study were (i) to describe adult fleas distribution in a strictly indoor cat colony composed of cats with flea allergy dermatitis (FAD) and non-FAD cats and (ii) to evaluate the efficacy of spinosad used alone. Skin lesions were scored according to the SCORing Feline Allergic Dermatitis lesion severity scale (SCORFAD) on days 0, 15, 30, 45, 60, and 90. Cats were combed prior to the treatment (days 0, 30, and 60) and on days 15, 45, and 90; collected fleas were replaced on the animals. All cats received flavored spinosad tablets (Comfortis) at a dosage of 50–75 mg/kg on days 0, 30, and 60. Cats were fed immediately afterwards. On day 0, a total of 60 fleas were collected (mean: 4 ± 4). Cats with FAD had a SCORFAD of 6, 8, 12, and 13 and harbored 0, 2, 1, and 0 fleas, respectively. Tablets were taken voluntarily by 8, 11, and 12 cats on days 0, 30, and 60, respectively. No adverse event was recorded. From day 15 to day 90, no fleas could be collected. SCORFAD was reduced by 40%, 71%, 80%, 89%, and 98% on days 15, 30, 45, 60, and 90, respectively.

Responsiveness and validity of the SCORFAD, an extent and severity scale for feline hypersensitivity dermatitis

Hypersensitivity (allergic) dermatitis (HD) is commonly seen in cats, causing pruritus and various patterns of skin lesions, including at least one of the following: head and neck excoriations, self-induced alopecia, eosinophilic plaques and miliary dermatitis. Few studies have evaluated the efficacy of therapeutic interventions for feline HD, and although various scales have been considered, none has been formally validated for the assessment of disease severity and its response to therapy. To design and validate a novel scale (SCORing Feline Allergic Dermatitis; SCORFAD) to assess the value of different criteria used as outcome measures for the treatment of feline HD and to set minimal thresholds for defining the clinical success of tested interventions. One hundred client-owned cats. The SCORFAD scale was designed to include the four most frequently identified lesion types in feline HD (eosinophilic plaque, head and neck excoriations, self-induced alopecia and miliary dermatitis) across 10 body regions. The extent and severity of each lesion type were graded prior to inclusion and after 3 and 6 weeks in a clinical study to compare the efficacy of two doses of ciclosporin with placebo. The SCORFAD scale was found to exhibit satisfactory content, construct, criterion and sensitivity to change. The percentage reduction in SCORFAD from baseline was determined to be the most valid assessment of clinical response. Inter- and intra-observer reliability was not assessed. The SCORFAD scale is proposed for use as a validated tool for the assessment of disease severity and response to therapeutic interventions in clinical trials for feline HD.