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Dermatology > Allergies > Flashcards

Allergies Flashcards

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1
Q

a genetically predisposed inflammatory and pruritic allergic skin disease with characteristic clinical features
It is associated most commonly with IgE antibodies to environmental allergens

A

allergy

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2
Q

IgE antibodies to environmental allergens

A

allergy

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3
Q

T/F: allergies are curable

A

False -but it can be managed and controlled, which is the primary focus

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4
Q

allergy is usually an _______ diagnosis

A

exclusionary diagnosis
There is no diagnostic test for allergy
-history and response to treatment can provide clues
-logical approach will lead to correct diagnosis and treatment

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5
Q

What are the 3 causes of allergy

A

1) Flea
2) Atopy - meds/immunotherapy
3) Cutaneous Adverse Reaction to food - food trial

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6
Q

With allergic dermatitis, what lesions are seen

A

-Erythema
-Excoriation
-Lichenificiation
-Alopecia

due to licking, chewing, biting, scratching
commonly on: ears, paws, underarm, groin, underface

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7
Q

What is the most common cause of allergic dermatitis in companion animals in the world

A

Flea Bite Hypersensitivity (Ctenocephalides felis)

but the deadlast cause in Colorado

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8
Q

Where is sarcptes scabei typically found

A

elbows, pinnae, distal limbs
extreme pruritus
do superficial skin scrape

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9
Q

What is the distribution seen with allergic dermatitis in cats

A

1) Papulocrustous lesions
-Crusted papules
-Visual and palpable
-often pruritic

2) Balded patches from overgrooming

3) Reaction pattern

4) ECG

5) Indolent ulcer

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10
Q

Balded patches in a cat can be a manifestation of *

A

allergies- overgrooming

1) flea bite hypersensitivity
2) atopy
3) dermatophytosis
4) cheyletiellosis
5) Bacterial pyoderma
6) Demodicosis
7) Pemphigus foliaceus

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11
Q

What might cause a reaction pattern in a cat

A

1) Feline atopy
2) Feline Symmetrical Alopecia (barbering)
3) Miliary Dermatitis
4) Eosinophilic Granuloma Complex (ECG)
-Eosinophilic plaques
-Eosinophilic Granulomas
-Indolent Ulcers

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12
Q

What are the three syndromes of the Eosinophilic Granuloma Complex in cats

A

-Eosinophilic plaques
-Eosinophilic Granulomas
-Indolent Ulcers

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13
Q

Eosinphilic Granuloma Complex can be responsive to

A

antibiotics

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14
Q

Where in the US are fleas high in populations

A

the southeast US and also Southern California
*fleas love humidity

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15
Q

Where do fleas typically bite the dog

A

on the caudal dorsum (pant sign)

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16
Q

What is the preferred medication for flea eradication

A

Isoxazoline parasiticides
-Bravecto (fluralaner)
-Nexgard (afoxolaner)
-Simparica (Sarolaner)
-Credelio (Lotilaner)

also good against mites and ticks
aim to kill fleas in about 24 hours (eradication) and ticks at about 48 hours (rickettsial prevention) at about 99% flea kill and 90% tick kill

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17
Q

Ectoparaciticides aim to kill fleas in about

A

about 24 hours (eradication) and ticks at about 48 hours (rickettsial prevention) at about 99% flea kill and 90% tick kill

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18
Q

Allergic dermatitis cannot be controlled in flea-endemic environmentas without

A

affective flea control

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19
Q

How to do you tell the difference between environmental and food allergy

A

seasonality is a major consideration, however you can have year round environmental allergies

*vomiting is a poor correlation

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20
Q

Food allergy is the least common cause of allergies in companion animals and horses, yet why do we place them on a food trial

A

you can change the food but you cannot change the environment

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21
Q

Cutaneous adverse food reaction is a ______ hypersensitivity

A

IgE hypersensitivity (Type I) to food protein, immune mediated

type III/IV are also possible

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22
Q

Cutaneous adverse food reaction signs mimic environmental allergy, what are the signs

A

1) Pruritus
2) Ear inflammation (otitis)
3) Secondary skin infections (pyoderma)
4) Hives (urticaria) - rare
5) +/- Gi disturbances

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23
Q

What is the number one cause of otitis

A

allergy

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24
Q

What are the food allergens causing the IgE hypersensitivity

A

Glycoproteins 10,000+ daltons
Animal proteins
-Chicken
-Beef
-Dairy
-Fish
-Wheat
-Egg

Dyes/Preservatives are rare - too simple

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25
Q

T/F: you are born with allergies

A

False- you are born with a genetic predisposition to have allergies
this is why the chicken, beef, dairy are all common food allergies

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26
Q

T/F: there is a food allergy test

A

False- there is no test available that will reliably diagnose allergy, including food

accurate assessment of specific food allergens cannot currently be made with any commercial test

False positives are common

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27
Q

What is the pathogenesis of food allergy

A

food allergen binds to IgE receptor and internalization
mast cell degranulation and release of prostaglandins, leukotriens, cytokines, and histamine

Type I hypersensitivty (also Type III/IV possible)

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28
Q

What is an elimination diet for food allergies *

A

8 weeks
strict.
novel/hydrolyzed - renders protein hypoallergenic by making it smaller, harder to bind to IgE

1) novel protein/carbohydrate
2) home-cooked vs commercial
3) Hydrolyzed
4) Avoiding the offending allergens- dietary history

*Remember treats, table foods, flavored medications, chew toys (rawhides)
*No Rawfood or over the counter diets

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29
Q

What should you do for novel diets for food allergy trial

A

home-cooked (gold standard)
commercial prescription

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30
Q

What is true of homecooked diets

A

Unbalanced
Compliance is hard
Often two ingredients - protein and carbohydrate
Consult a Nutrtionist
Use online resources (balanceit.com)

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31
Q

At what age are you more suspicious of food allergies

A

Dogs <1 year of age

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32
Q

What is true of commercial prescription diets

A

easy
beware cross-reactivity
-growth? if puppy
-expensive

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33
Q

What does a small protein size (<10,000d) do to prevent food allergies

A

discourages IgE- crosslinking

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34
Q

Why might animals still flare with hydrolyzed diets

A

because they arent novel

avoid commonly-fed hydrosates?

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35
Q

T/F: over the counter diets should not be used in restrictive dietary trials

A

True0 occult proteins were found in a variety of OTC wet, dry and raw diets

36
Q

If within 8 weeks of a restrictive dietary trial you had decreased pruritus/inflammation, what should you do?

A

Dietary re-challenge
-Feed the previous diet
-Cutaneous Adverse food reaction patients will flare within two weeks (usually sooner)
this is to make sure that the season didnt change over the past 2 months of the food trial

-if they do not flare within 2 weeks, its likely environment
-if they flare within 2 weeks, its food allergy and keep them on the diet for their life

37
Q

If fleas are killed and no response to diet trial, what should you do

A

Diagnose Atopy Dermatitis

38
Q

Dont use allergy test for diagnosis of allergy, use it for the

A

formulation of immunotherapeutics (only works for environmental)

39
Q

What is the tradename of Oclacitinib

A

Apoquel

40
Q

What is the average age for allergies to present in dogs

A

1-3 years of age

41
Q

Apoquel (oclacitinib) works by

A

Tmax <1hr (onset 2-4 hours)
half life is 4.1 hr

42
Q

Why is Apoquel (oclacitinib) used in dogs over one year of age

A

because one of its adverse effects is demodicosis, which young dogs have a higher prevalence in

43
Q

What is the efficacy of Apoquel (oclacitinib)

A

67% of dogs

44
Q

What are the adverse effects of Apoquel (oclacitinib)

A

Demodicosis
Papillomatosis

45
Q

Does Apoquel (oclacitinib) cause neoplasia?

A

No- only correlation because apoquel is the #1 allergy medication

46
Q

What is the mechanism of action of Apoquel (oclacitinib)

A

JAK1-STAT inhibitor - prevents cytokine release and signaling of
-IL2- T cell proliferation
-IL4- Th2 response (eosinophils, basophils, mast cells)
-IL6- Stimulation of acute phase response
-IL13- igE stimulation (asthma)
-IL31- pruritic mediator

47
Q

What is the pruritic mediator that Apoquel (oclacitinib) blocks

A

IL-31

48
Q

Why do patients on Apoquel (oclacitinib) have a predisposition for demodex

A

blocks the parasite pathway (2,4,6,13,31)
-IL2- T cell proliferation
-IL4- Th2 response (eosinophils, basophils, mast cells)
-IL6- Stimulation of acute phase response
-IL13- igE stimulation (asthma)
-IL31- pruritic mediator

49
Q

What should you do for the 1/3 of patients that do not respond to Apoquel (oclactinib)

A

-Twice daily apoquel? - 88% efficacy
-Antihistamines
-Steroids
-Cytokine (lokivetmab)
-Atopica (modified cyclosporine)
-Allergy testing/immunotherapy

50
Q

Dosing Apoquel (oclactinib) BID can potentially cause

A

inhibition of innate immune function (JAK 2)
1) GM-CSF: leukocyte growth factor
2) EPO- erythrocyte stimulation hormone

51
Q

What is the problem with anti-histamines

A

low efficacy- about 20%
possible placebo?

52
Q

Why are antihistamines commonly used in horses, despite low efficacy

A

used due to cost primarily but still poor efficacy

in horses: insects >atopy > food

-Hydroxyzine, Doxepin, Cetirizine, Chlorpheniramine, Diphenhydramine

53
Q

What are the common causes of allergies in horses

A

Insects > Atopy > food

54
Q

What are the different steroids used to manage allergies

A

Prednisone 0.5-1 mg/kg q24h
Methylprednisone
Dexamethasone
Triamcinolone (acetate)
Depomedrol

55
Q

What is calcinosis cutis associated with

A

iatrogenic or metabolic hypercortisolism

56
Q

T/F: calcinosis cutis is reversible

A

true- except for osteoma cutis

57
Q

How do you diagnose calcinosis cutis

A

biopsy

58
Q

How do you treat calcinosis cutis

A

withdraw steroid
topical DMSO?
minocycline 15mg/kg BID (case report)

resolution takes months

59
Q

calcinosis cutis can cause secondary

A

infection and pruritus

60
Q

caninized monoclonal antibody against IL-31 used to treat canine allergies

A

Cytopoint (lokivetmab)

61
Q

T/F: Cytopoint (lokivetmab) has an age requirement of >1year

A

False - no age requirement

62
Q

What is the onset of Cytopoint (lokivetmab)

A

8 hours (half life of 9 days?)

63
Q

TF: Cytopoint (lokivetmab) can be used in cats

A

False- it is caninized monoclonal antibody against IL-31

64
Q

What is the efficacy of Cytopoint (lokivetmab)

A

87% of dogs

65
Q

What are the adverse effects of Cytopoint (lokivetmab)

A

unsure- possible:
-vomiting?
-immunogenicity?
-drug interactions?
-long-term safety?

least amount of adverse effects of 4 allergy meds

66
Q

Calcineurin inhibitor used to manage allergies

A

Atopica (modified cyclosporine)

67
Q

T/F: you can combine apoquel with cytopoint after monotherapeutic failures

A

True

68
Q

What is the onset of Atopica (modified cyclosporine)

A

4-6 weeks
tmax 90min

69
Q

What is the efficacy of Atopica (modified cyclosporine)

A

74% dogs
78.6% cats

70
Q

What is the mechanism of action of Atopica (modified cyclosporine)

A

inhibits calcineurin, specifically T cell function- blocking
IL2, IL4, IFN (macrophage activator), and TNF-a (early immune activation)

71
Q

What are the indications to use Atopica (modified cyclosporine)

A

Atopic dermatitis
Lupoid disease
Pemphigus variants
Cutaneous vascultitis
Sterile pyogranulomatous dermatitis
Sterile panniculitis
Perianal fistulas
Sebaceous adenitis

72
Q

Of Apoquel, Cytopoint, and Atopica what is most likely to cause opportunistic infections

A

Atopica - global cytokine inhibitor

fungal (saprophytic)
UTI
papillomatosis, fibropapillomas
Demodicsosi
toxoplasma, herpes (cats)
Psioriasiform lichenoid dermatosis
digital pododermatitis

73
Q

What are the dose related adverse effects of Atopica (modified cyclosporine)

A

Vomiting
Diarrhea
Gingival hyperplasia
Hyperglycemia?
Opportunistic infection
Hypertrichosis, shedding
Tremors
Psioasiform lichenoid dermatosis
Pruritus
Neoplasia

74
Q

Why might you put Atopica (modified cyclosporine) in the freezer?

A

Reduces vomiting???

75
Q

What drug might cause gingival hyperplasia

A

Atopica (cyclosporine)
Amlodipine

76
Q

Is long-term use of Atopica (modified cyclosporine) or Steroids safer

A

Atopica (modified cyclosporine)

77
Q

How should you give Atopica (modified cyclosporine)

A

-Frozen (off-label)
-With food (off-label)
-if vomiting, wait

if no response in 4-6 weeks, increase the dose
if effective decrease to EOD

78
Q

How is the dose ketoconazole affect Atopica (modified cyclosporine) dosing

A

it reduces the dose and therefore the cost but remember that ketoconazole can cause hepatopathy and hair lightening

79
Q

How effective is allergy testing/immunotherapy

A

60-70% efficacy

80
Q

allergy testing/immunotherapy efficacy is acheieved in

A

6-12 months

81
Q

What is the most common environmental allergens in CO ***

A

grasses, trees, weeds

82
Q

What is the only treatment known to treat primary allergy disease

A

immunotherapy

83
Q

immunotherapy only works for what allergies

A

environmental- also the only non-drug option for environmental allergies

84
Q

T/F: allergy testing is a diagnostic test

A

False- you have patients without allergies getting positive skin test

this is just made to make the recipe for immunotherapy

85
Q

Allergy is the #1 cause of

A

secondary infectious pyoderma

86
Q

Whats the way to go for horses with environmental allergies

A

immunotherapy

Dermatology (10 decks)

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