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RUSVM SAM 2 > Pruritus 1 - FAD and Atopy > Flashcards

Pruritus 1 - FAD and Atopy Flashcards

1
Q

The unpleasant sensation of the skin the provokes the urge to scratch?

A

Pruritus

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2
Q

What does the owner see that indicates pruritus?

A 
Biting 
Licking
Chewing
Scratching
Gnawing 
Rubbing
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3
Q

What lesions do we see with pruritis?

A

Alopecia
Erythema
Excoriation

Followed by..
lichenification
Hyperpigmentation
Seborrhea

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4
Q

What are causes of pruritus in the dogs?

A

Allergens
Ectoparasites
Infections

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5
Q

What are possible allergens in a dog?

A

Flea bite allergy

Atopic dermatitis
Cutaneous adverse food rxn
Insect bite hypersensitivity/contact dermatitis
Vaccine/drug/heat and cold/sunlight/stress

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6
Q

Ectoparasites of dog?

A 
Sarcoptes 
Demodecosis 
Cheyletiella 
Lice 
Chiggers
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7
Q

Infections causing pruritus in dog?

A

Pyoderma
Dermatophytosis
Yeast

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8
Q

What is most commonly assorted with pruritus of the caudal dorsum ?

A

Flea allergy

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9
Q

What is most commonly associated with pruritus of the of the feet (licking/chewing)?

A

Food allergy/ atopy

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10
Q

What is most commonly associated with pruritus of the elbows and ears?

A

Sarcoptic mange

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11
Q

What pruritic conditions are affected by seasonality?

A

Flea allergy
Atopy
Insect allergy

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12
Q

Which pruritic conditions are not affected by seasonality?

A 
Scabies 
Food allergy 
Flea allergy 
Atopy 
Secondary infection 
Demodecosis
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13
Q

Pruritus can be graded on a scale of 1-10.. which conditions tend to be extremely pruritic at the high end of this scale?

A

Scabies
Flea bite allergy
Food allergy

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14
Q

If pruritis came before the lesions appeared.. what diseases will be at the top of you DDX?

A

Allergies

Scabies

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15
Q

If lesions showed up before pruritis.. what diseases will be at the top of your DDX?

A

Demodecosis

Dermatophytosis

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16
Q

What is generally part of your therapeutic plan in a pruritus case>

A

Flea control

Treat pyoderma if present - topical and systemic

Treat yeast infection if present

Treat for sarcoptes if suspected

Treat ear dz if present

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17
Q

Flea allergy dermatitis causes a type _____ hypersensitivity reaction

A

1

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18
Q

Classical distribution of flea allergy dermatitis?

A

Lumbo-sacral distribution

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19
Q

Lesions associated wtih flea allergy dermatitis?

A

Pruritic, crusting eruption and secondary erythema, seborrhea, alopecia

Excoriation
Pyoderma
Hyper pigmentation
Lichenification

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20
Q

Cats can present with a _____ dermatitis with flea allergy dermatitis

A

Miliary

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21
Q

T/F: an infestation of fleas is NOT necessary to cause flea allergy dermatitis?

A

True

Can only take one flea bite to set off allergic resposne

22
Q

Diagnosis of FAD?

A

Age - any

Distribution of lesions

  • dorsal lumbrosacral
  • tail base
  • cauda medial thigh
  • ventral abdomen
  • flank

Observe fleas or flea dirt

23
Q

What is a definitive diagnostic test for FAD?

A 
Flea antigen test 
3 injections  
- negative control - saline 
- positive control - histamine 
- flea allergen

OR

Elevated serum allergen specific IgE

24
Q

T/F: 80% of skin allergies are flea related

A

True

25
Q

What is the treatment for FAD?

A

Flea eradication

  • knock down product (nitenpyram, fipronil, imidacloprid, permethrin)
  • insect growth regulator (S-methoprene, imidacloprid)

Environmental control

Monthly controls

26
Q

What are monthly spot-ones that can be used for fleas in dogs>??

A

Advantage multi (imidacloprid and moxidectin)

Revolution (selamectin)

Frontline plus (fipronil and s-methoprene)

Vectra 3D (dinotefuran, permethrin, and pyriproxygen)

Promeris (metaflumizone and amitraz)

27
Q

T/F: most of the flea eggs, larvae, an pupae live in the environment and not not the pet

A

True

—> environmental control is very important

28
Q

You have a secondary bacterial infection from FAD.. how will you treat this?

A

Treat the secondary bacterial infection - topical antibiotics

Use prednisolone in moderate to severe cases once pyoderma is eliminated (lowest possible dose to control clinical signs—> reduce/stop pruritus )

29
Q

What type of hypersensitivity reaction is atopy?

A

Type 1

30
Q

Characteristic signs of atopy?

A

Pruritis
Chronic/relapsing/seasonal

Onset at 4months to 7yrs

Paws, face, distal extremities, elbow, ventrum, otitis externa

31
Q

What is the most common cause of primary otitis ?

A

Atopy (allergic dermatitis)

32
Q

What diagnostics can you do to confirm atopy?

A 
Serum tests (RAST and ELISA tests) 
Intradermal skin tests

Detect —> allergen-specific IgE

33
Q

When should allergy tests be done?

A

If clinical diagnosis of atopy is made

If allergen-specific immunotherapy (ASIT) is been considered

If allergen avoidance measures are been considered

34
Q

What is the gold standard test for atopy?

A

Intradermal allergy testing

35
Q

What allergens are tested for with intradermal allergy testing?

A

Seasonal —> trees, grasses, weeds, molds

Non-seasonal —> dust mites, cockamouse, moths, dander, storage mites

36
Q

How will you preform intradermal allergy testing?

A

Avoid antihistamines and essential fatty acids 2 weeks before

Avoid oral and topical steroids for at least a month

No baths for at least 5 days

Clip hair and sedate
Marker to indicate where allergen is given
0.05ml of allergen

Pos control - histamine
Neg control- saline

Grade 1-4

37
Q

What is hyposensitisation?

A

Injection of diluted allergens into the patient —> concentration increased up to a maintenance dose

38
Q

What factors effect the efficacy of hyposensitisation in atopic dermatitis?

A

Patients selection - dogs with less than 10 allergens have a better response

Allergen selection - based on IgE testing

Dose of allergen - higher dose protocol appears better

Administration of immunotherapy - conventional vs rush protocol

Time —> 2-5months improvement
Duration of allergen specific immunotherapy

39
Q

What are three possible therapies for atopy?

A

ASIT (allergen-specific immunotherapy) - hyposensitisation

Allergen avoidance

Symptomatic relief

40
Q

What are two forms of allergy shots for allergen-specific immunotherapy?

A

Subcutaneous immunotherapy — increased the dose and concentration slowly

Sublingual immunotherapy - twice daily

41
Q

What symptomatic therapy has the best evidence for atopy treatment?

A 
Glucocorticoids 
Cyclosporine A 
Oclacitinib 
Monoclonal antibody IL31
Recombinant canine interferon gamma
42
Q

What is the MOA of skin lipid therapy?

A

With atopy the epidermal barrier is compromised —> more penetration by allergens, irritants, and yeast

Skin lipid restores the barrier
—> dermoscent
—> duoxo
—> allerderm

43
Q

In an allergic crisis of as a therapeutic trial for atopy, corticosteroids can be used.. what preparations can be used?

A

Oral prednisolone

Injectable dexamethasone

44
Q

What are disadvantages to corticosteroids?

A

PU/PD
PP and weight gain

Iatrogenic hyperadrenocortisim 
Iatrogenic hypoadrenocorticism (if withdrawn quickly)

Less effective over time

More susceptible to infections
Urinary incontinence
Temperament/behavior changes

45
Q

What is the MOA of cyclosporine A (Atopica)?

A

Anti-allergic and immunosuppressive by blocking Tcell activation

Better absorbed on empty stomach

46
Q

Side effects of cyclosporine A (atopica)?

A

Vomiting/diarrhea

Exacerbate skin infections

47
Q

What is the MOA of oclacitinib (Apoquel)?

A

JAK 1 and 3 inhibitor -> inhibits proinflammatory mediators and cytokines

Decrease itching and inflammation

48
Q

What is a monoclonal antibody against IL31?

A

Cytopoint
— single injection 4-8weeks

IL31 is responsible for itching sensation

49
Q

T/F: antihistamines are effective in treatment of atopic dermatitis?

A

False

50
Q

What is the purpose of fatty acid supplementation in atopic dermatitis?

A

Steroid sparing effect

Improve cell membrane barrier

Less inflammatory eicosanoids
Less pro-inflammatory products
Less inflammation

RUSVM SAM 2 (44 decks)

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