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VETM 530 Dermatology > Pruritis and allergies > Flashcards

Pruritis and allergies Flashcards

(47 cards)

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1
Q

what is pruritis

A

unpleasant sensation that provokes desire to scratch

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2
Q

what is one of the only pieces of history that will help to diagnose atopy vs food allergy

A

seasonality (other is response to food trial)

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3
Q

atopy is often a ____ disease, while parasitic disease is likely a ______

A

progressive; more rapid onset

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4
Q

what are some general causes of pruritis

A

allergic disease, parasite, infectious, immune mediated, neuropathic, neoplastic

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5
Q

what are some questions to ask about pruritus

A

characterize pruritus, signalment, history, clinical signs, age, environment, seasonality, progression, response to meds, GI signs

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6
Q

this is a characteristic distribution of lesions for

A

flea allergy
caudal dorm, tail base, neck, inguinal

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7
Q

this is a characteristic distribution of lesions for

A

pediculosis and cheyletiellosis
dorm

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8
Q

this is a characteristic distribution of lesions for

A

scabies
pineal margins, elbows, hocks, ventrum

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9
Q

this is a characteristic distribution of lesions for

A

Demodex
paws, head, face, can be haphazard

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10
Q

this is a characteristic distribution of lesions for

A

Malassezia

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11
Q

this is a characteristic distribution of lesions for

A

canine atopic dermatitis

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12
Q

what is canine atopic dermatitis

A

hereditary, typically pruritic and
predominantly T-cell driven inflammatory skin disease involving
interplay between skin barrier abnormalities, allergen sensitization
and microbial dysbiosis

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13
Q

what are a few RISK factors for canine atopic dermatitis

A

urban environment, male, neutered, allowed on upholstered furniture, receiving flea control, exposure to smoke, being raised in a shed as a puppy, adopted at 8-12 weeks, living
in a county with a veterinary dermatologist, regular bathing, chocolate labs vs. other color labs

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14
Q

what are a few PROTECTIVE factors for canine atopic dermatitis

A

rural, walking in woodlands, fields or beaches, non-commercial diet,
raw diet, living with other animals

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15
Q

we used to think that CAD immune dysfunction had to do with a simply type 1 hypersensitivity to inhaled environmental allergens. now what do we think is happening?

A

multifactorial immune dysfunction is occurring: percutaneous abs or allergies is most important method of allergen contact; T cell driven inflammatory skin disease (Th 1, 2, 14, 22; Treg) with many cytokines involved (TSLP; IL-4, 17, 31, 33, 34)

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16
Q

talk about IL-31 role in CAD immune dysfunction

A

disease severity may correlate with IL-31 levels
associated with pruritus
binds to keratinocyte –> impact barrier function
atopic dogs have more IL-31 receptors

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17
Q

talk about IL-17 role in CAD immune dysfunction

A

causes release of pro-infl cytokines by keratinocytes; increased in CAD

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18
Q

talk about IL-33 role in CAD immune dysfunction

A

negatively impacts tight junctions and decreases barrier function of epithelium

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19
Q

talk about skin microbiota role in CAD immune dysfunction

Study These Flashcards
A

less diverse in atopics

more Staph. pseudointermedius, which directly induces inflammation and negatively effects skin barrier, and can trigger T cell responses

prone to Malassezia overgrowth, and this acts as allergen

20
Q

talk about IL-31 role in CAD

Study These Flashcards
A

increased allergen penetration and microbial colonization

21
Q

what is most common allergen in CAD patients

22
Q

is TOTAL IgE elevated in atopic vs non atopic dogs

Study These Flashcards
A

NO
(IgE to env allergens in most CAD dogs, but no increase total IgE
also not all CAD have allergen specific IgE with CAD
and non CAD dogs often have allergen specific IgE)

23
Q

what is the hallmark clinical sign of CAD? what are some primary atopic lesions?

Study These Flashcards
A

pruritis! and it is progressive
erythema and papules
(most lesions are secondary)

24
Q

what are 3 components of dx for CAD

Study These Flashcards
A

rule out (and treat) other diseases (pyoderma, yeast, dermatophytosis)
detailed analysis of hx and C/S (Favrot’s criteria)
demonstration of IgE (either by intradermal skin testing or serum IgE testing)

25
how is intradermal skin test performed and what is it looking for
SMALL (0.05 to 0.1 cc) intradermal injections on an area of body tests for MAST CELL BOUND IgE
26
_ out of 8 Favrot's criteria is 85% sensitive and 79% specific for _____
5; canine atopic dermatitis
27
what is serum IgE test looking for
CIRCULATING ALLERGEN IgE
28
give and advantage and a few disadvantages of serum IgE test
advantage: compared to intradermal skin test, less drug withdrawal, and is widely available and convenient disadvantages: little agreement between labs, there is seasonal variation in IgE, short half life of circulating IgE, and interference with other Abs
29
what are basic components of topical therapy for CAD
DELIVER antimicrobial ingredients and antipruritic ingredients REMOVE allergens from skin RESTORE skin barrier
30
what are basic components of treating CAD flares
identify and treat flare factors: is there ectoparasite, infection (staph, yeast), increased exposure to allergen (seasonal? food?), change in medication fast acting pruritus relief: oclacitinib, lokivetmab, corticosteroids are good, NOT cyclosporine
31
what are 4 medical options for relief or pruritis and inflammatin
oclacitinib, lokivetmab, cyclosporine, corticosteroids
32
what are 2 types of allergen specific immunotherapy (ASIT) for CAD? briefly compare these types
SC immunotherapy (SCIT) and sublingual immunotherapy (SLIT) more data for SCIT, but SLIT may work faster and less adverse effects
33
what is the only treatment for CAD than can ***decrease disease progression***
allergen specific immunotherapy
34
talk about oclacitinib (Apoquel)
JAK1 inhibitor, inhibits cytokines involved in CAD comparable efficacy to GCs fast acting, good for flares no evidence for neoplasia increased risk; serious adverse effects are rare label age >12 months oral BID for 14 days, then SID
34
talk about ilunocitinib (Zenralia)
newer JAK inhibitor, inhibits cytokines involved in CAD, maybe less specific than oclacitinib vaccine warning on label (stop 1 month before, restart 1 month after vx) oral SID
35
talk about lokivetmab (Cytopoint)
canonized mcAb that targets, binds, and inactivates IL-31 (assoc with pruritus, binds to keratinocyte and may affect barrier function) fast acting, useful for acute flares no drug interactions and minimal immunosuppression is for DOGS ONLY, any age SQ injection q4-8 weeks
36
talk about modified cyclosporines (CsA, Atomic)
calcineurin inhibitor adverse effects many dogs, but usually mild or moderate (GI, gingival hyperplasia, hypertrichosis, immune suppression) oral initially SID, decrease to EOD or less, takes 4-8 weeks to see full effect so not useful for flareups label age >6 mo
37
talk about corticosteroids for CAD
very effective for pruritus and allergic inflammation, but MANY side effects so best for short term use only TAPER dose, large breed dogs especially need lower doses generally prednisone and prednisolone equivalent in potency dexamethasone 10x more potent than prednisone methylprednisone 1.2x more potent than prednisone and less PU
38
what dose of corticosteroid prednisone equivalent) to start at for pruritis? what about inflammatory otic and pedal conditions?
0.5 mg/kg 1.0 mg/kg
39
what are some side effects of oral glucocorticoids
**PU, PD, PP** panting muscle atrophy weight gain steroid hepatopathy iatrogenic Cushing's GI ulcer lipidemia V/D immune suppression hypercoagulability skin: cutaneous atrophy, comedones, cysts, milia, calcinosis cutis, striae, hypotrichosis, alopecia, dull coat
40
what are soft steroids
potent steroids metabolized to weak steroids before systemic circulation topicals: hydrocortisone aceponate and mometasone
41
what is topical tacrolimus used for
CAD, similar to CsA but small molecule so better for topical use
42
describe chronic tx for CAD
ASIT combination therapy oclacitinib, lokivetmab, cyclosporine topical tx with AMD shampoo, maintenance for ear meds pulse antifungals for Malassezia infectio./overgrowth/allergy
43
is there an accurate commercially available test for food allergens?
intradermal, skin, saliva, hair - none of these are accurate need to use a food trial
44
what are 3 diet options for a food trial
limited ingredient (commercial pro home cooked) hydrolyzed
45
describe food trial
8 weeks, using itch meds at beginning of trial (oclacitinib good) if no improvement, no food allergy component; if improvement, rechallenge can't eat anything but the food trial! be aware of contaminated storage containers, bowls too
46
what are some reason for improvement during food trial
seasonal change placebo nutraceutical ingredients resolution of infection strict clean control true food allergy

VETM 530 Dermatology (7 decks)

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