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Marsella R. Pruritic Horse: Approach to Allergic Skin Diseases in Horses. Vet Clin North Am Equine Pract 2024; 40:219-235. [PMID: 38852012 DOI: 10.1016/j.cveq.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024] Open
Abstract
Allergy to insects is the most common skin allergy in horses. Pruritus in affected patients can be extreme. Face, ears, mane, and tail area are commonly affected areas. Diagnosis of insect bite hypersensitivity (IBH) is clinical and is based on history, clinical signs, and response to repellents. Allergy tests are not to be used for diagnostic purposes. Currently, there is no specific treatment for IBH other than insect avoidance, treatment of secondary infections, and symptomatic relief of pruritus. Many allergic horses become also sensitized to pollens. For these patients, allergen specific immunotherapy is beneficial.
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Affiliation(s)
- Rosanna Marsella
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, Room VC-34, Gainesville, FL 32610, USA.
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Herrmann I, Sanchez AJ. Efficacy and Safety of Subcutaneous Allergen-Specific Immuno-Therapy in Horses with Allergic Cutaneous and Respiratory Diseases-A Systematic Review. Vet Sci 2023; 10:613. [PMID: 37888565 PMCID: PMC10611411 DOI: 10.3390/vetsci10100613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Allergen-specific immunotherapy (AIT) is the only current intervention that has the ability to modify the immune response toward a tolerogenic state. This study aimed to assess the efficacy and safety of AIT in horses with allergic diseases in a systematic manner. Three databases were searched to identify articles reporting clinical outcomes and adverse events associated with AIT. The articles were evaluated for beneficial responses to AIT, defined as a ≥50% reduction in clinical signs, and clinical remission. Horses with respiratory diseases, urticaria, and pruritic dermatitis receiving insect monotherapy or multi-allergen AIT were included. All adverse events were graded, and analytical and confounding biases were assessed. The results showed that multi-allergen AIT had a beneficial response in 75% of horses with respiratory diseases, 88% with urticaria, and 56% with pruritic dermatitis. However, horses treated solely with insect AIT for pruritic dermatitis had a lower response rate (36%). Self-limiting local reactions were the most common adverse events, with systemic reactions grade II accounting for 11% of reported events. Analytical and confounding biases were identified as major limitations in the available studies. Further research is needed to address these biases and provide stronger evidence on the efficacy and safety of AIT in horses with allergic diseases.
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Affiliation(s)
- Ina Herrmann
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Adrianna Jordan Sanchez
- Department of Animal Sciences, College of Agriculture and Life Sciences, North Carolina State University, Raleigh, NC 27606, USA;
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Marsella R, White S, Fadok VA, Wilson D, Mueller R, Outerbridge C, Rosenkrantz W. Equine allergic skin diseases: Clinical consensus guidelines of the World Association for Veterinary Dermatology. Vet Dermatol 2023; 34:175-208. [PMID: 37154488 DOI: 10.1111/vde.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/03/2023] [Accepted: 02/26/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Allergic skin diseases are common in horses worldwide. The most common causes are insect bites and environmental allergens. OBJECTIVES To review the current literature and provide consensus on pathogenesis, diagnosis, treatment and prevention. MATERIALS AND METHODS The authors reviewed the literature up to November 2022. Results were presented at North America Veterinary Dermatology Forum (2021) and European Veterinary Dermatology Congress (2021). The report was available to member organisations of the World Association for Veterinary Dermatology for feedback. CONCLUSIONS AND CLINICAL RELEVANCE Insect bite hypersensitivity (IBH) is the best characterised allergic skin disease. An immunoglobulin (Ig)E response against Culicoides salivary antigens is widely documented. Genetics and environmental factors play important roles. Tests with high sensitivity and specificity are lacking, and diagnosis of IBH is based on clinical signs, seasonality and response to insect control. Eosinophils, interleukin (IL)-5 and IL-31 are explored as therapeutic targets. Presently, the most effective treatment is insect avoidance. Existing evidence does not support allergen-specific immunotherapy (ASIT) using commercially available extracts of Culicoides. Hypersensitivity to environmental allergens (atopic dermatitis) is the next most common allergy. A role for IgE is supported by serological investigation, skin test studies and positive response to ASIT. Prospective, controlled, randomised studies are limited, and treatment relies largely on glucocorticoids, antihistamines and ASIT based on retrospective studies. Foods are known triggers for urticaria, yet their role in pruritic dermatitis is unknown. Recurrent urticaria is common in horses, yet our understanding is limited and focussed on IgE and T-helper 2 cell response. Prospective, controlled studies on treatments for urticaria are lacking. Glucocorticoids and antihistamines are primary reported treatments.
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Affiliation(s)
- R Marsella
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - S White
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - V A Fadok
- Zoetis, US PET CARE, Bellaire, Texas, USA
| | - D Wilson
- School of Clinical Veterinary Sciences, University of Bristol, Bristol, UK
| | - R Mueller
- Medizinische Keleintierklinik, Zentrum für klinische Tiermedizin, LMU, Munich, Germany
| | - C Outerbridge
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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White SD. Approach to the pruritic horse. J Am Vet Med Assoc 2023; 261:S66-S74. [PMID: 36638000 DOI: 10.2460/javma.22.10.0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/05/2022] [Indexed: 01/14/2023]
Abstract
Pruritus in the horse may be due to several causes, the most common being a hypersensitivity response to salivary proteins in the Culicoides genera, which may coexist with atopic dermatitis, also known as an environmental allergy to pollens, molds, dust, storage mites, etc. Less common etiologies are food allergy and contact allergy, the latter often caused by owners applying various products to the skin. Other ectoparasites, such as Chorioptes mites, may also initiate pruritus. Secondary bacterial infections (usually Staphylococcus spp) may be pruritic in and of themselves. This article reviews the questions that need to be asked of owners to obtain a relevant history, always important for any organ system, but perhaps none more so than the skin. The various clinical findings such as alopecia and crusts and their location on the horse, diagnostic methods such as intradermal or serum testing for allergies, and subsequent hyposensitization are also discussed. Therapeutic options currently available for the potential underlying diseases, in particular for the hypersensitivity reactions to Culicoides spp or environmental allergens, are reviewed with the studies of hyposensitization over the last 40 years, as well as medications that may be effective. While the most common causes of pruritus in the horse are known, the current understanding of the pathophysiology still needs to be investigated, and consequently, the most effective treatments for those causes need to be improved. Newer research is discussed that may eventually add to the diagnostic and therapeutic options currently available for the pruritic horse.
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Affiliation(s)
- Stephen D. White
- School of Veterinary Medicine, University of California-Davis, Davis, CA
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Hopke K, Coleman M, Kneese E, Dominguez B, Diesel A, Patterson A. Prevalence of serum immunoglobulin E against cross‐reactive carbohydrate determinants in allergic and nonallergic horses, and its impact on polysensitisation in serum allergen tests. Vet Dermatol 2022; 33:338-e79. [DOI: 10.1111/vde.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Kaitlin Hopke
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, Texas A&M University TX USA
| | - Michelle Coleman
- Large Animal Clinical Sciences College of Veterinary Medicine, Texas A&M University TX USA
| | - Eric Kneese
- Large Animal Clinical Sciences College of Veterinary Medicine, Texas A&M University TX USA
| | - Brandon Dominguez
- Large Animal Clinical Sciences College of Veterinary Medicine, Texas A&M University TX USA
| | - Alison Diesel
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, Texas A&M University TX USA
| | - Adam Patterson
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, Texas A&M University TX USA
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Atopic Dermatitis in Domestic Animals: What Our Current Understanding Is and How This Applies to Clinical Practice. Vet Sci 2021; 8:vetsci8070124. [PMID: 34357916 PMCID: PMC8310319 DOI: 10.3390/vetsci8070124] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 12/18/2022] Open
Abstract
Atopic dermatitis is a clinical syndrome that affects both people and animals. Dogs closely mimic the complexity of the human skin disease, and much progress has been made in recent years in terms of our understanding of the role of skin impairment and the identification of new treatments. Cats and horses also develop atopic syndromes which include both cutaneous and respiratory signs, yet studies in these species are lagging. It is now recognized that atopic dermatitis is not a single disease but a multifaceted clinical syndrome with different pathways in various subgroups of patients. Appreciating this complexity is clinically relevant as we develop more targeted treatments which may work well in some patients but not in others. Different phenotypes of atopic dermatitis have been described in dogs, and it is possible that phenotypes related to breed and age may exist in other animals similar to how they are described in people. The awareness of different mechanisms of disease leads to the desire to correlate different phenotypes with specific biomarkers and responses to treatment. In this review, the current understanding and updated information on atopic syndrome in animals are described, highlighting opportunities for further studies in the future.
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White SL. Control of chronic allergic pruritus in horses. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S. L. White
- Department of Large Animal Medicine College of Veterinary Medicine University of Georgia Athens Georgia USA
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Fettelschoss V, Olomski F, Birkmann K, Kündig TM, Bergvall K, Fettelschoss‐Gabriel A. Interleukin 31 and targeted vaccination in a case series of six horses with chronic pruritus. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- V. Fettelschoss
- Department of Dermatology University Hospital Zurich SchlierenSwitzerland
- Faculty of Medicine University of Zurich ZurichSwitzerland
- Evax AG MünchwilenSwitzerland
| | - F. Olomski
- Department of Dermatology University Hospital Zurich SchlierenSwitzerland
- Faculty of Medicine University of Zurich ZurichSwitzerland
- Evax AG MünchwilenSwitzerland
| | | | - T. M. Kündig
- Faculty of Medicine University of Zurich ZurichSwitzerland
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - K. Bergvall
- Department of Clinical Sciences Swedish University of Agriculture Uppsala Sweden
| | - A. Fettelschoss‐Gabriel
- Department of Dermatology University Hospital Zurich SchlierenSwitzerland
- Faculty of Medicine University of Zurich ZurichSwitzerland
- Evax AG MünchwilenSwitzerland
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van Damme CMM, van den Broek J, Sloet van Oldruitenborgh-Oosterbaan MM. Discrepancies in the bilateral intradermal test and serum tests in atopic horses. Vet Dermatol 2020; 31:390-e104. [PMID: 32743929 PMCID: PMC7589420 DOI: 10.1111/vde.12871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Abstract
Background In equine atopic patients intradermal testing (IDT) and immunoglobulin (Ig)E serology are used frequently. There is little evidence regarding the reproducibility of the IDT and IgE serology in horses. Objectives To compare the results of a simultaneously performed IDT on the left and right side of the neck in atopic horses, and to compare these results with allergen‐specific IgE serology. Animals Ten equine patients from a university hospital population with chronic urticaria and/or pruritus. Methods and materials The IDT was performed using 16 allergens and the results were evaluated after 30 min, 1, 4 and 24 h. Thirteen allergens also were analysed in duplicate with two monoclonal allergen‐specific IgE enzyme‐linked immunosorbent assays (ELISA). Results Good agreement (Kappa > 0.6) between left and right IDT was found only for Dermatophagoides farinae, Lepidoglyphus destructor, birch pollen mixture and perennial rye at 30 min, birch pollen mixture at 1 h, and Acarus siro and nettle and common mugwort mixture at 4 h. The bilateral comparison of the other allergens and even the same allergens at other time points showed little or no concordance between left and right IDT. The interlaboratory comparison between both ELISAs, and the comparison between the ELISAs and IDT, showed a good agreement for two of 13 allergens: D. farinae and Dermatophagoides pteronyssinus. Conclusions and clinical importance Based on these preliminary data, IDT and IgE serological test results should be interpreted with great care and further studies are needed to indicate the clinical relevance of these findings.
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Affiliation(s)
- Catharina M M van Damme
- Department Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht NL, 3584 CM, The Netherlands
| | - Jan van den Broek
- Department Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, Utrecht NL, 3584 CM, The Netherlands
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Wilkołek P, Szczepanik M, Sitkowski W, Rodzik B, Pluta M, Taszkun I, Gołyński M. Evaluation of multiple allergen simultaneous (sIgE) testing compared to intradermal testing in the etiological diagnosis of atopic dermatitis in horses. J Vet Sci 2020; 20:e60. [PMID: 31775187 PMCID: PMC6883192 DOI: 10.4142/jvs.2019.20.e60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/06/2019] [Accepted: 09/04/2019] [Indexed: 11/20/2022] Open
Abstract
Although intradermal testing (IDT) is commonly used in the etiological diagnosis of allergies, in vitro testing for specific IgE (sIgE) is an attractive alternative. Currently, new laboratory techniques in veterinary allergological practice, including multiple allergen simultaneous tests (MASTs), gradually supersede in vivo tests. Both, serological (sIgE) and IDTs in fourteen atopic Malopolski horses were performed. Correlation and agreement between test results were evaluated. Receiver operating characteristic analysis showed that sIgE to Acarus siro had the best diagnostic performance (Area under the ROC curve [AUC] = 0.969), followed by Dermatophagoides pteronyssinus (AUC = 0.844), Dermatophagoides farinae (AUC = 0.813) and Tyrophagus putrescentiae (AUC = 0.803). A significant positive correlation between IDT and MAST was found for A. siro (rS = 0.870; p = 0.00005), and D. farinae (rS = 0.657; p = 0.011). There was significant moderate agreement for 2 of 5 allergens, A. siro (κ = 0.569) and D. farinae (κ = 0.485) in semiquantitative assessment and significant fair to substantial agreement for 3 of 5 allergens, D. pteronyssinus (κ = 0.689), A. siro (κ = 0.569), D. farinae (κ = 0.432) in dichotomic assessment. Sensitivity ranged from 44% to 89%, depending on the allergen, while specificity was significantly higher for all allergens in MAST (60%–100%); the mean accuracy was 73% (manufacturer cut-off) and 77.4% (optimal cut-off) based on the Youden index. Compared with IDT, serological MAST showed good detection performance for 60% allergen sIgE in dichotomic assessment with substantial diagnostic capability, but careful clinical interpretation is needed for some allergens.
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Affiliation(s)
- Piotr Wilkołek
- Sub-Department of Clinical Diagnostics and Veterinary Dermatology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-612 Lublin, Poland.
| | - Marcin Szczepanik
- Sub-Department of Clinical Diagnostics and Veterinary Dermatology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-612 Lublin, Poland
| | - Wiesław Sitkowski
- Sub-Department of Clinical Diagnostics and Veterinary Dermatology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-612 Lublin, Poland
| | - Beata Rodzik
- Institute of Mathematics, Marie Curie-Skłodowska University, 20-031 Lublin, Poland
| | - Michał Pluta
- Equine Breeding and Management Unit, Department of Biology and Animal Breeding, University of Life Sciences in Lublin, 20-950 Lublin, Poland
| | - Iwona Taszkun
- Sub-Department of Clinical Diagnostics and Veterinary Dermatology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, 20-612 Lublin, Poland
| | - Marcin Gołyński
- Nicolaus Copernicus University in Torun, Faculty of Biological and Veterinary Sciences, 87-100 Torun, Poland
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Wilkołek P, Szczepanik M, Rodzik B, Sitkowski W, Pluta M, Taszkun I, Gołyński M. A Comparison of Multiple Allergen Simultaneous Tests Using Allergen-Specific IgE Concentration and Intradermal Skin Tests in Atopic Horses With Pollen Allergy. J Equine Vet Sci 2020; 90:102992. [PMID: 32534770 DOI: 10.1016/j.jevs.2020.102992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
Intradermal tests (IDTs) and measurement of specific immunoglobulin E class (sIgE) levels in sera are the most common and reliable methods used in allergological clinical practice. The purpose of this study was to explore the sensitization of pollen allergy in atopic horses with pollinosis and to assess the diagnostic value of the multiple allergen simultaneous tests (MASTs) compared with that of the IDT. Twenty-one Malopolski horses with typical skin hypersensitivity symptoms during pollen seasons were enrolled. Intradermal tests were performed, and allergen-specific IgE concentrations in sera were measured using a monoclonal anti-IgE antibody to pollens of grass, weeds, trees, and cultivated plants. The highest sensitization rate was for Secale cereale (IDT, 76%; MAST, 66.7%), grass (IDT, 71%; MAST, 57%), and Brassica napus (IDT, 52.4%; MAST, 57%). Receiver operating characteristic (ROC) curve analysis and the area under the ROC curve (AUC) showed that Betula spp., Alnus spp., and Corylus spp. had the highest AUC at 0.854, followed by Secale cereale (AUC = 0.796), Plantago lanceolata (AUC = 0.726), Brassica napus (AUC = 0.704), and a grass allergen mixture (AUC = 0.695). The mean AUC for all allergens was 0.712 (0.604-0.867). The overall sensitivity of the sIgE plant horse panel was 78% (range, 68%-90%), the specificity was 86.3% (range, 64%-100%), and the accuracy was 79% (range, 64%-87%). Statistical kappa (κ) agreement between the MAST and IDT was reached for tree (κ = 0.767), rye (κ = 0.687), colza (κ = 0.671), and grass (κ = 0.664) pollen. The MAST showed a favorable agreement with the IDT and can be used for the detection of sIgE in atopic horses with pollinosis.
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Affiliation(s)
- Piotr Wilkołek
- Sub-Department of Diagnostics and Veterinary Dermatology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, Głęboka 30, 20-612 Lublin, Poland.
| | - Marcin Szczepanik
- Sub-Department of Diagnostics and Veterinary Dermatology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, Głęboka 30, 20-612 Lublin, Poland
| | - Beata Rodzik
- Institute of Mathematics, Maria Curie-Skłodowska University, Lublin, Poland
| | - Wiesław Sitkowski
- Sub-Department of Diagnostics and Veterinary Dermatology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, Głęboka 30, 20-612 Lublin, Poland
| | - Michał Pluta
- Equine Breeding and Management Unit, Department of Biology and Animal Breeding,University of Life Sciences in Lublin, Lublin, Poland
| | - Iwona Taszkun
- Sub-Department of Diagnostics and Veterinary Dermatology, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, Głęboka 30, 20-612 Lublin, Poland
| | - Marcin Gołyński
- Nicolaus Copernicus University in Torun, Faculty of Biological and Veterinary Sciences, Torun, Poland
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