The ACVD task force on canine atopic dermatitis: forewords and lexicon

Efficacy of Allogeneic and Xenogeneic Exosomes for the Treatment of Canine Atopic Dermatitis: A Pilot Study

Canine atopic dermatitis (CAD) is a genetically predisposed inflammatory pruritic skin disease. The available treatments for CAD have several adverse effects and vary in efficacy, indicating the need for the development of improved treatments. In this study, we aimed to elucidate the therapeutic effects of allogeneic and xenogeneic exosomes on CAD. Six laboratory beagle dogs with CAD were randomly assigned to three treatment groups: control, canine exosome (cExos), or human exosome (hExos) groups. Dogs in the cExos and hExos groups were intravenously administered 1.5 mL of cExos (5 × 1010) and hExos (7.5 × 1011) solutions, respectively, while those in the control group were administered 1.5 mL of normal saline three times per week for 4 weeks. Skin lesion score and transepidermal water loss decreased in cExos and hExos groups compared with those in the control group. The exosome treatments decreased the serum levels of inflammatory cytokines (interferon-γ, interleukin-2, interleukin-4, interleukin-12, interleukin-13, and interleukin-31) but increased those of anti-inflammatory cytokines (interleukin-10 and transforming growth factor-β), indicating the immunomodulatory effect of exosomes. Skin microbiome analysis revealed that the exosome treatments alleviated skin bacterial dysbiosis. These results suggest that allogeneic and xenogeneic exosome therapy may alleviate CAD in dogs.

A review of cutaneous hypersensitivity reactions in dogs: A diagnostician's guide to allergy

Allergic dermatoses are common in people and domestic animals. Resultant lesions are routinely biopsied and submitted for histological examination to confirm a diagnosis or rule out diseases with overlapping or atypical clinical features. Diagnostic pathologists and clinicians are often faced with the difficult task of determining whether an allergic reaction pattern is present on both the microscopic and macroscopic levels and correlating histopathologic findings with clinical and historical data to achieve a precise clinical diagnosis. The bulk of the current veterinary literature on allergic dermatoses focuses on atopic dermatitis in dogs, distantly followed by cats, horses, and other animals. The objectives of this review are to demonstrate the key histopathologic and clinical diagnostic features of the various allergy-mediated reaction patterns, and to provide diagnosticians with a practical guide for clinicopathological correlations. Current concepts in the pathophysiology of immediate hypersensitivity reactions, with a focus on atopic dermatitis, are discussed. Points of potential histopathologic overlap between the "classic" allergic reaction pattern and less common inflammatory, predominately eosinophilic, conditions that may mimic this pattern will be discussed with the goal of highlighting the critical need for collaboration between pathologists and clinicians in furthering patient care.

Quality of Life of Allergic Dogs Treated with Allergen-Specific Immunotherapy-A Retrospective Study

BACKGROUND

The quality of life (QoL) of dogs with canine atopic dermatitis (CAD) treated with allergen-specific immunotherapy (ASIT) was studied to determine whether the QoL of dogs treated with ASIT (AG) improved compared with dogs not treated with ASIT (CG).

METHODS

The power of the study was calculated in advance assuming that the AG would assess QoL 20% better than the CG. The CG consisted of 21 dogs with CAD and the AG of 46 dogs with CAD. Validated QoL1 (pre-treatment) and QoL2 (post-treatment) questionnaires were emailed to owners.

RESULTS

AG dogs were significantly less disturbed during mealtimes (i.e., had better appetites and scratched less during mealtimes) and caused significantly less physical discomfort to their owners (due to unpleasant odor, the impression of a dirty apartment) than CG dogs. Owners of dogs treated with ASIT were able to significantly improve their daily activities (leisure, vacation, walks, work, hunting), significantly reduce their expenses (treatment costs, veterinary costs), feel significantly less emotional distress (less guilt, powerlessness, sadness, regret, fear, anger, disgust, rage, frustration), and experience less influence on relationships with family members and friends compared to owners of dogs not treated with ASIT.

CONCLUSIONS

According to our results, the quality of life of dogs treated with ASIT and their owners seemed to improve significantly.

Establishing an experimental model for canine atopic dermatitis through epicutaneous application of Dermatophagoides farinae

There is no established protocol for the development of an experimental canine atopic dermatitis model in laboratory beagles. This study aimed to establish an experimental model that mimics spontaneous canine atopic dermatitis (CAD) clinically, immunologically, and microbiologically, by repeated epicutaneous applications of mite antigens and to describe the entire process including sensitization and provocation in detail for reproducibility. Six intact male laboratory beagle dogs aged 14 months were included in this study. During the sensitization and provocation phase, the house dust mite (HDM) paste consisted of Dermatophagoides farinae (Der f ) and mineral oil, which was applied focally to the 10 × 10 cm area of the right groin as evenly as possible. Further, 120 mg of Der f was applied to each dog twice a week for 12 weeks during the sensitization phase and 25 mg and 120 mg was applied to each dog for the first 2 weeks and subsequent 2 weeks, respectively, during the provocation phase. Thereafter, the applied area was covered with a dressing. Skin lesions including erythema, hyperpigmentation, excoriation, and lichenification were induced and exacerbated gradually through the experimental time course in all six dogs. The canine atopic dermatitis extent and severity index (CADESI) score and transepidermal water loss (TEWL) significantly increased after sensitization and provocation. IL-13 and IL-31 levels increased significantly after provocation as a result of the activation of the T helper-2 (Th2) response. On the contrary, the IL-10 levels decreased significantly after sensitization, which suggested a suppression of Tregs activity. After the completion of provocation, skin microbiome analysis showed that Firmicutes was the most abundant phylum, which indicated bacterial dysbiosis. This study demonstrated that epicutaneous application of HDM in beagle dogs resulted in the elevation of serum HDM-specific IgE levels and clinical atopic scores, a high TEWL, and microbiome dysbiosis resembling spontaneous CAD. These results suggest that this tailored protocol of epicutaneous exposure to Der f may provide support for the development of the experimental CAD model in laboratory beagles.

Clinical relevance of intradermal test results in atopic dogs

TOPIC AND AIMS

Canine atopic dermatitis (AD) is an inflammatory and pruritic skin disease and in most cases associated with IgE antibodies against environmental allergens. To date, the only causative therapeutic option is allergen immunotherapy (AIT). Offending allergens for AIT can be identified by intradermal testing (IDT) or serum allergen-specific IgE testing. The aim of the study was to evaluate positive IDT results considering the atopic dogs' clinical history.

MATERIAL AND METHODS

An IDT was performed on 48 atopic dogs and their owners completed a detailed questionnaire about the seasonal course of their pruritus. Results of IDT were correlated with the seasonal occurrence of pruritus.

RESULTS

The most common positive IDT reactions were observed to mite allergens (33.3-62.5 %). Prevalence of positive reactions to individual tree, grass and weed pollen ranged between 8.3 % and 25 %. Moulds and epithelial allergens produced positive reactions in only 0-6.3 %. A correlation between positive IDT reactions and course of pruritus could neither be found for perennial nor for seasonal allergens.

CONCLUSION

The evaluation of IDT reactions may not be an optimal method for identification of clinically relevant allergens in canine AD.

CLINICAL RELEVANCE

The results of this study emphasise the importance of considering clinical history in addition to allergy test results in the formulation of an allergen extract for desensitisation.

Clinical effects of 2 commercially available diets on canine atopic dermatitis

OBJECTIVE

Canine atopic dermatitis (CAD) is a common skin disease in dogs. Prior studies were able to determine beneficial effects of essential fatty acids (EFA) on the clinical signs of CAD. The aim of this study was set to evaluate the effects of a newly designed, EFA-enriched diet on the clinical signs of CAD compared to another EFA-enriched diet.

MATERIALS AND METHODS

In this prospective, randomized, double-blinded study, 31 privately owned dogs with atopic dermatitis received either the control diet (diet A, Hill's Prescription Diet™ d/d™ Salmon & Rice, n = 17) or the test diet (diet B, Veterinary HPM™ Dermatology Support D1, Virbac, n = 14) for 12 weeks. At the beginning of the study as well as after 4, 8 and 12 weeks, skin lesions and pruritus were evaluated via validated scores and the administered medication was documented. At the same time, the dogs' coat quality was evaluated via a distinct scoring system. In both groups, a total of 7 dogs each completed the entire study.

RESULTS

After 12 weeks, there was a mild improvement in lesion scores, pruritus and coat quality with both diets.

CLINICAL RELEVANCE

In this study, both diets improved the patients' skin lesions pruritus and coat quality.

A survey of primary care practitioners' referral habits and recommendations of allergen-specific immunotherapy for canine and feline patients with atopic dermatitis

BACKGROUND

A recent pilot study of primary care veterinarians' attitudes regarding canine atopic dermatitis and initiation of allergen-specific immunotherapy (ASIT) revealed several barriers to specialist referral (in the USA) and use of ASIT as a treatment modality.

HYPOTHESIS/OBJECTIVES

The primary objective was to collect data on referral habits and ASIT practices among a much larger cohort of primary care veterinarians located around the world, and to explore barriers to referral and management of atopic diseases of dogs and cats with ASIT.

METHODS AND MATERIALS

An online survey, administered through the Veterinary Information Network (VIN, Davis, CA, USA), asked participants to self-report their referral habits and immunotherapy recommendations, and rate barriers and motivating factors using Likert-scale responses.

RESULTS

Of 827 survey responses, 97.6% identified as primary care practitioners. A larger number of practitioners (84.5%) reported seeing atopic dogs often, compared with atopic cats (9.7%). Fewer of these veterinarians (56.6%) referred atopic cats for specialist care, compared to atopic dogs (73.5%). Timely communication, sharing long-term management of the case, and provision of local continuing education were identified as factors associated with increased willingness to refer. A higher proportion of practitioners reported recommending ASIT for dogs (44.3%) than for cats (16.0%). Only 56.0% of respondents considered success rates of ASIT to be acceptable, while 27.9% were neutral on the topic.

CONCLUSIONS AND CLINICAL RELEVANCE

Dermatology specialists might build stronger relationships with referring veterinarians through timely case follow-up and provision of continuing education regarding the long-term benefits of ASIT and symptomatic management practices.

[Effects of a homeopathic medication on clinical signs of canine atopic dermatitis]

OBJECTIVE

A commercially available medication containing homeopathic ingredients showed first signs of success in atopic dermatitis in dogs. The aim of this case series was to evaluate the effect of the preparation in a larger number of dogs with atopic dermatitis.

MATERIAL AND METHODS

Ten atopic dogs received the oral homoeopathic combination preparation daily for 3 weeks according to the manufacturer's specifications. The diagnosis of atopic dermatitis was made previously by medical history, clinical examination and exclusion of differential diagnoses. Skin infections with bacteria and yeasts were excluded by clinical examination and cytological evaluation of impression smears. In food-allergic dogs, an elimination diet was fed at least 2 months prior and during the entire study period. Patients with suspected or confirmed flea allergy received flea control for at least 1 month prior to and during the study. The clinical signs were evaluated before and after therapy using a validated Pruritus Visual Analogue Acale (PVAS) and the Canine Atopic Dermatitis Lesion Index (CADLI). The coat quality was assessed by the owners. Possible adverse effects were recorded at the recheck.

RESULTS

There were no significant changes in the lesion score (Wilcoxon test, p = 1.0), pruritus score (paired t test, p = 0.34) and coat quality (paired t test, p = 0.34) over the duration of treatment. Only one patient showed a slight improvement in itching and coat quality. No side effects were observed.

CONCLUSION AND CLINICAL RELEVANCE

In this case series, the tested homoeopathic preparation did not show a positive effect on the clinical signs of canine atopic dermatitis.

A pilot study to identify perceived barrier and motivating factors of primary veterinarians in the USA for specialty referral and management of atopic dermatitis with allergen-specific immunotherapy

BACKGROUND

Allergen-specific immunotherapy (ASIT) may decrease clinical signs and potential neosensitization in dogs with canine atopic dermatitis (cAD). Identification of barriers to referral and specialty level case management may improve clinical outcome and satisfaction for both clients and primary veterinarians.

HYPOTHESIS/OBJECTIVES

The objective of this cross-sectional, descriptive, survey-based pilot study was to identify factors influencing a veterinarian's decision to recommend dermatology referral and prescribe ASIT for management of cAD.

METHODS AND MATERIALS

An online survey was administered to small animal veterinarians through two veterinary associations in the western United States. Participants were asked to rate factors using Likert scales.

RESULTS

Of 60 responses, 18 (30%) rarely or never recommended ASIT. The top three factors against recommending ASIT included successful pharmaceutical management (100%), clients' concern for cost (94.4%) and veterinarians' perceptions that immunotherapy is unable to reduce pharmacological dependency (83.4%). The top three motivating factors included concerns for glucocorticoid adverse effects (83.3%), animal/owner quality of life (77.8%) and risk of antimicrobial resistant infection (55.6%). Results of the secondary objective revealed that 19 of 60 (31.7%) respondents rarely or never refer atopic pets to a dermatologist, citing cost of referral, availability of serological testing, and perception of limited benefits as the greatest barriers.

CONCLUSIONS AND CLINICAL SIGNIFICANCE

Numerous factors appear to influence decisions to recommend referral or ASIT for management of pets with cAD. Further work is needed to determine if these can be generalized to larger populations with a goal of providing suggestions to bridge these gaps and improve outcomes.

Lesion distribution in cases of canine atopic dermatitis in South Australia

OBJECTIVE

To determine the lesion distribution patterns in different breeds of dogs affected by atopic dermatitis in South Australia.

METHODS

The presence or absence of erythematous skin lesions in 267 cases of canine atopic dermatitis (CAD) was recorded across 36 anatomical sites. Breeds represented by ≥ 9 dogs were included in the analysis. The percentage of dogs showing lesions at each of the body sites was calculated and illustrated on colour-coded diagrams. Variations in affected body sites within and between breeds were compared using Kruskal-Wallis ANOVA and Dunn's multiple comparison tests.

RESULTS

The prevalence of skin lesions at different body sites differed significantly both in the population as a whole and within breeds. The sites affected in ≥ 75% dogs were the dorsal and ventral aspects of the front and hind paws. The sites affected in 50-74% were the medial pinnae, axillae, ventral chest, abdomen and perineum. Sites affected in 25-49% of dogs included the face, periocular region and forelimb. Remaining body sites were affected in < 25% of dogs. Analysis at the breed level revealed some differences from this standard distribution pattern.

CONCLUSION

The results of this study confirmed the typical lesion distributions seen in CAD and highlighted some subtle differences in breeds commonly seen in South Australia. This will be useful for clinical practitioners in prioritising differential diagnoses for pruritic skin conditions.

Vitamin D shows in vivo efficacy in a placebo-controlled, double-blinded, randomised clinical trial on canine atopic dermatitis

Atopic dermatitis (AD) in dogs is among the most common skin diseases in small animal practice. It is an inflammatory disease based on a genetic predisposition to develop hypersensitivity against environmental and food allergens and typical clinical signs up exposure. Treatment sometimes can be difficult and associated with adverse effects. Previous studies evaluating cholecalciferol as treatment for human AD have shown promising results. With canine AD being a good animal model for its human counterpart, it was hypothesised that cholecalciferol might have beneficial clinical effects in dogs, too. In this randomised, placebo-controlled, double-blinded eight-week cross-over study, 23 client-owned dogs received either systemic cholecalciferol (n=16), a vitamin D receptor analogue (n=8) or placebo (n=13). Blood samples for ionised calcium were obtained regularly during the study, and Canine Atopic Dermatitis Extent and Severity Index and pruritus scores, blood levels of vitamin D metabolites, measurements of skin pH and transepidermal water loss were determined before and after. Pruritus and lesion scores decreased significantly in the cholecalciferol group versus placebo. No differences in water loss or skin pH were observed. An increase in serum 25-hydroxycholecalciferol strongly correlated with a reduction in pruritus. Systemic cholecalciferol may be a viable treatment option for canine AD.

Lymphocytic, cytokine and transcriptomic profiles in peripheral blood of dogs with atopic dermatitis

Background

Canine atopic dermatitis (cAD) is a common chronic and pruritic skin disease in dogs. The development of cAD involves complex interactions between environmental antigens, genetic predisposition and a number of disparate cell types. The aim of the present study was to perform comprehensive analyses of peripheral blood of AD dogs in relation to healthy subjects in order to determine the changes which would be characteristic for cAD.

Results

The number of cells in specific subpopulations of lymphocytes was analyzed by flow cytometry, concentration of chosen pro- and anti-inflammatory cytokines (IL-4, IL-10, IL-13, TNF-α, TGF-β1) was determined by ELISA; and microarray analysis was performed on RNA samples isolated from peripheral blood nuclear cells of AD and healthy dogs. The number of Th cells (CD3⁺CD4⁺) in AD and healthy dogs was similar, whereas the percentage of Tc (CD3⁺CD8⁺) and Treg (CD4⁺CD25⁺ Foxp3⁺) cells increased significantly in AD dogs. Increased concentrations of IL-13 and TNF-α, and decreased levels of IL-10 and TGF-β1 was observed in AD dogs. The level of IL-4 was similar in both groups of animals. Results of the microarray experiment revealed differentially expressed genes involved in transcriptional regulation (e.g., transcription factors: SMAD2, RORA) or signal transduction pathways (e.g., VEGF, SHB21, PROC) taking part in T lymphocytes lineages differentiation and cytokines synthesis.

Conclusions

Results obtained indicate that CD8⁺ T cells, beside CD4⁺ T lymphocytes, contribute to the development of the allergic response. Increased IL-13 concentration in AD dogs suggests that this cytokine may play more important role than IL-4 in mediating changes induced by allergic inflammation. Furthermore, observed increase in Treg cells in parallel with high concentrations of TNF-α and low levels of IL-10 and TGF-β1 in the peripheral blood of AD dogs point at the functional insufficiency of Treg cells in patients with AD.

Electronic supplementary material

The online version of this article (doi:10.1186/s12917-016-0805-6) contains supplementary material, which is available to authorized users.

Specificity in the alteration of lesional and non-lesional skin lipids in atopic dogs

The present paper is in the same time an overview of the literature concerning the alterations of lipids in the stratum corneum (SC) of atopic dogs and a review of data based on our publications. Knowing the importance of the SC barrier function for against pathogens in atopic dermatitis, we show for the first time a detailed biochemical analysis of lipids corresponding to the same amount of proteins in the successive layers of canine SC taken using tape stripping and their specificity as compared to humans. Also we show new results concerning the changes in the composition for protein-bound ceramides, and for the other lipids in involved and non-involved skin areas in atopic dogs. We show how a topical or oral treatment can restore the SC lipid composition and reconstruct the barrier integrity by up-regulating the biosynthesis of protein-bound ceramides.

Gene expression in the skin of dogs sensitized to the house dust mite Dermatophagoides farinae

Atopic dermatitis is a multifactorial allergic skin disease in humans and dogs. Genetic predisposition, immunologic hyperreactivity, a defective skin barrier, and environmental factors play a role in its pathogenesis. The aim of this study was to analyze gene expression in the skin of dogs sensitized to house dust mite antigens. Skin biopsy samples were collected from six sensitized and six nonsensitized Beagle dogs before and 6 hr and 24 hr after challenge using skin patches with allergen or saline as a negative control. Transcriptome analysis was performed by the use of DNA microarrays and expression of selected genes was validated by quantitative real-time RT-PCR. Expression data were compared between groups (unpaired design). After 24 hr, 597 differentially expressed genes were detected, 361 with higher and 226 with lower mRNA concentrations in allergen-treated skin of sensitized dogs compared with their saline-treated skin and compared with the control specimens. Functional annotation clustering and pathway- and co-citation analysis showed that the genes with increased expression were involved in inflammation, wound healing, and immune response. In contrast, genes with decreased expression in sensitized dogs were associated with differentiation and barrier function of the skin. Because the sensitized dogs did not show differences in the untreated skin compared with controls, inflammation after allergen patch test probably led to a decrease in the expression of genes important for barrier formation. Our results further confirm the similar pathophysiology of human and canine atopic dermatitis and revealed genes previously not known to be involved in canine atopic dermatitis.

Efficacy of dimetinden and hydroxyzine/chlorpheniramine in atopic dogs: a randomised, controlled, double-blinded trial

Antihistaminic drugs are commonly used as symptomatic therapy of atopic dermatitis in dogs. Unfortunately, their clinical benefit is largely unsubstantiated. In a double-blinded, placebo-controlled, cross-over trial, the influence of dimetinden and of a combination of chlorpheniramine and hydroxyzine on pruritus and lesions was evaluated in 19 dogs. They were treated with either product or a placebo orally for 14 days, each time followed by a 14-day washout period. Before and after each period, the dogs were examined and the Canine Atopic Dermatitis Extent and Severity Index (CADESI) determined by a clinician, and the pruritus and general condition by the owner. Dimetinden improved the pruritus significantly (P=0.014) but not the CADESI (P=0.087), the combination of hydroxyzine and chlorpheniramine improved the CADESI (P=0.049) and pruritus (P=0.05) significantly. Ten of 17 dogs improved by more than 25 per cent in pruritus with the combination of hydroxyzine and chlorpheniramine, 12 of 18 with dimetindenmaleate and only 2 of 19 with placebo. Antihistamines can help to reduce pruritus in atopic dogs, but in most cases, the improvement is limited and additional treatment may be needed.

Concurrent short-term use of prednisolone with cyclosporine A accelerates pruritus reduction and improvement in clinical scoring in dogs with atopic dermatitis

Background

A randomized, unmasked, multicenter study was conducted to evaluate the rate of pruritus reduction and improvement in clinical scoring by cyclosporine A (5 mg/kg orally, once daily for 28 days) either alone (n = 25 dogs) or with concurrent prednisolone (1 mg/kg once daily for 7 days, followed by alternate dosing for 14 days; n = 23 dogs) for the treatment of atopic dermatitis in dogs. Dogs were included in the study after exclusion of other causes of pruritic dermatitis, and were assessed by dermatologists on days 0, 14 ± 1 and 28 ± 2. Assessments included: general physical examination, CADESI-03 lesion scoring, overall clinical response, evaluation of adverse events (AEs), body weight and clinical pathology (hematology, clinical chemistry and urinalysis). Owner assessments, including pruritus (visual analogue scale, VAS) and overall assessment of response were conducted every 3–4 days, either during visits to the clinic or at home. Owners reported AEs to the investigator throughout the study.

Results

By day 28 ± 2 both treatment groups resulted in a significant improvement of the atopic dermatitis. Both investigators and owners agreed that concurrent therapy resulted in a quicker improvement of the dogs ‘overall’ skin condition and of pruritus (significant reduction of pruritus by day 3–4, 72.8% improvement by day 14 ± 1), when compared to cyclosporine A alone (significant reduction of pruritus by day 7–8, 24.7% improvement by day 14 ± 1). CADESI-03 scores significantly improved in both groups by day 14 ± 1 onwards, and there were no significant differences in the scores between treatment groups at any time points. A total of 56 AEs (cyclosporine A alone = 34; concurrent therapy = 22) were reported in 33 dogs. No dogs died or stopped treatment due to an AE. The most commonly reported AEs in the cyclosporine A group were associated with the digestive tract, whilst systemic disorders were reported more frequently observed following concurrent therapy. Evaluation of body weight change and clinical pathology indices showed no overall clinically significant abnormalities.

Conclusions

In dogs with atopic dermatitis, a short initiating course of prednisolone expedited the efficacy of cyclosporine A in resolving pruritus and associated clinical signs. The observed adverse events were consistent with those expected for the individual veterinary medicinal products.

Cross-reaction and co-sensitization among related and unrelated allergens in canine intradermal tests

BACKGROUND

Intradermal tests are used to identify allergens for avoidance and immunotherapy in atopic dogs.

HYPOTHESIS/OBJECTIVES

To evaluate cross-reaction or co-sensitization among 53 intradermal test allergens.

ANIMALS

Six hundred and fifty-one client-owned dogs with atopic dermatitis.

METHODS

Intradermal tests were performed with 53 house dust/storage mite, epidermal, insect, tree, weed and grass pollen and mould allergens. Pairwise comparisons were used to calculate the odds ratios (ORs), 95% confidence intervals (CIs) and statistical significance for the results of each allergen pair, with significance at P < 0.0006 (Holm-Bonferroni correction to reduce the false-detection rate).

RESULTS

Apart from cotton, cockroach, red clover, grain smut and Penicillium, the results for the allergens within each group were statistically associated [ORs from 4.7 (CI 2.5-8.9) to 1229.4 (CI 166.5-1795.1); P = 0.0005 to P < 0.0001]. Excluding red clover and cotton, 94% of results between tree, weed and grass pollens were also statistically associated [ORs from 8.3 (CI 3.6-24.7) to 117 (CI 29.1-341); P = 0.0005 to P < 0.0001]. In contrast, few allergens from unrelated groups were statistically associated [ORs from 0.12 (CI 0.03-1.1) to 27.7 (CI 0.2-93); P = 1.0 to P < 0.0001]. The mean (SD) of the log e transformed ORs for the related and statistically associated allergens [5.3 (1.3)] was significantly greater than those for related but nonstatistically associated [1.7 (1.6)] or unrelated allergens [1.4 (1.4); P < 0.0001].

CONCLUSIONS AND CLINICAL IMPORTANCE

This suggests that there is cross-reaction or co-sensitization between related allergens. This could have implications for allergen selection in testing and immunotherapy, but further studies are required to differentiate cross-reaction from co-sensitization.

Genome-wide analysis in German shepherd dogs reveals association of a locus on CFA 27 with atopic dermatitis

Humans and dogs are both affected by the allergic skin disease atopic dermatitis (AD), caused by an interaction between genetic and environmental factors. The German shepherd dog (GSD) is a high-risk breed for canine AD (CAD). In this study, we used a Swedish cohort of GSDs as a model for human AD. Serum IgA levels are known to be lower in GSDs compared to other breeds. We detected significantly lower IgA levels in the CAD cases compared to controls (p = 1.1 × 10(-5)) in our study population. We also detected a separation within the GSD cohort, where dogs could be grouped into two different subpopulations. Disease prevalence differed significantly between the subpopulations contributing to population stratification (λ = 1.3), which was successfully corrected for using a mixed model approach. A genome-wide association analysis of CAD was performed (n cases = 91, n controls = 88). IgA levels were included in the model, due to the high correlation between CAD and low IgA levels. In addition, we detected a correlation between IgA levels and the age at the time of sampling (corr = 0.42, p = 3.0 × 10(-9)), thus age was included in the model. A genome-wide significant association was detected on chromosome 27 (praw = 3.1 × 10(-7), pgenome = 0.03). The total associated region was defined as a ~1.5-Mb-long haplotype including eight genes. Through targeted re-sequencing and additional genotyping of a subset of identified SNPs, we defined 11 smaller haplotype blocks within the associated region. Two blocks showed the strongest association to CAD. The ~209-kb region, defined by the two blocks, harbors only the PKP2 gene, encoding Plakophilin 2 expressed in the desmosomes and important for skin structure. Our results may yield further insight into the genetics behind both canine and human AD.

Gastrointestinal hemodynamics in dogs with nonfood induced atopic dermatitis

BACKGROUND

Canine atopic dermatitis can be a result of exposure to aeroallergens or trophallergens. Hemodynamic alterations occur in dogs with food hypersensitivity.

HYPOTHESIS/OBJECTIVES

To evaluate if hemodynamic alterations occur in dogs with NFICAD with lowered resistance to diastolic flow at fasting, after feeding, or both.

ANIMALS

Ten healthy dogs and 22 dogs with NFICAD were included from the hospital population.

METHODS

Blinded prospective study. Peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (MV), pulsatility index (PI), resistive index (RI) and PSV/EDV ratio were measured at fasting for both arteries (cranial mesenteric artery [CMA], celiac artery [CA]) and at 40 minutes after feeding in CMA and at 60 minutes in CA. The results were analyzed statistically with a mixed model.

RESULTS

There was no difference detected between groups of dogs for any variable except EDV during fasting (P = .01).

CONCLUSIONS AND CLINICAL IMPORTANCE

There is no decrease in resistance in NFICAD to diastolic flow. This observation could be explained by the absence intestinal inflammation in NFICAD.

Comparison of subjective and objective intradermal allergy test scoring methods in dogs with atopic dermatitis

An intradermal allergy test (IDT) is an important diagnostic tool for identifying offending allergens in canine atopic dermatitis. No standardized method of scoring an IDT has been described. The purpose of this study was to determine whether there is a correlation between a conventional, subjective IDT scoring method based on perceived wheal diameter, erythema, and turgor (0-4+) and an objective scoring method based on measuring wheal diameter alone. Thirty-four atopic dogs were skin tested with 68 different allergens. All skin tests were performed according to standard procedures, and any IDT score ≥2+ was considered clinically significant. When the subjective IDT scores were compared with the objective IDT scores in all dogs, there was a moderate level of correlation overall (r=0.457; P <0.0001). The highest level of agreement between subjective and objective scores was noted with the reactions assigned subjective scores of "0" and "2+." Overall, there was a slight level of agreement between subjective and objective scores based on clinical significance (i.e., subjective scores ≥2+; κ=0.20; P <0.0001). In conclusion, the authors believe that the objective scoring method used in this study may provide a point of reference for inexperienced individuals (dermatology residents, veterinarians, technicians) when learning to grade an IDT.

Common allergens of atopic dermatitis in dogs: comparative findings based on intradermal tests

Intradermal tests were performed on 58 dogs diagnosed with atopic dermatitis from 2004~2008 at the Veterinary Medical Teaching Hospital of Konkuk University, Korea. To compare the allergen distribution observed in the present investigation to the results from other studies conducted in Korea and elsewhere, the allergens were grouped according to their kinds. There was no significant difference in gender distribution among the dogs. The most common breeds among the 58 dogs were Maltese (n = 11) and Shih-tzu (n = 11). The average age was 4.8 years. The most frequently produced a positive reaction on the intradermal tests was mold (67.3%) followed by house dust (54.5%) and house dust mites (49.1%). The present study found a low distribution of dogs allergic to various outdoor allergens compared to studies performed in other countries; this may reflect differences in living conditions for dogs living in Korea.

Equine atopic skin disease and response to allergen-specific immunotherapy: a retrospective study at the University of California-Davis (1991-2008)

This retrospective study reports on the clinical presentation of equine atopic skin disease and evaluates response to treatment with allergen-specific immunotherapy (ASIT) based on intradermal testing and/or serum testing. Computerized medical records from January 1991 to December 2008 yielded 54 horses included in the study. Presenting clinical signs (CS) included urticaria (n=28), pruritus (n=8) or both (n=18). Forty-one of 54 horses received ASIT, and response to ASIT (n=32) was evaluated via telephone survey. Eighty-four per cent (n=27) of owners reported that ASIT reduced their horse's CS; 59% (n=19) were able to manage CS by ASIT alone. Three horses (9%) were managed with ASIT in combination with doxepin and discontinued use of corticosteroids. There was no statistical significance between type of test performed and reported success of ASIT (χ(2) analysis, P=0.53). Ninety-three per cent (n=30) of owners reported use of antipruritic medications prior to starting ASIT; 57% (n=17) of these owners reported discontinuing those medications due to success of ASIT. Adverse effects were limited to swelling at the injection site, seen in 16% (n=5). Seventy-five per cent (n=24) of owners elected to discontinue ASIT after 6 months to 8 years (mean 2.2 years): 15 due to resolution of CS, six due to persistent CS, two because the horse was sold, and one due to cost. Ten owners reported no recurrence of CS after discontinuing ASIT; five had recurrence within a median of 2 years of discontinuing ASIT (range 1-12 years). Allergen-specific immunotherapy is a safe and effective way to manage equine atopic skin disease.

Oxidative stress markers in canine atopic dermatitis

There are no data in the veterinary literature relating to oxidative stress in canine atopic dermatitis (CAD). The study aimed to determine levels of oxidative stress markers, plasma malondialdehyde (MDA), total antioxidant capacity (TAC), whole blood glutathione peroxidase (GPX) and erythrocyte superoxide dismutase (SOD), in 15 CAD patients and 17 healthy dogs. A correlation between CADESI (Canine Atopic Dermatitis Extent and Severity Index) score and MDA was also determined. Significantly higher plasma MDA levels were found in patients than in healthy dogs. The significant, highly positive correlation determined between CADESI score and MDA in the patient group indicates an association between the severity of CAD and the extent of oxidative damage to membrane lipids. There were no significant differences in TAC, GPX and SOD between patients and healthy dogs. Our findings suggest that oxidative stress with increased lipid peroxidation could be involved in the pathogenesis of atopic dermatitis in dogs.

Zinc-carnosine and vitamin E supplementation does not ameliorate gastrointestinal side effects associated with ciclosporin therapy of canine atopic dermatitis

Chelated zinc-carnosine and vitamin E [GastriCalm(®) (GCM); Teva Animal Health] is marketed as an anti-emetic supplement for dogs to assist the repair of damaged stomach and intestinal mucosa. The purpose of this prospective, double-blinded, placebo-controlled trial was to determine whether GCM reduced the frequency of vomiting, diarrhoea and appetite changes during initiation of ciclosporin (Atopica(®); Novartis Animal Health) therapy for the treatment of canine atopic dermatitis. Sixty privately owned dogs diagnosed with atopic dermatitis were randomly assigned to GCM (n=30) or placebo (n=30) groups. All dogs received ∼ 5 mg/kg ciclosporin (range, 3.5-5.8 mg/kg) once daily. Dogs <13.6 kg received half a tablet of GCM or placebo; dogs ≥ 13.6 kg received one tablet once daily. GastriCalm(®) or placebo was administered 30 min prior to eating, and the ciclosporin was administered 2 h after feeding. Owners recorded episodes of vomiting, diarrhoea and appetite changes. Dogs were examined on days 0 and 14. Forty-one of 60 dogs (68.3%) had at least one episode of vomiting, diarrhoea or appetite change, leaving nine placebo dogs (30%) and ten GCM dogs (33.3%) free of adverse events (AE). Twenty-seven of 60 dogs (45%) vomited, and 15 of 60 (25%) had diarrhoea. There was no significant difference in episodes of individual AEs, but the placebo group had a significantly lower total AE score (summation of episodes of appetite change, vomiting and diarrhoea; P=0.022). Small dogs (<6.82 kg) had significantly fewer total AEs in both treatment groups and tolerated ciclosporin better than larger dogs (P<0.05).

Genome-wide linkage study of atopic dermatitis in West Highland White Terriers

BACKGROUND

Canine atopic dermatitis (AD) is a common, heritable, chronic allergic skin condition prevalent in the West Highland White Terrier (WHWT). In canine AD, environmental allergens trigger an inflammatory response causing visible skin lesions and chronic pruritus that can lead to secondary bacterial and yeast infections. The disorder shares many of the clinical and histopathological characteristics of human AD and represents an animal model of this disorder that could be used to further elucidate genetic causes of human AD. Microsatellite markers genotyped in families of WHWTs affected with AD were used to perform a genome-wide linkage study in order to isolate chromosomal regions associated with the disorder.

RESULTS

Blood samples and health questionnaires were collected from 108 WHWTs spanning three families. A linkage simulation using these 108 dogs showed high power to detect a highly penetrant mutation. Ninety WHWTs were genotyped using markers from the Minimal Screening Set 2 (MSS-2). Two hundred and fifty six markers were informative and were used for linkage analysis. Using a LOD score of 2.7 as a significance threshold, no chromosomal regions were identified with significant linkage to AD. LOD scores greater than 1.0 were located in a 56 cM region of chromosome 7.

CONCLUSIONS

The study was unable to detect any chromosomal regions significantly linked to canine AD. This could be a result of factors such as environmental modification of phenotype, incorrect assignment of phenotype, a mutation of low penetrance, or incomplete genome coverage. A genome-wide SNP association study in a larger cohort of WHWTs may prove more successful by providing higher density coverage and higher statistical power.

Inhibitory effects of interleukin-10 plasmid DNA on the development of atopic dermatitis-like skin lesions in NC/Nga mice

Interleukin (IL)-10 exerts potent anti-inflammatory effects by suppression of both T-help (Th) 1 and Th2 cells. Previous studies have reported that IL-10 can ameliorate various inflammatory disorders. The present study was performed to examine whether IL-10 plasmid DNA could suppress development of atopic dermatitis (AD)-like skin lesions in NC/Nga mice, as an initial step towards the development of an appliance for use in dogs with AD. Intradermal injection of IL-10 plasmid DNA markedly inhibited the development of AD-like skin lesions, as evidenced by a marked decrease in skin symptoms and reduced inflammation within the skin lesions. Efficacy was confirmed by significant decreases in eosinophil ratio and serum IgE concentration, and a reduction in the number of Staphylococcus aureus recovered from the ear. Moreover, relative mRNA expression levels of IL-4 and interferon-γ in the skin lesions of mice injected with IL-10 plasmid DNA were also decreased compared with those of control mice. Of note, higher serum IL-10 levels in mice injected with IL-10 plasmid DNA were maintained compared with those in control mice. Taken together, the results indicate that IL-10 plasmid DNA can suppress the development of AD-like skin lesions by suppressing both Th1 and Th2 cell responses. Beneficial effects of IL-10 plasmid DNA may be expected in dogs with AD.

Determination of irritant threshold concentrations to weeds, trees and grasses through serial dilutions in intradermal testing on healthy clinically nonallergic dogs

Irritant threshold concentration (ITC) for intradermal testing (IDT) was determined in 31 healthy, clinically nonallergic dogs. Twenty-three allergens were tested at five variable concentrations ranging from 1000 to 8000 PNU/mL. To distinguish irritant reactions from subclinical IgE-mediated hypersensitivities, serum allergy testing was performed. ITCs were determined by evaluating the lowest concentration to which no dogs (0% cut-off) and to which at least 10% of dogs (> or = 10% cut-off) reacted. ITCs at the 0% cut-off were: 1000 PNU/mL (Johnson grass), 2000 PNU/mL (Ash, Lamb's Quarter and Bermuda), 3000 PNU/mL (Bahia, Rye, Pig Weed and Virginia Oak), 4000 PNU/mL (Marsh Elder and Maple), 5000 PNU/mL (Sorrel sheep) and 7000 PNU/mL (Cocklebur and Black Willow). ITC for Dog Fennel, Box Elder and Red Cedar was <1000 PNU/mL. ITCs at the > or = 10% cut-off were: 2500 PNU/mL (Johnson), 3000 PNU/mL (Box Elder), 5000 PNU/mL (Bahia), 6000 PNU/mL (Pigweed and Marsh Elder) and 8000 PNU/mL (Virginia Oak and Black Willow). For all other allergens, the ITC was >8000 PNU/mL and could not be determined. No significant agreement between positive values was found for the same allergen on IDT and serum allergy testing for each dog suggesting reactions caused by the determined ITCs are less likely subclinical IgE-mediated reactions. These results suggest that ITCs may vary, also they may be very high for the allergens tested and that higher test concentrations may be used for IDT for the tested allergens without inducing an irritant reaction. Further studies are needed to evaluate the benefit of higher IDT concentrations in atopic dogs.

Unravelling the skin barrier: a new paradigm for atopic dermatitis and house dust mites

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease caused by complex interactions between genetics and environmental factors. In human beings, impairment of the skin barrier is demonstrated and thought to be responsible for enhanced penetration of allergens and increased risk for allergic sensitization. Once inflammation is triggered, further impairment of the skin barrier occurs, leading to self-perpetuating cycles of sensitizations. Canine AD appears to share many similarities with the human counterpart, clinically and immunologically. It is hypothesized that a primary defect of skin barrier function also exists in subsets of atopic dogs (e.g. in an experimental model using high IgE-producing beagles), particularly in young dogs, and in sites predisposed to the development of lesions. This impairment is present in clinically normal skin, worsens with development of lesions and can be quantified by measurement of transepidermal water loss. Therefore, the distribution of lesions in AD may be linked to a primary skin barrier defect in those sites and not simply due to contact with allergens, and increased susceptibility to penetration of allergen may exist early in life. Ultrastructurally, transmission electron microscopy reveals that clinically normal skin in atopic dogs has abnormalities in lamellar body secretion and extracellular lamellar bilayer structure when compared with normal dogs. Development of lesions worsens these changes (e.g. widening of intercellular spaces, release of lamellar bodies, and disorganization of lipid lamellae). It is proposed that the paradigm of canine AD as primarily due to immunologic aberration ('inside/outside') should be shifted to include a primary defect in barrier function ('outside/inside').

Masitinib for the treatment of canine atopic dermatitis: a pilot study

There is an on-going need to identify medications suitable for the long-term treatment of canine atopic dermatitis (CAD). Masitinib mesilate is a potent and selective tyrosine kinase inhibitor of the c-KIT receptor. A strong relationship exists between the SCF/c-KIT pathway and pathogenesis of CAD, suggesting that masitinib may potentially fulfil the above role. This study reports on an uncontrolled pilot study of masitinib in CAD. Masitinib was administered orally to 11 dogs at a mean dose of 11.0 +/- 1.83 mg/kg/day (free base) for 28 days. Treatment response was assessed by evolution of clinical appearance according to a modified version of the Canine Atopic Dermatitis Extent and Severity Index (mCADESI), pruritus scale and surface area of lesions. Masitinib improved CAD with a mean reduction in mCADESI of 50.7 +/- 29.8% (95% C.I. = 29.4-72.0; p = 0.0004) at day 28 relative to baseline, with 8/10, 8/10 and 4/10 dogs showing improvement of >or=33%, >or=40% and >or=50%, respectively. Improvement was further evidenced by a decrease in pruritus score and the surface area of lesions. No serious or severe adverse events occurred during this trial, although 6/11 dogs presented with mild to moderate treatment related adverse events. There is sufficient compelling evidence to warrant further investigation.