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Adverse Food Reactions- are they worth
investigating?
Anthony Chadwick BVSc CertVD MRCVS
The Webinar Vet
In my Liverpool home
• Qualified in 1990
• CertVD in 1995
• Set up The Webinar Vet in 2010
• Sold first opinion practice in 2011
The Story of Rosie McCartney
The Take Home Messages
• Food Allergy/Intolerance is an important cause of
skin disease in dogs and cats
• Food Trials are difficult to do well
• There are often other components contributing to
the itch
Outline of Talk
• Some definitions
• Aetiology and Pathogenesis
• Clinical Signs
• Diagnosis
• Treatment
Definitions
• Adverse reaction to food
• Food allergy reactions
• Food intolerance reactions
Atopic dermatitis and food allergy in humans
• Numerous studies show a clear relationship
between food allergens and the development of AD
• Often food allergy seen in infants and young
children
• Just under 40% of AD cases will have concurrent
food allergy
Aetiology and Pathogenesis
• Not fully elucidated in dogs
• A subset have an IgE mediated food allergy
• Also type III and IV
• However vast majority no immunological cause
found
Aetiopathogenesis
• Puppies who have a poor start to life
• Intestines damaged by virus or worms. Protein allergens can
gain access systemically
• Histamine releasing factors continue to be active long after
offending allergen removed
• In older dogs sensitisation to an antigen may follow a long
refractory period of upto 2 years before clinical signs are
present
• In 80% of cases only 1-2 allergens involved
• Common allergens include: beef, soya, chicken,
milk, corn, lamb, wheat, eggs and lamb
How long should you perform a food trial for
• 7 days
• 21 days
• 28 days
• 42 days
• 84 days
What % of your allergic pets have a food
component
• Less than 5%
• 5-10%
• 10-15%
• 15-20%
• More than 20%
How common is Adverse Reaction to Food
• 30% Chamberlain
• 3% Kunkle
• 2% Carlotti
• 13% Saridomichelakis
• 23% Jackson
Clinical Signs
• Food allergy can develop at any age
• I see 2 subsets: very young and 7 plus
• Labradors predisposed
• Abyssinians also
Clinical signs 2
• Non seasonal pruritus
• Recurrent pyoderma
• Similar distribution to atopy
• angioedema
• Otitis
• Concurrent GI signs
Clinical signs in cats
• Miliary dermatitis
• Symmetrical alopecia
• Head and neck pruritus
• Eosinophilic granuloma complex
• Concurrent GI signs in about 30% of cats
Diagnosis
Food Trial!
Food Trialling
• 4-12 weeks required
• Home prepared
• Unusual protein source
• Hydrolysate
• All non seasonal pruritus should be food trialled
Hydrolysed Proteins
Mast cell
degranulation
Allergenic
protein
Histamin
e
IgE
Sensitised mast cell
Polypeptides
(HYDROLYSATES)
Intact
protein
Enzymatic
hydrolysis
Hydrolysed Proteins
Mast cell
degranulation
Hydrolyse
d
proteins
No crosslinking – no degranulation
26
© Royal Canin SAS 2012. All Rights Reserved.
Extreme hydrolysation:
• Low molecular weight feather
hydrolysate
• In an overall diet analysis, 95%
of the diet is less than 1kDa
EXTREME HYDROLYSIS
Independent analysis of final product
Alternative tests
• Intestinal permeability
• Gastric provocation
• Colonoscopy provocative test
• Intradermal skin test
• Patch test
• Serum IgE testing
Food Challenging
• Feed all old diet back again
• Response usually rapid but upto 3 weeks reported
• Then individual ingredients
• Dairy relapse in 4 days, cereal 8 days(Harvey)
Treat other clinical signs
• Malassezia
• Pyoderma
• Otitis
How much allergen is too much?
• Jackson’s beagle colony reacted to 1g of corn
• Some animals may be less sensitive
Are the diets sufficient for lifelong use?
• Anallergenic
• Hypoallergenic
• Home prepared diet
My plan for non-seasonal pruritus
• Treat infections
• Food and flea trial
• See back in 4 weeks
• Continue food trial if some improvement, possibly skin
test
• Food challenge at 8 weeks
• If positive try individual allergens
Vets South offer
• All my topics on slide share and access at The
Webinar Vet
• £1 membership offer
• Access to pet webinars
Upcoming webinars
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• Cushings disease- The American Perspective
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Thanks
Vets South team
Any Questions?
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Adverse reactions to food. Are they worth investigating

  • 1. Adverse Food Reactions- are they worth investigating? Anthony Chadwick BVSc CertVD MRCVS The Webinar Vet
  • 3. • Qualified in 1990 • CertVD in 1995 • Set up The Webinar Vet in 2010 • Sold first opinion practice in 2011
  • 4. The Story of Rosie McCartney
  • 5. The Take Home Messages • Food Allergy/Intolerance is an important cause of skin disease in dogs and cats • Food Trials are difficult to do well • There are often other components contributing to the itch
  • 6. Outline of Talk • Some definitions • Aetiology and Pathogenesis • Clinical Signs • Diagnosis • Treatment
  • 7. Definitions • Adverse reaction to food • Food allergy reactions • Food intolerance reactions
  • 8. Atopic dermatitis and food allergy in humans • Numerous studies show a clear relationship between food allergens and the development of AD • Often food allergy seen in infants and young children • Just under 40% of AD cases will have concurrent food allergy
  • 9. Aetiology and Pathogenesis • Not fully elucidated in dogs • A subset have an IgE mediated food allergy • Also type III and IV • However vast majority no immunological cause found
  • 10. Aetiopathogenesis • Puppies who have a poor start to life • Intestines damaged by virus or worms. Protein allergens can gain access systemically • Histamine releasing factors continue to be active long after offending allergen removed • In older dogs sensitisation to an antigen may follow a long refractory period of upto 2 years before clinical signs are present
  • 11. • In 80% of cases only 1-2 allergens involved • Common allergens include: beef, soya, chicken, milk, corn, lamb, wheat, eggs and lamb
  • 12. How long should you perform a food trial for • 7 days • 21 days • 28 days • 42 days • 84 days
  • 13. What % of your allergic pets have a food component • Less than 5% • 5-10% • 10-15% • 15-20% • More than 20%
  • 14. How common is Adverse Reaction to Food • 30% Chamberlain • 3% Kunkle • 2% Carlotti • 13% Saridomichelakis • 23% Jackson
  • 15. Clinical Signs • Food allergy can develop at any age • I see 2 subsets: very young and 7 plus • Labradors predisposed • Abyssinians also
  • 16. Clinical signs 2 • Non seasonal pruritus • Recurrent pyoderma • Similar distribution to atopy • angioedema • Otitis • Concurrent GI signs
  • 17.
  • 18.
  • 19. Clinical signs in cats • Miliary dermatitis • Symmetrical alopecia • Head and neck pruritus • Eosinophilic granuloma complex • Concurrent GI signs in about 30% of cats
  • 20.
  • 21.
  • 23. Food Trialling • 4-12 weeks required • Home prepared • Unusual protein source • Hydrolysate • All non seasonal pruritus should be food trialled
  • 24. Hydrolysed Proteins Mast cell degranulation Allergenic protein Histamin e IgE Sensitised mast cell Polypeptides (HYDROLYSATES) Intact protein Enzymatic hydrolysis
  • 26. 26 © Royal Canin SAS 2012. All Rights Reserved. Extreme hydrolysation: • Low molecular weight feather hydrolysate • In an overall diet analysis, 95% of the diet is less than 1kDa EXTREME HYDROLYSIS Independent analysis of final product
  • 27. Alternative tests • Intestinal permeability • Gastric provocation • Colonoscopy provocative test • Intradermal skin test • Patch test • Serum IgE testing
  • 28. Food Challenging • Feed all old diet back again • Response usually rapid but upto 3 weeks reported • Then individual ingredients • Dairy relapse in 4 days, cereal 8 days(Harvey)
  • 29. Treat other clinical signs • Malassezia • Pyoderma • Otitis
  • 30. How much allergen is too much? • Jackson’s beagle colony reacted to 1g of corn • Some animals may be less sensitive
  • 31. Are the diets sufficient for lifelong use? • Anallergenic • Hypoallergenic • Home prepared diet
  • 32. My plan for non-seasonal pruritus • Treat infections • Food and flea trial • See back in 4 weeks • Continue food trial if some improvement, possibly skin test • Food challenge at 8 weeks • If positive try individual allergens
  • 33. Vets South offer • All my topics on slide share and access at The Webinar Vet • £1 membership offer • Access to pet webinars
  • 34. Upcoming webinars • Sub plexus flaps • Cushings disease- The American Perspective • Glaucoma • Equine series • 400 hours of archive
  • 37. 10% of sales going to gorilla conservation • Bwindi Impenetrable Forest 2005 • #gorillachallenge

Editor's Notes

  1. Inflammatory mediators Cytokines chemokines