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Integumentary (SP23, Exam2) > Module 5 MiniModule 1: Pruritus - Allergy > Flashcards

Module 5 MiniModule 1: Pruritus - Allergy Flashcards

(51 cards)

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1
Q

What allergic dermatitis is often a diagnosis of exclusion?

A

Atopic dermatitis (AD)
- diagnosis made by excluding other diseases that may mimic the disease, such as CAFR.
- Serum allergy testing and intradermal allergy testing are performed after the diagnosis has been made, and if the owner chooses ASIT for treatment

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2
Q
  • Immunologically mediated adverse response to food
    • IgE-mediated (Type I hypersensitivity reaction)
    • Non-IgE-mediated (Delayed hypersensitivity reaction) (rare occasions)
A

CAFR
- “good disease”
- May be a challenge to diagnose

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3
Q

Definition:
Abnormal physiologic response to a food

A

Food intolerance

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4
Q

List the Clinical Signs for CAFR:

A
  • No primary lesions (specifically w/ dog)
  • Pruritus – primary complaint
  • Otitis external (very common on dogs, not on cats)
  • Secondary infections
  • +/- GI signs – reported in up to 31% of cases
  • May Resemble:
    - Atopic dermatitis – most common
    - Flea allergy dermatitis
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5
Q
  • Nonseasonal pruritus
  • Severe pruritus
  • Very young/very old
  • “poor” response to glucocorticoids
    Clinical signs: Identical to atopic dermatitis
    With this history, you should suspect …
A

CAFR

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6
Q

When can a diet be considered hypoallergenic?

A

If the animal was never exposed to the food components before

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7
Q

What is the hydrolysis of proteins?

A
  • Peptides and AA
  • Reduces the molecular weight (MW) of the original protein expressed in Daltons
  • Molecules are too small to cross-bind IgE on Mast Cells
  • Prevents degranulation and IgE-mediated hypersensitivity
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8
Q

How long is the duration of a food trial?

A

8-12 weeks
- treat secondary infections first if present, then start food trial
- initial 4 weeks, then recheck
- check for “errors” from owners
- continue diet for 4 more weeks, then recheck

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9
Q

(T/F) The food items that are allergic in an individual animal are those that the animal has been exposed to

A

True

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10
Q

Definition:
Genetically predisposed inflammatory dermatosis associated with IgE antibodies to environmental allergens

A

Atopic Dermatitis
- Pruritus
- chronicity
- typical lesion distribution

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11
Q

AD: Pathogenesis
- Activation of naive T lymphocytes
- Cytokine Release
- B cells produce ASIgE
- Th2 cells migrate to the skin
- ASIgE enter circulation-bind to cells (MC, LC)

A

Sensitization

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12
Q

What are the primary lesions for AD?

A

Trick question, there are no primary lesions for atopic dermatitis

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13
Q

What is the common age of onset for Atopic dermatitis?

A

6 mo to 3 years of age

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14
Q

(T/F) In the dog, atopic dermatitis is most common cause of otitis

A

True

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15
Q

Feline “AD”: NFNFIFHD

A
  • Onset 6 to 12 mo in 74% of cases
  • Usually non-seasonal
  • Rare to have secondary infections
  • Rare to have otitis
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16
Q
  • In dogs, it is a genetically predisposed inflammatory disease
  • Very common
  • Pathogenesis is multifaceted
  • Disease of young to young adult animals
  • Seasonal or nonseasonal
  • Clinical signs identical to CAFR in the dog
  • NOT diagnosed by allergy testing
A

Atopic dermatitis

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17
Q
  • Antihistamines
  • Essential fatty acids
  • Topicals
A

Treatments with WEAK evidence of efficacy

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18
Q

Treatments with WEAK evidence of efficacy
- 10 to 14 days trial
- Sequential trials (try different ones)
- Up to 30% may respond

A

Antihistamines

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19
Q

Treatments with WEAK evidence of efficacy
- Omega-3 essential fatty acids (fish oil)
- Eicosapentaenoic acid (EPA)
- Need 2 to 3 months for incorporation into cell membranes
- Synergistic when administered with AH (work better together)

A

Essential fatty acids

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20
Q

Treatments with WEAK evidence of efficacy
- Glucocorticoids
- Pramoxine
- Oatmeal

A

Topicals

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21
Q

Medications with FAIR evidence of efficacy
- Oral nutraceutical
- Ultra-micronized Palmitoylethanolamide(PEA-um)
- Naturally occurring lipid compounds found in animals and plants
- Acts on cannabinoid receptors
- Downregulate cells of inflammation (KC, macrophages, mast cells, pro-in-flam T cells)

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A

Redonyl Ultra

22
Q

Medications with FAIR evidence of efficacy
- PUFAs + Essential oils
- Vitamin E
- Once weekly x 8 weeks
- 9/23 (39%) > 50% improvement in pruritus
- Use as adjunctive therapy

23
Q

Medications with FAIR evidence of efficacy
- 0.015% triamcinolone
- Twice/day x 7 days, once/day x 7days, EOD x 7 days
- Improvement noted in 67% of treated dogs
- 24% of control dogs

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A

Genesis Topical Spray

24
Q

Medications with STRONG evidence of efficacy:
(safest) ASIT > Cytopoint > Apoquel > CSA > GCs
This is in relation to …

25
Medications with STRONG evidence of efficacy: (quickest) Apoquel > Cytopoint > GCs > CSA > ASIT This is in relation to ...
Time until effect
26
Medications with STRONG evidence of efficacy: (least expensive) GCs > ASIT > Apoquel > Cytopoint > CSA This is in relation to ...
Cost
27
Medications with STRONG evidence of efficacy: - "Crisis Buster” - Quick relief of pruritus - Prednisone - 1 mg/kg q 24h x 3 days - Provide relief for 5 to 7 days
Glucocorticoids
28
List the things you would like to do to monitor GC:
- Prior to initiation - At one to two months recheck - At least once every 6 months to a year - CBC, biochemical profile - U/A, Urine culture
29
"GC Dependent" Dog: What would you want to do to decrease the total prednisone dose?
- Add Omega 3 fatty acid (fish oil) - Add antihistamine - Add topicals - Add all 3 - Temaril P
30
Medications with STRONG evidence of efficacy: - Atopica - Neoral - Caution with generics! - Cyclosporine (modified) generic - MOA - Block the transcription of cytokine genes in activated T cells (i.e. IL-2)
Cyclosporine (CSA) - Minimum 4-week trial - If responsive, begin to decrease
31
Medications with STRONG evidence of efficacy: What drug are you NOT giving if the patient has a previous history of neoplasia?
Cyclosporine
32
Medications with STRONG evidence of efficacy: - Synthetic Janus Kinase (JAK) *inhibitor* - Inhibits the function of pruritogenic and pro-inflammatory cytokines (i.e. IL-31) that are dependent on JAK1 enzyme activity - Decreases pruritus within 1 to 3 hours - Not for use in dogs less than 12 mo of age or in dogs with serious infections; pregnant, lactating, or breeding dogs - Has not been evaluated with GCs - Has been evaluated with Atopica
Apoquel (oclacitinib)
33
Medications with STRONG evidence of efficacy: - *Caninized*monoclonal antibody that inhibits IL-31 - CANNOT be used on a cat! - Subcutaneous injection – 4 to 8 weeks - Keep refrigerated-DO NOT WIPE TOP OF VIAL - Vomiting, diarrhea, lethargy - RARE: neurological event, vaccine reaction - Monitoring – currently none - 77% dogs had a > 50% decrease in pruritus - 20 kg dog, one dose/mo: $87
Lokivetmab (Cytopoint)
34
Medications with STRONG evidence of efficacy: - “Desensitization”, “Hyposensitization” - Subcutaneous injection or sublingual administration of *increased quantities* of the allergen - Injected or sublingual administration of allergens, exactly what the animal is allergic to - *Only treatment that changes the immune response from over-reactive to tolerant* - Can be formulated with either SAT or IDT result
Allergen-Specific Immunotherapy (ASIT)
35
Medications with STRONG evidence of efficacy: What is the only treatment that changes the immune response from over-reactive to tolerant?
Allergen-Specific Immunotherapy (ASIT)
36
Allergy testing will ...
distinguish between animals that have a hypersensitivity vs those that do not - DO NOT distinguish between animals with AD and those without AD
37
Fill in the blanks Allergens: - Seasonal - Spring: ___(1)____ - Summer:__(2)___ - Fall:___(3)___ - Summer, Fall: ___(4)___
1. Trees 2. Grasses 3. Weeds 4. Outdoor molds - Alternaria, *Aspergillus*, Cladosporium, *Fusarium*
38
Allergens: - House dust mites - Dermatophagoidesfarinae; D. pteronyssinus - Storage mites - Tyrophagus - Lepidoglyphus - Indoor molds-– Penicillium, Aspergillus, Fusarium - Cockroach, moth - Danders (cat, dog, human, horse) These are ...
Non-seasonal allergens
39
Intradermal Testing vs Serum Testing - Measures IgE in skin: ____(1)______ - Measures Ige in serum: ___(2)______
1. Intradermal testing (IDT) 2. Serum Testing
40
List ASIT Duration:
- Most respond after months (usually 6 to 0 months); some after 3 months - Failure determined after 1 year - If successful, continue lifelong - Additional treatment for pruritus
41
Allergy tests are performed once ____ is diagnosed
AD
42
- No allergy testing - Immunotherapy is formulated based on the region, *not individualized therapy* - All contain weeds, trees, grasses, molds, house dust mites - It is discouraged
Regionally-Specific Immunotherapy (RESPIT)
43
*** FILLER CARD ***
Miscellaneous Pruritic Diseases
44
- Allergens/irritants - Outdoor - Plants - Indoor - Chemicals, fabrics - Topical medications - Otic preparations, shampoos - Neomycin, propylene glycol
Contact Dermatitis History: - Intermittent/Continuous - *Corticosteroid responsive* - May resolve when boarded - Animals affected - Allergy -- one animal at home - Irritant -- all animals at home
45
List the clinical signs of Contact Dermatitis:
- Erythema, papules - Exudation - Crusting, scaling, alopecia - Hyperpigmentation, lichenification - Well-demarcated
46
Canine Acral Lick Dermatitis (ALD) -- "Lick Granuloma" - *Boredom/stress* - *Psychogenic -- obsessive-compulsive disorder (OCD)* - Allergic disease (AD, CAFR, FAD) - Focal stimulus (wound, infection, joint disease) - Foreign body - Neuropathy - Endocrinopathy (hypothyroidism)
Primary Causes
47
Canine Acral Lick Dermatitis (ALD) -- "Lick Granuloma" - Change in habitat or additional pets - Change in people in the home - Change in routine - Anxiety/Separation - Inadequate recreation/exercise - Boarding/hospitalization - Clipping fur/IV catheters
Predisposing factors
48
Canine Acral Lick Dermatitis (ALD) -- "Lick Granuloma" - Bacterial infection - Keratin foreign body - Fibrosis - Osteomyelitis/periostitis/arthritis - Learned behavior
Perpetuating factors
49
List ALD Differential Diagnoses:
- Neoplasia - Nodular dermatitis - infectious - sterile - Demodicosis
50
List Topical Therapy for ALD:
- Glucocorticoids --> *Fluocinolone* in DMSO
51
List Systemic Therapy for ALD:
- Apoquel (oclacitinib) - Cytopoint - Oral Glucocorticoids - *Trazodone* --> behavior drug

Integumentary (SP23, Exam2) (5 decks)

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