A randomized, double-blinded crossover trial testing the benefit of two hydrolysed poultry-based commercial diets for dogs with spontaneous pruritic chicken allergy

Establishment of clinical criteria for the diagnosis of adverse food reactions in dogs with atopic dermatitis

BACKGROUND

Diagnosis of canine adverse food reactions (AFRs) is based on vague criteria, such as '>50% improvement' during elimination diet trial (EDT) followed by 'deterioration' during provocation test (PT).

OBJECTIVE

The objective of the study was to use predefined criteria to evaluate response during EDT [i.e., Owner Global Assessment of Treatment Efficacy (OGATE) = good-to-excellent] and relapse during PT [i.e., Owner Global Assessment of Challenge Deterioration (OGACD) = moderate-to-severe and/or >100% increase of lesional (Canine Atopic Dermatitis Extent and Severity Index, 4th iteration, CADESI-04) and/or of pruritus (pruritus Visual Analog Scale, PVAS) scores].

ANIMALS

Twenty-nine dogs with atopic dermatitis.

MATERIALS AND METHODS

An extensively hydrolysed diet was fed to all dogs followed, in seven of 11 nonresponders, by a second home-made novel-protein EDT. Dogs responding to either EDT were challenged with their previous diet.

RESULTS

Thirteen (44.8%) dogs were diagnosed with AFRs: at the end of EDT, their OGATE was good (9 of 13; 69.2%) or excellent (four of 13; 30.8%), and both CADESI-04 (46.7%) and PVAS (71.1%) had decreased significantly; at the end of PT, OGACD was moderate or severe in 12 of 13 (92.3%) dogs, and both CADESI-04 (127.9%) and PVAS (181.8%) had increased significantly. Of the 16 dogs without AFRs, 6 (37.5%) responded to the commercial (n = 5) or home-made (n = 1) diet [OGATE = good (three of six) or excellent (three of six)], with significant concurrent reduction of CADESI-04 and nonsignificant reduction of PVAS, yet they did not relapse during PT.

CONCLUSIONS AND CLINICAL RELEVANCE

The proposed (predefined) criteria for the evaluation of response during EDT and deterioration during PT seem reliable and are easily applicable in clinical practice and research.

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

BACKGROUND

The diagnosis of cutaneous adverse food reactions (CAFR) in dogs is dependent on a diet trial and provocative challenge.

HYPOTHESIS/OBJECTIVES

To evaluate the efficacy of an elemental diet for the diagnosis of CAFR in dogs.

ANIMALS

Sixty-two client-owned nonseasonally pruritic dogs.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSION AND CLINICAL RELEVANCE

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.

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

Background

Canine 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.

Hypothesis

The 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 methods

Forty 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.

Results

Both 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.

Conclusion

The results suggest that a novel therapeutic diet can assist in the management of cAD by helping to control pruritus and reducing reliance on medication.

The usefulness of a hydrolysed fish and rice starch elimination diet for the diagnosis of adverse food reactions in cats: an open clinical trial

BACKGROUND

Diagnosis of adverse food reaction (AFR) is based on an eight week elimination diet (ED) and is confirmed by relapse upon re-challenge with the previously fed diet. Hydrolysed EDs are commonly used for this purpose.

OBJECTIVE

To evaluate the commercially available hydrolysed fish protein and rice starch ED Farmina UltraHypo (FUH) for the diagnosis of feline AFR.

ANIMALS

Thirty-two nonseasonally pruritic cats.

METHODS AND MATERIALS

Pruritus was assessed with a new dual Visual Analog Scale, lesions with the Scoring Feline Allergic Dermatitis scale and Quality of Life with a validated questionnaire on days 0 and 56. Short-acting corticosteroids or oclacitinib were permitted during the first six weeks. Cats showing 50% pruritus and/or lesional improvement were separately challenged with their prior diet, fish and rice. Cats not responding to the study diet were fed another hydrolysed diet for two months.

RESULTS

Twenty-five cats completed the ED: four dropped out due to vomiting and/or diarrhoea, one owing to low palatability and two were lost to follow-up. In 17 cats, pruritus improved by >50% and these underwent dietary challenges. Of these, nine reacted to their prior diet and/or fish and/or rice and were diagnosed with AFR, while eight did not relapse (and a diagnosis of AFR was considered to be doubtful). Of the eight cats in which pruritus did not improve, four underwent a second ED with no improvement.

CONCLUSION AND CLINICAL IMPORTANCE

FUH may be a useful ED for the diagnosis of feline AFR, even in cats reacting to fish or rice.

Sensitivity and specificity of a shortened elimination diet protocol for the diagnosis of food-induced atopic dermatitis (FIAD)

BACKGROUND

The gold standard to diagnose food allergy in dogs is an eight week elimination diet trial (EDT) followed by a re-challenge. A recent study demonstrated that a shorter EDT is possible if prednisolone is administered initially.

HYPOTHESIS/OBJECTIVES

The goal was to evaluate the sensitivity and specificity of the EDT based on the number of relapses after prednisolone discontinuation. In addition, the aim was to determine whether the initial treatment length or the replacement of prednisolone with oclacitinib would influence the outcome.

ANIMALS

Eighty-seven dogs with atopic dermatitis.

METHODS AND MATERIALS

Dogs were fed an elimination diet and treated with either prednisolone or oclacitinib for two to three weeks. Relapsing dogs were treated a second time. In the absence of a relapse after two weeks off medication, dogs then were challenged. Dogs never achieving two weeks off treatment without relapse received the regular EDT.

RESULTS

Fifty-eight of 87 dogs completed the study. Thirty-nine of 58 dogs received prednisolone; 21 of these were diagnosed with FIAD and had no relapse (n = 14), one relapse (n = 6) or two relapses (n = 1). Nineteen of 58 dogs received oclacitinib; 11 of these were deemed food-allergic and had no relapse (n = 7) or two relapses (n = 4). The initial treatment duration did not influence the outcome. The threshold of one relapse or less for the diagnosis of FIAD was associated with a sensitivity of 95% for prednisolone and 63% for oclacitinib. The specificity was 100% for both drugs.

CONCLUSION AND CLINICAL IMPORTANCE

Initial prednisolone or oclacitinib use in EDT shortens the time to diagnosis of FIAD.

Hydrolyzed diets may stimulate food-reactive lymphocytes in dogs

Hydrolyzed proteins are often prescribed for dogs with food hypersensitivity in food elimination programs. However, the potential of these diets to stimulate lymphocyte-mediated hypersensitivity is currently unknown. In this study, two commercially available hydrolyzed diets for dogs, D-1 (Aminopeptide Formula Dry, Royal Canin Japon, Tokyo, Japan), and D-2 (Canine z/d Ultra Dry, Hill's-Colgate (Japan) Ltd., Tokyo, Japan), were analyzed to identify residual proteins or peptides, as well as activated helper T-lymphocyte reactions in dogs with suspected food hypersensitivity. Proteins and peptides with molecular weights >1 kDa (majority 1.5-3.5 kDa) were detected in both diet extracts with sodium dodecyl sulfate polyacrylamide gel electrophoresis, and size exclusion chromatography. When peripheral blood mononuclear cells (PBMC's) from 316 dogs with suspected food allergies were cultured with hydrolyzed diet extracts, flow cytometry analysis revealed detectable levels of CD25^low helper T-lymphocytes stimulated by D-1 and D-2 in 91 of 316, (28.8%), and 75 of 316 (23.7%) samples, respectively. These data indicated that the extracts contained proteins or peptides large enough to activate the lymphocytes. The percentages of CD25^low helper T-lymphocytes stimulated by D-1 and D-2 extracts increased to 38.7% and 29.6%, respectively, in 186 of the original 316 samples (186/316, 58.9%), also reactive to poultry-related antigens. Thus, both poultry-related antigens, and D-1 and D-2 diet extracts may activate helper T-lymphocytes. These results demonstrate that hydrolyzed diets may contain proteins that stimulate helper T-lymphocytes, and may not be effective for treating all dogs with food hypersensitivity.

The usefulness of short-course prednisolone during the initial phase of an elimination diet trial in dogs with food-induced atopic dermatitis

BACKGROUND

Food allergy is a possible cause of atopic dermatitis (AD) in dogs; it is typically diagnosed following an eight-week elimination diet trial (EDT) and a provocation with the original diet. This lengthy procedure is difficult for owners and its interpretation may be unclear.

HYPOTHESIS/OBJECTIVES

To test the effect of prednisolone used in the first weeks of an EDT in order to reduce the total time period for diagnosis. The goal was to perform food challenges earlier than after the traditionally recommended eight weeks.

ANIMALS

Fifty-three dogs with AD were included in the study.

METHODS AND MATERIALS

All dogs were fed a commercially available extensively hydrolyzed protein-based commercial pet food and treated with prednisolone for at least two weeks to control pruritus and inflammation. Dogs were challenged two weeks after prednisolone finished, provided that no flare had occurred. Dogs with relapsing signs were fed the hydrolyzate for at least eight weeks with or without further prednisolone treatment.

RESULTS

Ten of 53 dogs (19%) had no relapse after two weeks off prednisolone: they were subsequently challenged with their regular food, had a relapse of signs and were diagnosed with a food-induced AD within four to six weeks of starting the EDT. In the other dogs, signs remained uncontrolled without prednisolone or relapsed rapidly after its discontinuation: they were considered nonfood-allergic after an eight week EDT.

CONCLUSION AND CLINICAL IMPORTANCE

This study demonstrates that a shorter EDT is possible if the allergic pruritus and inflammation are initially controlled with a short course of glucocorticoids. This shortened trial is likely to improve owner adherence and facilitate the diagnosis of food allergy.

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

BACKGROUND

Outside of pruritus, there is no clear consensus on the nature and prevalence of cutaneous manifestations of adverse food reactions (AFRs) in dogs and cats.

RESULTS

We 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.

CONCLUSIONS

CAFRs 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.

An open label clinical trial to evaluate the utility of a hydrolysed fish and rice starch elimination diet for the diagnosis of adverse food reactions in dogs

BACKGROUND

The diagnosis of adverse food reaction (AFR) is based on an eight week elimination diet (ED) and is confirmed by relapse upon re-challenge with the previously fed diet. Hydrolysed EDs are commonly used for this purpose.

OBJECTIVE

To evaluate a commercially available hydrolysed fish protein and rice starch ED for the diagnosis of AFR.

ANIMALS

Fifty nonseasonally pruritic dogs.

METHODS AND MATERIALS

Pruritus was assessed with a Visual Analog Scale, lesions with the Canine Atopic Dermatitis Lesions Index and quality of life with a validated questionnaire on days 0 and 56. Antimicrobial treatments were permitted during the first four weeks, and corticosteroids and oclacitinib during the first six weeks. Dogs showing at least 50% pruritus improvement were separately challenged with their prior diet, fish and rice.

RESULTS

Thirty eight dogs completed the ED, four were dropped out due to worsening clinical signs, three to low palatability and five were lost to follow-up. In 24 dogs, pruritus improved by >50% and 22 underwent dietary challenges. Of these, 15 reacted to their prior diets and were diagnosed with AFR, whereas seven did not relapse (and a diagnosis of AFR was considered to be doubtful). Five dogs reacted to fish and four to rice. Of the 14 dogs in which pruritus did not improve, some underwent a second ED and others were successfully treated for atopic dermatitis.

CONCLUSION AND CLINICAL IMPORTANCE

The hydrolysed fish and rice diet seemed to be a useful ED for the diagnosis of AFR, even in dogs allergic to fish or rice.

DNA and Protein Analyses to Confirm the Absence of Cross-Contamination and Support the Clinical Reliability of Extensively Hydrolysed Diets for Adverse Food Reaction-Pets

Adverse food reactions (AFR) are a common cause of skin diseases in cats and dogs. The correct diagnosis and management of AFR relies upon clinical nutrition. The reliability of commercial hypoallergenic diets commonly used in AFR has been questioned because studies have shown the presence of proteins not declared on the label ingredients. It is proposed that extensively hydrolysed protein-based diets constitute a reliable nutritional solution. Royal Canin Anallergenic™ Canine and Feline diets are formulated with very low molecular weight feather protein and purified corn starch. Protein gel electrophoresis and thin layer paper chromatography were used to characterize protein hydrolysis in these diets and their hydrolysed raw materials; protein species were identified by mass spectrometry. To detect cross-contaminating protein, species-specific DNA was measured and correlated with ancillary protein content using calibration curves. The only protein components detected in the extensively hydrolysed feather protein raw material were amino acids and small oligopeptides. GBSS-I (Granule-bound starch synthase 1) was detected in the finished diets; this has not been reported as a clinically apparent allergen in dogs or cats. The DNA threshold corresponding to the maximum acceptable level of ancillary protein was not exceeded in 99.9% of more than 2150 product batches tested and no products were released to the market with cross-contaminating proteins. These results demonstrate the extensive level of protein hydrolysis in Royal Canin Anallergenic™ Canine and Feline diets and the absence of cross-contaminating protein, both key requirements for a diet to be used during diagnosis and for management of pets with AFR.

Comparing immediate-type food allergy in humans and companion animals-revealing unmet needs

Adverse food reactions occur in human as well as veterinary patients. Systematic comparison may lead to improved recommendations for prevention and treatment in both. In this position paper, we summarize the current knowledge on immediate-type food allergy vs other food adverse reactions in companion animals, and compare this to the human situation. While the prevalence of food allergy in humans has been well studied for some allergens, this remains to be investigated for animal patients, where owner-reported as well as veterinarian-diagnosed food adverse reactions are on the increase. The characteristics of the disease in humans vs dogs, cats, and horses are most often caused by similar, but sometimes species-dependent different pathophysiological mechanisms, prompting the specific clinical symptoms, diagnoses, and treatments. Furthermore, little is known about the allergen molecules causative for type I food allergy in animals, which, like in human patients, could represent predictive biomarkers for risk evaluation. The definite diagnosis of food allergy relies-as in humans-on elimination diet and provocation tests. Besides allergen avoidance in daily practice, novel treatment options and tolerization strategies are underway. Taken together, numerous knowledge gaps were identified in veterinary food allergy, which need to be filled by systematic comparative studies.

Extensive protein hydrolyzation is indispensable to prevent IgE-mediated poultry allergen recognition in dogs and cats

Background

The central premise for the commercialization of diets with hydrolyzed ingredients is that the small-sized digested peptides would be unable to crosslink allergen-specific IgE at the surface of tissue mast cells and induce their degranulation. Evidence for the validity of this concept to diagnose food allergies in dogs and cats is limited, however. Our objectives were to study the recognition of standard and variably hydrolyzed poultry extracts by sera from dogs and cats with elevated chicken-specific serum IgE.

Results

Forty sera from dogs and 40 from cats with undetectable, low, medium or high serum levels of chicken-specific IgE were tested by ELISA on plates coated with the positive controls chicken, duck and turkey meat extracts and the negative controls beef meat (dogs) or wheat (cats). Plates were also coated with a non-hydrolyzed chicken meal, and mildly- or extensively-hydrolyzed poultry feather extracts. The frequencies of dogs with positive IgE against the various extracts were: chicken meat: 100%, duck and turkey meats: 97%, beef meat: 3%, non-hydrolyzed chicken meal: 73%, mildly-hydrolyzed poultry feathers: 37% and extensively-hydrolyzed poultry feathers: 0%. For cats, these respective percentages were (with wheat replacing beef as a negative control): 100, 84, 97, 7, 7, 0 and 0%. To detect any allergenic cross-reactivity between poultry meat-based and feather hydrolysate-derived extracts, an IgE ELISA inhibition was also done. Ten canine sera with the highest level of anti-poultry IgE in the previous experiment were incubated overnight with a previously optimized 50 μg amount of each of the extracts used above. We performed ELISA on plates coated with chicken, duck or turkey meats with or without inhibitors. The median inhibition percentages after incubation with the non-hydrolyzed chicken meal were ~22%, with the mildly-hydrolyzed poultry feathers: 14–22%, and those with the extensively-hydrolyzed poultry feathers: 5 to 10%; the last inhibition level was similar to that of the beef meat negative control.

Conclusions

Altogether, these results suggest that an extensive—but not partial—hydrolyzation of the poultry feather extract is necessary to prevent the recognition of allergenic epitopes by poultry-specific IgE.

Electronic supplementary material

The online version of this article (doi:10.1186/s12917-017-1183-4) contains supplementary material, which is available to authorized users.

Detection of IgE-reactive proteins in hydrolysed dog foods

BACKGROUND

Commercial hydrolysed diets are used for the diagnosis of food allergy in dogs. The cleaved parent proteins are presumed to be too small to elicit an allergic response by reacting with allergen-specific immunoglobin E (IgE).

OBJECTIVES

To evaluate three commercial hydrolysed dog diets for proteins.

ANIMALS

Sera were collected from dogs with suspected food allergy.

METHODS

Two batches of each hydrolysed diet were examined by electrophoresis and visualized by Coomassie blue, silver nitrate staining and IgE immunoblotting.

RESULTS

From two to five proteins, ranging from 21 to 67 kDa, were detected in all three diets evaluated. Circulating IgE antibodies targeting these proteins were detected by immunoblotting of dog sera. Six different carbohydrate proteins were identified by mass spectrometry; maize/potato granule-bound starch synthase-1, soybean glycinin, soybean β-conglycinin α chain, potato aspartic protease inhibitor, rice glutelin type B1 and soybean sucrose-binding protein. Four of these proteins have been described as allergens in humans.

CONCLUSIONS

Some commercial hydrolysed diets contain carbohydrate proteins. Some dogs have circulating IgE antibodies targeting these proteins. The clinical significance of these findings is unknown.

Cutaneous Hypersensitivity Dermatoses in the Feline Patient: A Review of Allergic Skin Disease in Cats

Feline allergic skin disease presents a unique set of challenges to the veterinary practitioner. Although there is some similarity to what is seen in the allergic canine patient, cutaneous hypersensitivity dermatoses in cats can manifest with strikingly different clinical signs, treatment options and outcomes, and secondary complications/disease entities. Additionally, less is known about the pathogenesis of feline allergic skin diseases, particularly "feline atopic syndrome" when compared to dogs or people. This article aims to review what is currently known in regards to allergic skin disease in the feline patient, with focus on non-flea, non-food hypersensitivity dermatitis.