Allergic skin disease

Question 1

List 3 common triggers for allergic skin disease

Answer 1

environmental allergens
Foods
ectoparasites

Question 2

what hypersensitivity is most commonly involved with allergic skin disease

Answer 2

type 1- immediate - IgE

Question 3

Define canine atopic dermatitis

Answer 3

A common chronic, relapsing, pruritic and inflammatory skin syndrome with characteristic clinical features- broken down into environmental and food- triggered

Question 4

List 3 factors needed for environmental canine atopic dermatisis

Answer 4

defective cutaneous barrier function
microbial dysbiosis/ overgrowth/ infection
hypersensitivity reaction

Question 5

List 2 things targeted in some canine atopic dermatitis treatments

Answer 5

IL31
Janus kinase pathways

Question 6

what are the pathognomonic signs for canine atopic dermatitis

Answer 6

there are none

Question 7

If you see crusty ear margins what is it likely to be

Answer 7

sarcoptic mange

Question 8

Describe the history typically seen with canine atopic dermatitis

Answer 8

nearly always pruritic
scratch, lick, rub, scoot
onset usually 6m-3 yr
may start seasonally –> year round
most will respond to anti-inflammatory dose of corticosteroids

Question 9

what age does food-triggered atopic dermatitis generally start

Answer 9

can develop at any age
30-50% start at <1yr
More likely than environmental CAD if onset <6mo?
Sensitisation not associated with diet change!

Question 10

List the clinical signs of food-triggered allergic atopic dermatitis

Answer 10

Skin signs clinically indistinguishable from environmental CAD

+/- Concurrent clinical signs, e.g.
- GI signs
- Urticaria/angioedema
- Malassezia dermatitis

Question 11

Describe feline atopic syndrome

Answer 11

can manifest in skin, GI tract or resp tract

Question 12

Describe Feline atopic skin syndrome (FASS)

Answer 12

Inflammatory/pruritic skin syndrome, likely associated with IgE to environmental allergens
Usually young adult – 6mo-5y onset (occasionally older)
Seasonal/ non-seasonal
most commonly presents with one of the 4 reaction patterns

Question 13

Describe Feline food allergy (FFA)

Answer 13

can occur at any age from 3 months onwards
Non-seasonal
+/- GI/conjunctivitis/respiratory signs
most commonly presents with one of the 4 reaction patterns

Question 14

How common is contact hypersensitivity

Answer 14

very uncommon

Question 15

what does contact hypersensitivity need to be differentiated from

Answer 15

contact irritant dermatitis

Question 16

Describe how contact hypersensitivity present

Answer 16

Sensitisation usually over prolonged period
Lesions in areas of contact only!
Particularly affects sparsely haired regions

Question 17

Describe how to diagnose contact hypersensitivity

Answer 17

patch test- rarely performed

Question 18

Describe eosinophilic folliculitis/ furunculosis

Answer 18

Reaction to presumed arthropod bite
Acute onset, highly pruritic
Often affects dorsal muzzle +/- other sites

Question 19

List the 3 I’s we are trying to control in atopic dermatitis

Answer 19

Inflammation
Itch
Infection

Question 20

List 4 things we need to balance when treating atopic dermatitis

Answer 20

Product efficacy/ speed of onset`
Risk side effects
Treatment feasibility/ owner compliance
Cost

Question 21

how does oclacitinib target

Answer 21

JAK inhibitor

Question 22

what does lokivetmab target

Answer 22

IL-31 monoclonal antibody- only affects pruritus not inflammation

Question 23

Describe action of glucocorticoids to treat pruritus

Answer 23

highly effective re inflammation and pruritus, rapid onset (24h), inexpensive – but significant risk of side effects, esp with long term use

Question 24

List 3 things we aim for when using glucocorticoids to treat pruritus

Answer 24

aim to use:
lowest potency product
lowest dose
shortest time

that will be effective

Question 25

describe the effects of oclacitinib

Answer 25

Excellent antipruritic, some anti-inflammatory effect NB for treatment of allergic pruritus and dermatitis only,

Question 26

Descrieb the effects of lokivetmab

Answer 26

Excellent antipruritic but minimal anti-inflammatory effect

Question 27

Describe the effects of ciclosporin

Answer 27

Excellent anti-inflammatory and antipruritic takes 1-2 months to work

Question 28

List 3 ways to improve the skin barrier

Answer 28

topical moisturisers systemic essential fatty aids essential oils

Question 29

List 3 ways to control flare factors

Answer 29

Good ectoparasite control Avoid overheating Control microbial populations –e.g. antimicrobial shampoos/wipes/foams

Question 30

which products are licensed for atopic dermatitis in cats

Answer 30

GCCs and ciclosporin

Question 31

An 11yo patient that is on oclacitinib for control of canine atopic dermatitis is diagnosed with renal failure. What would be the safest option for ongoing control of his skin condition?

Answer 31

Change to lokivetmab

Question 32

List 3 common environmental CAD allergens

Answer 32

dust mites pollens moulds

Question 33

What pathway is used to activate and proliferate inflammatory cells

Answer 33

Janus Kinase (JAK) pathways

Question 34

Describe what happens when there is chronic scratching

Answer 34

activated keratinocytes adn other immune cells increased monocyte/macrophage recruitment and activation thickening of the epidermis/stratum corneum

Question 35

List 3 types of adverse food reactions

Answer 35

food allergy food intolerance intoxication

Question 36

when do the majority of food allergies develop

Answer 36

when the animal is older than 1

Question 37

what is the most common cause of cutaneous reaction patterns of cats

Answer 37

feline atopic skin syndrome feline food allergy feline allergy dermatitis

Question 38

Describe how to diagnose FASS - feline atopic skin syndrome

Answer 38

eliminate ectoparasites and bacterial/fungal infections do a diet exclusion trial to rule out FFA

Question 39

Describe how to diagnose FFA- feline food allergy

Answer 39

diet exclusion trial

Question 40

are allergy tests of value for diagnosis of canine atopic dermatitis

Answer 40

No

Question 41

List 4 options for anti-pruritics

Answer 41

glucocorticoids ciclosporin oclacitinib lokivetmab

Question 42

what is a problem with depo injection of systemic glucocorticoids

Answer 42

diabetogenic and risk HPA axis suppression

Question 43

how often do we want to give oral glucocorticoids and why

Answer 43

we want the lowest effective alternate day dose, so that we can prevent HPA axis suppression

Question 44

what are the risks of long term glucocorticoid topical application

Answer 44

systemic absorption and skin thinning

Question 45

can we put hydrocortisone aceponate spray on broken skin

Answer 45

No

Question 46

how old do animals need to be in order to have oclacitinib

Answer 46

1 year old minimum

Question 47

how often do we give lokivetmab

Answer 47

every 4 weeks

Question 48

how does ciclosporin cause anti-pruritic effects

Answer 48

T-cell suppressor

Question 49

can antihistamines be used in animals

Answer 49

yes but they are unlicensed

Question 50

what can allergen-specific immunotherapies be made against

Answer 50

environmental allergens or Malassezia

Question 51

how long do you have to wait to see if allergen therapy has worked

Answer 51

trial for 12 months

Question 52

what are the 2 phases of atopy treatment

Answer 52

reactive - initial rapid control proactive - ongoing maintenance therapy to prevent recurrence