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SA DX & TX II > Exam 2 - Canine Atopic Dermatitis > Flashcards

Exam 2 - Canine Atopic Dermatitis Flashcards

1
Q

what is canine atopic dermatitis?

A

genetically predisposed inflammatory & pruritic allergic skin disease with characteristic clinical features associated with IgE Ab most commonly directed against environmental allergens

pollen, mold, dander, mites, insects, & foodstuffs

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2
Q

what is canine atopic-like dermatitis?

A

inflammatory & pruritic skin disease with clinical features identical to those seen in canine atopic dermatitis in which an IgE response to environmental or other allergens cannot be documented

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3
Q

T/F: it is estimated that 10-15% of animals have canine atopic dermatitis

A

true

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4
Q

what breeds are predisposed to canine atopic dermatitis?

A

terriers, spaniels, bulldogs, dalmatians, & sharpeis

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5
Q

what is the age of onset seen in dogs with atopic dermatitis?

A

0.5-3 years old

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6
Q

T/F: in a dog with atopic dermatitis, if there are no underlying infections, it will have an excellent response to steroids for treating the pruritus

A

true

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7
Q

what are some clinical signs that may clue you in to canine atopic dermatitis?

A

itch, recurring to chronic skin/ear infections, self-traumatic hair loss, & odor

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8
Q

the lesion distribution is commonly seen in what skin disease?

A

canine atopic dermatitis

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9
Q

how is canine atopic dermatitis diagnosed?

A

there is no reliable test that can differentiate it from other pruritic inflammatory conditions, so the diagnosis is based on history, clinical signs/findings, & the exclusion of other differential diagnoses

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10
Q

when is allergy testing used as a tool for patients with canine atopic dermatitis?

A

identifying offending allergens for inclusion in immunotherapy in atopic patients with a compatible history & clinical signs for more than 6 months out of the year

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11
Q

what are the favrot clinical criteria that are used for a clinical diagnosis of canine atopic dermatitis?

A

onset under 3 years of age

mostly indoor dog

steroid responsive pruritus

chronic or recurring yeast infections

alesional pruritus at onset

front paws affected

pinnae affected

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12
Q

what is the pathophysiology of canine atopic dermatitis?

A

sensitization - allergens are absorbed & epidermal langerhans cells capture/uptake/process it & takes it to regional lymph nodes as an antigen presenting cell to t cells

CD4 Th2 cells proliferate & secrete IL-4, IL-5, & IL-13 which induce B cells to produce IgE antibodies

re-exposure - allergen-specific IgE bound to LC capture/uptake/processing & then are presented to allergen specific T cells

CD4 Th2 cells proliferate & secrete IL-4, IL-5, IL-13, IL-31 (pruritogenic cytokine) which induces b cells to produce IgE antibodies & mast cell activation

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13
Q

what is ASIT?

A

practice of administering gradually increasing quantities of an allergen extract to an allergic subject to ameliorate the symptoms associated with subsequent exposure to the causative allergen

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14
Q

why are allergy tests used?

A

to select candidate allergens for immunotherapy & to institute allergen avoidance strategies

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15
Q

T/F: no allergy test is completely sensitive or specific & can just reflect allergen exposure in normal patients

A

true

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16
Q

T/F: allergy tests are screening tests for allergies in pruritic dogs

A

false - not screening tests

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17
Q

what is intradermal testing? how is it used for patients with atopic dermatitis?

A

process of introducing antigens into the dermis of atopic patients to elicit macroscopic hypersensitivity reactions - a positive challenge can manifest as an immediate-phase reaction or a late phase reaction

doesn’t diagnose it but it can help support the presence of atopic-like dermatitis with a negative test

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18
Q

what are some indications for pursuing intradermal testing for patients that are suspected to have canine atopic dermatitis?

A

after you have a clinical diagnosis of CAD established

used to support diagnosis

patient has persistent signs over 6 months

used to select allergens for immunotherapy

owner is willing to administer immunotherapy

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19
Q

what is allergen-specific IgE serology?

A

blood allergy test - process by which allergen-specific IgE is identified & quantified in the serum of a patient suspected of being affected with atopy

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20
Q

once atopic dermatitis has been confirmed in your patient, how is ASIT used? how long does it take?

A

retrain the immune system in your patient that has signs that occur greater than 6 months out of the year

or if symptomatic therapy isn’t tolerated or effective

may take 6-12 months to take effect

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21
Q

what is hypersensitivity?

A

objectively reproducible clinical signs initiated by exposure to a defined stimulus as a dose tolerated by normal dogs

22
Q

what is an allergy?

A

hypersensitivity reaction initiated by a specific immunological response to an allergen & mediated either by antibodies or cells

23
Q

what is an allergen?

A

antigen that favors the development of a hypersensitivity response

24
Q

what is atopy?

A

genetically predisposed tendency to develop IgE-mediated allergy to environmental allergens

25
Q

what is atopic disease?

A

any clinical manifestation of atopy - in the dog, atopic dermatitis is most commonly diagnosed

26
Q

how is canine atopic dermatitis characterized?

A

characterized by t-cell dysregulation often beginning as a typical type I hypersensitivity reaction (IgE) with progression towards a type IV hypersensitivity (cell-mediated) cellular infiltrate over time

27
Q

what cells are at the root of pathology in canine atopic dermatitis?

A

t lymphocytes

28
Q

what is the key cytokine present in canine atopic dermatitis? why?

A

IL-31

IL-31 is the cytokine that binds to the JAKS receptor which is what triggers the sensation of itch

29
Q

what is the role of janus kinase enzymes?

A

intracellular signaling enzymes that function in cell communication with many cytokines signaling through JAK (IL-31)

30
Q

what role do janus kinase enzymes play in the sensation of itch?

A

IL-31 binds to their receptors - JAKS enzymes stimulate the phosphorylation of STAT which causes downstream effects of turning on pro-allergic/inflammatory genes to propagate the allergic response

31
Q

what are the 5 F’s in regards to lesion distribution of canine atopic dermatitis?

A

face, feet, folds, flexure surfaces, & friction surfaces

32
Q

what are the 2 phases of therapy when approaching a patient with atopic dermatitis?

A

reactive therapy - induction of the clinical sign remission to stop the flare, depending on the degree of clinical signs, glucocorticoids or oclacitnib

proactive therapy - prevention of clinical sign recurrence to reduce relapses, dependent upon the degree of clinical inflammation: allergen avoidance, immunotherapy, proactive use of drugs

33
Q

why does topical therapy help patients with canine atopic dermatitis?

A

removes the allergens & microbial agents & improves epidermal barrier function

34
Q

how do glucocorticoids work for dogs with atopic dermatitis?

A

they suppress innate & cell-mediated immunity

35
Q

what is the MOA of oclacitnib?

A

specifically targets & inhibits IL-31 mediated janus kinase activity (JAK1) resulting in diminished pro-inflammatory cytokine & enzyme activity

36
Q

how does lokivetmab work for dogs with atopic dermatitis?

A

caninized monoclonal antibody that binds to IL-31 rendering it non-functional

37
Q

what is the intended goal of immunotherapy when treating canine atopic dermatitis?

A

not to eliminate or cure signs because it won’t but to reduce the extent & severity of signs

38
Q

what is the suggested MOA of ASIT?

A

largely unknown, but we think it induces t regulatory cells to produce IL-10 (anti-inflammatory), reduce IgE production, & produce IgG blocking antibodies to quench the allergen

39
Q

atopic dermatitis is a disease suspected to be caused by ______ _________ & a faulty __________ __________

A

cytokine dysregulation

epidermal barrier

40
Q

atopic dermatitis is the second most common allergic canine skin disease - what is the first?

A

flea allergy dermatitis

41
Q

what is important about CD4 Th2 cells in dogs with atopic dermatitis?

A

atopic individuals have a skewed proportion of Th1:Th2 cells favoring the Th2 subtype & less immunosuppressive TGFb

42
Q

what is the griffin clinical criteria used for canine atopic dermatitis?

A

suggestive - history & PE findings with pruritus present in areas other than the dorsolumbar region

compatible - pruritus in one or more of the following: face, pinnae, axillae, flexor elbow, flexor carpus, extensor tarsus, & paws

tentative - compatible criteria plus the exclusion of major differentials

definitive - tentative criteria plus positive intradermal or serologic test to one or more non-insect aeroallergens

43
Q

what are the 2 main parts of the development of canine atopic dermatitis?

A

sensitization - animal is becoming allergic & Th2 lymphocyte polarization occurs

re-exposure - clinically allergic animal that has cytokine dysregulation

44
Q

cytokine dysregulation in dogs with atopic dermatitis causes mass release of what cytokines?

A

IL-2, IL-4, IL-5, IL-6, IL-13, & IL-31

45
Q

T/F: stimulated Th2 lymphocytes release pro-inflammatory cytokines in clinically allergic dogs with canine atopic dermatitis

A

true

46
Q

what cytokine plays a key role in neuronal stimulation in atopic dermatitis?

A

IL-31 - key component of ongoing pruritus & inflammation

47
Q

what are the absolutes of management in a dog with canine atopic dermatitis that is often neglected?

A

identifying & eliminating infections

flea control

topical therapy

48
Q

what dosing is used for lokivetmab for dogs with atopic dermatitis? is it useful for seasonal & non-seasonal dermatitis?

A

dose based off of product insert ~2mg/kg given SQ every 4-8 weeks

works for both seasonal & non-seasonal

49
Q

what dosing is used for oclacitnib for dogs with atopic dermatitis? is it useful for seasonal & non-seasonal dermatitis?

A

apoquel 0.4-0.6mg/kg by mouth every 12 hours for 2 weeks & then every 24 hours

50
Q

what dosing is used for cyclosporine for dogs with atopic dermatitis? is it useful for seasonal & non-seasonal dermatitis?

A

5mg/kg by mouth every 24 hours for 4-6 weeks & then tapered to every 48 hours thereafter

used for non-seasonal atopic dermatitis in animals that have had a poor response to other therapies

51
Q

T/F: steroids are not ideal for chronic use when managing a patient with canine atopic dermatitis

A

true

52
Q

what dosing is used for prednisone for dogs with atopic dermatitis? is it useful for seasonal & non-seasonal dermatitis?

A

0.5-1.0mg/kg by mouth every 24 hours for 7 days & then taper to the lowest effective dose every 48 hours

used for seasonal atopic dermatitis

SA DX & TX II (62 decks)

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