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

Module 5 MiniModule 1: Pruritus - Allergy Flashcards

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)

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

A

Dermoscent

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

A

Genesis Topical Spray

24
Q

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

A

Safety

25
Q

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

A

Time until effect

26
Q

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

A

Cost

27
Q

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

A

Glucocorticoids

28
Q

List the things you would like to do to monitor GC:

A
  • 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
Q

“GC Dependent” Dog:
What would you want to do to decrease the total prednisone dose?

A
  • Add Omega 3 fatty acid (fish oil)
  • Add antihistamine
  • Add topicals
  • Add all 3
  • Temaril P
30
Q

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)

A

Cyclosporine (CSA)
- Minimum 4-week trial
- If responsive, begin to decrease

31
Q

Medications with STRONG evidence of efficacy:
What drug are you NOT giving if the patient has a previous history of neoplasia?

A

Cyclosporine

32
Q

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

A

Apoquel (oclacitinib)

33
Q

Medications with STRONG evidence of efficacy:
- Caninizedmonoclonal 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

A

Lokivetmab (Cytopoint)

34
Q

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

A

Allergen-Specific Immunotherapy (ASIT)

35
Q

Medications with STRONG evidence of efficacy:
What is the only treatment that changes the immune response from over-reactive to tolerant?

A

Allergen-Specific Immunotherapy (ASIT)

36
Q

Allergy testing will …

A

distinguish between animals that have a hypersensitivity vs those that do not
- DO NOT distinguish between animals with AD and those without AD

37
Q

Fill in the blanks
Allergens:
- Seasonal
- Spring: ___(1)____
- Summer:__(2)___
- Fall:___(3)___
- Summer, Fall: ___(4)___

A
  1. Trees
  2. Grasses
  3. Weeds
  4. Outdoor molds
    • Alternaria, Aspergillus, Cladosporium, Fusarium
38
Q

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 …

A

Non-seasonal allergens

39
Q

Intradermal Testing vs Serum Testing
- Measures IgE in skin: ____(1)______
- Measures Ige in serum: ___(2)______

A
  1. Intradermal testing (IDT)
  2. Serum Testing
40
Q

List ASIT Duration:

A
  • 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
Q

Allergy tests are performed once ____ is diagnosed

A

AD

42
Q
  • 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
A

Regionally-Specific Immunotherapy (RESPIT)

43
Q

** FILLER CARD **

A

Miscellaneous Pruritic Diseases

44
Q
  • Allergens/irritants
    • Outdoor
      • Plants
    • Indoor
      • Chemicals, fabrics
    • Topical medications
      • Otic preparations, shampoos
      • Neomycin, propylene glycol
A

Contact Dermatitis
History:
- Intermittent/Continuous
- Corticosteroid responsive
- May resolve when boarded
- Animals affected
- Allergy – one animal at home
- Irritant – all animals at home

45
Q

List the clinical signs of Contact Dermatitis:

A
  • Erythema, papules
  • Exudation
  • Crusting, scaling, alopecia
  • Hyperpigmentation, lichenification
  • Well-demarcated
46
Q

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)

A

Primary Causes

47
Q

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

A

Predisposing factors

48
Q

Canine Acral Lick Dermatitis (ALD) – “Lick Granuloma”
- Bacterial infection
- Keratin foreign body
- Fibrosis
- Osteomyelitis/periostitis/arthritis
- Learned behavior

A

Perpetuating factors

49
Q

List ALD Differential Diagnoses:

A
  • Neoplasia
  • Nodular dermatitis
    - infectious
    - sterile
  • Demodicosis
50
Q

List Topical Therapy for ALD:

A
  • Glucocorticoids –> Fluocinolone in DMSO
51
Q

List Systemic Therapy for ALD:

A
  • Apoquel (oclacitinib)
  • Cytopoint
  • Oral Glucocorticoids
  • Trazodone –> behavior drug

Integumentary (SP23, Exam2) (5 decks)

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