Skin: atopy

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Sections available in full article Introduction, Presenting signs, Geographic incidence, Age predisposition, Sex predisposition, Breed predisposition, Cost considerations, Pathogenesis, Etiology, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Histopathology findings, Differential diagnosis, Treatment, Standard treatment, Monitoring, Subsequent management, Prevention, Control, Prophylaxis, Sequelae, Prognosis, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Rosanna Marsella DVM DipACVD
Dr Richard Squires BVSc PhD DVR DipACVIM MRCVS
Synonyms Atopic disease, atopic dermatitis, allergic inhalant dermatitis

Introduction

  • Cause : inherited predisposition to develop hypersensitivity-mediated skin disease against environmental allergens.
  • Signs : pruritic skin disease (may be seasonal), recurrent skin and ear infections.
  • Diagnosis : suggestive history, compatible clinical signs and exclusion of other pruritic skin diseases.
  • Treatment : desensitization or symptomatic management.
  • Prognosis : guarded - problems likely to persist lifelong.
    Print off the owner factsheet on Atopy Atopy to give to your client.

Diagnosis

Clinical signs

  • Diagnosis is clinical and by exclusion of other pruritic skin diseases.
  • Facial erythema and pruritus Atopy: peri-orbital.
  • Pedal erythema and pruritus Atopy: extremities.
  • Ventral erythema Atopy: chronic - groin.
  • Secondary staphylococcal pyoderma Pyoderma: metatarsus.
  • Pinnal erythema.
  • Lichenification of the flexor surface of the tarsal joint and/or the extensor surface of the carpal joint Lichenification.
  • Chronic or chronically relapsing dermatitis.
  • Salivary staining of coat.
  • Otitis externa Otitis externa: chronic - Cocker Spaniel.
  • Hyperhidrosis.
  • Conjunctivitis.
  • Lichenification Lichenification.
  • Alopecia.
  • Rhinitis.
  • Asthma.
  • Cataracts Cataract: English Springer Spaniel 6 yearsCataract: Border Collie 18 months.

Diagnosis

Differential diagnosis


Pruritus
  • Flea allergy Skin: flea bite hypersensitivity.
  • Sarcoptic mange Skin: sarcoptic mange.
  • Bacterial folliculitis Skin: bacterial folliculitis.
  • Food hypersensitivity Skin: food hypersensitivity.
  • Cheyletiellosis Skin: cheyletiellosis.
  • Malasseziadermatitis Skin: malassezia disease.
  • Pediculosis Skin: pediculosis.
  • Drug eruption Skin: toxic epidermal necrolysis.
  • Contact hypersensitivity Skin: allergic contact dermatitis.
  • Intestinal parasite hypersensitivity.

Sequelae

Prognosis

  • Good if seasonally affected; 90% can be satisfactorily controlled.
  • Many develop multiple allergies over succeeding years → increased difficulty in control.
  • Cost and time implications for owners of severely affected dogs may lead to requests for euthanasia.

Reasons for treatment failure

  • Failure to diagnose concurrent disease, eg flea allergy, food sensitivity.
  • Many cases become less responsive to glucocorticoids with the passage of time - frequently due to a failure to manage concurrent disease.
  • Inability of client to cope with treatment schedules.

Sources

Publications

Refereed papers

  • Recent references from PubMed.
  • Nuttall T J, Hill P B, Bensignor E, Willemse T & the members of the International Task Force on Canine Atopic Dermatitis (2006) House dust and forage mite allergens and their role in human and canine atopic dermatitis. Vet Dermatol 17 94), 223-235 PubMed.
  • Schnabl B, Bettenay S V, Dow K & Mueller R S (2006) Results of allergen-specific immunotherapy in 117 dogs with atopic dermatitis. Vet Rec 158 , 81-815 PubMed.
  • Steffan J, Parks C, Seewald A & the North American Veterinary Dermatology Cyclosporine Study Group (2005) Clinical trial evaluating the efficacy and safety of cyclosporine in dogs with atopic dermatitis. JAVMA 226 (11), 1855-1863 PubMed.
  • Steffan J, Horn, J, Gruet P, Strehlau G, Fondati A, Ferrer L & Noli C (2004) Remission of the clinical signs of atopic dermatitis in dogs after cessation of treatment with cyclosporin A or methylprednisolone. Vet Rec 154 , 681-684.
  • Olivry T, Steffan J, Fisch R D, Prelaud P, Guaguere E, Fontaine J & Carlotti D N (2002) Randomized controlled trial of the efficacy of cyclosporine in the treatment of atopic dermatitis in dogs. JAVMA 221 (3), 370-377.
  • Fontaine J & Olivry T (2001) Treatment of canine atopic dermatitis with cyclosporine - a pilot clinical study. Vet Rec 148 , 662-663.
  • Marsella R, Nicklin C F (2000) Double blinded placebo controlled cross over study on the effects of pentoxifylline in canine atopy. Vet Dermatol 11 , 255-260.
  • Mueller R S, Bettenay S V & Tideman L (2000) Aero-allergens in canine atopic dermatitis in south-eastern Australia based on 1000 intradermal skin tests. Aust Vet J 78 , 392-399.
  • Olivry T, Rivierre C, Jackson H A & Murphy K M (2000) Cyclosporin A decreases skin lesions and pruritus in dogs with atopic dermatitis - a prednisolone controlled blinded trial. Vet Dermatol 11 (Suppl 1), 47.
  • Harvey R G (1999) A blinded, placebo-controlled study of the efficacy of borage seed oil and fish oil in the management of canine atopy. Vet Rec 155 (15), 405-407.
  • Olivry T, Dean G A, Tompkins M B, Dow J L & Moore P F (1999) Toward a canine model of atopic dermatitis - amplification of cytokine-gene transcripts in the skin of atopic dogs. Exp Dermatol 8 (3), 204-211.
  • Scott D W & Miller W H (1999) Antihistamines in the management of allergic pruritus in dogs and cats. JSAP 40 , 359-364.
  • Thomas R C, Logas D, Radosta L & Harrison J (1999) Effects of 1% hydrocortisone conditioner on haematological and biochemical parameters, adrenal function testing and cutaneous reactivity to histamine in normal and pruritic dogs. Vet Dermatol 10 , 109-116.
  • Derer M, Morrison-Smith G & de Weck A L (1998) Monoclonal anti IgE antibodies in the diagnosis of dog allergy. Vet Derm 9 , 185-190.
  • Halliwell R E W, Gilbert S M & Lian T M (1998) Induced and spontaneous Ig E antibodies to Dermatophagoides farinae in dogs and cats - evidence of functional heterogeneity of IgE. Vet Derm 9 , 179-184.
  • Hammerling R & de Weck A L (1998) Comparison of 2 diagnostic tests for canine atopy using monoclonal anti IgE antibodies. Vet Derm 9 , 191-199.
  • Olivry T, Guaguere E & Heriret D (1997) Treatment of atopic dermatitis with misoprostal, a prostaglandin E-1 analogue - an open study. J Dermatol Treat 8 , 243-247.
  • Schwartzman R M & Mathis L (1997) Immunotherapy for canine atopic dermatitis - efficacy in 125 atopic dogs with vaccine formulation based on ELISA allergy testing. J Vet Allergy Clin Immunol 5 , 144-152.
  • Olivry T, Moore P F, Affolter V K & Naydan D K (1996) Langerhans cell hyperplasia and IgE expression in canine atopic dermatitis. Arch Dermatol Res 288 (10), 579-585.
  • Ritschel W A (1996) Microemulsion technology in the reformulation of cyclosporine - the reason behind the pharmacokinetic properties of Neoral. Clin Transplant 10 (4), 364-373.
  • Paterson S (1995) Additive benefits of EFAs in dogs with atopic dermatitis after partial response to antihistamine therapy. JSAP 36 (9), 389-394.
  • Codner E C & Griffin C E (1996) Serologic allergy testing in dogs. Comp Cont Ed Prac Vet 18 , 237-248.
  • Willemse T (1985) Atopic skin disease - a review and a reconsideration of diagnostic criteria. JSAP 27 , 771-778.

Other sources of information

  • Bevier D E (1990) Long-term management of atopic disease in the dog. Vet Clin North Am 20 , 1487-1507.

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