伴侣动物食物不良反应的批判性评价话题 (3)：犬猫皮肤食...

王帆

Critically appraised topic on adverse food reactions of companion animals (3): prevalence of cutaneous adverse food reactions in dogs and cats

伴侣动物食物不良反应的批判性评价话题 (3)：犬猫皮肤食物不良反应的患病率

Thierry Olivry 和 Ralf S. Mueller

翻译：许晓鸥

Abstract

Background: The prevalence of cutaneous adverse food reactions (CAFRs) in dogs and cats is not precisely known. This imprecision is likely due to the various populations that had been studied. Our objectives were to systematically review the literature to determine the prevalence of CAFRs among dogs and cats with pruritus and skin diseases.

Results: We searched two databases for pertinent references on August 18, 2016. Among 490 and 220 articles respectively found in the Web of Science (Science Citation Index Expanded) and CAB Abstract databases, we selected 22 and nine articles that reported data usable for CAFR prevalence determination in dogs and cats, respectively. The prevalence of CAFR in dogs and cats was found to vary depending upon the type of diagnoses made. Among dogs presented to their veterinarian for any diagnosis, the prevalence was 1 to 2% and among those with skin diseases, it ranged between 0 and 24%. The range of CAFR prevalence was similar in dogs with pruritus (9 to 40%), those with any type of allergic skin disease (8 to 62%) and in dogs diagnosed with atopic dermatitis (9 to 50%). In cats presented to a university hospital, the prevalence of CAFR was less than 1% (0.2%), while it was fairly homogeneous in cats with skin diseases (range: 3 to 6%), but higher in cats with pruritus (12 to 21%) than in cats with allergic skin disease (5 to 13%).

Conclusions: Among dogs and cats with pruritus and those suspected of allergic skin disease, the prevalence of CAFR is high enough to justify this syndrome to be ruled-out with a restriction (elimination)-provocation dietary trial. This must especially be considered in companion animals with nonseasonal pruritus or signs of allergic dermatitis.

Keywords: Allergy, Atopic Dermatitis, Canine, Cat, Dog, Feline, Food Allergy, Itch, Pruritus

摘要

背景：犬猫皮肤食物不良反应 (CAFRs) 的患病率尚不明确。这种不确定可能归因于研究数量不同。我们的目的是系统地回顾文献，以确定瘙痒和皮肤病犬和猫中 CAFRs 的患病率。

结果：我们于 2016 年 8 月 18 日在两个数据库中检索了相关参考文献。在 Web of Science（科学引文索引扩充版）和 CAB 摘要数据库中分别发现的 490 篇和 220 篇文献中，我们分别选择了 22 篇和 9 篇报告可用于犬和猫中 CAFR 患病率确定的数据。发现犬和猫中 CAFR 的患病率根据诊断类型而变化。在所有兽医师诊断的患犬中，患病率为 1% 至 2%，在皮肤病患犬中，患病率范围为 0% 至 24%。CAFR 患病率范围与瘙痒症 (9-40%)、任何类型过敏性皮肤病 (8-62%) 和诊断为特应性皮炎 (9-50%) 的患犬比例相似。在就诊于大学医院的猫中，CAFR 的患病率低于 1% (0.2%)，而在皮肤病患猫中则相当均匀（范围：3～6%），但在瘙痒症 (12～21%) 中的比例高于过敏性皮肤病患猫 (5～13%)。

结论：在患有瘙痒和疑似过敏性皮肤病的犬和猫中，CAFR 的患病率很高，足以证明通过限制（消除）-激发食物试验排除该综合征的合理性。尤其是在伴侣动物出现非季节性瘙痒或过敏性皮炎体征时。

关键词：过敏症、特应性皮炎、犬科、猫、犬、猫科、食物过敏、痒、瘙痒

Background

There is variability about the reported prevalence of cutaneous adverse food reactions (CAFRs) in dogs and cats. This heterogeneity of data might be caused by a combination of differences in the geographical populations studied, variability in animal groups in which the prevalence is reported and, perhaps, in the method of diagnosis of CAFR itself.

背景

在犬和猫中报告的皮肤食物不良反应 (CAFR) 的患病率各不相同。这种数据差异可能是由研究的不同地区的数量差异、报告患病率的动物组差异以及（可能）CAFR 本身诊断方法共同导致的。

Clinical scenario

You have two patients: a 1-year-old male intact West Highland white terrier and a 3-year-old female spayed Siamese cat. Both animals exhibit pruritus that manifests by year-round scratching. The dog also suffers from occasional episodes of urticaria, as well as bouts of soft mucus-containing stools. The cat has several patches of self-induced hair loss on the abdomen and medial thighs. You inform the owners of both patients that you suspect that all clinical signs might be caused by a reaction to their pet’s diet. The owners ask you how frequent this type of problem is.

临床案例

你有两个病例：一只 1 岁的雄性西高地白㹴和一只 3 岁的已绝育雌性暹罗猫。两种动物均表现为瘙痒，表现为常年搔抓。该犬还出现偶尔发作的荨麻疹，以及阵发性软便。猫腹部和大腿内侧有几处自我损伤引起的脱毛斑。您告知两名患者的主人，您怀疑所有临床体征可能是由其饮食反应引起的。宠物主人会问你这种类型的问题有多常见。

Structured question

What is the prevalence of CAFR among dogs and cats with pruritus or skin diseases?

结构化问题

患有瘙痒或皮肤病的犬和猫中 CAFR 的患病率是多少？

Search strategy

We searched the Web of Science (Science Citation Index Expanded) and CAB Abstract databases on August 18, 2016 using the following string: ((dog or dogs or canine) or (cat or cats or feline)) and (food or diet*) and (atop* or allerg* or reaction*) and (prurit* or cutan* or skin) not (human* or adult* or child*). We limited the search to journal articles published from 1980 to present; there were no language restrictions.

检索策略

我们于 2016 年 8 月 18 日使用以下字符串检索了 Web of Science（科学引文索引扩展）和 CAB 摘要数据库：[（犬dog 或 犬的复数形式dogs或canine）或（猫cat或猫的复数形式cats或filine）]和（食物或饮食 *）和（atop*  或allerg * 或反应 *）和（瘙痒prurit * 或角质cutan * 或皮肤）   非（人类 * 或成人 * 或儿童 *）。我们限制检索 1980 年至今发表的期刊论文；没有语言限制。

Identified evidence

Our literature search identified 490 and 220 articles in the CAB Abstract and Web of Science databases, respectively. Citations were initially assessed for the identification of articles reporting original information; review papers were not considered further. Abstracts were then screened and potentially relevant papers were read in full. The bibliography of these articles was examined further for additional pertinent citations.

已识别的证据

我们的文献检索在 CAB 摘要和 Web of Science 数据库中分别识别了 490 篇和 220 篇文献。最初评估引文以识别报告原始信息的文章；未进一步考虑综述论文。然后筛选摘要，全文阅读可能相关的论文。进一步检查这些文章的参考书目，以获得额外的相关引文。

Altogether, we selected 28 papers that provided us- able information. Twenty-seven articles were identified from the search of the CAB abstract data- base, while 18 of these 27 papers (67%) were also found in the Web of Science archives; none was uniquely detected in the Web of Science query, while one additional publication was identified from scanning the references of selected articles . There were nine studies reporting information on the prevalence of CAFR in cats and 22 on that in dogs; three reported data usable for both dogs and cats . Studies were reported from 1990 to 2015 . All papers were in English except for one each in French, Dutch, German , Italian and Portuguese .

总之，我们选择了 28 篇提供了可用信息的论文。检索 CAB 摘要数据库识别出 27 篇文章，而在 Web of Science 档案中也发现了这 27 篇文章中的 18 篇 (67%)；在 Web of Science 查询中未检测到唯一的文章，而通过扫描所选文章的参考文献识别出了另外一篇出版物。有 9 项研究报告了猫中 CAFR 的患病率信息，22 项研究报告了犬中 CAFR 的患病率信息；3 项研究报告的数据可用于犬和猫。1990年至2015年报告了研究。所有论文均为英文，但法语、荷兰语、德语、意大利语和葡萄牙语各 1 篇除外。

Evaluation of evidence

The selected articles reported information from small animal patients from all over the world: cats came from Australia, Canada, New Zealand, the UK, the USA or from a worldwide survey. Dogs with CAFR had been diagnosed in Brazil , Canada , the Czech Republic, Hungary, Iran, Italy, the Netherlands and Belgium, Slovenia, Switzerland, Sweden, the UK and the USA; there was also a large worldwide survey. Only two articles contained reviews of diagnoses made in general veterinary practices, while all other reports were from patients seen at university or private specialty clinics.

证据评价

所选文章报告了来自世界各地小动物患者的信息：猫来自澳大利亚、加拿大、新西兰、英国、美国或来自全球调查。在巴西、加拿大、捷克共和国、匈牙利、伊朗、意大利、荷兰和比利时、斯洛文尼亚、瑞士、瑞典、英国和美国确诊患有CAFR的犬；还有一项大型全球调查。仅有两篇文献包含对一般兽医实践中诊断的审查，而所有其他报告均来自大学或私人专科门诊就诊的患者。

The method of diagnosis of CAFR was not specified in three surveys, while, in all other reports, the diagnosis was made after observing a reduction of pruritus manifestations after feeding an elimination diet lasting most often between 6 and 8 weeks. In all but four studies, this elimination diet was followed by a challenge with offending allergens. Importantly, in only four articles was an elimination diet performed in the entire population of study patients.

在 3 项调查中未规定诊断 CAFR 的方法，而在所有其他报告中，观察到饲喂低敏日粮持续6-8周后，瘙痒表现减少后作出诊断。除 4 项研究外，所有其他研究是在进行日粮排除试验之后均进行过敏原激发试验。重要的是，仅有 4 篇文章对研究的所有病例都进行了日粮排除试验。

The prevalence of CAFRs in dogs and cats was found to vary depending upon the type of diagnosis made. In dogs (Fig. 1), the prevalence of CAFRs was low among dogs presented to their veterinarian for any diagnosis (1 to 2%) or among those with skin diseases (median: 6%; range: 0 to 24%). Furthermore, ranges of reported prevalence of CAFR overlapped between dogs with pruritus (median: 18%; range: 9 to 40%), those with any type of allergic skin disease (median: 20%; range: 8 to 62%) and dogs with skin lesions suggestive of atopic dermatitis (median: 29%; range: 9 to 50%) (Fig. 1; Additional file 1). A similar pattern was found in feline patients (Fig. 2). In cats presented to a university hospital , the prevalence of CAFR was reported to be very low (0.2%), while it was fairly homogeneous in cats with skin diseases (median: 5%; range: 3 to 6%); it was higher in cats with pruritus (12 and 21%) than in cats with allergic skin disease (median: 10%; range: 5 to 13%) (Fig. 2; Additional file 2). We attribute the latter observation to cats occasionally manifesting a CAFR as pruritus without visible dermatitis. Altogether, there were not enough data to compare the prevalence of CAFR in dogs and cats from different geographical locations.

发现犬和猫中 CAFRs 的患病率根据诊断类型而变化。在犬中（图 1），因任何诊断 (1-2%) 或患有皮肤病（均值：6%；范围：0 至 24%）而于兽医就诊的犬中，CAFR 的患病率较低。此外，报告的 CAFR 患病率范围在瘙痒犬（均值：18%；范围：9-40%）、任何类型的过敏性皮肤病犬（均值：20%；范围：8-62%）和皮肤病变提示特应性皮炎的犬（均值：29%；范围：9-50%）之间重叠（图 1；附加文件 1）。在猫患者中也发现了类似的模式（图 2).在就诊于大学医院的猫中，报告 CAFR 的患病率非常低 (0.2%)，而在患有皮肤病的猫中则相当均一（均值：5%；范围：3～6%）；在患有瘙痒的猫中（12 和 21%）高于患有过敏性皮肤病的猫（均值：10%；范围：5～13%）（图 2；附加文件 2）。我们将后一种观察结果归因于猫偶尔表现为瘙痒而无可见的皮炎。总之，没有足够的数据来比较不同地理位置的犬和猫中 CAFR 的患病率。

As in most summaries incorporating results from studies performed at different times and institutions, the main limitation of this review is the likely variability of methods or criteria used to make the diagnosis of CAFR. A similar inconsistency probably also existed in the way atopic dermatitis was diagnosed between studies. Whenever details were provided, however, CAFRs and AD were diagnosed according to accepted standards at the time of publication. Importantly, in all but four studies , not all animals from the reported population (e.g. dogs with any or skin diseases) had been subjected to an elimination diet. This lack of systematic dietary testing likely led to a lower prevalence of CAFR reported in articles where the diet change was not made in all pets.

正如大多数汇总不同时间和机构的研究所得结果一样，本综述的主要局限性是用于诊断 CAFR 的方法或标准可能存在差异。类似的不一致性也可能存在于不同研究之间特应性皮炎的诊断方式中。然而，无论何时提供细节，在出版时根据公认的标准诊断 CAFRs 和 AD。重要的是，除 4 项研究外，并非所有报告种群的动物（例如，患有任何疾病或皮肤病的犬）均接受了食物排除试验。这种缺乏系统的饮食检测可能导致了较低的流行的 CAFR 的报道，在文章中的饮食改变并没有在所有的宠物（进行）。

Conclusion and implication for practitioners

Our review of the existing evidence suggests that the prevalence of CAFRs in dogs and cats varies depending upon the population in which it is calculated. Despite the likely heterogeneity existing between methods of diagnosis, the prevalence of CAFRs in companion animals appears somewhat similar. Among dogs and cats with any disease, skin disease, pruritus or allergic skin disease, the median prevalence of CAFR is less than 1%, about 5%, between 15 to 20% and 10 to 25%, respectively; it is also estimated to be around one third of dogs with atopic dermatitis.

结论和对临床医生的意义

我们对现有证据的审查表明，犬和猫中 CAFRs 的患病率因计算的种群而异。尽管诊断方法之间可能存在异质性，但伴侣动物中 CAFRs 的患病率似乎有些相似。在患有任何疾病、皮肤病、瘙痒或过敏性皮肤病的犬和猫中，CAFR 的平均患病率分别低于 1%、约 5%、15% 至 20% 和 10% 至 25%；估计也约为患有特应性皮炎犬的三分之一。

图 1患有各种疾病的犬中 CAFRs 的患病率。空心圆圈对应未指明 CAFR 诊断方法的三项研究[1, 10,

图 2患有各种疾病的猫中 CAFR 的患病率。空心圆圈对应两项未指明 CAFR 诊断方法的研究[1, 10,

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