Food allergy dermatitis

From Cat
Food allergy dermatitis in a 3-year-old Devon rex cat. Courtesy Dr Jim Euclid
File:Foo2.jpg
Severe facial dermatitis associated with food allergy
File:Food03.jpg
Feline Lip Ulcers (Rodent ulcer) associated with food allergy
Food allergy dermatitis in a 8-year-old Persian cat which responded to long-term corticosteroid therapy. Courtesy Dr Jim Euclid

Food allergy is a common problem in cats. Such allergies present as skin problems or gastrointestinal problems. The skin sores are usually thought to be due to fleas and the owner often becomes frustrated that the problem persists in spite of regular worm and flea treatment.

Food allergy is about as common as atopy in cats. The history is that of a non-seasonal pruritus, with little variation in the intensity of pruritus from one season to another in most cases. The distribution of pruritus and lesions varies markedly between animals. Ear canal disease that manifests as pruritus and secondary infection with bacteria (usually Staphylococcus intermedius, Pseudomonas spp, Proteus spp, or Escherichia coli) or yeast (Malassezia pachydermatis) are common and may be the only presenting complaint. Other patterns seen include blepharitis, generalized pruritus, generalized seborrhea, a papular eruption, or a distribution pattern that may mimic that of atopy (feet, face, and ventrum) or flea allergy dermatitis (dorsal lumbosacrum and hindlegs). The most common areas of involvement include the ears, feet, inguinal region, axillary area, proximal anterior forelegs, periorbital region, and muzzle. The degree of pruritus is usually moderate to severe. Response to corticosteroids varies from poor to excellent[1].

In humans, non-immunological food reactions like toxic food reactions (e.g toxin secreted by Salmonella spp), pharmacological reactions (e.g. caffeine) and metabolic reactions (e.g. lactate deficiency) comprise the majority of food-related problems. The term 'hypersensitivity is used more stringently only for immunologically-mediated reactions to food ingredients. Type I hypersensitivity is the most common, although type IV-mediated food hypersensitivity and mixed forms have been described (Mueller & Dethioux, 2008). Immunoglobulin E appears to be the predominant antibody involved in this hypersensitivity response.

  • Dietary allergens - including eggs, fish, cod liver oil, dairy products, and most meats
  • Genetic predisposition - Siamese cats genetically predisposed
  • Maldigestion - cats with Irritable bowel disease tend to be more predisposed to dietary allergens, suggesting maldigestion may contribute to exposure to dietary allergens.
  • Concurrent hypersensitivities to flea allergy tend to aggravate food allergies[2]

Most cats present with miliary dermatitis, areas of hair loss, pruritic focal lesions around face, heck, and ventrum. There is no reliable diagnostic test other than a strict food elimination diet. Serological testing and intradermal testing for food allergens have proved unreliable. The ideal food elimination diet should be balanced and nutritionally complete and not contain any ingredients that have been fed previously to the animal. Many diets contain novel protein or carbohydrate sources (eg, lamb and rice). However, it is often misunderstood that if any previously fed ingredient is present in the elimination diet, the animal may be allergic to the novel ingredient and the diet trial will be a failure. The key point in any food elimination diet trial is that only novel food ingredients can be fed.

The trial diet should be fed for up to 3 mo. If marked or complete resolution in the pruritus and clinical signs occurs during the elimination diet trial, food allergy can be suspected. To confirm that a food allergy exists and that the clinical improvement was not just coincidental, the animal must be challenged with the previously fed food ingredients and a relapse of clinical signs must occur. The return of clinical signs after challenge is usually between 1 hr and 14 days, although it is sometimes within 3 days. Once a food allergy is confirmed, the elimination diet should be reinstituted until clinical signs resolve, which usually takes <14 days. At this point, previously fed individual ingredients should be added to the elimination diet for a period of up to 14 days. If pruritus recurs, the individual ingredient is considered positive for having a causative role in the food allergy. If pruritus does not recur the individual ingredient is not considered important in causing the clinical signs.

The number of offending food allergens varies from 1-5 ingredients. The most frequently identified causative allergens in canine food allergy include beef, chicken, eggs, corn, wheat, soy, and milk. Once the offending allergens are identified, control of the food allergy is by strict avoidance. Concurrent diseases (such as atopy or flea allergy) may complicate the identification of underlying food allergies. Infrequently, a dog will react to new food allergens as it ages.

Clinical presentations of food allergy in cats include:

No breed, sex, or age predilection is seen, although Siamese and Siamese crosses may be more predisposed[3]. Age of onset varies from 3 months to 11 years of age.

Response to steroids is variable, but about two-thirds of cats show excellent response initially. Many cats develop a poor response to steroids with repeated treatments. As with canine food allergy, an elimination diet should be fed for up to 3 months. The elimination diet should not contain any previously fed ingredients. Food elimination diets can be difficult in cats because many cats are reluctant to change diets. Cats should not be starved or forced into eating a new elimination diet due to the serious nature of hepatic lipidosis that may be induced by prolonged anorexia.

Response time to the elimination diets varies from 1-9 wk. Time until relapse of pruritus after challenge with the offending food varies from 15 min to 10 days. The most frequently identified food allergens in cats include fish, beef, and chicken. Avoidance of the offending allergens will control the clinical signs associated with the food allergy[4].

In cases of concurrent irritable bowel disease, dietary supplements to correct cobalamin deficiency and use of probiotics is also recommended.

References

  1. Mueller, RS & Dethioux, F (2008) How nutrition contributes to dermatology. Royal Canin Publication, France. pp:6-25
  2. August, JR (2006) Consultations in feline internal medicine. Vol 5. Elsevier Saunders, Philadelphia
  3. Bryan J & Frank LA (2010) Food allergy in the cat A diagnosis by elimination. J Feline Med Surg 12(11):861-866
  4. Cave NJ. (2006) Hydrolyzed protein diets for dogs and cats. Vet Clin North Am Small Anim Pract 36(6):1251-68