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Lewis ST, Kennis RA, Clark-Price SC, White AG. Influence of a single oral dose of trazodone on intradermal histamine reactivity in clinically healthy dogs. Vet Dermatol 2024; 35:62-70. [PMID: 37700596 DOI: 10.1111/vde.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 05/31/2023] [Accepted: 08/26/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Drug interactions are significant considerations for intradermal testing (IDT). Trazodone (TRZ) is an anxiolytic and selective histaminergic (H1 ) antagonist with no interaction in human prick tests; however, interaction in canine IDT is unknown. HYPOTHESIS/OBJECTIVES Trazodone will not adversely affect intradermal histamine reactions in dogs. ANIMALS Fourteen nonanxious, nonatopic, healthy client-owned dogs were enrolled in this randomised, blinded, cross-over study. MATERIALS AND METHODS Dogs were randomised to receive low-dose TRZ (4 mg/kg) (Teva Pharmaceuticals), high-dose TRZ (8 mg/kg) or no TRZ per os two hours before intravenous sedation with dexmedetomidine (5 mcg/kg) (Dexdomitor; Zoetis). Intradermal testing was performed with five quadrupling dilutions of histamine (1:100,000 to 1:25,600,000 w/v; Greer) and 0.9% saline (Hospira), observing a minimum two weeks washout period between treatments. Two observers, who were blinded to treatment and the identity of the injections, evaluated each test using previously established subjective and objective methods. RESULTS The mean wheal diameter of histamine 1:1,600,000 w/v was significantly smaller with low-dose TRZ (4 mg/kg) compared to the control group (p = 0.048; repeated measures ANOVA with post hoc Tukey's test). For all other histamine dilutions and saline, mean wheal diameter was not significantly different among groups. There were no significant differences in the subjective scores of all histamine dilutions and saline (p > 0.05; Friedman test). CONCLUSION AND CLINICAL RELEVANCE A single oral dose of TRZ does not adversely affect intradermal histamine reactions in dogs.
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Affiliation(s)
- Sarah Taylor Lewis
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - Robert Allen Kennis
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - Stuart Charles Clark-Price
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - Amelia Grant White
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
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Fleischman DA, Morris DO. Pilot study to determine the concordance between skin prick and intradermal test (IDT) reactivity to environmental allergens in atopic dogs using IDT as the gold standard. Vet Dermatol 2023; 34:505-513. [PMID: 37382082 DOI: 10.1111/vde.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Prick testing is widely used as the first-line in vivo test for environmental allergens in people owing to its noninvasive nature and speed of performance. OBJECTIVES To determine concordance between skin prick testing (SPT) and intradermal testing (IDT) reactivity to environmental allergen mixes in dogs with atopic dermatitis (cAD). ANIMALS Forty client-owned dogs with cAD. MATERIALS AND METHODS Skin prick testing (GREER Pick System; Stallergenes Greer) and IDT were performed on 40 dogs using seven glycerinated and aqueous environmental allergen mixes, respectively (tree, grass and weed pollens, house dust mites and three mould mixes). Reactions for IDT and SPT were evaluated both subjectively and objectively (mean wheal diameter; MWD) and compared to saline and histamine controls. RESULTS Using IDT as the gold standard, with subjective scoring, SPT was 47.0% sensitive [95% confidence interval (CI) 36.0%-58.7%], 92.1% specific (95% CI 87.6%-95.3%) and agreement was moderate (79%, Cohen's kappa = 0.424). The positive predictive value of SPT was 36% and negative predictive value was 95%. Objective and subjective scores had only fair agreement. CONCLUSIONS AND CLINICAL RELEVANCE Skin prick testing with allergen mixes was specific yet poorly sensitive as compared to IDT. For both IDT and SPT, 95% (38 of 40) dogs failed to react to an allergen mix, despite showing a positive reaction to at least one component. Future studies comparing SPT and IDT should test individual allergens rather than mixes to prevent the dilution of individual components, which may have resulted in false negatives.
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Affiliation(s)
- Drew A Fleischman
- Department of Clinical Studies & Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel O Morris
- Department of Clinical Studies & Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Meason C, Salazar R, Gentry CM. Alfaxalone provides reliable sedation for intradermal allergen testing in dogs and does not significantly affect results when compared to dexmedetomidine. Vet Dermatol 2023; 34:404-414. [PMID: 37286524 DOI: 10.1111/vde.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Dexmedetomidine (Dexmedetomidine hydrochloride-Dexdomitor; Zoetis) is the preferred sedative used for canine intradermal allergen testing (IDT) in the United States. Alfaxalone (Alfaxan Multidose; Jurox Animal Health) is a neuroactive steroid, and its effect on sedation and allergen reactivity scores is unknown. HYPOTHESIS/OBJECTIVES We hypothesised that alfaxalone would produce an adequate level of sedation with fewer cardiovascular adverse effects and would not affect allergen reactivity scores or histamine wheal size compared to dexmedetomidine. MATERIALS AND METHODS Twenty client-owned dogs were included in two groups: 10 atopic and 10 nonatopic. In a randomised, controlled, blinded, cross-over design all dogs underwent two modified IDT, 1-4 weeks apart, using intravenous dexmedetomidine (2.87-5.22 μg/kg) or alfaxalone (1.8-2.4 mg/kg). Anaesthetic parameters and sedation level were recorded over 25 min using a validated canine sedation scale described by Grint et al. (Small Anim Pract, 2009, 50, 62). Simultaneously, both objective and subjective reactivity scores were measured in technical triplicates at 10, 15 and 20 min. The modified IDT included eight allergens, histamine-positive and saline-negative controls. RESULTS Alfaxalone produced a significantly higher sedation score across all time points (p < 0.05). All objective scores were significantly correlated to the corresponding subjective scores (Spearman R = 0.859, p < 0.0001). Sedative used did not significantly affect subjective allergen scores for nine atopic dogs (p > 0.05, 15 min). Sedative used did not affect the diameter of objective scores for individual allergens and histamine wheals (p > 0.05, 15 min). CONCLUSIONS AND CLINICAL RELEVANCE Intravascular alfaxalone is an alternative sedative for IDT in dogs. Alfaxalone may be preferred to dexmedetomidine in some clinical scenarios as a result of having fewer cardiovascular adverse effects.
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Aleksandrova S, Sofou EΙ, Badulescu E, Chatzis M, Saridomichelakis MN. Repeatability and reproducibility of the interpretation of intradermal test results in dogs with atopic dermatitis. Vet Dermatol 2022; 33:527-533. [DOI: 10.1111/vde.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Svetlina Aleksandrova
- Clinic of Medicine, Faculty of Veterinary Science University of Thessaly Karditsa Greece
| | - Evi Ι. Sofou
- Clinic of Medicine, Faculty of Veterinary Science University of Thessaly Karditsa Greece
| | - Elisa Badulescu
- Clinic of Medicine, Faculty of Veterinary Science University of Thessaly Karditsa Greece
| | - Manolis Chatzis
- Clinic of Medicine, Faculty of Veterinary Science University of Thessaly Karditsa Greece
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Onuma M, Terada M, Ono S, Murakami A, Ishida T, Sano T. Incidence of anaphylactic reactions after propofol administration in dogs. J Vet Med Sci 2017; 79:1446-1452. [PMID: 28717055 PMCID: PMC5573835 DOI: 10.1292/jvms.16-0550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Propofol is an anesthetic agent suspended in an emulsion system that includes egg yolk
lecithin and soybean oil, because of which, there is concern about the use of propofol in
patients allergic to these substances. We examined the association between propofol
administration and incidence of adverse events in dogs with allergy to egg yolk lecithin
and soybean oil. On the basis of the findings of an allergen-specific immunoglobulin E
(IgE) test, 14 dogs with high levels (high-IgE group) and 7 dogs with low levels
(normal-IgE group) of IgE were selected. Following intravenous administration of propofol,
the incidence of anaphylactic reactions and plasma histamine concentrations under general
anesthesia maintained with isoflurane throughout surgery were compared between the two
groups. The frequency of anaphylactic reactions and plasma histamine concentrations were
compared by the chi-square test and Student t-test, respectively. The
statistical significance for both tests was set at P<0.05. In the
high- and normal-IgE groups, the average frequencies of anaphylactic reactions after
propofol administration were 21.4 and 14.3%, and the mean plasma histamine concentrations
were 167.9 ± 94.5 nM and 65.7 ± 40.3 nM, respectively. Animals of neither groups
experienced shock-like symptoms. These results revealed that propofol might be relatively
safe, although careful perioperative anesthesia monitoring and standby protocols are
required when using propofol in dogs with a history of allergic diseases or high chicken-
or soybean-specific IgE levels.
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Affiliation(s)
- Mamoru Onuma
- Oosagami Animal Clinic, 1-33-3 Laketown, Koshigaya, Saitama 343-0828, Japan.,Chiba Institute of Science Faculty of Risk and Crisis Management, 15-8 Shiomi-cho, Choshi, Chiba 288-0025, Japan
| | - Misao Terada
- Dokkyo Medical University Laboratory Animal Research Center, Kitakobayashi 880, Shimotsugagun Mibumachi, Tochigi 321-0207, Japan
| | - Sadaharu Ono
- Oosagami Animal Clinic, 1-33-3 Laketown, Koshigaya, Saitama 343-0828, Japan
| | - Akiyoshi Murakami
- Oosagami Animal Clinic, 1-33-3 Laketown, Koshigaya, Saitama 343-0828, Japan
| | - Tomoko Ishida
- Oosagami Animal Clinic, 1-33-3 Laketown, Koshigaya, Saitama 343-0828, Japan
| | - Tadashi Sano
- Rakuno Gakuen University School of Veterinary Medicine, 582, Bunkyodai-Midorimachi, Ebetsu, Hokkaido 069-8501, Japan
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Hensel P, Santoro D, Favrot C, Hill P, Griffin C. Canine atopic dermatitis: detailed guidelines for diagnosis and allergen identification. BMC Vet Res 2015; 11:196. [PMID: 26260508 PMCID: PMC4531508 DOI: 10.1186/s12917-015-0515-5] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Canine atopic dermatitis (AD) is a common, genetically predisposed, inflammatory and pruritic skin disease. The variation in clinical presentations, due to genetic factors, extent of the lesions, stage of the disease, secondary infections, as well as resemblance to other non-atopic related skin diseases, can complicate a diagnosis of canine AD. A sub-group of the International Committee for Allergic Diseases in Animals (ICADA) was tasked with the development of a set of practical guidelines that can be used to assist practitioners and researchers in the diagnosis of canine AD. Online citation databases and abstracts from international meetings were searched for publications related to the topic, and combined with expert opinion where necessary. The final set of guidelines was approved by the entire ICADA committee. RESULTS A total of 81 publications relevant for this review were identified. The guidelines generated focus on three aspects of the diagnostic approach: 1. Ruling out of other skin conditions with clinical signs resembling, or overlapping with canine AD. 2. Detailed interpretation of the historical and clinical features of patients affected by canine AD. 3. Allergy testing by intradermal versus allergen-specific IgE serum testing. CONCLUSIONS The diagnosis of canine AD is based on meeting clinical criteria and ruling out other possible causes with similar clinical signs. Flea combing, skin scraping and cytology should be performed, where necessary, as part of a thorough work-up. Elimination diet trials are required for patients with perennial pruritus and/or concurrent gastrointestinal signs. Once a clinical diagnosis of canine AD is made, allergy testing can be performed to identify potential causative allergens for allergen-specific immunotherapy.
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Affiliation(s)
- Patrick Hensel
- Tierdermatologie Basel, Emil Frey-Strasse 127, Münchenstein, Switzerland.
| | - Domenico Santoro
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
| | - Claude Favrot
- Vetsuisse Faculty University of Zurich, Clinic of Small Animal Internal Medicine, Zurich, Switzerland.
| | - Peter Hill
- Companion Animal Health Centre, School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy, SA, 5371, Australia.
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Milosevic MA, Cain CL, Frank LA, Rohrbach BW. Effects of butorphanol versus dexmedetomidine sedation on intradermal allergen and histamine responses in dogs with atopic dermatitis. Vet Dermatol 2013; 24:582-6, e139-40. [DOI: 10.1111/vde.12085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Milivoj A. Milosevic
- Department of Small Animal Clinical Sciences; University of Tennessee; Knoxville TN 37996-4544 USA
| | - Christine L. Cain
- School of Veterinary Medicine; Department of Clinical Studies-Philadelphia; University of Pennsylvania; Philadelphia PA 19104-6010 USA
| | - Linda A. Frank
- Department of Small Animal Clinical Sciences; University of Tennessee; Knoxville TN 37996-4544 USA
| | - Barton W. Rohrbach
- Department of Biomedical and Diagnostic Sciences; University of Tennessee; Knoxville TN 37996-4544 USA
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Hubbard TL, White PD. Comparison of subjective and objective intradermal allergy test scoring methods in dogs with atopic dermatitis. J Am Anim Hosp Assoc 2012; 47:399-405. [PMID: 22058346 DOI: 10.5326/jaaha-ms-5638] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Boesch JM, Gleed RD, Gagne JW, Ortved K, Dykes NL, Horne WA. Acute noncardiogenic pulmonary edema in an anesthetized Nubian goat kid. Vet Anaesth Analg 2009; 36:567-73. [PMID: 19845929 DOI: 10.1111/j.1467-2995.2009.00488.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBSERVATIONS A 1-month-old Nubian goat presented for sialocyst resection. Physical examination and bloodwork were unremarkable. While pre-oxygenating, the goat was sedated with midazolam and morphine (0.1 mg kg(-1) each) intravenously (IV). General anesthesia was induced 5 minutes later with 1.7 mg kg(-1) propofol. Sevoflurane was administered in oxygen without assisted ventilation via a cuffed orotracheal tube. Throughout the first 85 minutes of anesthesia, the goat was well-oxygenated (SpO(2), > or =97%), ventilating adequately (Pe'CO(2), 36-48 mmHg), and had normal mean arterial blood pressure (MAP, 60-85 mmHg). Blood-gas values at 45 minutes were consistent with adequate ventilation on oxygen. At 75 minutes, the goat moved in response to surgical stimulation, requiring additional propofol (0.4 mg kg(-1)). After 10 minutes, MAP dropped precipitously to 40 mmHg and frequent multiform premature ventricular contractions (PVCs) were observed. Crystalloids, hetastarch, and dopamine (5 mug kg(-1) minute(-1)) were administered to correct the hypotension. Arterial blood-gas analysis revealed that the goat had become hypoxemic (PaO(2), 50 mmHg). Intermittent positive pressure ventilation (IPPV) was initiated. Subsequent blood-gas analysis did not show significant improvement in PaO(2) (53 and 56 mmHg, respectively). Occasional PVCs were observed thereafter. Surgery ended, and sevoflurane and IPPV were discontinued. The goat was extubated within 7 minutes and received 100% oxygen by mask. Diffuse crackles were ausculted over both hemithoraces. Suspecting pulmonary edema, furosemide (1 mg kg(-1)) was administered IV. Radiographs taken immediately post-operatively revealed a severe, caudodorsal airspace (alveolar) pattern, confirming the diagnosis. Respiration improved considerably within an hour with nasal oxygen and two additional doses of furosemide. CONCLUSIONS The goat developed acute, drug-induced, noncardiogenic pulmonary edema in response to the second dose of propofol.
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Affiliation(s)
- Jordyn M Boesch
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
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Saridomichelakis MN, Marsella R, Lee KW, Esch RE, Farmaki R, Koutinas AF. Assessment of cross-reactivity among five species of house dust and storage mites. Vet Dermatol 2008; 19:67-76. [PMID: 18336423 DOI: 10.1111/j.1365-3164.2008.00654.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In vitro cross-reactivity among two house dust (Dermatophagoides farinae, D. pteronyssinus) and three storage (Acarus siro, Tyrophagus putrescentiae, Lepidoglyphus destructor) mites was examined in 20 mite-sensitive dogs with natural occurring atopic dermatitis (group A), 13 high-IgE beagles experimentally sensitized to D. farinae (group B), and five healthy beagles (group C). Intradermal testing (IDT) and serology for allergen-specific IgE demonstrated that co-sensitization for all possible pairs of the five mites was generally 45% or higher among group A dogs. In the same dogs, enzyme-linked immunosorbent assay cross-inhibition results indicated that each one of D. farinae, A. siro and T. putrescentiae was a strong inhibitor of all the remaining mites, whereas D. pteronyssinus was a strong inhibitor of L. destructor. A high number of positive IDT and serology test results for D. pteronyssinus, A. siro, T. putrescentiae and L. destructor were recorded among group B dogs. No conclusive evidence of exposure to these mites was found upon analysis of dust samples from their environment and their food for the presence of mites and guanine. Also, the number of positive test results was generally higher among group B than among group C dogs. Enzyme-linked immunosorbent assay cross-inhibition revealed that D. farinae was a strong inhibitor of D. pteronyssinus, A. siro and T. putrescentiae. Collectively, these results demonstrated extensive in vitro cross-reactivity among house dust and/or storage mites that can explain false-positive results upon testing of dust mite-sensitive dogs with atopic dermatitis.
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Abstract
Otitis externa is common in atopic dogs and is frequently treated using potent glucocorticoids topically. These preparations can cause adrenal suppression and affect skin test reactivity. The purpose of this study was to determine if an otic product containing betamethasone could decrease skin reactivity in normal dogs. Sixteen laboratory beagles were used in a cross-over, blinded trial. Dogs were enrolled in two groups; one received placebo and the other a betamethasone-containing otic preparation (Otomax) twice daily for 2 weeks. After a 4-week wash-out period, treatments were switched. Dogs were intradermally tested on days 0 and 14 of each treatment period with histamine phosphate (1 : 100,000 and 1 : 200,000 w/v) and allergens common in the area. Adrenocorticotropic hormone (ACTH) stimulation tests were done before and after treatment to investigate adrenal suppression. After 2 weeks of otic betamethasone, Dermatophagoides farinae (P = 0.0034), Cynodon dactylon (P = 0.0459) and histamine 1 : 100,000 w/v (P = 0.0028) reactions were significantly reduced. Pre-treatment post-ACTH serum cortisol levels and those obtained after both treatments did not differ statistically (P = 0.6362). Betamethasone induced a slight but statistically significant elevation (P = 0.0002) of serum alkaline phosphatase. Despite the increase, values were within normal range. It is concluded that, although otic betamethasone did not suppress adrenal glands, it mildly suppressed intradermal reactions to 1 : 100,000 w/v histamine, D. farinae and C. dactylon.
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Affiliation(s)
- Pedro J Ginel
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, University of Cordoba, Cordoba, Spain.
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Martin DD, Martin AL. Pain management and anesthesia in veterinary dermatology. Vet Clin North Am Small Anim Pract 2006; 36:1-14, v. [PMID: 16364775 DOI: 10.1016/j.cvsm.2005.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- David D Martin
- Companion Animal Division, Pfizer Animal Health, New York, NY, USA.
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Kona-Boun JJ, Silim A, Troncy E. Immunologic aspects of veterinary anesthesia and analgesia. J Am Vet Med Assoc 2005; 226:355-63. [PMID: 15702683 DOI: 10.2460/javma.2005.226.355] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jean-Jacques Kona-Boun
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada
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