Canis ISSN: 2398-2942

Skin: atopy

Synonym(s): Atopic disease, atopic dermatitis, allergic inhalant dermatitis

Contributor(s): David Godfrey, Rosanna Marsella, Richard Squires

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.

Pathogenesis

Etiology

  • Unknown: thought in part to be associated with dysregulation of cytokine production and alterations in T-cell subset populations.
  • Abnormal epidermal integrity is also probably important.

Predisposing factors

General
  • Familial history of atopy.
  • Some studies show a link between month of birth and development of atopy. Dogs born during the pollen season may become sensitized in the first few months of life.
  • Parasites may increase the dog's production of IgE to other environmental allergens.
  • Viral infection or vaccination also increase production of IgE to environmental allergen.
  • Being raised in a rural environment may protect against the development of atopic dermatitis.

Pathophysiology

  • Still poorly understood. There seems to be both epithelial barrier function and immunological abnormalities.
  • There is an imbalance in T-cell populations and aberrant cytokine production.
  • Antigen-presenting cells stimulate the production of T helper 2 cells both locally and at distant lymph nodes → stimulate IgE-producing B cells, producing interleukins → mast cell and eosinophil.
  • Mast cell degranulation releases vasoactive factors → start of the inflammatory cascade.
  • The corneocytes of atopic dogs have greater adherence for Staphylococcus pseudintermedius Staphylococcus intermedius , → the high frequency of development of secondary pyoderma Skin: bacterial skin disease - overview.
  • A defective epidermal barrier allows percutaneous absorption of allergen. The allergen contacts allergen specific IgE on Langerhans' cells. Allergens are trapped, processed, and presented to allergen specific T lymphocytes. This results in increased numbers of T helper 2 cells which produce interleukins. Ultimately, there is enhanced production of allergen specific IgE by B lymphocytes.

Aeroallergens

  • Indoor allergens appear important throughout the world:
    • House dust mites - Dermatophagoides farina, D. pteronysinus and possibly Blomia tropicalis and Euroglyphyus maynei.
    • Storage mites - Acarus siro, Tyrophagus putrescentiae and Lepidoglyphus destructor are of less certain signifcance.
  • Pollens are important in Australia and North America and may be less commonly important in Europe.
  • Molds are uncommonly important allergens.
  • Malassezia is sometimes used in immunotherapy.
  • Danders from other mammals, and bird feather allergens are sometimes included.

Timecourse

  • Disease is uncommon <6 months of age (except in Shar Pei - seen earlier).
  • Signs worsen with age.
  • Disease that starts seasonally often becomes year round.
  • Secondary pyoderma or Malassezia Skin: malassezia disease disease is often a significant part of disease.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Olivry T, DeBoer DJ, Favrot C, Jackson HA, Mueller RS, Nuttall T, Prélaud P (2015) Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC Veterinary Research 11, 210 BMC Vet Research.
  • Olivry T, Saridomichelakis M, Nuttall T et al (2014) Validation of the Canine Atopic Extent and Severity Index (CADESI)-4, a simplified severity scale for assessing skin lesions of atopic dermatitis in dogs.Vet Dermatol 25 (2), 77-85 PubMed.
  • Cosgrove S B, Wren J A, Cleaver D M et al (2013) A blinded, randomized, placebo-controlled trial of the efficacy and safety of the janus kinase inhibitor oclatinib (Apoquel) in client-owned dogs with atopic dermatitis. Vet Dermatol 24 (6), 587-597 PubMed.
  • Fleck T, Humphrey W, Coscarelli E (2013) Comparison of the janus kinase (JAK) inhibitor, oclacitinib, and prednisolone in canine models of pruritus. Vet Dermatol 23 (Suppl 1), 2-104 ScienceOpen.
  • Olivry T & Bizikova (2013) A systematic review of randomized controlled trials for prevention or treatment of atopic dermatitis in dogs: 2008-2011 update. Vet Dermatol 24 (1), 97-117 PubMed.
  • Favrot C, Steffan J, Seewald W & Picco F (2010) A prospective study on the clinical features of chronic canine atopic dermatitis and its diagnosis. Vet Dermatol 21 (1), 23-31 PubMed.
  • Olivry T (2010) New diagnostic criteria for canine atopic dermatitis. Vet Dermatol 21 (1), 123-126 PubMed.
  • Olivry T, Foster A P, Mueller R F et al (2010) Interventions for atopic dermatitis in dogs: a systemic review of randomized controlled trials. Vet Dermatol 21 (1), 4-22 PubMed.
  • Olivry T, DeBoer D J, Favrot C, Jackson H A, Mueller R S, Nuttall T & Prelaud P (2010) Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis. Vet Dermatol 21 (3), 233-248 PubMed.
  • Nuttall T, Mueller R, Bensignor E et al (2009) Efficacy of a 0.0584% hydrocortisone aceponate spray in the management of canine atopic dermatitis: a randomized, double blind, placebo-controlled trial. Vet Dermatol 20 (3), 191-198 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 (4), 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 (3), 81-85 PubMed.
  • Steffan J, Favrot T & Mueller R (2006) A systematic review and meta-analysis of the efficacy and safety of cyclosporin for the treatment of atopic dermatitis in dogs. Vet Dermatol 17 (1), 3-16 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 (22), 681-684 PubMed.
  • Olivry T, Mueller R S, The International Task Force on Canine Atopic Dermatitis (2003) Evidence-based veterinary dermatology: a systemic review of the pharmacology of canine atopic dermatitis. Vet Dermatol 14 (3), 121-146 PubMed.
  • Olivry T, Steffan J, Fisch R D, Prelaud P, Guaguere E, Fontaine J, Carlotti D N, European Veterinary Dermatology Cyclosporine Group (2002) Randomized controlled trial of the efficacy of cyclosporine in the treatment of atopic dermatitis in dogs. JAVMA 221 (3), 370-377 PubMed.
  • Fontaine J & Olivry T (2001) Treatment of canine atopic dermatitis with cyclosporine - a pilot clinical study. Vet Rec 148 (1), 662-663 PubMed.
  • Marsella R, Nicklin C F (2000) Double-blinded cross-over study on the efficacy of pentoxifylline for canine atopy. Vet Dermatol 11 (4), 255-260 VetMedResource.
  • 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 (6), 392-399 VetMedResource.
  • Olivry T, Rivierre C, Jackson H A et al (2000) Cyclosporin A decreases skin lesions and pruritus in dogs with atopic dermatitis - a prednisolone controlled blinded trial. Vet Dermatol 13 (2), 77-87 PubMed.
  • 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 PubMed.
  • 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 (3), 204-211 PubMed.
  • Scott D W & Miller W H (1999) Antihistamines in the management of allergic pruritus in dogs and cats. JSAP 40 (8), 359-364 PubMed.
  • 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 (2), 109-116 VetMedResource.
  • Dérer M, Morrison-Smith G & de Weck A L (1998) Monoclonal anti IgE antibodies in the diagnosis of dog allergy. Vet Derm 9 (3), 185-190 VetMedResource.
  • 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 (3), 179-184 Wiley Online Library.
  • Hämmerling R & de Weck A L (1998) Comparison of 2 diagnostic tests for canine atopy using monoclonal anti IgE antibodies. Vet Derm (3), 191-199 VetMedResource.
  • 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 (4), 243-247 ResearchGate.
  • 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 (4), 144-152 VetMedResource.
  • Codner E C & Griffin C E (1996) Serologic allergy testing in dogs. Comp Cont Ed Prac Vet 18 (3), 237-248 VetMedResource.
  • 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 PubMed.
  • 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 PubMed.
  • Paterson S (1995) Additive benefits of EFAs in dogs with atopic dermatitis after partial response to antihistamine therapy. JSAP 36 (9), 389-394 PubMed.
  • Willemse T (1985) BSAVA Education Committee commissioned article. Atopic skin disease: a review and a reconsideration of diagnostic criteria. JSAP 27 (11), 771-778 VetMedResource.

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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