This article is sponsored content brought to you by Royal Canin.
By Dr Julie Summerfield BVSc, Royal Canin Scientific Services Veterinarian
The long road of diagnosis and management for your Pruritic canine & feline patients can be frustrating, not least is managing owner expectations of the possibilities and prognosis ahead.
Whether it is a Canine or Feline patient with itchy skin, it is often not a quick fix, and sometimes it is management rather than resolution that can be best achieved. But where do you start when the owner is after that quick fix, for the best outcomes long term?
We know pruritus is a reason around a third of your patients present. We also know about half of them will have some sort of Atopic Dermatitis (AD). 1,2 Diagnosis of AD is by exclusion, so performing a dietary elimination trial to rule out adverse food reactions is also recommended. “Every dog diagnosed with nonseasonal (i.e., perennial) atopic dermatitis should undergo one or more dietary restriction-provocation challenges (i.e., ‘elimination diets’) to determine, and then eliminate, any dietary allergens that might cause flares of the disease”.4 Cutaneous adverse food reactions (CAFR) seen also in cats, are most seen with non-seasonal pruritus, but also concurrent gastrointestinal signs in 17-22% of affected cats.5
So, while not easy, Elimination diets for what can be a lifelong issue are crucial to accurate diagnosis. “Food allergens can cause flares of clinical signs of AD in dogs hypersensitive to such allergens. Such patients are likely to exhibit chronic recurrent year-round clinical signs”4. “Before implementing long-term anti-inflammatory or antipruritic drugs in dogs with nonseasonal AD, practitioners must remember that treatment is unlikely to be successful if a dog hypersensitive to dietary components regularly ingests offending allergens”.5
Once Adverse Food reactions have been ruled out, for which 8 weeks is recommended for many animals to show improvement in their clinical signs. A recent study in dogs with non-seasonal pruritus however, showed that initial treatment with anti-inflammatory doses of glucocorticoids for at least two weeks may shorten the length of the trial by two to four weeks.6
Then, left with a diagnosis of Atopic Dermatitis there are two components to treat:
Abnormal Immune response. Medical treatments like Glucocorticoids, Immune-Modulating Cytokine inhibitors and Monoclonal Antibody therapies are mainstay to down regulate the immune response. Atopic dermatitis is a condition where clinical signs need to be managed judiciously as side effects of treatment can be another main concern of owners along with cost.
Defective Skin Barrier function. Epithelial cells in atopic patients lack the normal tight lipid junctions that form a waterproof barrier in the skin, like a brick wall where the mortar is the lipid. This allows the antigenic allergens entrance into, and water loss through the epidermis, resulting in dry itchy “leaky skin.”
Multimodal management, including, nutritional therapy in the form of prescription diets indicated for Atopic & other Dermatitis, can benefit the cellular skin structure, to help minimise antigenic presentation to the local immunity. Dietary formulations enriched with Omega 3 & 6 essential fatty acids can assist, supporting reduction of inflammation and improved ceremide function, helping strengthen the compromised barrier.
Additional nutritional benefit for the atopic patient can come in the form of amino acids for cell repair and regeneration, or specific vitamins and minerals involved in keratinisation, fatty acid metabolism and reduction of oxidation.
Where compliance can be difficult in such chronic multifactorial disease, supporting patients’ health through diet, along with other topical, medical, and immunological management modalities can offer them a shorter road to remission.
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1. Hill PB, Lo A, Eden CAN, et al. Survey of the prevalence, diagnosis, and treatment of dermatological conditions in small animals in general practice. Vet Rec 2006; 158:533-539.
2. Banfield internal data, 2020
3. International Task Force on Canine Atopic Dermatitis. Thierry Olivry, Douglas J. DeBoer, Claude Favrot, Hilary A. Jackson, Ralf S. Mueller, Tim Nuttall, Pascal Prélaud
4. Food for thought: pondering the relationship between canine atopic dermatitis and cutaneous adverse food reactions. Veterinary Dermatology 2007; 18: 390–1. Olivry T, DeBoer DJ, Bensignor E, Prélaud P for the International Task Force on Canine Atopic Dermatitis.
5. Olivry T, Mueller RS. Critically appraised topic on adverse food reactions of companion animals (7): signalment and cutaneous manifestations of dogs and cats with adverse food reactions. BMC Vet Res 2019; 15:140.
6. Favrot C, Bizikova P, Fischer N, et al. The usefulness of short course prednisolone during the initial phase of an elimination diet trial in dogs with food induced atopic dermatitis. Vet Dermatol 2019; 30:498.