简化食物排除试验

赵博

Simplifying Dietary Elimination Trials

简化食物排除试验

作者：Alison Diesel, DVM, DACVD Texas A&M University

翻译：陈坚（宠医帮用户名：363305633）

校对：赵博

文献：Favrot C, Bizikova P, Fischer N, Rostaher A, Olivry T. The usefulness of short-course prednisolone during the initial phase of an elimination diet trial in dogs with food-induced atopic dermatitis. Vet Dermatol. 2019;30(6):498-e149.

Although less common than atopic dermatitis caused by environmental allergens, cutaneous adverse food reaction (ie, food allergy, food-induced atopic dermatitis) is an important differential diagnosis in a pruritic dog when infections, including parasitic infections, have been ruled out. Diagnosis is typically based on the results of an 8- to 12-week dietary elimination trial, which can often be difficult to perform due to a lack of appropriate pet owner compliance.

虽然皮肤食物不良反应（即食物过敏、食物诱导的特应性皮炎）比环境过敏原引起的特应性皮炎更少见，但当排除感染，包括寄生虫感染时，皮肤食物不良反应是瘙痒犬的重要鉴别诊断。诊断通常基于8-12周的食物排除试验结果，由于宠物主人缺乏依从性，通常很难进行该试验。

The aim of this prospective study* was to evaluate the usefulness of administering a short course of oral prednisolone for a minimum of 2 weeks of a dietary elimination trial to reduce the time required to confirm or refute a food allergy diagnosis. Fifty-three dogs with a diagnosis of nonseasonal atopic dermatitis were fed a commercially available, extensively hydrolyzed diet and given anti-inflammatory dosages of prednisolone for ≥2 weeks. Two weeks after prednisolone was discontinued, 10 of the 53 dogs did not show signs of flare-up; these dogs were then challenged with their original diets and experienced relapse of signs. When the extensively hydrolyzed diet was reintroduced to this group, clinical signs improved. These dogs were subsequently diagnosed with food-induced atopic dermatitis. Median duration of the food elimination trial for the food-allergic dogs was 28 days (range, 28-44 days). In the other 43 dogs, pruritus could not be controlled without concurrent prednisolone administration and clinical signs did not worsen with diet challenge. In these dogs, elimination diet trials lasted a median of 60 days (range, 54-70 days).

这项前瞻性研究的目的是：确认或排除食物过敏的诊断需要进行食物排除试验，口服至少2周泼尼松龙，评估缩短试验时间是否有效。53只诊断为非季节性特应性皮炎的犬，被饲喂超级水解商品粮，并给予抗炎剂量的泼尼松龙≥2周。停用泼尼松龙两周后，53只犬中有10只没有出现症状;然后，这些犬用原来的日粮激发，症状复发。对此组再次使用超级水解粮时，临床症状改善。这些犬随后被诊断为食物诱导的特应性皮炎。食物过敏犬的食物排除试验的中位持续时间为28天(范围，28-44天)。在另外43只犬中，如果不同时给予泼尼松龙，瘙痒就不能得到控制，并且临床症状没有随着食物激发而恶化。在这些犬中，食物排除试验的中位持续时间为60天(范围54-70天)。

FIGURE German shepherd dog with cutaneous adverse food reaction. This dog had concurrent environmental allergy. Both food and environmental triggers exacerbate clinical signs of atopic dermatitis.

图 罹患皮肤食物不良反应的德国牧羊犬。该犬并发环境过敏。食物和环境诱因均可加重特应性皮炎的临床症状。

… TO YOUR PATIENTS

Key pearls to put into practice:

… 对于你的病例

实施的关键

1 Historically, atopic dermatitis has been referred to as allergic skin disease triggered by environmental allergens. There is growing evidence that supports food as a possible trigger for some dogs with atopic dermatitis. In these dogs, pruritic skin disease with clinical characteristics of atopic dermatitis can develop with ingestion of various foods. Canine food allergy is believed to involve both immunologic and nonimmunologic pathomechanisms of development ; this could support shared immunologic responses in the conditions previously considered to be separate

1 在历史上，特应性皮炎被称为由环境过敏原引发的过敏性皮肤病。越来越多的证据支持食物可能是一些特应性皮炎患犬的触发因素。对于这些犬，摄入各种食物可发展为具有特应性皮炎临床特征的瘙痒性皮肤病。犬食物过敏的发生涉及免疫和非免疫病理机制；我们支持这两种病存在共同的免疫反应，而先前认为不同。

2 A strict dietary elimination trial remains the gold standard for diagnosing food allergy in dogs and cats. A recent literature review evaluated information on in vitro and in vivo testing for food allergies in veterinary species; results lack support for any evaluated test other than diet trial. However, these trials can be frustrating for owners and often lead to noncompliance. Concurrent administration of anti-inflammatory steroids as described in the present study may allow for reduced time to achieve a diagnosis in truly food-allergic dogs.

2 严格的食物排除试验仍然是诊断犬猫食物过敏的金标准。最近的一篇回顾性文献评估了兽医临床相关物种的食物过敏体外和体内试验信息;结果不支持任何除食物试验外的评估试验。

然而，这个试验会让宠主感到沮丧，并导致经常不遵医嘱。对真正的食物过敏患犬，本研究同时给予抗炎类固醇的方法，可达到缩短诊断时间的目的。

3 Reducing inflammation is key when managing allergic skin disease in dogs and cats. Focusing on this in the early stages of dietary elimination trials can help dampen pathways that lead to itch and inflammation. Steroids have a broad effect with regard to inflammation; whether these same effects would be noted with more targeted therapeutics (eg, oclacitinib, lokivetmab) is unknown.

在管理犬猫过敏性皮肤病时，减少炎症是关键。在食物排除试验初期专注于抑制瘙痒和炎性过程。类固醇具有广谱抗炎作用；尚不清楚靶向性更强的治疗（如奥拉替尼、洛基维特单抗）是否存在同样效果。

References

1. Olivry T, DeBoer DJ, Prélaud P, International Task Force on Canine Atopic Dermatitis. Food for thought: pondering the relationship between canine atopic dermatitis and cutaneous adverse food reactions. Vet Dermatol. 2007;18(6):390-391.

2. Jackson H. The pathogenesis of food allergy. In: Noli C, Foster A, Rosenkrantz W, eds. Veterinary Allergy. Oxford, UK: John Wiley and Sons; 2013:103-107.

3. Mueller RS, Olivry T. Critically appraised topic on adverse food reactions of companion animals (4): can we diagnose adverse food reactions in dogs and cats with in vivo or in vitro tests? BMC Vet Res. 2017;13:275.

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