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An Update regarding Feline Asthma

Feline asthma is a common inflammatory disease of the lower airway affecting approximately 1-5% of the cat population and is believed to be triggered by aeroallergens1,2. The median age of presentation is at 4-5 years of age although, it is thought many of the cats presenting at this time will already have a long-term history of the disease, so the actual age of onset could well be significantly younger2.

Feline asthma

Clinical signs are variable and are sometimes categorised as acute, where episodic severe respiratory distress on expiration is seen, or as chronic, where more persistent wheezing and coughing of various degrees of severity may be observed1. However, approximately 10-15% of cases will present with a history of vomiting or paroxysmal hacking and coughing. This may result in a diagnostic work-up for gastrointestinal conditions such as hairballs, rather than one for respiratory issues2. Some cats with a history suggestive of asthma may be asymptomatic at the time of presentation. In these patients gentle tracheal palpation will often easily elicit a cough2. The subtly of clinical signs in some cats with chronic disease means the condition can remain undiagnosed for a significant period of time. This delay allows progression of pathological changes within the lung tissue2.

Even with a thorough diagnostic respiratory investigation, discriminating feline asthma from other lower airway disorders (including chronic bronchitis and parasitic, infectious, cardiac or neoplastic conditions) is difficult which is, at least in part, why there are relatively few clinical trials into therapeutics for the disease1-3. Diagnosis is usually through a combination of history, clinical signs, thoracic radiography, exclusion of respiratory parasites, bronchoalveolar lavage cytology and response to trial therapy with bronchodilators and glucocorticoids1. Once a diagnosis has been made, allergy testing can then be used to identify allergens to which the cat is showing a hypersensitivity response2. These are then interpreted alongside the history to establish their clinical relevance. Intra-dermal skin testing and allergen-specific IgE determination by ELISA were both found to specific in a study by Lee-Fowler et al. (2009), with the conclusion being drawn that either test could be used to guide the selection of allergens in allergen-specific immunotherapy (ASIT)4.

Treatments which are typically used include oral, parenteral and/or inhaled steroids and bronchodilators. Lung function may still decline over time as these therapies are palliative in nature and do not ameliorate chronic airway remodelling2. While effective in many cats some cases will be minimally or unresponsive to the drugs, furthermore, the long-term use of steroids is contraindicated for various common feline conditions (diabetes for example) and are not always well tolerated2. Therefore, it is advantageous to consider other treatment modalities as part of the solution for this lifelong condition. When allergen identification has occurred it opens up two additional possibilities; allergen avoidance through environmental changes and allergen-specific immunotherapy (ASIT) which has been shown to be a successful treatment option for some cats5,6.

  1. Reinero, R. (2011). Advances in the understanding of pathogenesis, and diagnostics and therapeutics for feline allergic asthma. The Veterinary Journal 190: 28–33
  2. Trzil, J.E. & Reinero, C.R. (2014). Update on feline asthma. Vet Clin North Am Small Anim Pract 44(1):91-105
  3. Moriello, K.A., Stepien, R.L., Henik, R.A. & Wenholz, L.J. (2007). Pilot study: prevalence of positive aeroallergen reactions in 10 cats with small-airway disease without concurrent skin disease. Veterinary Dermatology 18(2):94-100.
  4. Lee-Fowler, T.M., Cohn, L.A., DeClue, A.E., Spinka, C.M., Ellebracht, R.D. & Reinero, C.R. (2009). Comparison of intradermal skin testing (IDST) and serum allergen-specific IgE determination in an experimental model of feline asthma. Vet Immunol Immunopathol 132(1):46-52
  5. Halliwell, R. (1997). Efficacy of hyposensitization in feline allergic diseases based upon result of in vitro testing for allergen-specific immunoglobulin E. Journal of the American Animal Hospital Association 33: 282-288.
  6. Prost, C. (2008). Treatment of allergic feline asthma with allergen avoidance and specific immunotherapy: Experience with 20 cats. Revue française d’allergologie et d’immunologie clinique 48(5):409-413

Jo Gourlay is the Senior Veterinary Technical Manager for Avacta Animal Health.

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Common Pitfalls During an Elimination Diet Trial for Dogs and Cats

Conducting an elimination diet trial for dogs and cats while juggling owner’s expectations can be challenging. Undeniably this is often a lengthy process, but the rewards can be well worth the effort.

Dog at Vets

As a veterinary surgeon it is important to explain to owners that this is a diagnostic test in itself which needs to be carried out with total commitment. Communicating your expectations to the owner and ensuring their understanding will hopefully result in a higher level of compliance.

Getting a definitive diagnosis will mean, that in most cases, an effective lifelong treatment plan can be put in place which is both convenient and affordable for the owner. Making your clients aware of potential pitfalls, such as the ones in the list below, will give a greater chance of success!

Common mistakes during a diet trial:

  • Giving treats – if the owner wants to continue to give treats suggest having a container with a small amount of the approved food in it for those moments when they want to give a reward.
  • Flavoured medication – owners should avoid tablets and other medications which contain a protein based covering or flavouring to aid palatability.
  • Other potential sources of allergen – list with the owner everything else the pet normally consumes as they may not assume these are included, for example; supplements, dental or rawhide chews, pigs ears, bones or anything used to coat the inside of chew toys.
  • Accidently contaminating the diet – owners must take great care to wash bowls, serving scoops and their hands before preparing food to avoid stray proteins being passed on. It is also worth changing to a ceramic or glass bowl if the clinical signs are predominantly around the muzzle and face in the (albeit unlikely) chance of a contact reaction with the bowl.
  • Children dropping food – removing animals from the dining area at meal times and making sure any spills are cleared up straight away is important.
  • Cats going to other houses and being fed by neighbours – making neighbours aware of the diet will help. The owner may also wish to invest in a bright coloured ‘do not feed me’ safety collar and tag if a collar is appropriate for their cat.
cat eating grass
  • Someone else looking after the animal – making sure that kennels, dog walkers, pet sitters and friends and relatives who visit, all understand what food is to be fed will ensure the diet is strictly kept to. The more people involved the greater the chance of a lapse.
  • Stealing food from work tops, bins or raiding feed stores – keeping all kitchen and dining areas clean, general waste bins inaccessible and all cupboards and feed bins secure will help avoid mishaps.
  • Eating something out on a walk / while out of house – keeping dogs on leads while walking will help prevent this. Putting a bell on a cat (if appropriate and safe to do so) will make hunting more difficult. In addition keeping them inside at natural hunting times (dawn and dusk) may decrease hunting activity.
  • Having more than one animal in house – separating pets at meal times and cleaning out bowls afterwards will stop animals eating food intended for other pets.
  • ‘Non believers’ in the house sneaking a snack – it is really important that everyone involved is on board. Owners should sit down and explain the ‘rules’ and why the diet trial matters (the impact the condition is having on their pet) to all family members and friends who live there, visit the house or have contact with the pet.
  • Stopping too soon – some animals can take eight weeks or longer to show a positive response to a diet trial, so owners must understand the importance of persevering right through to the agreed end date. Gastrointestinal signs usually improve faster than skin signs so a positive improvement in the gut can be helpful in persuading owners to keep enduring.

A list of common mistakes can be downloaded here which can then be printed off and handed out to clients.

dogscratch2

The re-challenge!

Owners must understand the need for a re-challenge of the diet, the improvement could just be coincidental and caused by something totally unrelated to the diet. This is something which many pet owners are not keen to carry out for obvious reasons, but it is the only way to confirm a diagnosis.

Brief the owner before so they feel prepared and reassured about what will follow. Talk them through what plans are in place in case the animal flares up so they feel like they are one step ahead.

Supporting owners from start to finish

  1. Starting the process by running a SENSITEST for your client will help to select suitable foods for an elimination diet.
  2. Talking owners through the rules of the trial and the reasons for it will help keep them going through the challenging moments.
  3. Regular check-ups or phone calls to monitor progress will help to keep motivation high and iron out any problems along the way.
  4. Provide details of a specific named person to contact at the practice if they have any concerns or for general advice and support.
  5. Having nurse led allergy clinics where owners can drop in for support would help offer a guiding hand all the way through the trial.

 Supporting you from start to finish

We know that there are never enough hours in the day so our customer services team are always on hand to offer you and your clients extra advice relating to diet selection.  They can also help you in setting up a nurse led allergy clinic at your practice, to give added time and support to owners.

If you are interested in running a test or speaking to one of our advisors please contact Customer Services.

Emma Kilmurray is a Customer Service Advisor for Avacta Animal Health

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Help with Explaining the Clinical Signs of Allergy in Dogs and Cats to Clients

There are several common clinical signs associated with allergy in dogs or cats, but what is the best practise for veterinary professionals when explaining them to pet owners?

Pet Allergy Week was launched on Monday and over 500 veterinary practices, up and down the country, have signed up to join in the campaign to increase clients’ awareness of the clinical signs of allergies within companion pets, whether it be from environmental factors, food or signs associated with secondary bacterial and yeast infections where a little encouragement is needed to help owners hunt for an underlying cause.

As part of the campaign Avacta Animal Health developed a dog and cat character (named in our BSAVA competition as Fred and Ginger) to help veterinary professionals educate pet owners as to what to look out for if they suspect their pets has an allergy.

A challenge of all professionals is how to explain complex problems to clients in layman’s terms, especially when the diagnostic process and treatment is also far from simple as well as being time consuming and costly. Even if you missed out on signing up to PAW, the following information may come in handy for future consultations with your clients.

When and how?

The first thing pet owners need to consider is when and how the clinical signs occur. Allergic disease in dogs usually first appears between 6 months to 3 years of age. In both species the clinical signs may start seasonally which can give clues to the potential allergens involved, but might then progress to become a year round problem and it is possible for signs to both increase and decrease in severity over time.

Gastrointestinal signs

gastro wobbler

Gastrointestinal signs associated with food allergens can be allergic (IgE mediated) or could be an intolerance or occur through another non-immune mediated mechanism. Reactions can manifest themselves in many forms from a softening of stools and the excretion of mucus to any of the other listed clinical signs below. It’s worth probing to get as detailed a general and dietary history as possible, as many owners will refer to any GI upset as just diarrhoea or vomiting, which could be easily attributed to many other commonly seen conditions (these do need to be ruled out first).

    • Colitis
    • Gastroenteritis
    • Tenesmus
    • Borborygmi
    • Weight loss
    • Reduced appetite

Ear problemsears wobbler

Ear problems are usually one of several presenting clinical signs when hypersensitivity to an allergen is present, however some dogs present with only recurrent otitis externa. Owners may not think of allergy as a potential cause when all they see are itchy, sore and hot ears or notice certain behavioural changes in their dog such as constantly rubbing their ear on the ground.

Skin problems

Itchy, hot, red skin is often how owners describe their pet especially when secondary infections or ectoparasite infestations are present. However, the itchiness is only the tip of the iceberg. If left untreated, chronic cases can develop alopecia, excoriations, lichenification and hyperpigmentation.

For cats, some of the signs of allergic skin problems are very different to dogs and less predictable so owners may be less likely to make the connection to allergy. Symmetrical alopecia (which can also be caused by stress), lesions on the lips and erosions or ulcerations on the chin or neck (sometimes caused by eosinophilic granulomas) can all be seen.

skin wobblerPaw chewing, over grooming and constant face rubbing are all behaviours of self-trauma also associated with skin problems which can cause secondary damage.

Secondary bacterial and yeast infections

Secondary bacterial and yeast infections, commonly caused by Malassezia and Staphylococci, can cause pyoderma and the variety of skin lesions associated with this (e.g. pustules, papules, and epidermal collarettes). Clients may simply describe this as smelly, spotty or scabby skin.

Respiratory signs in cats

If an owner’s cat is suffering from a persistent cough, wheezing, sneezing or is having difficulty breathing it is worth keeping feline asthma high on the list of differential diagnoses.

respiratory wobblerOf course, as most of the clinical signs listed above can also be caused by other conditions it should be explained to clients that the alternatives to allergy should be eliminated before allergy testing commences.

Free blood storage

Avacta Animal Health provide a free storage service for blood/serum samples for up to 3 months if other causes need to be ruled out before allergy testing commences. This allows blood to be taken when the animal is most symptomatic before any medication has been given or a food trial is commenced. For further information contact customer services.

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10 TIPS TO HELP WITH THE CONTROL OF ALLERGIES IN HORSES

 

When a horse is found to be hypersensitive to a particular allergen, regardless of whether this is found in culicoides saliva, lurking in a dusty feed bin or is airborne such as a grass pollen, the most logical solution to prevent the horse reacting to it is to avoid the allergen in question. This sounds great in theory but in reality can prove a little more challenging. The tips below are designed to offer some both strategic and practical ideas that horse owners can implement to reduce exposure and help control the clinical signs.

Insect bite hypersensitivity

Horse in rug CircleFly-proof garments

Creating a physically barrier with fly-proof garments can be helpful. Knowing your enemy is beneficial here as certain insects will attack the belly or legs, whereas others target the ears or face. Within the culicoides species alone you find location preferences and variable clinical signs as a result. You can then provide strategic accessories to a fly rug such as ear nets, face masks, belly bands (to ensure the ventrum has no sneaky gaps) or tail covers. Make sure these fit properly as if too big or small they won’t work well and may rub, leading to additional problems. Face masks may need some tactical extra securement like attaching to the head collar (as long as this is safe to do). All garments should be changed frequently, hot weather combined with soiled material against the skin is a recipe for secondary infections.

Fly prevention

Check that fly prevention products are true repellents (>2% permethrin if this is the active ingredient) not just insecticides and also what residual efficacy they have. How much does the product adhere to the skin and will rain, sweat or UV exposure render it much less effective? Frequent reapplication is normally required. Following the manufacturer’s instructions for general good coverage, also target in particular any areas especially relevant to the flies known to be a problem. For head shy animals, and to avoid direct contact with the eyes, squirt sprays onto a cloth before application or use roll on products or creams for the head and ears to ensure this area is also well covered.

Turnout schedule

Modify the horses turnout schedule to minimise exposure to the type of flies causing the problem. For culicoides this means stabling when they are most active (dusk and dawn) but other flies are most bothersome in broad daylight, such as Stomyxs calcitrans (stable fly) or Tabanidae spp. (horse fly). Avoid fields with standing, stagnant water (slow running streams or muddy banks count too) where flies are more likely to breed. If you are in a hilly area chose the highest windiest field!

Stabling environment

You can improve the stabling environment by installing fine-mesh screens to keep insects out and also set up strong fans (if possible safely) in front of the stable, or entrance and exit points, as culicoides struggle to fly in wind. Turn lights off when possible at night as this will attract flies. Finally, consider sticky fly tape on the ceiling or fly traps which can also help you monitor the number currently hatched in your area.

General yard maintenance

General yard maintenance, such as removal of manure and also standing water when possible, disrupts insect breeding and will help reduce their numbers. Encouraging seasonal fly eating birds such as swallows and house martins is a novel approach!

 

Other environmental allergies

white horse in stable CircleIndoor allergens

If indoor allergens are suspected turn the horse out as much as possible. Source good quality forage with minimal dust and mould. Feed forage from the ground so the inhaled particles drop downwards rather than into the airways. Haylage or bagged grass is usually a better option than hay, if only hay is available soaking or steaming it will help minimise the dust.

When stabling is necessary low dust bedding for the affected horses stable and all other stables within the same airspace is a good idea (ideally they should not be fed dusty hay either). Ensuring adequate ventilation is also very important.

Storage mites

For storage mites always empty the feed from the original packaging into resealable plastic containers discarding the dust at the bottom of the bag. Clean these plastic containers regularly, again discarding any dust at the bottom and always do this before adding new feed. Keep the feed in dry, cool conditions. Wipe the horses muzzle with a damp cloth after finishing hard feed to remove any food residues.

Dust mites

Dust mites can take up residence in horse rugs so it is advised, if these have been identified as an issue, to frequently wash and dry the rugs on a hot wash ideally drying them in the sun afterwards (not always easy in the UK in winter) as mites struggle in hot/dry conditions. Old rugs are believed to often house both live and dead mites so before putting them away for the summer clean thoroughly as previously described and store individually in either an airtight container or sealed plastic bag.

Outdoor allergies

If a horse’s outdoor allergies are aggravated by the pollens of summer pastures, when the pollen count is high move the horse inside. Again the devil is in the detail, if you know what to avoid there may be certain hacks you can steer clear of while particular crops are in flower. Using a pollen net or face mask may be beneficial.

Concurrent allergies

Check for concurrent allergies. It is now thought that the allergy threshold in usually made up of multiple different allergens rather than one single allergen. The more relevant allergens you tackle successfully the better the chance of getting below the threshold and the horse becoming asymptomatic. Avoidance and reduction of exposure to allergens, while playing an important role, is usually just part of the solution in helping control allergies in horses.

If you are a veterinary surgeon and you’d like to discuss other components such as allergen-specific immunotherapy please contact us for more information.

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Pet Allergy Week 2016 – Harvey MacKay Case Study

Harvey 3 CircleHarvey suffered from repeated bouts of otitis externa, with occasional mild dermatitis and pruritus since January 2016. He was on Prednisolone treatment that helped to control the inflammation in his ears however, his owner didn’t want him to be on the steroids long term. Therefore Harvey’s blood was sent to Avacta Animal Health for a Complete Plus allergy test during PAW in June 2016. By using the results from SENSITEST Harvey started on immunotherapy and his diet was adjusted.

Click HERE to read the full story on Harvey’s PAW success story.

 

Therapy Guide of Dogs with Skin Allergies

Therapy imageAvacta Animal Health has published its latest aid for clients – ‘Therapy Guide for Dogs with Skin Allergies.’

The DL leaflet has been design to specifically help dog owners:

  • understand the treatment choices for dogs diagnosed with an allergic skin condition
  • explore both avoidance techniques and therapies
  • manage potential flare-ups
  • consider the pros and cons of each therapy through a direct comparison

Copies of the leaflet will be distributed in May to practices who have registered for our Pet Allergy Week pack. Alternatively, a PDF version can be downloaded here.

EQUINE ALLERGY

THE GROWING ACCEPTANCE OF TESTING AND SUBSEQUENT TREATMENTS

HORSE HIVES circleBoth allergen-specific immunotherapy (ASIT), and the use of environmental serological testing as an aid to the diagnosis of atopic dermatitis, are clinically well accepted within canine practice 1. This is not currently the situation for equine allergy cases, although ASIT in horses is becoming a much more accepted and frequently conducted treatment, with the benefits discussed at the World Congress of Veterinary Dermatology in Bordeaux last year 2,3.

Dr. Yu, who presented in Bordeaux, wrote in the proceedings of the American Association of Equine Practitioners convention 2015, these take home messages; 1) “Treatment of equine allergies requires a multi-modal approach including environmental control, topical, and systemic therapy, and allergen-specific immunotherapy”. 2) “Allergen-specific immunotherapy should be considered for all presentations of equine allergies including hives, heaves, scratches, and head-shaking as it is a cost-effective weight independent treatment option that is not banned by the FEI, has minimal adverse effects, and may eventuate a cure”.4

To enable ASIT, and also allow targeted avoidance, problem allergens first need to be identified. Much of the recent literature states that either serological testing or intra-dermal skin testing are acceptable methods for equine allergen detection in atopic dermatitis, respiratory allergies and insect bite hypersensitivity (IBH).2,5,6,7

Similarly to canine allergy diagnosis, judicious interpretation of either test result is critical as Marsella (2013) states; “the single most important aspect in formulating a successful immunotherapy is not which test is used but how the allergens are selected (i.e., emphasis is placed on correlating the results with the seasonality and environmental exposure of the individual patient to increase the likelihood of including clinically relevant allergens among the ones that tested positive”)8. With the recent advent of more relevant allergens available through our serological test (UK and Northern European panel), it is hoped more horses will now benefit from ASIT.

Request your FREE Equine Lunch and Learn here.

(1) Olivry, T., DeBoer, D.J., Favrot, C., Jackson, H.A., Mueller, R.S., Nuttall, T & Prélaud, P. (2015). Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee
on Allergic Diseases of Animals (ICADA). BMC Veterinary Research, 11:210
(2) Mueller, R.S., Janda, J., Jensen-Jarolim, E., Rhyner, C. & Marti, E. (2016). Allergens in veterinary medicine. Allergy 71: 27-35
(3) Loewenstein, C. & Mueller, R.S. (2008). A review of allergen-specific immunotherapy in human and veterinary medicine. Veterinary Dermatology 20(2): 84(15)
(4) Yu, A.A. (2015). Treatment of Equine Allergies. In: Proceedings of the 61st American Association of Equine Practitioners convention, Las Vegas, 2015
(5) Fadok, V.A. (2013). Update on equine allergies. Vet Clin North Am Equine Pract. 29(3): 541-550
(6) Jensen-Jarolim, E., Einhorn, L., Herrmann, I., Thalhammer, J.G. & Panakova, L. (2015). Pollen allergies in humans and their dogs, cats and horses: differences and similarities. Clinical and
translational allergy 5:15
(7) Stepnik, C.T., Outerbridge, C.A., White, S.D and Kass, P.H. (2012). Equine atopic skin disease and response to allergen-specific immunotherapy: a retrospective study at the University of California
Davis (1991-2008). Veterinary Dermatology, 23(1):29-3
(8) Marsella, R. (2013). Equine allergy therapy: Update on the treatment of environmental, insect bite hypersensitivity, and food allergies. Vet Clin North Am Equine Pract. 29(3): 551-557

BSAVA Congress 2017

congress-2017-exhibitor-email-footer-808

Avacta Animal Health are delighted to be exhibiting at the BSAVA Congress in Birmingham from 6 – 9 April 2017. Come along to stand 808 to say ‘Hello’

Whether you want to know more about our allergy services or our non-allergy products and innovations such as our canine lymphoma multi-marker algorithm-based test, there will be someone available to answer your questions.

At our stand you have the chance to win a £100 Amazon gift card by completing the exhibition voucher in the delegate packs, and whilst you’re there you may like to show off your creative skills by entering our ‘Name the PAW Pets’ competition.

Finally, there will be the opportunity to register your interest and get an exclusive look at this year’s Pet Allergy Week pack!

We look forward to seeing you there!

Avacta Animal Health 2016 Christmas opening hours

Please note over the festive period we will be closed for the national bank holidays. The customer services department and laboratory will be open for the normal working days between Christmas and New Year from 09.00 – 15.00.

All canine Lymphoma Blood Tests and Acute Phase Protein tests will be run as normal during working days.

Full working hours will resume on Tuesday 3rd January.

May we wish you a Happy Christmas and New Year from all the team at Avacta Animal Health.

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Visit us at London Vet Show 2016!

lvs-buttonWe are delighted to be exhibiting and supporting the London Vet Show holiday passport at this year’s event in its new home at ExCel. Come along to M63 to learn about our complete allergy service of tests and treatments, including our new enhanced equine allergy test.

We’ll also be showcasing our range of revolutionary multi-marker algorithm based tests, including the canine lymphoma blood test (cLBT), and you can enter our caption competition courtesy of Natural VetCare Prescribed and have your advert created in Vet Times and VN Times!

We look forward to seeing you there!