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Skin: food hypersensitivity
Synonym(s): Dietary intolerance, Food hypersensitivity
Introduction
- Cause: sensitivity to components of the diet resulting in skin disease.
- Signs: there may be concurrent gastrointestinal signs and this may be the reason for advice being sought.
- Can mimic any dermatosis, but often clinically indistinguishable from atopy.
- Diagnosis: history, clinical signs, histopathology, response to treatment.
- Treatment: hypoallergenic diet.
- Prognosis: excellent if allergens identified and eliminated.
Presenting signs
- Primarily a papular rash
. - No sites of predilection, although may mimic atopy Skin: atopy.
- Secondary staphylococcal pyoderma relapsing soon after withdrawal of antibiotics.
- Persistent otitis externa Skin: otitis externa.
- Secondary seborrhea.
- Secondary Malessezia dermatitis
and otitis.
Acute presentation
- Urticaria Urticaria and angioedema.
Geographic incidence
- May account for up to 10% of all allergic skin disease.
- Prevalence in gastrointestinal disease unclear.
Age predisposition
- 33% <1 year old.
- >1 year old.
Cost considerations
- Diagnostic costs only.
Pathogenesis
Etiology
-
- Unknown.
- Common foodstuffs documented to cause disease: beef, dairy products, chicken, wheat, eggs, corn, soya - related to prevalence of food stuffs in diet.
Predisposing factors
General
- Underlying gastrointestinal pathology.
Specific
- Gluten sensitive enteropathy Gluten-sensitive enteropathy.
- IBD Inflammatory bowel disease: overview.
- Eosinophilic enterocolitis Enteritis: eosinophilic.
- Lymphocytic-plasmocytic enterocolitis Enteritis: lymphocytic plasmacytic.
- In most normal dogs effective mechanisms suppress inappropriate immune responses to harmless dietary allergens resulting in tolerance.
- When this system breaks down immune responses may be mounted.
Pathophysiology
- An uncommon disease.
- True food allergy does exist but is clinically indistinguishable from non-immunologic food intolerance.
- Diagnosis of adverse response to food usually confirmed through response to exclusion diet.
- Reactions may be immediate (1-2 hours) or delayed (several days).
- Food allergies affecting skin are often caused by a single food whereas multiple food allergies are more common in gastrointestinal disease (Guilford 1994).
- Very little known about pathophysiology of food allergy. Most commonly accepted theory is Type I hypersensitivity.
- Anaphylactoid reaction due to presence of histamine may be one mechanism.
- Food allergy response in dogs is typically delayed (Rosser 1993).
- Antigenic exposure gives rise to histamine-releasing factors which remain active some time after antigen is removed. This may explain the lag between introduction of a hypoallergenic diet and clinical improvement.
- Allergic response may only become apparent when immunological activity threshold is breached, allergic breakthrough.
- This is when a small increase in allergen load may provoke an allergic response, similarly removal of exposure to one of inciting allergens may be sufficient to produce clinical improvement.
Timecourse
- Food sensitivities may occur immediately or may take months/years to develop ( >70% cases have been fed offending diet for more than 2 years).
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from VetMedResource and PubMed.
- Verlinden A, Hesta M, Millet S, Janssens G P J (2006) Food allergy in dogs and cats: a review. Crit Rev Food Sci Nutr 46(3), 259-273 PubMed DOI: 10.1080/10408390591001117.
- Ellwood C M & Garden O A (1999) Gastrointestinal immunity in health and disease. Vet Clin North Am Small Anim Pract 29 (2), 471-500 PubMed.
- Hill P (1999) Diagnosing cutaneous food allergies in dogs and cats - practical considerations. In Practice 21 (6), 287-294 VetMedResource.
- White S D (1998) Food allergy in dogs. Comp Cont Ed Prac Vet 20 (3), 261-269 VetMedResource.
- Paterson S (1995) Food hypersensitivity in 20 dogs with skin and gastrointestinal signs. JSAP 36 (12), 529-534 PubMed.
- Simpson J W (1995) Management of colonic disease in the dog. Waltham Focus 5, 17-22.
- Fadok V A (1994) Diagnosing and managing the food-allergic dog. Comp Cont Ed Prac Vet 16 (12), 1541-1544 VetMedResource.
- Halliwell R E W (1993) The serological diagnosis of IgE-mediated allergic disease in domestic animals. J Clin Immunoassay 16 (2), 103-108 VetMedResource.
- Rosser E J (1993) Diagnosis of food allergy in dogs. JAVMA 203 (2), 259-262 PubMed.
- Halliwell R E W (1992) Management of dietary hypersensitivity in the dog. JSAP 33 (4), 156-160 VetMedResource.
- Kunkle G & Horner S (1992) Validity of skin testing for diagnosis of food allergy in dogs. JAVMA 200 (5), 677-680 PubMed.
- Jeffers J G, Shanley K J & Meyer E K (1991) Diagnostic testing of dogs for food hypersensitivity. JAVMA 198 (2), 245-250 PubMed.
- Scott D W (1978) Immunologic skin disorders of the dog and cat. Vet Clin North Am 8 (4), 641-664 PubMed.
Other sources of information
- Fascetti A J, Delaney S J, Larsen J A, Villaverde C (eds) (2023) Applied Veterinary Clinical Nutrition. 2nd edn. Wiley. ISBN: 9781119375142.
- Hardy J, Gajanayake I (2022) Diagnosis and management of adverse food reactions in dogs and cats. In Practice 44 (4), 196-203 https://doi.org/10.1002/inpr.197.
- Brostoff J & Hall A (1996) In: Immunology. 4th edn. Roti I, Brostoff J & Male D (eds). D Mosby, London. pp 15.
- Wills J M & Halliwell R E W (1994) Dietary Sensitivity. In: The Waltham Book of Clinical Nutrition of the Dog and Cat. pp 167-188.
- Reedy L M & Miller W H (1989) Allergic skin diseases of Dogs and Cats. W B Saunders, Philadelphia. pp 147-159.