Effect of omega-3 fatty acids on canine atopic dermatitis

Yeast-Derived Nucleotides Enhance Fibroblast Migration and Proliferation and Provide Clinical Benefits in Atopic Dermatitis

Nucleotides, glycosaminoglycans, and omega-3 essential fatty acids (O3s) could be used for improving skin health, although their modes of action, alone or in combination, are not yet fully understood. To gain some insight into these mechanisms, we performed two in vitro tests and one in vivo pilot trial. The effects on human dermal fibroblast proliferation and migration were evaluated with the following compounds and combinations: 0.156 mg/mL O3s, 0.0017 mg/mL hyaluronic acid (HA), 0.0004 mg/mL dermatan sulfate (DS), 0.0818 mg/mL nucleotides, and [O3s + HA + DS] and [O3s + HA + DS + nucleotides] at the same concentrations. In both in vitro assays, adding nucleotides to [O3s + HA + DS] provided significant improvements. The resulting combination [O3s + HA + DS + nucleotides] was then tested in vivo in dogs with atopic dermatitis by oral administration of a supplement providing a daily amount of 40 mg/kg nucleotides, 0.9 mg/kg HA, 0.18 mg/kg DS, 53.4 mg/kg EPA, and 7.6 mg/kg DHA. After 30 days, the pruritus visual analog scale (pVAS) score was significantly reduced, and no adverse effects were observed. In conclusion, the combination of nucleotides plus glycosaminoglycans and O3s could serve as a useful therapeutic alternative in skin health applications.

Nutritional evaluation of new alternative types of dog foods including raw and cooked homemade-style diets

BACKGROUND

New alternative types of pet foods such as raw and cooked homemade-style diets containing human food ingredients have been introduced due to a trend of pet humanization and diversification of consumer needs.

OBJECTIVES

To evaluate nutritional adequacy of new alternative types of dog foods containing human food ingredients as maintenance diets for dogs.

METHODS

Eleven homemade-style foods for adult dogs were purchased from online channel in Korea and analyzed to evaluate nutritional adequacy for adult dogs. Nutrients analyzed included crude protein, amino acids, crude fat, fatty acids, and minerals.

RESULTS

Crude protein and amino acids in all products satisfied Association of American Feed Control Officials (AAFCO) requirements. Crude fat in one of 11 products did not meet AAFCO requirements. The most deficient minerals were selenium (10 of 11, 90.9%), copper (five of 11, 45.5%), zinc (five of 11, 45.5%), potassium (three of 11, 27.3%), calcium (three of 11, 27.3%), iron (two of 11, 18.2%), and magnesium (one of 11, 9.1%). Six products were not in the range of the recommended Ca:P ratio in AAFCO dog food maintenance nutrient profiles.

CONCLUSIONS

This study performed nutritional evaluation of raw and cooked homemade-style foods as maintenance diets for adult dogs. Some nutritional inadequacies were observed including some minerals, Ca:P ratio, and omega-6:omega-3 fatty acid ratio, although three products (26.2%) satisfied the AAFCO standard except selenium. Overall, the data suggest a need for accurate nutritional adequacy statement for consumers based on proper methods to validate the formula.

A randomised, double-blinded comparison between subcutaneous rush and intralympathic allergen immunotherapy induction in atopic dogs

BACKGROUND

Atopic dermatitis (AD) is one of the most common skin diseases in small animal practice. Allergen immunotherapy (AIT) is the only curative treatment for the disease, and oral, subcutaneous and intralymphatic administration of allergens are commonly employed.

OBJECTIVES

To compare the efficacy of AIT following an induction phase with intralymphatic injections (ILIT) or rush immunotherapy (RIT).

ANIMALS

Fifty privately owned dogs with AD.

MATERIALS AND METHODS

In a double-blinded study, dogs were randomly assigned to either four monthly ILIT of allergen extract or RIT with five injections administered subcutaneously at hourly intervals on the first day. They were assessed by validated scores; Canine Atopic Dermatitis Lesion Index (CADLI) and pruritus Visual Analog Scale (PVAS) at the beginning of the study and after 1, 3, 6 and 12 months. The latter were performed daily for 7 days before each revisit. Medication scores and a total clinical score were calculated and compared between each group and time point.

RESULTS

There was no significant difference in CADLI and PVAS scores, or CADLI and medication scores between groups at any of the time points. A significant improvement with both ILIT and RIT was seen in total and pruritus scores, respectively. An owner global assessment of good-to-excellent treatment efficacy was seen in 40% of the dogs; total scores improved by 27% and 35% in the RIT and ILIT group, respectively. Adverse effects were not seen.

CONCLUSIONS AND CLINICAL RELEVANCE

Induction of AIT can be conducted either as RIT or ILIT with no loss in efficacy.

Evidence-base for the beneficial effect of nutraceuticals in canine dermatological immune-mediated inflammatory diseases - A literature review

BACKGROUND

Immune-mediated inflammatory diseases (IMIDs) are associated with an abnormal immune response, resulting in a disturbed homeostasis and chronic inflammation. Most canine dermatological IMIDs (cDIMIDs), such as allergies, autoimmune and immune-mediated diseases, require long-term treatment with immunosuppressive drugs with potential adverse effects. In general, nutraceuticals are thought to be safe. As a result, there is a tendency for the more frequent use of nutraceuticals in veterinary medicine.

OBJECTIVES

The aim of this review was to present evidence-based proof for the use of various nutraceuticals in the treatment of cDIMIDs and, where possible, to provide conclusions to guide their use in veterinary dermatological practice.

METHODS

A comprehensive literature search on common cDIMIDs and nutraceuticals was performed. Only peer-reviewed articles published in English and related to the study topic were included. A total of 64 eligible publications were classified in five categories based on study design and substantively assessed on additional criteria such as standardisation of diets and number of included animals. For final appraisal, classification of major, minor or no evidence was used whereby efficacy was based on clinical outcome measurements.

CONCLUSIONS

Minor evidence for the beneficial use of several nutraceuticals, including essential fatty acids, niacinamide and probiotics, was found for treatment of specific cDIMIDs. These nutraceuticals may improve clinical signs or reduce the required dose of concurrent medication (e.g. drug-sparing effect) in some dogs. Some nutraceuticals also may be used for long-term maintenance therapy. Despite some promising findings, major evidence for the use of nutraceuticals in cDIMIDs is lacking, warranting further research.

Comparison of Fish, Krill and Flaxseed as Omega-3 Sources to Increase the Omega-3 Index in Dogs

(1) Background: it is only the longer chain omega-3 polyunsaturated fatty acids (n-3 PUFAs), eicosapentaenoic acid (20:5n-3, EPA), and docosahexaenoic acid (22:6n-3, DHA) and not the shorter chain α-linolenic acid (ALA, 18:3n-3) that have been linked to health benefits. (2) Methods: 45 dogs divided into three groups were first given premium dry food for 38 days (baseline). The O3I was then used as a diagnostic tool to provide a measure of the sum of EPA + DHA in red blood cell membranes given as a percentage of all fatty acids. The dogs were subsequently fed with either krill meal (krill), fishmeal/oil (fish) or flaxseed cake (flax) included in raw food providing daily 416 mg EPA + DHA (971 mg ALA), 513 mg EPA + DHA (1027 mg ALA) and 1465 mg ALA (122 mg EPA + DHA), respectively. (3) Results: the average baseline O3I level of all dogs was low (1.36%), warranting n-3 supplementation. After four weeks, O3I levels were significantly increased in the krill (from 1.36 ± 0.44 to 2.36 ± 0.39%) and fish (from 1.35 ± 0.22 to 1.9 ± 0.35%) groups (p < 0.001). No significant modification of the O3I was detected in the flax animals. (4) Conclusions: only marine n-3 PUFAs resulted in a significantly increased O3I, with dietary krill meal providing the highest increase.

Dietary Ground Flaxseed Increases Serum Alpha-Linolenic Acid Concentrations in Adult Cats

We evaluated effects of dietary ground flaxseed on fecal and serum alpha-linolenic acid (ALA) concentrations, nutrient digestibility, and stool quality in female and male adult cats (n = 20 (8 males, 12 females); 3.95 ± 1.49 years of age (mean ± SD); 3.88 ± 0.82 kg BW). We hypothesized that adding ground flaxseed would increase serum ALA compared with feeding no flax, without changing nutrient digestibility. Cats were fed as-is 2.6% added-flaxseed (flax, n = 10) or no-flax (control, n = 10) diets (2.66 vs. 0.78% ALA of total fatty acids; crude protein 35%, fat 20%, fiber 3% as-fed) twice daily to maintain body weight for 28 days. Fecal collections were conducted on days 23−27 for total-tract nutrient digestibility, stool quality (scale 1−5; 1 = watery diarrhea, 5 = hard, dry, crumbly) and long-chain fatty acid (LCFA) analyses. Blood was collected on days 0, 14, and 28 for serum LCFA and chemistry analysis. Digestibility and fecal data were analyzed by ANOVA (SAS v9.4, Cary, NC, USA) and a repeated measures ANOVA for serum ALA. Flax-fed cats, compared with control-fed, had greater (p < 0.05) serum ALA after 14 days (4.00 vs. 0.71 µg/mL) and 28 days (7.83 and 3.67 µg/mL). No differences were observed in stool quality, and dry matter, protein, fat, and ALA digestibility. However, metabolizable energy was greater in the flax vs. control diet (4.18 vs. 3.91 kcal/g; p < 0.05). Overall, these data demonstrate that ground flaxseed added to cat diets increases serum ALA within 14 days, with no detriments to nutrient digestibility. We conclude that flaxseed can be used as a bioavailable source of ALA in cat diets.

Dietary Betaine and Fatty Acids Change Circulating Single-Carbon Metabolites and Fatty Acids in the Dog

In order to evaluate the interaction of betaine and n-3 PUFA in foods consumed by the dog, six extruded dry foods were formulated. The control food had no specific source of added betaine or n-3 fatty acids, while the test foods were supplemented with betaine, flax or fish oil in a 2 × 3 factorial design (no added n-3 source, added flax, added menhaden fish oil, and all with or without added betaine). Forty eight adult dogs were used in this study. All dogs were assigned to one of the six dietary treatments and consumed that food for the length of the 60-day study. Blood was analyzed for metabolomics (plasma), fatty acids and selected health-related analytes (serum) at the beginning and the end of the study. Added dietary betaine increased single-carbon metabolites (betaine, dimethyl glycine, methionine and N-methylalanine), decreased xenobiotics (stachydrine, N-acetyl-S-allyl-L-cysteine, 4-vinylguaiacol sulfate, pyrraline, 3-indoleglyoxylic acid, N-methylpipecolate and ectoine) and enhanced the production of eicosapentaenoic acid (EPA). Dietary betaine also decreased the concentration of circulating carnitine and a number of carnitine-containing moieties. The addition of the n-3 fatty acids alpha-linolenic, EPA and docosahexaenoic acid (DHA) increased their respective circulating concentrations as well as those of many subsequent moieties containing these fatty acids. The addition of alpha-linolenic acid increased the concentration of EPA when expressed as a ratio of EPA consumed.

Interleukin 10 and transforming growth factor-beta 1 plasma levels in atopic dogs before and during immunotherapy

BACKGROUND

Human studies suggest that the cytokines, interleukin 10 (IL-10) and transforming growth factor-beta 1 (TGF-ß1) may play an important role in allergen-specific immunotherapy (ASIT). However, there is little known about the function of these cytokines in atopic dogs. This study compared the plasma levels of IL-10 and TGF-ß1 in atopic and control dogs and investigated their changes during different ASIT approaches.

METHODS

A total of 54 atopic and 32 control dogs were included. Immunotherapy was performed in 30 atopic dogs. The dogs undergoing immunotherapy were allocated to four groups of different ASIT approaches (namely subcutaneous, intralymphatic, sublingual ASIT and subcutaneous ASIT with recombinant allergens). Blood samples were collected at four timepoints throughout the one year of ASIT. Canine atopic dermatitis extent and severity index, pruritus visual analogue scale and medication score were recorded at each timepoint. Commercially available ELISA kits were used to quantify IL-10 and TGF-ß1 in plasma.

RESULTS

There was no significant difference in IL-10 and TGF-ß1 between atopic and control dogs. The IL-10 levels were significantly increased in the intralymphatic group at the end of the study. No significant differences were found in the other groups for both IL-10 and TGF-ß1.

CONCLUSION

The findings of this work suggest that IL-10 and TGF-ß1 cannot be used to monitor the course of the disease during ASIT.

Randomized, double-blind, placebo-controlled clinical trial measuring the effect of a dietetic food on dermatologic scoring and pruritus in dogs with atopic dermatitis

Background

Canine atopic dermatitis (AD) is a common condition that often requires multimodal therapy. Including a diet in the multimodal management of AD may reduce medication doses, saving pet owners money and reducing side effects. The objective of this randomized, double-blind, placebo-controlled clinical trial was to determine if a diet fortified in antioxidants, polyphenols, and omega-3 fatty acids can reduce the clinical signs of AD. Forty client-owned dogs with AD were enrolled in the study and assigned to either an enriched diet (diet B) or control diet (diet A) for 60-days. CADESI-4 index scores and owner-reported pruritus scores were measured periodically.

Results

Total CADESI-4 index scores for dogs eating diet B were lower on day 60 compared to baseline (P = 0.003). There was no statistical difference in scores for dogs eating diet A over a 60-day period. Diet B dogs had 25 and 49% reductions in CADESI-4 index scores on days 30 and 60, respectively (P = 0.0007) while diet A had no change over the study period. When comparing the percent change in owner-reported pruritus scores, diet B also performed better than diet A. By day 60, owners feeding diet B to their dogs reported a significant reduction (P < 0.0001) of 46.4% in itching, while those on diet A reported a 26.8% reduction, which was not statistically significant (P = 0.08).

Conclusions

These study results demonstrate feeding a diet enriched with ingredients to improve skin health and reduce inflammation improves the clinical signs of AD in dogs.

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.

Puppyhood diet as a factor in the development of owner-reported allergy/atopy skin signs in adult dogs in Finland

BACKGROUND

The increased prevalence of atopic dermatitis (AD) in dogs necessitates research in its disease etiology.

OBJECTIVES

To explore the association between puppyhood dietary exposures and prevalence of owner-reported allergy/atopy skin signs (AASS) after the age of 1 year.

ANIMALS

Four thousand and twenty-two dogs were eligible, 1158 cases, and 2864 controls.

METHODS

This cross-sectional hypothesis-driven observational study was extracted from the DogRisk food frequency questionnaire. Forty-six food items and the ratio of 4 major diet types were tested for their association with AASS incidence later in life. Potential puppyhood dietary risk factors for AASS incidence were specified using binary multivariable logistic regression. The model was adjusted for age and sex.

RESULTS

Eating raw tripe (odds ratio, 95% confidence intervals OR, 95% CI = 0.36, 0.16-0.79; P = .01), raw organ meats (OR, 95% CI = 0.23, 0.08-0.67; P = .007), human meal leftovers, and fish oil supplements as well as eating more that 20% of the diet as raw and/or <80% of the diet as dry, in general, were associated with significantly lower AASS incidence in adulthood. In contrast, dogs fed fruits (OR, 95% CI = 2.01, 1.31-3.07; P = .001), mixed-oil supplements, dried animal parts, and dogs that drank from puddles showed significantly higher AASS incidence in adulthood.

CONCLUSIONS AND CLINICAL IMPORTANCE

Puppyhood exposure to raw animal-based foods might have a protective influence on AASS incidence in adulthood, while puppyhood exposure to mixed oils, heat processed foods and sugary fruits might be a potential risk factor of AASS incidence later. The study suggests a causal relationship but does not prove it.

Therapeutic Effect of EPA/DHA Supplementation in Neoplastic and Non-neoplastic Companion Animal Diseases: A Systematic Review

BACKGROUND/AIM

The aim of this study is to identify and describe randomized controlled studies evaluating the therapeutic effect of EPA and DHA supplementation in companion animal diseases.

MATERIALS AND METHODS

A systematic search was conducted in PubMed database and the information collected was summarized and evaluated according to the risk of bias, using the revised Cochrane tool (RoB2).

RESULTS

Twenty-three studies were eligible for inclusion: twenty performed in dogs and three in cats. A therapeutic benefit was found in canine allergic dermatitis, haircoat disorder, keratoconjunctivitis sicca, valvular disease, and canine and feline osteoarthritis. Dogs diagnosed with chronic heart failure and lymphoma and cats with allergic dermatitis also seem to benefit from supplementation with omega-3 fatty acids, but studies with improved methodological quality are needed to strengthen this evidence.

CONCLUSION

EPA and DHA supplementation has proven benefits in the adjuvant treatment of various neoplastic and non-neoplastic diseases in dogs and cats.

A study into the fatty acid content of selected veterinary diets, supplements and fish oil capsules in Australia

BACKGROUND

Dogs with cutaneous diseases often receive supplementation with omega-3 (n-3) and omega-6 (n-6) essential fatty acids (FA), either through their diet or the use of an oral supplement. Labelling on these products is not always clear, especially regarding the total and relative amounts of FA.

OBJECTIVES

To provide clinicians with a breakdown of the FA content of selected veterinary diets, supplements and fish oil capsules so that the daily dose of supplementation can be calculated more easily. Repeated measurements of FA content over time demonstrate whether FA content changes temporally.

METHODS AND MATERIALS

Eight veterinary diets, four veterinary oral FA supplements and four fish oil supplements were analysed for FA content by gas chromatography at days 0, 28 and 56.

RESULTS

The n-6:n-3 ratio varied among the supplement types with the food samples having higher ratios than the liquid supplements and fish oil capsules. The composition of n-3 FA differed between products with some having higher concentrations of the less active n-3 FA alpha-linolenic acid than eicosapentaenoic acid and docosahexaenoic acid. No decreases in FA content over time were detected.

CONCLUSIONS AND CLINICAL RELEVANCE

The results of this study provide the reader with a means to calculate the FA concentrations that their patient is receiving for each product tested, as well as allowing them to compare products for their differences in n-6:n-3 ratios and relative amounts of individual FA molecules. The FA concentrations did not change significantly over 56 days.

A proposed medication score for long-term trials of treatment of canine atopic dermatitis sensu lato

BACKGROUND

The use of concurrent medications is necessary in trials of treatment of canine atopic dermatitis. Our aim was to use the best available evidence to construct and then to validate a medication score (MS) formula that will estimate the impact of concurrent medications on trial outcomes.

METHODS

Trials of 15 interventions were scrutinized to find those that were consistent in terms of specific medication, administration route and dosage regimen. A MS was constructed in five steps, starting from assigning a score of 1 for each day on oral prednisone, prednisolone or methylprednisolone at 0.5-1.0 mg/kg. The MS score was validated using the clinical records of 35 dogs with atopic dermatitis that had been treated for a period of 12 ± 2 weeks with six of these medications and compared with a previously published non-validated MS.

RESULTS

A MS could be assigned to eight treatments, six of which had been administered to the 35 dogs. A positive correlation was seen with the previously published MS and a negative correlation with changes in lesional and pruritus scores.

CONCLUSION

This MS may be a useful tool in new studies evaluating the efficacy of treatments in canine atopic dermatitis.

Enhanced omega-3 index after long- versus short-chain omega-3 fatty acid supplementation in dogs

Background

The Omega‐3 Index is a test that measures the amount of the long‐chain omega‐3 polyunsaturated fatty acids (n‐3 PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in red blood cell membranes, which is expressed as a percentage of all fatty acids. However, alpha‐linolenic acid (ALA) from flaxseed oil, which is a short‐chain n‐3 PUFA, is often promoted in pet feed as a n‐3 source, implicitly assuming it is an effective precursor of EPA and DHA.

Objective

This study was aimed to compare the effect of supplementation with a plant‐based short‐chain n‐3 PUFA source (flaxseed oil, FSO) with a marine long‐chain n‐3 PUFA source (astaxanthin krill oil, AKO) to increase the Omega‐3 Index in dogs.

Methods

Ten adult Alaskan Huskies of both genders were supplemented daily with 1,155 mg of EPA/DHA from AKO, whereas another 10 dogs received 1,068 mg ALA from flaxseed oil for 6 weeks. Fatty acid and Omega‐3 Index measurements of the two groups were taken after 0, 3 and 6 weeks for comparison.

Results

The EPA and DHA concentrations increased significantly only in the dogs fed with AKO resulting in a significant increase in mean Omega‐3 Index, from 1.68% at baseline to 2.7% after 6 weeks of supplementation (p < .0001). On the contrary, both EPA and DHA concentrations decreased significantly in the dogs fed with FSO, which led to a significant decrease in mean Omega‐3 Index from 1.6% at baseline to 0.96% at study end (p < .0001).

Conclusions

The results showed that supplementation of AKO from Antarctic krill led to a significant increase in the Omega‐3 Index in comparison to FSO in dogs. This suggests that preformed marine EPA and DHA sources are needed in dog feeds, as the dietary requirements proposed by feed industry organizations are not met with conversion from short‐chain n‐3 fatty acids.

Shortened immunotherapy dose-escalation saves time, but is it safe? A case-control study comparing the rates of adverse reactions between conventional and fast-escalation subcutaneous immunotherapy protocols during the induction phase

BACKGROUND

Allergen immunotherapy (AIT) is the only intervention believed to change the course of atopic diseases. As dogs appear to have fewer severe adverse events (AEs) compared to people receiving AIT, a prolonged dose-escalation induction phase might not be needed.

OBJECTIVES

To report the incidence and characteristics of AEs induced by a fast-escalation subcutaneous immunotherapy (f-SCIT) protocol compared to a conventional (c-SCIT) regimen.

ANIMALS

One hundred dogs treated with either f- SCIT (Centre 1, 50 dogs) or c-SCIT (Centre 2, 50 dogs).

METHODS AND MATERIALS

A case-control study retrospectively evaluating AEs during the induction of AIT. We determined the incidence and type of AEs in each SCIT group; we also assessed factors such as self-limitation and the need for AE-associated protocol changes.

RESULTS

Twelve of 100 dogs (12%) developed a SCIT-attributable AE during the induction phase, with one dog having a local and 11 having systemic reactions (nine Grade I, two Grade II, none of grades III or IV). Dogs treated with the f-SCIT had a significantly higher rate of AEs (11 of 50; 22%) compared to those receiving the c-SCIT (one of 50; 2%). Most of the AEs (10 of 11; 91%) in the f-SCIT group were mild and self-limiting.

CONCLUSIONS AND CLINICAL IMPORTANCE

The induction phase of f-SCIT is simpler, and the maintenance phase is reached faster than that of the c-SCIT. Despite its higher rate of AEs than with the c-SCIT regimen, the majority of f-SCIT-associated AEs were mild and self-limiting. Whether or not this f-SCIT protocol leads to a faster time-to-efficacy needs to be determined.

Impact of Nutritional Supplementation on Canine Dermatological Disorders

Nutritional supplements, also known as complementary feeds, are products administered with the aim of furnishing health benefits, regardless of nutritional needs. They have been used since ancient times in veterinary dermatology, and a number of studies have focused on investigating the health benefits of some ingredients found in commercially available complementary feed for dogs. The aim of this paper is to review the literature available on the use of nutritional supplementation for the management of canine skin diseases, critically appraising the clinical efficacy of such interventions and summarizing the current state of knowledge. This review highlights how these feeds can be considered useful in the management of dermatological disorders and outlines their beneficial effects in the prevention of dietary deficiencies and treatment of diseases, alone, or in addition to conventional pharmacological therapy. In recent years, nutritional supplements have found increasing potential application in veterinary medicine, and the scientific proofs of their beneficial effects are described in this review.

Interventions for chronic pruritus of unknown origin

BACKGROUND

Pruritus is a sensation that leads to the desire to scratch; its origin is unknown in 8% to 15% of affected patients. The prevalence of chronic pruritus of unknown origin (CPUO) in individuals with generalised pruritus ranges from 3.6% to 44.5%, with highest prevalence among the elderly. When the origin of pruritus is known, its management may be straightforward if an effective treatment for the causal disease is available. Treatment of CPUO is particularly difficult due to its unknown pathophysiology.

OBJECTIVES

To assess the effects of interventions for CPUO in adults and children.

SEARCH METHODS

We searched the following up to July 2019: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and trials registries. We checked the reference lists of included studies for additional references to relevant trials.

SELECTION CRITERIA

We sought to include randomised controlled trials and quasi-randomised controlled trials that assessed interventions for CPUO, as defined in category VI ('Other pruritus of undetermined origin, or chronic pruritus of unknown origin') of the International Forum for the Study of Itch (IFSI) classification, in children and adults. Eligible interventions were non-pharmacological or topical or systemic pharmacological interventions, and eligible comparators were another active treatment, placebo, sham procedures, or no treatment or equivalent (e.g. waiting list).

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Our primary outcomes were 'Patient- or parent-reported pruritus intensity' and 'Adverse events'. Our secondary outcomes were 'Health-related quality of life', 'Sleep disturbances', 'Depression', and 'Patient satisfaction'. We used GRADE to assess the certainty of evidence.

MAIN RESULTS

We found there was an absence of evidence for the main interventions of interest: emollient creams, cooling lotions, topical corticosteroids, topical antidepressants, systemic antihistamines, systemic antidepressants, systemic anticonvulsants, and phototherapy. We included one study with 257 randomised (253 analysed) participants, aged 18 to 65 years; 60.6% were female. This study investigated the safety and efficacy of three different doses of oral serlopitant (5 mg, 1 mg, and 0.25 mg, once daily for six weeks) compared to placebo for severe chronic pruritus; 25 US centres participated (clinical research centres and universities). All outcomes were measured at the end of treatment (six weeks from baseline), except adverse events, which were monitored throughout. A pharmaceutical company funded this study. Fifty-five per cent of participants suffered from CPUO, and approximately 45% presented a dermatological diagnosis (atopic dermatitis/eczema 37.3%, psoriasis 6.7%, acne 3.6%, among other diagnoses). We unsuccessfully attempted to retrieve outcome data from study authors for the subgroup of participants with CPUO. Participants had pruritus for six weeks or longer. Total study duration was 10 weeks. Participants who received serlopitant 5 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by the visual analogue scale (VAS; a reduction in VAS score indicates improvement) compared to placebo (126 participants, risk ratio (RR) 2.06, 95% confidence interval (CI) 1.27 to 3.35; low-certainty evidence). We are uncertain of the effects of serlopitant 5 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (127 participants; RR 1.48, 95% CI 0.87 to 2.50); health-related quality of life (as measured by the Dermatology Life Quality Index (DLQI); a higher score indicates greater impairment; 127 participants; mean difference (MD) -4.20, 95% CI -11.68 to 3.28); and sleep disturbances (people with insomnia measured by the Pittsburgh Sleep Symptom Questionnaire-Insomnia (PSSQ-I), a dichotomous measure; 128 participants; RR 0.49, 95% CI 0.24 to 1.01). Participants who received serlopitant 1 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by VAS compared to placebo; however, the 95% CI indicates that there may also be little to no difference between groups (126 participants; RR 1.50, 95% CI 0.89 to 2.54; low-certainty evidence). We are uncertain of the effects of serlopitant 1 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (128 participants; RR 1.45, 95% CI 0.86 to 2.47); health-related quality of life (DLQI; 128 participants; MD -6.90, 95% CI -14.38 to 0.58); and sleep disturbances (PSSQ-I; 128 participants; RR 0.38, 95% CI 0.17 to 0.84). Participants who received serlopitant 0.25 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by VAS compared to placebo; however, the 95% CI indicates that there may also be little to no difference between groups (127 participants; RR 1.66, 95% CI 1.00 to 2.77; low-certainty evidence). We are uncertain of the effects of serlopitant 0.25 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (127 participants; RR 1.29, 95% CI 0.75 to 2.24); health-related quality of life (DLQI; 127 participants; MD -5.70, 95% CI -13.18 to 1.78); and sleep disturbances (PSSQ-I; 127 participants; RR 0.60, 95% CI 0.31 to 1.17). The most commonly reported adverse events were somnolence, diarrhoea, headache, and nasopharyngitis, among others. Our included study did not measure depression or patient satisfaction. We downgraded the certainty of evidence for all outcomes due to indirectness (only 55% of study participants had CPUO) and imprecision. We downgraded outcomes other than patient-reported pruritus intensity a further level due to concerns regarding risk of bias in selection of the reported result and some concerns with risk of bias due to missing outcome data (sleep disturbances only). We deemed risk of bias to be generally low.

AUTHORS' CONCLUSIONS

We found lack of evidence to address our review question: for most of our interventions of interest, we found no eligible studies. The neurokinin 1 receptor (NK1R) antagonist serlopitant was the only intervention that we could assess. One study provided low-certainty evidence suggesting that serlopitant may reduce pruritus intensity when compared with placebo. We are uncertain of the effects of serlopitant on other outcomes, as certainty of the evidence is very low. More studies with larger sample sizes, focused on patients with CPUO, are needed. Healthcare professionals, patients, and other stakeholders may have to rely on indirect evidence related to other forms of chronic pruritus when deciding between the main interventions currently used for this condition.

Sterile granulomatous dermatitis and lymphadenitis (juvenile cellulitis) in adult dogs: a retrospective analysis of 90 cases (2004-2018)

BACKGROUND

It has long been speculated that sterile granulomatous dermatitis and lymphadenitis (SGDL) occurs in adult dogs. However, only three published case reports exist.

HYPOTHESIS/OBJECTIVES

To describe clinical presentation, identify breed predispositions, and assess treatment and outcomes of adult dogs with the histopathological diagnosis of SGDL.

ANIMALS

Included are 90 dogs with biopsies submitted to a veterinary teaching hospital with a histopathological diagnosis consistent with SGDL, from 2004 to 2018, of which 35 had medical records available for review.

METHODS

Data were analysed retrospectively from histopathology submission forms, medical records, surveys and telephone calls. Scoring systems were created to aid statistical analysis of outcomes.

RESULTS

Havanese dog (P < 0.0001), Australian shepherd dog (P < 0.0001), Irish setter (P < 0.0001), Dachshund (P = 0.0002), bichon frise (P = 0.0003) and Maltese dog (P = 0.004) were significantly over-represented breeds. The median age at onset was 1,292 days (3.54 years). Dogs up to five years of age were significantly over-represented (P < 0.01). Of 35 dogs with medical records available for review, the median treatment duration was 60 days and the median time to remission 28 days. Remission status was not established for five dogs but the remaining 30 dogs reached remission. Nineteen dogs remained in complete remission. Recrudescence occurred in 11 dogs (median follow-up 60 days).

CONCLUSIONS AND CLINICAL IMPORTANCE

This study shows a close parallel in clinical appearance, histopathological results and clinical behaviour, of both adult and juvenile onset SGDL; therefore, SGDL should be considered as a differential diagnosis for dogs of all ages.

Effects of a diet enriched with eicosapentaenoic, docosahexaenoic and glutamine on cytokines as immunological markers for systemic inflammation in bitches before and after ovariohysterectomy

The post-operative period can generate immunological stress and can be modulated through supplementation with the omega-3 series of polyunsaturated fatty acids. This study aimed to evaluate the effects of diets enriched with high doses of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids and glutamine on inflammatory mediators in dogs before and after ovariohysterectomy (OVH). Twelve female dogs were divided into two groups: group A was fed a commercial diet without the addition of EPA and DHA, and group B was fed an experimental diet enriched with EPA and DHA (0.2 g/100 kcal). Experimental diet intake initiated 21 days before surgery and continued until 30 days after OVH. Parameters measured were serum cytokines (TNF-α, IL-6 and IL-10), C-reactive protein (CRP), IGF-1, lymphoproliferation and body composition before and after surgery. Statistical analyses were performed with SAS software considering the effects of age and diet and their interactions, and means were compared by the Tukey test. There was no difference between groups in body weight (p = .682), lean mass (p = .101) and body fat (p = .103). There were no group differences in serum concentrations of TNF-α, IL-6, IL-10, IGF-1, CRP and the percentage of lymphocyte proliferation. However, a time effect for TNF-α was observed (p < .001), in which T_0P (10 days after the surgical procedure) presented lower values of this cytokine when compared to the other evaluation time points; and interaction effects between group and time were observed for serum concentrations of IL-6 (p < .001) and IL-10 (p = .002). OVH procedure was not considered invasive enough to increase inflammatory cytokines after 30 days of surgery, as well as the dosage of the EPA and DHA used before and after the surgery did not modulate the inflammatory markers.

Canine ischaemic dermatopathy: a retrospective study of 177 cases (2005-2016)

BACKGROUND

Ischaemic dermatopathy encompasses a poorly understood subset of canine diseases that share similar clinical and histological features. Very little information is currently available regarding population characteristics, progression and outcome.

HYPOTHESIS/OBJECTIVES

This study aimed to describe the clinical features and therapeutic outcomes of ischaemia dermatopathy, excluding familial dermatomyositis, using cases diagnosed by histopathological analysis.

ANIMALS

One hundred and seventy-seven cases submitted for histopathological analysis between 2005 and 2016 met inclusion criteria, of which 93 had complete medical records available.

METHODS AND MATERIALS

Both records and pointed surveys were used to retrieve information. Scoring systems were created to subjectively evaluate clinical outcomes and likelihood of a vaccine association.

RESULTS

Of 177 cases, toy and miniature poodles, Chihuahuas, Maltese, Yorkshire terriers and Jack Russell terriers were significantly over-represented (P < 0.001). Of the 93 cases for which historical data were obtained, median age at skin biopsy was five years (0.42-13 years) and median body weight was 7.3 kg (range 1.32-50.3 kg). The condition in 45 dogs (48.3%) was found likely to be associated with vaccination. Younger ages (P = 0.011) and higher body weights (P = 0.003) were positively correlated with greater likelihood of vaccination. Body weight <10 kg (P = 0.0045) and older ages (P = 0.0048) were significantly associated with worse outcomes.

CONCLUSIONS AND CLINICAL IMPORTANCE

This study provides support for breed predispositions and identifies potential prognostic factors. Importantly, over half of the cases were considered unlikely to be vaccine-associated, demonstrating the need to investigate other underlying causes of this condition.

Non-controlled, open-label clinical trial to assess the effectiveness of a dietetic food on pruritus and dermatologic scoring in atopic dogs

BACKGROUND

Canine atopic dermatitis (AD) is a common skin disease. The goal of this study was to evaluate food designed to improve skin barrier function and lower inflammation to reduce pruritus and clinical severity in client-owned atopic dogs. The food contained an antioxidant blend to reduce oxidative stress, plant polyphenols to stabilize mast cells, and polyunsaturated fatty acids to improve skin health and reduce inflammation.

RESULTS

Seventeen dogs were included in the analysis. Initially 48 adult atopic dogs were enrolled and exclusively fed a dermatologic food for 8 weeks in a non-controlled, open-label study. Thirty-one dogs were excluded for the following reasons: oral and topical medication changes (n = 17), missing data (n = 4), fatty acid supplementation (n = 3), food refusal (n = 3), dropped out (n = 3), and owner concerns (n = 1). Using a scale from 0 (normal) - 4 (severe), veterinarians evaluated the presence and severity of clinical signs of atopy at weeks 0, 4, and 8. Pet owners also rated their pet's clinical signs of atopy on a scale from 0 (not present) - 10 (present continuously) at weeks 0, 4, and 8. Compared with initial baseline scores (median 19, range 3-69), the total veterinarian scores were significantly lower at weeks 4 (median 11, range 1-15) and 8 (median 7, range 3-46) (p < 0.05). Similarly, owner assessments showed significant improvements in the least squares mean (LSM) from baseline to 4 weeks (itching, redness, licking, and scratching) continuing to 8 weeks (itching, redness, and scratching) (p < 0.05).

CONCLUSIONS

In this open, non-controlled study evaluating a dermatologic diet in seventeen client-owned dogs, owner and veterinarian assessments showed statistically significant reductions in clinical scores designed to measure severity of atopic dermatitis. While these results show promise for the management of canine atopic dermatitis, controlled clinical trials are also needed to affirm our findings.

Comparison of the systemic phospholipid profile in dogs diagnosed with idiopathic inflammatory bowel disease or food-responsive diarrhea before and after treatment

BACKGROUND

Inflammatory bowel disease (IBD) and food-responsive diarrhea (FRD) are common chronic enteropathies in dogs, of which the exact pathogenesis has not been fully understood. In people dyslipidemia has been reported in patients with IBD, and potential therapeutic benefits of polyunsaturated fatty acids (PUFA) in the treatment of IBD have been investigated. Studies on the phospholipid profile in dogs with IBD and FRD are still lacking.

AIM

To investigate the systemic phospholipid profile of dogs with IBD or FRD and to evaluate possible differences in phospholipids before and after treatment.

METHODS

The phospholipids in whole blood and EDTA plasma of 32 dogs diagnosed with either IBD (n = 16) or FRD (n = 16) were analyzed by hydrophilic interaction liquid chromatography (HILIC) prior to and after initiation of treatment, which included an elimination diet enriched with PUFAs.

RESULTS

A clear separation of the phospholipids between whole blood and plasma was demonstrated on principal component analysis plots. In addition to the type of specimen, treatment and disease severity were the most significant factors determining the variance of the phospholipid profile. An increase in lysolipids was observed after treatment. The phosphatidylcholine (PC) species changed from PC 38:4 before treatment to mainly lysophosphatidylcholine 18:0 after treatment. Furthermore, several differences in the abundance of individual phospholipids were identified between dogs with IBD and dogs with FRD and between treatment statuses using random forest analysis.

CONCLUSION

Significant variances were identified in the phospholipid profiles of dogs with IBD and FRD. These were particularly determined by type of specimen used, disease severity and treatment status. After treatment, a shift of phospholipid species towards lysophosphatidylcholine 18:0 was observed. Future studies should further investigate the role of lipids in the pathophysiology of IBD and FRD as well as their potential therapeutic benefits.

Effects of the consumption of polyunsaturated fatty acids on the oxidative status of adult dogs

The present study evaluated the alterations of the oxidative stress markers in adult dogs fed with high levels of PUFA from the mixture of soybean oil enriched with docosahexaenoic acid (DHA) and supplemented with a natural algae-based antioxidant (AOX). Twelve healthy adult (2 years old) Beagle dogs (6 males and 6 females, 11.20 ± 1.92 kg BW), were distributed in 2 completely randomized blocks design and fed with 4 experimental diets coated with 2 lipid sources: saturated (13% bovine tallow) or unsaturated (13% soybean oil enriched with DHA), supplemented or not with 500 mg of AOX for 4 wk, intercalated with a 4-wk adaptation period. Blood samples were collected on days 0, 15, and 30 of each block. Glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), sulfhydryl group (SH), protein carbonylation, thiobarbituric acid reactive substances (TBARS), and total reactive antioxidant potential (TRAP) were evaluated in the serum, while GSH-Px, SOD, glutathione S-transferase (GST), catalase (CAT), SH, and TBARS were measured in erythrocytes. There was no significant difference in most of the oxidative markers evaluated. In contrast, GST activity in erythrocytes was greater in the animals that consumed the diets coated with bovine tallow compared to dogs that consumed diets coated with soybean oil enriched with DHA (P < 0.05). Serum from dogs fed on diets supplemented with AOX presented greater TRAP values (P < 0.05). These data demonstrate that the concentrations of unsaturated fatty acids (UNS) used in the diets for dogs were not sufficient to cause large changes in the oxidative status. It was not possible to evaluate the efficiency of the natural antioxidant in maintaining the oxidative balance of the animals as it appears that the oxidative status of the dogs was not challenged by the unsaturated diets. Our findings also suggest that dogs, as descendants from carrion carnivores, may have some natural protection against oxidation.

An open study on the efficacy of a recombinant Der f 2 (Dermatophagoides farinae) immunotherapy in atopic dogs in Hungary and Switzerland

BACKGROUND

Previously published studies evaluating a recombinant Der f 2-based immunotherapy have demonstrated efficacy in the treatment of dogs experimentally and naturally sensitized to house dust mites (HDM). Der f 2 sensitization is thought to play a minor role in European atopic dogs sensitized to HDM.

OBJECTIVE

The study evaluated the short-term efficacy of a recombinant Der f 2 product in the treatment of naturally sensitized atopic dogs in Switzerland and Hungary.

ANIMALS

Fifteen atopic dogs with positive test reactions to Dermatophagoides farinae (Df).

MATERIAL AND METHODS

Recombinant Der f 2 allergens were injected subcutaneously at increasing doses once weekly for 6 weeks. Canine Atopic Dermatitis Extent and Severity Index (CADESI-04), pruritus Visual Analog Scale (pVAS) and medication scores were assessed at days 0 and 42. Efficacy was recorded as excellent, good, fair or poor, depending on the number of scores decreasing by more than 50%.

RESULTS

Mean CADESI, pVAS and medication scores at inclusion were 35, 6 and 15 (SD = 30, 2, 7), respectively. At Day 42 the scores decreased to 8, 3 and 5, respectively (Wilcoxon matched pairs signed rank tests P = 0.0002, 0.002 and 0.001). Four dogs were classified as excellent responders with a reduction of >50% in all three scores. Nine dogs were classified as good (five) or fair (four) responders and scores deteriorated in two dogs.

CONCLUSION

These data suggest that recombinant Der f2 allergens may be as effective and show benefit faster than traditional allergen immunotherapy in European dogs sensitized to Df.

The effect of dietary corn oil and fish oil supplementation in dogs with naturally occurring gingivitis

The aim of this randomized, double-blinded, placebo-controlled study was to evaluate if downregulation of the inflammatory response due to ingestion of high levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) can slow down gingivitis development, and thus delay the progression of periodontal disease (PD) in dogs. To this aim, 44 client-owned adult dogs (>1 and <8 years old) with naturally occurring PD (stages 1 and 2) were submitted to a plaque, gingivitis and calculus scoring followed by a dental cleaning procedure and collection of blood samples. The animals were then fed a canine adult maintenance diet, supplemented with either corn oil (0.00 g EPA and 0.00 g DHA) or fish oil (1.53 g EPA and 0.86 g DHA, both per 1,000 kcal ME) over the following 5 months. At the end of this period, the PD scoring and the blood sampling were repeated. The animals consuming fish oil had higher plasma levels of the longer chain (C ≥ 20) omega 3 fatty acids (p < 0.01) and similar plasma levels of alpha-linolenic acid (p = 0.53), omega 6 fatty acids (p > 0.63) and C reactive protein (p = 0.28) then the ones consuming corn oil. There were no differences between fish oil and corn oil diet supplementation on plaque (18.2 vs. 17.8, p = 0.78), calculus (10.1 vs. 11.5, p = 0.18) or gingivitis (19.3 vs. 19.0, p = 0.77) indexes. The authors conclude that supplementation with EPA + DHA does not slow down progression of PD in dogs.

Rapid Prediction of Fatty Acid Content in Marine Oil Omega-3 Dietary Supplements Using a Portable Fourier Transform Infrared (FTIR) Device and Partial Least-Squares Regression (PLSR) Analysis

Using a portable field device, a Fourier transform infrared spectroscopy (FTIR) and partial least-squares regression (PLSR) method was developed for the rapid (<5 min) prediction of major and minor fatty acid (FA) concentrations in marine oil omega-3 dietary supplements. Calibration models were developed with 174 gravimetrically prepared samples. These models were tested using an independent validation set of dietary supplements. FAs analyzed included eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA); the sums of saturated, branched-chain, and monounsaturated FAs; and n-6, n-4, n-3, n-1, and trans polyunsaturated FA. The spectral ranges 650-1500 or 650-1500 and 2800-3050 cm^-1 provided reliable predictions for FA components in 34 neat oil products: standard error of prediction, 0.73-1.58%; residual predictive deviation, 6.41-12.6. This simple, nondestructive quantitative method is a rapid screening tool and a time and cost-saving alternative to gas chromatography for verifying label declarations and in quality control.

Cutaneous Adverse Drug Reactions in Dogs Treated with Antiepileptic Drugs

Epilepsy is one of the most common neurologic disorders in dogs and life-long treatment with antiepileptic drugs (AED) is frequently required. Adverse events of AED targeting the skin are only rarely reported in veterinary medicine and the true incidence and spectrum of cutaneous reactions in epileptic dogs remains unknown. In this study, we hypothesized that cutaneous reactions commonly occur in epileptic dogs and are related to AED treatment. A retrospective case review of 185 dogs treated for epilepsy identified 20.0% with simultaneous appearance of dermatologic signs. In a subsequent prospective case investigation (n = 137), we identified newly appearing or distinct worsening of skin lesions following initiation of AED therapy in 10.9% of dogs treated for epilepsy (95% CI 6.8–17.7%). Cutaneous lesions were classified as probably drug-induced in 40.0% of these cases. Patch testing and intradermal testing were further investigated as potential diagnostic methods to confirm AED hypersensitivity. They were of high specificity but sensitivity and positive predictive value appeared inappropriate to recommend their routine use in clinical practice.

An update on the treatment of canine atopic dermatitis

Canine atopic dermatitis is a common skin disease seen in veterinary clinical practice. Several factors appear to contribute to the cutaneous inflammation and pruritus. The therapeutic strategy should focus on control of those factors that can be identified and for which interventional measures are feasible; these include ectoparasites, bacterial/fungal infection and dietary hypersensitivity. Ectoparasites, particularly fleas, are not the cause of atopic dermatitis, but they are a confounding factor, which can exacerbate pruritus, and preventative measures are therefore indicated. Bacterial and yeast infections are frequently associated with atopic dermatitis and initial systemic and/or topical therapy should be considered, followed by regular topical treatment for preventing relapse. Concurrent dietary hypersensitivity should be investigated by undertaking an elimination/provocation trial, followed by feeding of a hypoallergenic diet where appropriate. Depending on the severity of the clinical signs of atopic dermatitis and the willingness and expectations of owners, symptomatic treatment and/or specific interventional therapy for environmental allergy (allergen avoidance, allergen-specific immunotherapy) may be implemented. Symptomatic treatment includes use of glucocorticoids (systemically or topically), ciclosporin and oclacitinib. Other treatment modalities of lower or less proven efficacy include antihistamines, dextromethorphan, fatty acids, feline interferon-omega, misoprostol, pentoxifylline, specific serotonin re-uptake inhibitors and tricyclic antidepressant drugs. The therapeutic approach should be reviewed at regular intervals and tailored to the individual's needs. A successful long-term outcome can usually be achieved by combining the various treatment approaches in a way that maximises their benefits and minimises their drawbacks.

Relationship of body weight to maintenance cyclosporine a dose in canine atopic dermatitis

Cyclosporine A (CsA) is a commonly prescribed and effective therapy for canine atopic dermatitis. The purpose of this study was to investigate the potential relationship between patient body weight and CsA dosing. Seventy-seven cases of canine atopic dermatitis managed between 2000 and 2011 were evaluated retrospectively. Duration of CsA therapy was at least 16 wk. Groups analyzed included the study population as a whole, those treated with only CsA, and those treated with both CsA and metoclopramide. The division between small and large dogs was set at 15 kg. Descriptive analysis, two-way analysis of variance, Pearson correlations, and a Student t test were used to analyze data. There were no significant differences between CsA dose and body weight regardless of method of analysis. Concurrent corticosteroid use, other medication use, and pruritus score were also analyzed over the study period. There was a significant decrease in CsA dose, corticosteroid dose, medication score, and pruritus score between the time points for all patients, but no significant relationship between those changes and body weight. These study findings suggest that differential CsA dosing is not warranted based on body weight.

Oral and subcutaneous therapy of canine atopic dermatitis with recombinant feline interferon omega

Canine atopic dermatitis (CAD) is a common allergic skin disease that has been treated with subcutaneously administered interferons (IFN). Recombinant feline IFN-ω (rFeIFN-ω) was reported to be efficacious for CAD. Whether dogs develop neutralizing antibodies against rFeIFN-ω during long-term treatment and whether orally administered IFNs are efficacious in CAD is unknown. The aim of this study was to evaluate the potential development of antibodies against rFeIFN-ω in atopic dogs and to compare subcutaneous and oral IFN therapy. Twenty-six atopic dogs were randomly assigned to two groups. The first group (n=15) received eight subcutaneous injections of rFeIFN-ω (Virbagen® omega, Virbac, Carros, France) over four months, the second group (n=11) received rFeIFN-ω daily orally. Concurrent medication was permitted, except systemically acting glucocorticoids and cyclosporin, which had to be withdrawn at least two weeks prior to the study. Serum samples for antibody detection were collected before and after the study. On days 0, 60 and 120 skin lesions and pruritus were evaluated using a validated lesion score (Canine Atopic Dermatitis Extent and Severity Index=CADESI) and a validated pruritus score. Concurrent medications were recorded. For every visit a total score, consisting of CADESI, pruritus score and medication score was created. For antibody detection an indirect ELISA, using Virbagen® omega as antigen, was performed. Comparison of pruritus scores, CADESI and total scores between days 0 and 120 showed improvement in both groups, however, significant improvement could only be detected in the oral group with CADESI and total scores (61%, P=0.04 and 36%, P=0.02 respectively). Serum antibodies against rFeIFN-ω could not be detected in any of the dogs. In this study antibody production could not be demonstrated. It suggests better efficacy with oral IFN administration, which should be further verified in larger, randomized, controlled studies.

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.

Potential adverse effects of omega-3 Fatty acids in dogs and cats

Fish oil omega-3 fatty acids, mainly eicosapentaenoic acid and docosahexaenoic acid, are used in the management of several diseases in companion animal medicine, many of which are inflammatory in nature. This review describes metabolic differences among omega-3 fatty acids and outlines potential adverse effects that may occur with their supplementation in dogs and cats with a special focus on omega-3 fatty acids from fish oil. Important potential adverse effects of omega-3 fatty acid supplementation include altered platelet function, gastrointestinal adverse effects, detrimental effects on wound healing, lipid peroxidation, potential for nutrient excess and toxin exposure, weight gain, altered immune function, effects on glycemic control and insulin sensitivity, and nutrient-drug interactions.

The Influence of Topical Unsaturated Fatty Acids and Essential Oils on Normal and Atopic Dogs

Seven dogs with atopic dermatitis and six normal dogs were treated with a spot-on product containing essential oils and unsaturated fatty acids q 7 days for 8 wk. Seven additional atopic dogs received a daily spray containing similar ingredients to the spot-on. In all dogs, transepidermal water loss (TEWL) was measured before and after treatment using a closed chamber device. In atopic dogs, a validated lesion score (canine atopic dermatitis extent and severity index, CADESI) was determined and pruritus was assessed with a visual analog scale before and after treatment. The mean CADESI scores in atopic dogs decreased with the spot-on (P=0.0043) and with the spray (P=0.0366). Similarly, the pruritus scores decreased with the spot-on (P=0.266) and with the spray (P=0.0177). There was a significant difference between the TEWL values of healthy and atopic dogs on the abdomen (P=0.0181) and back (P=0.0123). TEWL decreased significantly on the back after treatment with the spray (P=0.016), but not on the abdomen (P=0.078). Adverse effects were not observed. The results of this pilot study indicate that topical fatty acids and essential oils are a useful treatment option for canine atopic dermatitis.

Fatty acid composition of serum lipid classes in mice following allergic sensitisation with or without dietary docosahexaenoic acid-enriched fish oil substitution

Dietary fatty acids have been shown to influence allergic sensitisation. Bothn-3 andn-6 PUFA are involved in targeted mediation of inflammatory responses during allergic sensitisation and manifestation of atopic diseases. In the present experiments we investigated whether supplementation of DHA-enriched fish oil partly substituting dietary sunflower-seed oil, in comparison with sunflower-seed oil, supplemented to mice influences fatty acid composition of serum lipid classes. The effects of the two different diets were also investigated depending on allergic sensitisation. Supplementation of DHA and EPA in doses of 2 and 0·12 % (w/w) to non-sensitised and sensitised mice resulted in significantly increased percentile contributions of DHA to all lipid classes. In contrast, serum values of then-6 PUFA arachidonic acid (AA) were significantly lower, both in non-sensitised and sensitised mice fed the DHA-enriched diet. The fatty acid composition of serum lipids also reflected allergic sensitisation: the EPA:AA ratio in TAG, cholesteryl esters and phospholipids in non-supplemented animals fell to 23, 29 and 29 % respectively of the original value after allergic sensitisation, whereas it decreased to 70, 80 and 76 % respectively only in the animals supplemented with DHA. In summary, allergic sensitisation alone decreased significantly the EPA:AA ratios in serum TAG, while concomitant supplementation of DHA-enriched fish oil ameliorated this decrease. We postulate from the present results that the amelioration of the severity of allergic sensitisation after DHA supplementation may be linked to altered ratios of the eicosanoid precursors EPA and AA as well as DHA needed for further metabolic activation to pro- or anti-inflammatory bioactive lipids.

Plasma and skin concentrations of polyunsaturated fatty acids before and after supplementation with n-3 fatty acids in dogs with atopic dermatitis

OBJECTIVE

To determine essential fatty acid concentrations in plasma and tissue before and after supplementation with n-3 fatty acids in dogs with atopic dermatitis.

ANIMALS

30 dogs with atopic dermatitis.

PROCEDURE

Dogs received supplemental flaxseed oil (200 mg/kg/d), eicosapentaenoic acid (EPA; 50 mg/kg/d)-docosahexaenoic acid (DHA; 35 mg/kg/d), or mineral oil as a placebo in a double-blind, placebo-controlled, randomized trial. Clinical scores and plasma and cutaneous concentrations of linoleic acid, arachidonic acid, alpha-linolenic acid (alpha-LLA), EPA, DHA, prostaglandin E2, and leukotriene B4 were determined.

RESULTS

Total plasma concentrations of alpha-LLA and EPA increased and those of arachidonic acid decreased significantly with administration of EPA-DHA, and concentrations of alpha-LLA increased with flaxseed oil supplementation; nevertheless, there was no significant change in the concentrations of these fatty acids or eicosanoids in the skin. There was no correlation between clinical scores and plasma or cutaneous concentrations for any of the measured fatty acids or eicosanoids.

CONCLUSION AND CLINICAL RELEVANCE

Results indicated that at the dose used, neither the concentrations of fatty acids in skin or plasma nor a decrease in the production of inflammatory eicosanoids was a major factor involved in the mechanism of action in dogs with atopy that responded to fatty acid supplementation.

Omega-3 fatty acids: molecular approaches to optimal biological outcomes

PURPOSE OF REVIEW

This review discusses recent advances in delineating basic mechanisms underlying the beneficial effects of omega-3 fatty acids on health and on disease.

RECENT FINDINGS

While a substantial number of studies have delineated many differences between the biological effects of saturated versus polyunsaturated fatty acids, less is known about the long-chain omega-3 fatty acids commonly present in certain fish oils. In this review, we focus on recent studies relating to basic mechanisms whereby omega-3 fatty acids modulate cellular pathways to exert beneficial effects on promoting health and decreasing risks of certain diseases. We will use, as examples, conditions of the cardiovascular, neurological, and immunological systems as well as diabetes and cancer, and then discuss basic regulatory pathways.

SUMMARY

Omega-3 fatty acids are major regulators of multiple molecular pathways, altering many areas of cellular and organ function, metabolism and gene expression. Generally, these regulatory events lead to "positive" endpoints relating to health and disease.

Use of immunostimulatory liposome-nucleic acid complexes in allergen-specific immunotherapy of dogs with refractory atopic dermatitis - a pilot study

This pilot study evaluated the effects of immunostimulatory liposome-plasmid-DNA complexes combined with specific allergens for immunotherapy of refractory canine atopic dermatitis. Seven dogs with previously diagnosed atopic dermatitis and unsatisfactory response to at least 12 months of conventional allergen-specific immunotherapy underwent a series of six intradermal injections (weeks 0, 2, 4, 6, 10 and 14), with patient-specific allergen extracts contained in cationic liposome-DNA complexes. Degree of pruritus was assessed on a visual analogue scale. Lesion scores were determined using the Canine Atopic Dermatitis Extent and Severity Index (CADESI) and medication usage was recorded at weeks 0 and 14. Canine cytokine mRNA expression in peripheral blood mononuclear cells collected prior to treatment and at the completion of the study was determined for IFN-gamma, IL-4, TNF and IL-10 genes using quantitative reverse transcription competitive polymerase chain reaction. Repeated intradermal injections of specific allergens incorporated into liposome-nucleic acid complexes were well tolerated in all seven dogs. There was a significant improvement in pruritus scores (P = 0.0277) and concurrent significant decrease in IL-4 production (P = 0.0428) at the completion of the trial compared to pretreatment values. Medication scores, CADESI and production of other cytokines did not change significantly with treatment. These early results suggest that antigen-specific immunotherapy using a novel liposome-nucleic acid complex vaccine may be beneficial for treatment of established atopic dermatitis in dogs using lower antigen doses. Further investigations in larger numbers of dogs with earlier stages of disease are warranted.

Mouse Models of Atopic Eczema Critically Evaluated

Atopic eczema (AE) is a chronic relapsing inflammatory skin disorder with increasing prevalence in Western societies. Even though we have made considerable progress in understanding the cellular and molecular nature of cutaneous inflammation, the precise pathomechanisms of AE still remain elusive. Experimental animal models are indispensable tools to study the pathogenic mechanisms and to test novel therapeutic approaches in vivo. For AE a considerable number of mouse models have been proposed and have been used to study specific aspects of the disease, such as genetics, skin barrier defects, immune deviations, bacteria-host interactions or the role of cytokines or chemokines in the inflammatory process. While some models closely resemble human AE, others appear to reflect only specific aspects of the disease. Here we review the currently available mouse models of AE in light of the novel World Allergy Organization classification of eczematous skin diseases and evaluate them according to their clinical, histopathological and immunological findings. The pathogenetic analogies between mice and men will be discussed.