![Hoff S.](/sites/default/files/images/media/image/Unknown_4.jpg)
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Feline cutaneous adverse food reactions
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Owners are often keen to blame their cat’s diet if their pet develops a skin problem, but is this correct? In this article the authors discuss appropriate methods for the diagnosis and treatment of adverse food reactions.
Sarah Hoff - DVM, MPH
Dr. Hoff completed a Masters of Public Health in epidemiology prior to attending veterinary school at the University of Missouri. After graduation she spent three years in small animal general practice before pursuing specialization in dermatology. She is currently a third-year dermatology resident at Iowa State University.
![Hoff S.](/sites/default/files/images/media/image/Unknown_4.jpg)
Darren Berger - DVM, Dip. ACVD
Dr. Berger qualified from Iowa State University in 2007 and worked in small animal practice for some years before returning to academia. He is currently an Associate Professor of Dermatology at Iowa State University’s College of Veterinary Medicine, with research interests that include clinical pharmacology and the management of allergic hypersensitivity disorders.
![Berger D.](/sites/default/files/images/media/image/Berger_Darren_web_0.jpg)
Key points
- Cutaneous adverse food reaction in cats is indistinguishable from other allergic hypersensitivities on the basis of clinical presentation and lesion location.
- Non-seasonal pruritus is the most common clinical sign associated with an adverse food reaction.
- An adverse food reaction can only be accurately diagnosed through an elimination diet trial utilizing a balanced home-cooked diet, prescription novel protein or hydrolyzed diet for at least 8 weeks.
- Client education will improve compliance with diet elimination trials and can be key to successful diagnosis and treatment.
Introduction
A common misconception amongst pet owners is that clinical signs of a food allergy occur soon after a change of diet. While adverse reactions to foods can occur shortly after a new diet is introduced, such reactions are rarely allergic in nature because of the time required to develop an immunologic response, and it is important to educate owners on the distinction between food intolerance and food allergy. Food intolerance represents any abnormal physiological response that is not immunologically mediated to a component, toxin, or product in the food that results in an undesirable side effect (1). The most common example is lactose intolerance, in which the inability to digest lactose results in hyper-osmotic diarrhea and subsequent flatulence, abdominal discomfort and diarrhea. Food allergy, on the other hand, refers to an immunological reaction to a component in a food, and may be either an immediate type I hypersensitivity reaction, mediated through IgE, or a delayed type hypersensitivity, mediated through lymphocytes and their cytokines (1). In animals the distinction between food intolerance and food allergy may be difficult to make, and thus the term “adverse food reaction” has been proposed to encompass all etiologies that result in a clinically abnormal response attributable to the ingestion of a food substance (2). In the cat, adverse food reactions most commonly manifest as skin disease and gastrointestinal disease, although more rarely they can result in conjunctivitis, rhinitis, neurological signs, and behavioral abnormalities (1) (3). This article will primarily discuss manifestations of cutaneous adverse food reactions (CAFR).
Initial investigations for CAFR
CAFR is a relatively uncommon diagnosis in cats, with the overall reported prevalence ranging from 0.2-6%, although prevalence greatly increases amongst cats presenting to a veterinarian for a primary complaint of pruritus (12-21%) or allergic skin disease (5-13%) 4, and a structured approach to diagnosis is essential.
History and clinical presentation
In order to make an accurate diagnosis and treatment plan, the importance of obtaining a complete history cannot be understated; this includes a thorough diet history, which helps to determine previous exposures and guide future treatments. Examples of important questions to ask owners regarding their cat’s skin disease are listed in Table 1, and information gained from a thorough history can narrow the differential list and help guide next steps. For example, the absence of a regular flea control program may make flea allergy dermatitis a primary differential, and if multiple animals from a household are displaying clinical signs a contagious parasite or pathogen is more likely.
![Table 1. Sample questions for acquisition of a complete history.](/sites/default/files/images/media/image/Screenshot%202021-04-15%20at%2010.01.27.png)
Clinical signs of CAFR can appear at any age but are most commonly seen in young to middle aged cats, with an average age at onset of 3.9 years, and there does not appear to be a clear breed or sex predilection (5). The most frequent clinical sign is non-seasonal pruritus (5), with a variable prevalence of concurrent gastrointestinal signs, reported at around 17-22% of affected cats (2). When present, the most common gastrointestinal sign associated with an adverse food reaction is vomiting, followed by flatulence and diarrhea (3).
Previous response to therapy can be variable. One study reported that all 17 cats diagnosed with CAFR had at least a partial response to either systemic or topical glucocorticoids (6), but another retrospective study of 48 affected cats noted that systemic glucocorticoids were ineffective in 61% of cases (7). In a third study of 10 cats with CAFR, owners reported no benefit from injectable long-acting glucocorticoids (8). [...]
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