猫特应性综合征的临床症状和诊断:正确诊断的详细指南（FASS系列2 ...

王帆

Clinical signs and diagnosis of feline atopic syndrome: detailed guidelines for a correct diagnosis

猫特应性综合征的临床症状和诊断:正确诊断的详细指南（上）

Domenico Santoro* , Cherie M. Pucheu-Haston† , Christine Prost‡, Ralf S. Mueller§ and Hilary Jackson

 

翻译：王帆

 

Background – Feline atopic syndrome (FAS) describes a spectrum of hypersensitivity disorders characterised by highly diverse clinical presentations including skin, gastrointestinal and respiratory systems. Among these disorders is feline atopic skin syndrome (FASS), in which hypersensitivity is typically associated with environmental allergens, although food allergy may coexist. Involvement of other organ systems (e.g. asthma) also may occur. Because of its highly heterogeneous clinical presentation, diagnosis of FASS can be challenging.

Objectives – A subgroup of the International Committee on Allergic Diseases of Animals was tasked to summarise the most current information on the clinical presentations of FASS and to develop diagnostic guidelines.

Methods and materials – Online citation databases and abstracts from international meetings were searched for publications related to feline allergic conditions. These were combined with expert opinion where necessary.

Results – A total of 107 publications relevant to this review were identified. Compilation of these data enabled development of a detailed description of the clinical features of FASS and development of guidelines focusing on systematic elimination of other skin conditions with similar clinical characteristics. As allergen tests are frequently used by dermatologists to support a clinical diagnosis of FASS, a brief review of these methodologies was also performed.

Conclusions and clinical importance – In a similar way to atopic dermatitis in dogs, FASS is a clinical diagnosis based on the presence of compatible clinical signs and exclusion of other diseases with similar clinical features. Elimination or exclusion of fleas/flea allergy, other parasites, infections and food allergy is mandatory before reaching a diagnosis of FASS.

摘要

背景–猫特应性综合征(FAS)涵盖了一系列过敏性疾病, 以高度多样化的临床表现为特征,包括皮肤、胃肠道和呼吸系统。这些疾病包括猫特应性皮肤综合征(FASS), 其中过敏反应通常与环境过敏原相关,但可能同时存在食物过敏。也可能累及其他器官系统(如哮喘)。由于其高度异质性的临床表现, FASS的诊断可能具有挑战性。

目的–国际动物过敏性疾病委员会(ICADA)的一个亚组的任务是总结FASS临床表现的最新临床表现,并制定诊断指南。

方法–检索在线引文数据库和国际会议摘要中与猫过敏相关的出版物。必要时结合专家意见。

结果–共找出107篇与本综述相关的出版物。汇编这些资料能够制定FASS临床特征的详细描述和制定指南, 重点是系统性消除具有相似临床特征的其他皮肤疾病。由于皮肤科医生经常使用过敏原试验来支持FASS的临床诊断, 因此还对这些方法进行了简要综述。

结论和临床重要性–与犬特应性皮炎相似, FASS的临床诊断是基于相符的临床症状,并排除具有相似临床特征的其他疾病。在确诊FASS之前, 必须消除或排除跳蚤/跳蚤过敏、其他寄生虫、感染和食物过敏。

 

Introduction

介绍

The term “feline atopic syndrome” (FAS) encompasses a variety of allergic diseases in cats. These disorders include allergic dermatitis, asthma/respiratory diseases and gastrointestinal diseases that may be associated with a hypersensitivity to environmental allergens and foods, and which may coexist with flea allergy dermatitis. Unlike dogs, cats may demonstrate a pleomorphic clinical response when sensitised to any of these items. In addition, there has been some lack of consensus regarding the role of immunoglobulin (Ig)E in the development of hypersensitivity to environmental allergens (formerly atopic dermatitis), whereas the role of this antibody is more evident in other species (e.g. dogs and people). Because of these difficulties, there has been some hesitancy to use the term “atopic dermatitis” when describing cats demonstrating hypersensitivity to environmental allergens. Different alternative terminologies have been proposed, including “nonflea, nonfood-induced feline hypersensitivity dermatitis”.1,2 In this series of manuscripts, we propose that this latter nomenclature be changed to “feline atopic skin syndrome” (FASS).

术语“猫特应性综合征”(FAS)包括猫的各种过敏性疾病。这些疾病包括过敏性皮炎、哮喘/呼吸道疾病和胃肠道疾病，这些疾病可能与环境过敏原和食物过敏有关，可能与跳蚤过敏性皮炎共存。不同于犬，猫受到任何刺激时，可能会表现临床反应多样化。此外，关于免疫球蛋白(Ig)E在环境过敏原(以前称为特应性皮炎)过敏反应发展中的作用，目前还缺乏一些共识，而这种抗体的作用在其他物种(如犬和人)中更明显。由于这些困难，在描述猫环境过敏原的过敏反应时，人们对使用“特应性皮炎”这个术语有些犹豫。人们提出了不同的替代术语，包括“非跳蚤、非食物诱发的猫过敏性皮肤病”。在本系列手稿中，我们建议将后者命名为“猫特应性皮肤综合征”(FASS)。

 

The first manuscript of this series describes the most updated information on the pathogenesis of FAS and the reasons behind the proposed new nomenclature. The primary aim of the current manuscript is to summarise the clinical presentations associated with FASS. This work will focus on cutaneous and noncutaneous manifestations of FASS. However, as many of the conditions that comprise FAS may be tightly and inextricably linked with FASS, some discussion will be devoted to them as well (Table 1).

本系列的第一份手稿描述了FAS发病机制的最新信息和提出新命名背后的原因。本文的主要目的是总结与FASS相关的临床表现。这项工作将集中在皮肤和非皮肤表现的FASS。然而，由于许多构成FAS的条件可能与FASS紧密而不可分割地联系在一起，一些讨论也将专门针对它们(表1)。

 

A secondary aim of this manuscript is to provide information to guide the practitioner towards a correct diagnosis of FASS. This diagnosis may be challenging because of the striking similarities in clinical presentation among feline allergic and nonallergic dermatoses. Thus, we describe a logical diagnostic pathway based upon the evaluation of the patient for the presence of clinical signs consistent with FASS and exclusion of other skin conditions resembling FASS. Finally, similar to published guidelines for canine atopic dermatitis, a subgroup of the International Committee on Allergic Diseases of Animals (ICADA) reviewed the most up-to-date information on diagnostics to help confirm a clinical presumptive diagnosis of FASS.

本手稿的第二个目的是提供信息，以指导医生对FASS的正确诊断。这种诊断可能是具有挑战性的，因为临床表现在猫过敏性和非过敏性皮肤病之间惊人的相似。因此，我们基于患者是否存在与FASS一致的临床症状·的评估，并排除其他类似FASS的皮肤状况，描述了一个合乎逻辑的诊断路径。最后，与已发布的犬特应性皮炎指南类似，国际动物过敏性疾病委员会(ICADA)的一个小组回顾了最新的诊断信息，以帮助确认FASS的临床推定诊断。

 

Methods and materials

方法和材料

A literature search for studies on feline allergies published between 1950 and 2020 was conducted using Pubmed (pubmed.gov), Web of Science (Thomson Reuters), CAB Abstracts (EBSCOhost Research Databases) and CAB Abstracts Archive (EBSCOhost Research Databases) databases. Restrictions (date or language) were not enforced for the manuscript search. Published abstracts from annual meetings of the European Society of Veterinary Dermatology/European College of Veterinary Dermatology, American Academy of Veterinary Dermatology/ American College of Veterinary Dermatology and World Congresses of Veterinary Dermatology between 1995 and 2016 were included. Finally, expert options were reported where necessary to supplement the literature search. A total of 107 manuscripts were selected and summarised below.

我们使用Pubmed、Web of Science、CAB Abstracts和CAB Abstracts Archive 数据库对1950年至2020年间发表的关于猫过敏症的研究进行了文献检索。对手稿搜索的限制(日期或语言)没有强制执行。收录了1995年至2016年欧洲兽医皮肤科学会/欧洲兽医学院、美国兽医学会/美国兽医学院和世界兽医皮肤科大会的年度会议摘要。最后，在必要时报告专家选择以补充文献搜索。共有107份手稿被挑选和总结如下。

 

Clinical characteristics of FASS

FASS临床特征

Clinical appearance

临床表现

By contrast with species such as people and dogs (in which atopic dermatitis typically is associated with a limited range and distribution of clinical signs), the cutaneous lesions of FASS are far more variable in appearance and less predictable in distribution. As is seen in other forms of feline skin disease, the majority of cats with FASS typically present with one or more “cutaneous reaction patterns”. These patterns include miliary dermatitis (MD), self-inflicted alopecia/hypotrichosis (SIAH), head and neck pruritus (HNP) and eosinophilic granuloma complex (EGC). Either alone or in combination, and after excluding other possible causes, these patterns are consistent with a diagnosis of FASS.

与人类和犬等物种相比(特应性皮炎通常与有限的临床症状范围和分布相关)，FASS的皮肤病变在外观上更多变，在分布上更难以预测。与其他形式的猫皮肤疾病一样，大多数患有FASS的猫通常会出现一个或多个“皮肤反应模式”。这些类型包括粟粒性皮炎(MD)、自发性脱毛/少毛症(SIAH)、头颈部瘙痒症(HNP)和嗜酸性肉芽肿复合物(EGC)。无论是单独或合并，在排除其他可能的病因后，这些模式都与FASS的诊断一致。

 

In its simplest form, MD presents as several small (typically ~ 1–2 mm) papules, generally surrounded by crusts (Figure 1). These lesions may be distributed over relatively small portions of the body or may be present in a more generalised fashion. This condition is usually pruritic and, as a result, excoriations, erosions and varying degrees of hair loss often are superimposed on MD. In some cases, MD may be present without a history of pruritus. Some of these cats may truly be nonpruritic, yet it is likely that many of them may simply not be observed to be pruritic by the owners. Regardless, patients with “nonpruritic” MD may appear clinically normal from a distance, with the presence of lesions becoming obvious only upon handling the cat and close inspection of the skin.

MD最简单的表现为几个小丘疹(典型约1 - 2毫米)，通常被结痂包围(图1)。这些病变可能分布在身体小部分，也可能全身出现。这种情况通常是瘙痒的，因此，抓痕、糜烂和不同程度的脱毛与MD同时出现。在某些病例，MD可能没有瘙痒史。这些猫中的一些可能真的不痒，但很可能它们中的许多可能只是没有被主人观察到痒。无论如何，“非瘙痒性”MD的患者从远处看可能是临床正常的，只有在触诊猫和仔细检查皮肤时，病变的存在才会变得明显。

 

In SIAH, the pruritic cat removes its hairs either by repetitively licking, biting or pulling at the fur, occasionally accompanied by scratching (Figure 2). This behaviour often results in the swallowing of excessive hair and the formation of hairballs, which may cause vomiting. It may be helpful to ask the owners of affected cats whether they have noticed the patient vomiting, or if they have noticed excessive hair being passed in the faeces. These activities may be mistaken for normal grooming by the client and so are not reported. Alternatively, the cat may perform these activities in seclusion. In these cases, the client may believe that the cat is losing hair spontaneously. In other cases, the exuberant overgrooming may be noted, yet misinterpreted by the client or the veterinarian as an aberrant response to some stressful condition rather than a manifestation of pruritus. Although some cats may remove their own hair under real or perceived stressful conditions (“psychogenic alopecia”), primary behaviour-based overgrooming appears to be uncommon in cats. In one study of 21 cats referred for evaluation of psychogenic alopecia, a primary behavioural or psychogenic cause was demonstrated only in two cats. By contrast, 16 of the cats were found to be suffering from pruritic dermatitis alone, with the remaining three cats afflicted by pruritic disease with a superimposed behavioural component.

在SIAH中，瘙痒的猫通过反复舔、咬或拉毛来除去毛发，偶尔还伴有抓挠(图2)。这种行为通常会导致猫吞下过多的毛发并形成毛球，这可能导致呕吐。询问患猫的主人是否注意到患猫呕吐，或是否注意到粪便中有过多毛发排出，可能会有帮助。这些活动可能会被客户误认为是正常的理毛，因此不会被报告。另外，猫也可以在隐居的环境中进行这些活动。在这些情况下，客户可能认为猫是自发脱毛。在其他情况下，过度理毛可能会被注意到，但被客户或兽医误解为对某些应激状况的异常反应，而不是瘙痒的表现。尽管一些猫可能会在真实的或感知到的应激条件下(“精神性脱毛”)掉自己的毛发，但主要基于行为的过度理毛在猫身上似乎并不常见。在一项针对21只猫的心因性脱毛评估研究中，只在两只猫身上证实了主要的行为或心因性脱毛原因。相比之下，其中16只猫被发现患有瘙痒性皮炎，剩下的3只猫患有瘙痒性疾病，并有叠加的行为因素。

 

The third reaction pattern (HNP) is characterised by (often intense) pruritus of the face, head and neck. Patients may claw or scratch frantically at the areas, resulting in varying degrees of excoriation, erosion and ulceration (Figure 3). Blepharitis may be observed, with or without associated corneal ulceration. The pruritus associated with this pattern may be particularly severe and difficult to manage, often requiring physical intervention (in the form of bandages or protective collars) to minimise self-trauma.

第三种反应模式(HNP)的特征是面部、头部和颈部瘙痒(通常是强烈的)。患猫可能会挠或疯狂抓该部位，导致不同程度的抓痕、糜烂和溃疡(图3)。可观察到睑炎，可伴有或不伴有角膜溃疡。与这种模式相关的瘙痒可能特别严重，难以管理，通常需要物理干预(以绷带或保护项圈的形式)以尽量减少自我创伤。

 

The fourth reaction pattern is EGC. This “complex” consists of a loosely grouped (and often confusingly named) set of clinical syndromes. The first is indolent ulcer, also known as “rodent ulcer”. This condition typically affects the upper lip, at or immediately adjacent to the mucocutaneous junction (Figure 4). Lesions initially start as focal ulceration on the lip margin. Unilateral disease is more common than bilateral disease, at least in the beginning. As the condition progresses, the lip can become ulcerated and fibrotic, resulting in the deformation of the entire rostral portion of the lip up to (and occasionally past) the planum nasale. This syndrome is typically not pruritic unless complicated by bacterial infections.

第四种反应模式是EGC。这个“复合物”由一组松散的临床症状组成(通常命名令人困惑)。第一种是无痛性溃疡，又称“侵蚀性溃疡”。这种情况通常影响上唇，或紧邻皮肤粘膜交界处(图4)。病变最初是唇缘局灶性溃疡。单侧疾病比双侧疾病更常见，至少在开始时是这样。随着病情的发展，唇部可能会出现溃疡和纤维化，导致整个唇部的嘴部部分变形，直到(偶尔超过)鼻平面。这种综合征通常不会瘙痒，除非并发细菌感染。

 

The second syndrome is eosinophilic granuloma, also called “linear granuloma”. Lesions can appear in a variety of locations, each with its own phenotype. Lesions on the rear legs typically appear as linear areas of dermal thickening on the caudal aspect of the thigh and may extend distally past the stifle fold onto the caudal crus. Erosion or ulceration is common. This syndrome also may present as proliferative lesions in the mouth, especially on the tongue or hard palate (Figure 5), or as poorly defined chin swelling (“fat chin”). These lesions may or may not be pruritic.

第二种综合征是嗜酸性肉芽肿，又称“线性肉芽肿”。病变可以出现在不同的位置，每个位置都有自己的表型。后腿的病变通常表现为大腿尾部的线性真皮增厚区域，并可向远端延伸至膝关节后褶至小腿尾部。糜烂或溃疡是常见的。这种综合征也可能表现为口腔内增生病变，尤其是在舌头或硬腭(图5)，或定义不清的下巴肿胀(“肥下巴”)。这些病变可能会瘙痒，也可能不会。

 

The third clinical syndrome is eosinophilic plaque. These lesions are most frequent on the ventral abdomen and medial thighs, yet may appear in other locations (Figure 6). These are characterised by raised, frequently eroded or ulcerated areas. Individual lesions range in shape from circular, to oval, to serpiginous. They often are associated with intense pruritus, with self-inflicted damage resulting in a self-perpetuating positive feedback cycle of inflammation. These lesions often are complicated by secondary bacterial infections.

第三种临床综合征是嗜酸性斑块。这些病变最常见于腹侧和大腿内侧，也可能出现在其他部位(图6)。这些病变的特征是隆起、常见糜烂或溃疡区域。个别病变的形状从圆形、椭圆形到蛇形不等。它们通常与强烈的瘙痒有关，与自我诱发损伤有关，导致炎症的自我持续的正反馈循环。这些病变常因继发性细菌感染而复杂化。

 

Although any of these reaction patterns may be seen with FASS, some patterns appear to be seen more frequently than others. A review of 10 manuscripts describing 263 cats diagnosed exclusively with FASS suggests the following overall prevalence rates: 31.2% with MD; 60.1% with SIAH; 43.0% with HNP; and 25.9% with one or more forms of EGC. The number of cats demonstrating multiple syndromes was not always specifically stated, yet 37.7% of cats were reported as having at least two syndromes.

虽然这些反应模式中的任何一种都可以在FASS中看到，但有些模式似乎比其他模式更常见。对10份描述263只被诊断为患有FASS的猫的手稿的回顾表明:患有MD的猫的总体患病率为31.2%;SIAH 为60.1%;HNP为43.0%;一种或多种形式EGC为25.9%。出现多综合征患猫的数量并不总是明确说明，但据报道，37.7%的猫至少有两种综合征。

 

Nonetheless, there is considerable variability in the prevalence values for each of these patterns between the individual manuscripts (Table 2). This is particularly true for MD and HNP, with SIAH being somewhat less variable and EGC the least variable of all. Some of this variability may be related to the small number of cases in some studies. A second reason may be related to differences in pattern characterisation between observers. For example, although one observer might characterise a cat as having MD localised to the neck, another observer might describe that same cat as having HNP. By contrast, there is far less variability in the reported prevalence of EGC, which tends to be distinct in appearance.

尽管如此，在各个手稿之间，每种模式的发病率相当多变(表2)。对于MD和HNP尤其如此，SIAH的变化较小，而EGC的变化最小。这种可变性可能与某些研究中病例数量较少有关。第二个原因可能与观察者之间的模式特征差异有关。例如，虽然一个观察者可能描述一只猫患有局限于颈部的MD，但另一个观察者可能描述同一只猫患有HNP。相比之下，报道的EGC发病率的可变性要小得多，它往往有明确外观。

 

Few articles provide specifics regarding the distribution of lesions in cats with FASS. Frequently involved areas appear to include the face, head, neck and pinnae, the ventral abdomen, the legs (especially the medial aspects) and the dorsum. Less common areas of involvement include the lateral thorax/flanks, perineum, axillae and lumbosacral area. “Lesionless” alopecia and generalised or multifocal involvement occasionally are reported. By contrast with dogs, paw involvement appears to be uncommonly involved in FASS.

很少有文章提供关于FASS猫病变分布的细节。经常患病部位包括面部、头部、颈部和耳廓、腹侧、腿部(尤其是内侧)和背部。较少见的患病部位包括侧胸/侧腹、会阴、腋窝和腰骶区。“无病变性”脱毛和全身性或多灶性脱毛偶有报道。与犬相比，爪部患病与FASS似乎不常见。

 

Otitis is a frequent clinical presentation in dogs with atopic dermatitis. In cats, the presence of otitis, with or without secondary infectious, has been reported in 20.9% (48 of 230) of patients with FASS.

耳炎是特应性皮炎犬的常见临床表现。在猫的FASS患者中，有20.9%(230例中的48例)报告存在耳炎，伴有或不伴有继发性感染。

 

Finally, there also are “atypical” clinical signs that have been attributed (tentatively or definitively) with FASS. These include pododermatitis (with or without plasma cell involvement) and alesional pruritus. In some cases, these signs have been reported as the only manifestation of FASS, whereas in others they accompany more “typical” manifestations of FASS.

最后，也有“非典型”临床症状被归因于(暂时或确定)FASS。包括足皮炎(有或没有浆细胞浸润)和无病变性瘙痒。在某些病例，这些症状被报道为FASS的唯一表现，而在其他情况下，它们伴随FASS更“典型”的表现。

 

Age of onset

发病年龄

Determination of the average age of onset of FASS is somewhat complicated by the fact that many studies either provide only the age at presentation or a range of ages. In many cases, cats have been adopted as adults, and thus the information is not known. Furthermore, approximate ages of onset may have been “back-calculated” by subtracting the estimated duration of disease from the current age. Regardless, the age at which cats first demonstrate signs of FASS appears to vary widely, ranging from cats as young as six months to cats as old as 15 years. However, the majority of reports suggest that most cases have a relatively young age of onset, with reported means ranging from 0.5 to 4.8 years. This pattern is similar to that described in two large-scale retrospective studies. In one of these studies, the median age of onset was two years, with 62% of patients first experiencing signs before three years of age and only 22% developing disease after seven years of age. In the second study, the mean age of onset was three years, with 72% first showing signs before three years and only 12% developing disease after six years of age. These results contrast with those from an older report in which five of 10 cats first developed signs at seven years or older.

FASS发病平均年龄的确定有些复杂，因为许多研究要么只提供发病年龄，要么提供年龄范围。在很多病例中，猫是成年后被收养的，因此信息并不为人所知。此外，通过从当前年龄减去估计的疾病持续时间，可以“反算”出大约的发病年龄。无论如何，猫首次表现出FASS症状的年龄似乎差异很大，从6个月大的猫到15岁大的猫。然而，大多数报告表明，大多数病例的发病年龄相对较低，报告的平均值为0.5至4.8岁。这一模式与两项大规模回顾性研究中描述的模式相似。在其中一项研究中，发病年龄中间值2岁，62%的患猫在3岁前首次出现症状，只有22%的患者在7岁后发病。在第二项研究中，发病年龄平均值为3岁，72%的人在3岁前首次出现症状，只有12%的人在6岁后发病。这些结果与一份更早的报告形成了对比，在该报告中，10只猫中有5只在7岁或更大的时候首次出现症状。

 

Sex predilection

性别易感性

In general, FASS appears to be reported more frequently in female than male cats. Of the 226 cats with confirmed FASS (as a sole diagnosis) reported in the literature reviewed for this study, females represented 58.4% (132 of 226) while males represented only 41.6% (94 of 226).These figures must be viewed with some skepticism, as many of these manuscripts were relatively small case reports and were not compared to the clinical population as a whole. There are only two large reports in which sex specifics were provided for cats diagnosed with FASS (as a sole diagnosis). However, the sex ratios in these studies were similar to those reported above (59.7% female: 40.3% male).

一般来说，FASS在母猫上的报道发病率高于公猫。在本研究综述的文献中报道的226只猫中，确诊为FASS(作为唯一诊断)的猫中，雌性占58.4%(226只猫中132只)，而雄性只占41.6%(226只猫中94只)。必须以一些怀疑的态度看待这些数字，因为这些手稿中的许多是相对较小的病例报告，并没有与临床数量作为一个整体进行比较。只有两份大型报告提供了被诊断为FASS的猫的性别特征(作为唯一的诊断)。然而，这些研究中的性别比例与上述报告相似(59.7%的雌性:40.3%的雄性)。

 

Three studies evaluated the sex proportions of cats with FASS in which flea and/or food allergy was either present as a concurrent problem in some or all of the cats, or in which it could not be ruled out in all cases owing to owner compliance issues.Of these 267 cats, females and males accounted for 58.4% (156 of 267) and 41.6% (111 of 267), respectively.

三项研究评估了FASS猫的性别比例，其中跳蚤和/或食物过敏在部分或所有猫中都是并发问题，或者所有病例中因主人的依从性问题而不能排除。在这267只猫中，母猫和公猫分别占58.4%(156/267)和41.6%(111/267)。

 

Seasonality

季节性

It must be noted that there is some degree of uncertainty inherent in the determination of whether or not a patient demonstrates seasonal or nonseasonal disease, as this determination often is based upon client assessment. Although astute owners may be able to distinguish between complete remission and partial remission, or between partial remission and no improvement, not all clients are capable of making these observations.

必须指出，在确定患猫是否患有季节性或非季节性疾病方面存在一定程度的不确定性，因为这种确定往往是基于宠主的评估。虽然精明的宠主可能能够区分完全缓解和部分缓解，或部分缓解和没有改善，但是并不是所有的客户都有能力进行这些观察。

 

The presence or absence of seasonality was reported for 141 cats diagnosed with FASS, of which 75.2% (106 of 141) demonstrated nonseasonal disease. Two of these cats had initially presented with seasonal disease, and developed nonseasonal signs over time. Of the 35 cats with seasonal disease, further specifics were available for seven. Of these seven cats, one demonstrated signs in spring, one in spring and summer, two in late summer to early autumn, one in both spring and autumn, one in winter and one demonstrated signs corresponding to its oestrus cycle.

141只被诊断为FASS的猫报告存在或不存在季节性，其中75.2%(106/141)显示非季节性疾病。其中两只猫最初表现出季节性疾病，随着时间的推移出现了非季节性症状。在35只患有季节性疾病的猫中，有7只猫有进一步的细节。在这7只猫中，1只在春季出现症状，1只在春夏出现症状，2只在夏末至初秋出现症状，1只在春秋两季同时出现症状，1只在冬季出现症状，1只出现与发情周期相对应的症状。

 

Two additional studies evaluated populations of cats with FASS including cats with concurrent flea and/or food allergy. In these 238 cats, 70.2% (167 of 238) demonstrated nonseasonal signs, while 29.8% (71 of 238) of cats demonstrated seasonal signs. In the nonseasonally affected cats, 9.6% (16 of 167) had always demonstrated nonseasonal signs, 72.5% (121 of 167) had nonseasonal signs with seasonal exacerbations, 6% (10 of 167) progressed from seasonal to nonseasonal signs, and 12% (20 of 167) had intermittent or waxing and waning exacerbations. Of seasonally affected cats, 25.4% (18 of 71) demonstrated signs during the spring, 39.4% (28 of 71) during the summer, 33.8% (24 of 71) during the autumn and 46.5% (33 of 71) during the winter. Many of these cats demonstrated clinical signs during two or three seasons (primarily summer and autumn).

另外两项研究评估了FASS患猫，包括同时患有跳蚤和/或食物过敏的猫。在238只猫中，70.2%(238只猫中的167只)表现出非季节性症状，而29.8%(238只猫中的71只)表现出季节性症状。在非季节性患猫中，9.6%(167只猫中有16只)一直表现出非季节性症状，72.5%(167只猫中有121只)出现季节性加重的非季节性症状，6%(167只猫中有10只)从季节性症状发展为非季节性症状，12%(167只猫中有20只)出现间歇性或时好时坏加重。在季节性患猫中，25.4%(71只猫中的18只)在春季出现症状，39.4%(71只猫中的28只)在夏季出现症状，33.8%(71只猫中的24只)在秋季出现症状，46.5%(71只猫中的33只)在冬季出现症状。其中许多猫在两到三个季节(主要是夏季和秋季)表现出临床症状。

 

Breed predisposition and heritability

品种易感性和遗传性

By contrast with dogs, in which varying degrees of breed predisposition, heritability and/or predisposing genetic polymorphisms have been demonstrated, relatively little is known of the contribution of heritability to feline allergic diseases. One possible reason for this is the relatively small number of purebred cats in relation to domestic mixed-breed cats (domestic short hair and domestic long hair cats). In addition, the large breeding populations of stray cats in many areas makes any attempt at discerning specific lineages extremely difficult. Finally, although many dog breeds often have very distinctive appearances, many breeds of cat (and their crosses) are difficult to distinguish by the untrained eye.

与犬相比，犬的不同程度的品种易感性、遗传性和/或易感性基因多态性已被证明，相对而言，遗传性对猫过敏性疾病的贡献知之甚少。其中一个可能的原因是，与家养混血猫(家养短毛猫和家养长毛猫)相比，纯种猫的数量相对较少。此外，在许多地区，大量繁殖的流浪猫使得辨别特定血统的尝试变得极为困难。最后，虽然许多犬的品种通常有非常独特的外观，但许多猫的品种(和它们的杂交)很难未经训练进行眼观区分。

 

Nonetheless, there is some evidence that there may be a heritable component to the development of allergic dermatitis in cats. The Abyssinian breed was disproportionately affected by FASS in two large retrospective evaluations of allergic cats. Abyssinians (along with cats of the Somali and Ocicat breeds) were over-represented in cats demonstrating “skin allergy” (Odds Ratio of 2.1 for all three breeds) in a large retrospective study of >8,000 Finnish cats. In another retrospective study of 502 cats with allergic and nonallergic dermatitis, Abyssinians were found exclusively in the “nonflea hypersensitive dermatitis” group. However, the clinical relevance of this finding is difficult to determine, as this breed represented only a small portion of the cats evaluated (10 cats total). Abyssinians and Abyssinian crosses frequently appear in smaller studies as well, although their prevalence typically has not been compared to the general hospital population in most of these studies.

尽管如此，仍有一些证据表明，猫过敏性皮炎的发生可能存在遗传因素。在对过敏症患猫进行的两项大型回顾性评估中，阿比西尼亚品种患FASS不成比例。在一项针对＞8000只芬兰猫的大型回顾性研究中，阿比西尼亚猫(以及索马里和奥西猫)在表现出“皮肤过敏症”的猫中占比过高(所有三个品种的优势比为2.1)。在另一项对502只患有过敏性和非过敏性皮炎的猫的回顾性研究中，阿比西尼亚猫只出现在“非跳蚤过敏性皮炎”组。然而，这一发现的临床相关性很难确定，因为该品种仅代表被评估猫的一小部分(共10只猫)。阿比西尼亚和阿比西尼亚杂交也经常出现在小型研究中，但在大多数这些研究中，它们的发病率通常没有与全科医院病例数进行比较。

 

There have been a small number of case reports describing familial dermatitis of allergic origin. One case report described three littermates that developed varying degrees of pruritus and self-inflicted alopecia of the head and neck starting at approximately six months of age. By one year of age, the signs had expanded to include biting at the legs and furious licking of the abdomen. Skin scrapings, faecal flotation, otoscopic examination, ear cytological evaluation and examination of surface debris failed to demonstrate parasites or infectious causes of pruritus. The cats’ pruritus also failed to respond to a flea control trial, ivermectin therapy or an elimination diet trial. Intradermal testing was performed, and the cats were started on immunotherapy based on the results. Two of the cats had an excellent response and were asymptomatic for most of the year, while the signs of the third cat were considerably improved. Interestingly, the dam of these kittens was noted to develop crusting of the head and neck as well as ventral abdominal alopecia during the autumn. Unfortunately, a workup was not permitted in this cat. Another report mentioned that five of 16 cats with atopic dermatitis had first-degree relatives (siblings or parents) affected in a similar way, yet further specifics were not provided.

有少数病例报告描述家族性过敏性皮炎。一个病例报告描述了三个同窝猫，首次6月龄出现不同程度的瘙痒和自损性头颈部脱毛。到一岁时，这些症状已经扩大到咬腿和愤怒地舔腹部。皮肤刮片、粪便漂浮、耳镜检查、耳细胞学评估和表面压片检查未能证明瘙痒的寄生虫或感染性病因。此外，跳蚤控制试验、伊维菌素治疗或食物排查试验对猫的瘙痒也无效。进行皮内试验，并根据结果对猫进行免疫治疗。其中两只猫有很好的效果，在一年的大部分时间里都没有症状，而第三只猫的症状有了很大的改善。有趣的是，这些幼猫的猫妈妈在秋天的时候会出现头部和颈部的结痂以及腹侧脱毛。不幸的是，这只猫不允许做检查。另一份报告提到，16只患有特应性皮炎的猫中有5只有一级亲属关系(兄弟姐妹或父母)症状相似，但没有提供进一步的细节。

 

Two further reports describe cats with lesions and/or clinical signs consistent with allergic dermatitis, for which specific diagnoses were not made. One described three closely related Abyssinians which developed intensely pruritic, crusting dermatitis, rhinitis, conjunctivitis, peripheral eosinophilia and elevated total serum IgE levels. However, it is unclear whether the affected cats all lived in the same household at the time of the development of disease (between 12 and 18 months of age). Furthermore, there is no mention of the methods used to rule out flea allergy, food allergy or nonallergic causes of dermatitis. The second manuscript described seven Norwegian forest cats that developed indolent ulcers and/or linear granulomas. None of these cats were pruritic. All cats had the same father and were born to either the same cat, or to her daughter. Detailed information was not provided for all cats, and the age of onset was reported to be between five and 15 months, with some lesions possibly present as early as one week of age. None of these cats lived in the same household. Unfortunately, as no attempt was made to identify any associated allergic or nonallergic diseases, definitive attribution of these lesions to FASS (or any other allergic disease) cannot be made.

另外两份报告描述了猫的皮肤病变和/或临床症状，与过敏性皮炎一致，但没有作出具体的诊断。一项研究描述了三名关系近的阿比西尼亚猫，他们出现强烈瘙痒、结痂性皮炎、鼻炎、结膜炎、外周嗜酸性粒细胞增多症和血清总IgE水平升高。然而，尚不清楚患猫在发病时(12至18个月大)是否都生活在同一个家庭。此外，也没有提到用于排除跳蚤过敏、食物过敏或非过敏皮肤病病因的诊断方法。第二份手稿描述了7只挪威森林猫出现无痛性溃疡和/或线性肉芽肿。这些猫都不瘙痒。所有的猫都有同一个父亲，要么是同一只猫或她的女儿生的。没有提供所有猫的详细信息，据报道发病年龄在5 - 15个月之间，有些病变可能早在一周大时就出现。这些猫都不住在同一家。不幸的是，由于没有尝试确定任何相关的过敏性或非过敏性疾病，无法确定这些病变是否与FASS(或任何其他过敏性疾病)有关。

郑江涛

曾医生