2023美国动物医院协会犬猫过敏性皮肤病管理指南-中文版 ...

王帆

2023 AAHA Management of Allergic Skin Diseases in Dogs and Cats Guidelines

2023美国动物医院协会犬猫过敏性皮肤病管理指南

作者：Julia Miller,Andrew Simpson, Paul Bloom, Alison Diesel, Amanda Friedeck, Tara Paterson,Michelle Wisecup, Chih-Ming Yu

 

翻译：王帆

 

Abstract

摘要

These guidelines present a systematic approach to diagnosis,treatment,and management of allergic skin diseases in dogs and cats.The guidelines describe detailed diagnosis and treatment plans for flea allergy,food allergy,and atopy in dogs and for flea allergy,food allergy,and feline atopic skin syndrome in cats.Management of the allergic patient entails a multimodal approach with frequent and ongoing communication with the client.Obtaining a comprehensive history is crucial for diagnosis and treatment of allergic skin diseases,and the guidelines describe key questions to ask when presented with allergic canine and feline patients.Once a detailed history is obtained,a physical examination should be performed,a minimum dermatologic database collected,and treatment for secondary infection,ectoparasites,and pruritus (where indicated)initiated.The process of diagnosing and managing allergic skin disease can be prolonged and frustrating for clients.The guidelines offer recommendations and tips for client communication and when referral to a dermatologist should be considered,to improve client satisfaction and optimize patient outcomes.

这些指南提出了犬和猫的过敏性皮肤病诊断、治疗和管理的系统性方法。该指南详细描述了犬的跳蚤过敏、食物过敏和特应性皮炎，以及猫的跳蚤过敏、食物过敏和猫特应性皮肤综合征的诊断和治疗方案。过敏症患病动物的管理需要多模式且持续管理，以及与客户进行频繁沟通。获得全面的病史对过敏性皮肤病的诊断和治疗至关重要，指南描述了在遇到过敏性患犬和患猫时的重点问诊内容。获得详细病史后，应进行体格检查，收集皮肤病学最小数据库，并开始针对继发性感染、体外寄生虫和瘙痒(表现)的治疗。诊断和管理过敏性皮肤病的过程可能会延长，并使客户感到沮丧。该指南提供了与客户沟通的建议和技巧，为了提高客户满意度和优化患病动物治疗效果，应考虑转诊给皮肤科医生。

 

These guidelines were prepared by a taskforce of experts convened by the American Animal Hospital Association.This document is intended as a guidelne only,not an AAHA standard of care.These guidelines and recommendations should not be construed as dictating an exclusive protocol,course of treatment,or procedure.Variations in practice may be waranted based on the needs of the individual patient,resources, and limitations unique to each individual practice seting.Evidence- guided support for specific recommendations has been cited whenever possible  and  appropriate.Other  recommendations are based  on practical cinical experience and a consensus of expert opinion.Further research is needed to document some of these recommendations.Drug approvals and labeling are curent at the time of writing but may change over time.Because each case is different,veterinarians must base their decisions on the best avalable scientfic evidence in conjunction with their own knowedge and experience.

这些指南是由美国动物医院协会召集的一个专家小组制定的。本文件仅作为指南，而非AAHA的标准治疗。这些指南和建议不应被理解为规定了排他性方案、疗程或操作。临床实践中可能需要根据个体患病动物的需求、资源和每个医疗机构特有的局限性进行调整。在可能和适当的情况下，引用了对具体建议的证据指导支持。其他建议是基于实际临床经验和专家意见共识。需要进一步研究来记录其中一些建议。在撰写本文时，药物批准和标签是最新的，但可能会随着时间的推移而变化。因为每个病例都是不同的，兽医必须根据他们自己的知识和经验，根据最好的科学证据做出决定。

 

Introduction

介绍

An itchy pet is one of the most common reasons a client seeks veterinary care.Allergic skin diseases can cause not only significant discomfort and distress to the individual animal but also stress and disruption to the pet's family members.Because of the complex nature of allergic skin disease,diagnosis can be time-consuming and may require multiple follow-up visits before a final diagnosis is achieved.Patients with allergic skin  disease often require lifelong management to optimize their quality of life.These guidelines offer a step-by-step approach to diagnose and manage flea  allergy,food allergy,and atopy in the dog and cat.

宠物瘙痒是客户寻求兽医治疗的最常见原因之一。过敏性皮肤病不仅会给动物个体带来明显的不适和痛苦，还会给宠物的家庭成员带来压力和干扰。由于过敏性皮肤病的复杂性，诊断可能耗时，在最终诊断之前可能需要多次随访。过敏性皮肤病患病动物往往需要终身管理，以优化其生活质量。这些指南提供了诊断和管理犬和猫的跳蚤过敏、食物过敏和特应性皮炎的方法。

 

·Section I describes the steps in diagnosing the canine patient with allergic skin disease.

·Section 2 describes initial and long-term management of canine allergic skin diseases and acute flares.

·Section 3 addresses diagnosing allergy in the feline patient,including clinical presentations of dermatitis in cats and key differences between cats and dogs.

·Section 4 describes initial and long-term management of feline allergic skin diseases and acute flares.

·Section 5 provides an overview of diagnosis and treatment of allergic otitis externa.

·Section 6 presents spectrum of care considerations for managing allergic skin diseases,including referral recommendations,telehealth,and communication tips.

·Section 7 discusses the vital role  of veterinary technicians in the management of allergic patients and how to optimize their involvement in these cases.

·Section 8 offers key messaging points for client communication.

·第一部分：过敏性皮肤病患犬的诊断步骤。

·第二部分：犬过敏性皮肤病和急性发作的早期和长期管理。

·第三部分：猫过敏症的诊断，包括猫皮肤病的临床表现以及猫和犬之间的主要区别。

·第四部分：猫过敏性皮肤病和急性发作的早期和长期管理。

·第五部分：过敏性外耳炎的诊断和治疗。

·第六部分：管理过敏性皮肤病的一系列护理注意事项，包括转诊建议、远程医疗和沟通技巧。

·第七部分：讨论兽医技术人员在过敏症患病动物管理中的重要作用，以及如何优化他们在这些病例中的作用。

·第八部分：客户沟通重点信息。

 

These guidelines are designed to simplify the path to diagnosis and management of canine and feline allergic skin diseases,while  emphasizing a multimodal approach for the patient and effective client communication to ensure the best possible outcome.

这些指南旨在简化犬和猫过敏性皮肤病的诊断和管理方法，同时强调对患病动物的多模式管理方法和有效的客户沟通，以确保最佳治疗结果。

 

Section 1:Diagnosing the Allergic Canine Patient

第一部分:过敏症患犬的诊断

Top 3  Takeaways:

三大要点:

1.A detailed history,including a review of previous medical records, should be obtained.Information regarding seasonality,pruritus level,ectoparasite prevention,and  response to previous therapies are all paramount in the workup of the pruritic dog.

1.应获得详细的病史，包括对以前医疗记录的回顾。有关季节性、瘙痒程度、外寄生虫预防和对以前治疗效果的信息在瘙痒犬的检查中都是至关重要的。

 

2.A minimum dermatologic database should be performed including skin cytology,flea combing,skin scrapings,and ear cytology(if ear disease is present).

2.应进行皮肤病学最小数据库采集，包括皮肤细胞学检查、跳蚤梳理、皮肤刮片和耳分泌物细胞学(如果存在耳病)。

3.Atopy is a diagnosis of exclusion.Allergy testing (intradermal or serum)to identify allergens should only be performed if immunotherapy is planned.

3.特应性皮炎是一种排除性诊断。只有在计划进行免疫治疗时，才应进行过敏原试验(皮内或血清)以确定过敏原。

 

 

 

Overview

概述

Diagnosing allergic skin disease in the canine patient requires the veterinary team to be well versed in obtaining accurate clinical histories that include key questions about the dog's level of pruritus,the environment,and any other medical conditions present.A  minimum dermatologic database should also be performed on pruritic patients to assess for the presence of ectoparasites and skin infections. Because atopy is a diagnosis of exclusion,the process may be time-consuming and frustrating for clients.Clear communication regarding timelines and expectations is crucial for successful results.

诊断过敏性皮肤病患犬需要兽医团队充分了解准确的临床病史，包括有关犬的瘙痒程度、环境和存在的任何其他疾病的关键问题。还应对瘙痒患病动物进行最起码的皮肤病数据库采集，以评估是否存在体外寄生虫和皮肤感染。因为特应性皮炎是一种排除性诊断，这个过程对客户来说可能是费时和令人沮丧的。关于时间表和期望的清晰沟通对于成功的结果至关重要。

 

Step One:Clinical History and Dermatologic Physical Examination

第1步:临床病史和皮肤体格检查

Clinical History

临床病史

A detailed history should provide essential information about the dog's clinical signs,patterns  of pruritus,and  environment,which will assist the practitioner in diagnosing the specific allergic disease.When asking a client about the presence and intensity of pruritus,it is important to clearly explain the signs of pruritus to owners who may not readily recognize them.Clients may not understand that scratching,biting,chewing,licking,gnawing,rubbing,or rolling can all be evidence of an itchy dog.Pruritus scales(usually ranging from 1 to 10 with 10 representing constant itching)can be a helpful tool to use with clients.The validated canine Pruritus Visual Analog Scale can be found athttps://www.vetdermclinic.com/pruritus-visual-analog- scale-canine/.

详细的病史应提供有关犬的临床症状、瘙痒模式和环境的基本信息，这将有助于医生诊断具体的过敏性疾病。当询问客户是否存在瘙痒以及瘙痒程度时，重要的是要让宠主了解什么是瘙痒的症状。客户可能不明白，抓挠、咬、嚼、舔、啃、揉或滚都可能是犬瘙痒症状。瘙痒评分表(通常为1 ~ 10分，10分代表持续瘙痒)对客户来说是一个有用的工具。经过验证的犬瘙痒视觉评分表可在网站上找到。（https://www.vetdermclinic.com/pruritus-visual-analog-scale-canine/.）

 

Educating clients and helping them to understand that each question in the client history provides significant diagnostic clues can make the process seem less of a formality and more like progress toward the  mutual  goal of a more comfortable and happier dog. Engaging clients in this way can create the sense that everyone is on the same team,for what may be a long road ahead.

教育客户并帮助他们了解客户病史中的每个问题都提供了重要的诊断线索，可以使这个过程看起来不那么拘泥于形式，而更像是朝着更舒适、更快乐的犬的共同目标迈进。以这种方式吸引客户可以创造一种每个人都在同一个团队中的感觉，因为前面可能有很长的路要走。

 

Veterinary technicians are an invaluable asset in dermatologic appointments. From taking comprehensive clinical histories to educating clients, technicians serve a vital role in the workup and successful management of pruritic patients.

兽医技术人员在皮肤科预约中起关键作用。从全面的临床病史到教育客户，技术人员在瘙痒患病动物的检查和成功管理中起着至关重要的作用。

 

Key Questions for Clinical History

临床病史的关键问题

1.What was the distribution of the pruritus initially?What is it now? Have there been changes?

Note that only ectoparasites have a predictable distribution.The distribution of pruritus for atopy or food allergy is identical.'

1.瘙痒最初的分布是什么?现在是什么?有什么变化吗?

请注意，只有体外寄生虫具有可预测的分布。特应性皮炎和食物过敏的瘙痒分布相同。

 

2.Is the pruritus seasonal,year-round,or year-round with a seasonal flare?

2.瘙痒是季节性的、全年的、还是全年发病伴季节性加重?

Seasonal pruritus is most consistent with atopy.Year-round pruritus may be associated with food allergy,atopy due to indoor allergens,and atopy  in  certain  geographical  locations  where  outdoor allergens lack seasonality.

季节性瘙痒与特应性皮炎最为一致。全年瘙痒可能与食物过敏、室内过敏原引起的特应性皮炎以及无明显地区差异的非季节性室外过敏原引发的特应性皮炎有关。

 

3.What was the age of onset?

3.发病年龄是多少？

Food allergies may start at any age,but because atopy has a more defined age of onset (i.e.,clinical signs starting between 6 mo and 4 yr of age),food allergy may be prioritized in the very young and older patients.Pruritus due to ectoparasites may present at any age.

食物过敏可以在任何年龄开始发病，但由于特应性皮炎有一个更明确的发病年龄(即临床症状开始于6月龄至4岁)，因此食物过敏可能在非常年轻和老年患病动物中优先考虑。体外寄生虫引起的瘙痒可在任何年龄出现。

 

 

4.What previous treatments were prescribed and how efiective were they?

4.以前开过什么治疗方法，效果如何?

Response to treatments such as oclacitinib or lokivetmab will vary among allergic patients.Response to glucocorticoids does not help narrow the cause of pruritus as any pruritic disease may respond to antipruritic doses of glucocorticoids.Failure to respond to gluco- corticoids,however,may suggest the presence of secondary infections(bacterial or Malassezia),ectoparasites,and/or food allergy.In addition,an incomplete response to antibiotic therapy may indicate the presence of antimicrobial resistance.Commonly,antimicrobials and antipruritic therapies are prescribed and discontinued at the same time.To truly assess response to these therapies,it is helpful to avoid discontinuation of these medications at the same time.

对奥拉替尼或洛基维特单抗等治疗的效果，因过敏症患病动物不同而反应不同。对糖皮质激素有效不能帮助缩小瘙痒的病因，因为任何瘙痒性疾病都可能对止痒剂量的糖皮质激素有效。然而，糖皮质激素治疗无效可能提示存在继发性感染(细菌或马拉色菌)、体外寄生虫和/或食物过敏。此外，对抗生素治疗效果不佳，可能表明存在抗生素耐药性。常见抗生素和止痒药同时给药同时停药。为了真正评估这些治疗的效果，应避免同时停药。

 

5.Are other pets or humans affected?

Pruritus affecting other pets or humans strongly suggests the presence of ectoparasites such as fleas,scabies,or Cheyletiella.

5.其他宠物或人是否患病吗?

其他宠物或人有明显瘙痒表明存在体外寄生虫，如跳蚤、疥螨或姬螯螨。

 

6.Is there any vomiting,soft stool,or increased flatulence that may suggest a food allergy?

In addition to cutaneous signs,19-27% of food-allergic dogs will  also exhibit vomiting,soft stool,and/or diarrhea.Using a fecal score chart can be benefcial(see https://www.proplanveterinarydiets.ca/ sites/g/files/2021-02/180107_PPPVD-Fecal-Scoring-Chart-UPDATE- EN-FINAL.pdf).

6. 是否有可能提示食物过敏的呕吐、软便或胀气症状增加?

7. 除了皮肤症状，19-27%的食物过敏犬还会表现出呕吐、软便和/或腹泻。使用粪便评分表可能有帮助。

 

Dermatologic Physical Examination

皮肤学体格检查

Perform a complete physical examination,including flea combing and an otoscopic examination.An otoscopic examination should be performed even if the owner does not report otic pruritus because it is common for dogs to not show overt clinical signs of ear disease until it is moderately severe.Note that up to 50%of allergic dogs may have otitis externa'and this may be the first and only clinical signs of allergic disease.Be sure to assess the skin in areas where infammation may be less obvious,including the paws,claws,perianal skin,and intertriginous areas such as the axillary and inguinal regions and skin folds (see Figure 2).A complete nose-to-tail examination is essential and may require sedation if an animal is very uncomfortable or resistant to handling.

进行全面的体格检查，包括跳蚤梳理和耳镜检查。即使宠主没有报告耳部瘙痒，也应该进行耳镜检查，因为犬通常在中度严重之前不会表现出明显的耳部疾病的临床症状。注意，高达50%的过敏症犬可能有外耳炎，这可能是过敏性疾病的第一个和唯一的临床症状。一定要评估炎症可能不太明显的部位的皮肤，包括爪部、甲部、肛周皮肤，以及如腋窝和腹股沟区域和皮肤皱褶等部位(见图2)。必须从头到位进行完整的检查，如果动物非常不舒服或难以处理，可能需要镇静。

 

Flea combing should always be performed as part of the initial physical examination.

跳蚤梳理应始终作为早期体格检查的一部分.

 

Step Two:Minimum Dermatologic Database

第2步:皮肤病学最小数据库

A minimum dermatologic database should be collected as the next step and consists of the following;

下一步应收集皮肤病学最小数据库，包括以下内容:

·Cytology of skin and ears (where evidence of ear disease is present)

·皮肤和耳道(如果有耳病)细胞学检查

·Skin scrapings (deep/superficial to assess for both Demodex and Sarcoptes mites)

·皮肤刮片(深层/浅层以评估蠕形螨和疥螨)

 

If there are financial constraints, consider a therapeutic trial with an isoxazoline, rather than performing skin scrapings. However, be aware that although uncommon, failures in the treatment of mites using isoxazolines have been anecdotally reported. As alternatives to traditional deep skin scrapings, plucking hairs (trichogram) or acetate tape samples on pinched skin may be able to detect Demodex mites in areas that are too sensitive for a deep skin scrape.

如果有资金限制，则考虑使用异恶唑啉驱虫药进行治疗性试验，而不进行皮肤刮片。然而，请注意，使用异恶唑啉驱虫药治疗螨虫的失败虽然不常见，但已经有轶事报道。在皮肤深刮过于敏感的区域，作为传统的皮肤深刮替代方法，采用先挤捏皮肤然后拔毛镜检(毛发镜检)或醋酸胶带采样可能能够检测到蠕形螨。

 

·±Dermatophyte test medium(DTM)culture (depending on regional prevalence,history,and index of suspicion)

·±皮肤癣菌培养基(DTM)培养(取决于地区流行情况、病史和怀疑程度)

 

Depending on state regulations, collecting samples for a minimum dermatologic database may be assigned to a veterinary technician.

根据地区规定，可由兽医技术人员进行皮肤病学最小数据库采样。

 

 

 

Step Three:Treat Pruritus

第3步：治疗瘙痒

A critical aspect in managing both the patient and the owner's quality of life is reducing pruritus.Consider the use of an antipruritic agent(glucocorticoids,oclacitinib,or lokivetmab)and/or topical therapy(see Table 1 and Section 2 for more information).These therapies may be less effective in the face of active infection;therefore,appropriate diagnosis and treatment of secondary infections is critical before assessing response to antipruritic therapy.

减少瘙痒对改善患病动物和宠主的生活质量都很重要。考虑使用止痒药(糖皮质激素、奥拉替尼或洛基维特单抗)和/或外部治疗(更多信息见表1和第二部分)。面对活跃性感染，这些治疗可能效果较差;因此，在评估抗瘙痒治疗的效果之前，适当的诊断和治疗继发性感染是至关重要的。

 

Step Four:Treat Secondary Infections and Ectoparasites

第4步:治疗继发性感染和体外寄生虫

Secondary bacterial and Malassezia infections must be treated concurrently with controlling pruritus and diagnosing the underlying allergic disease (see Tables 4 and 5).Otitis externa,if present,should also be treated (see Section 5).Prescribe a flea and tick preventive if the dog is not currently receiving one and discuss compliance with the client.The guidelines task force prefers an oral isoxazoline as this drug class offers flea,tick,and mite prevention and allows for routine bathing.All parasiticides may lower seizure threshold,and consultation with a neurologist is recommended in severely epileptic patients

必须在控制瘙痒和诊断潜在过敏性疾病的同时进行继发性细菌和马拉色菌感染治疗(表4和表5)。如果有外耳炎，也应进行治疗(见第五部分)。指南工作组倾向于口服异恶唑啉，因为这类药物可以预防跳蚤、蜱虫和螨虫，并且可以常规洗澡。所有杀寄生虫剂均可降低癫痫发作阈值，建议重度癫痫患病动物咨询神经科医师用药。

 

Step Five:Recheck,Verify Medication,and Assess Response to Treatment

第5步:重新检查，核实用药，并评估治疗效果

Assessing the response to medications such as flea preventives and antipruritic drugs is a key step in the diagnostic process.It is important to ensure that the veterinary team and the client are all on the same page about medication administration,duration of therapy, and follow-up examinations.Response to therapy should be assessed 14 days after initiating therapy,and this is ideally done with an in-person recheck examination.However,if a physical examination is not feasible for the client,this would be a reasonable application for a telehealth appointment.If multiple medications were prescribed,it is recommended to discontinue these one at a time to help determine which,if any,were responsible for the response.It is not ideal to stop antipruritic and antimicrobial therapies at the same time as this muddies the  water and does not allow you to interpret what was causing the patient's itch-the infection or the allergic inflammation.

评估对预防跳蚤和止痒药物等药物的效果是诊断过程中的一个关键步骤。重要的是要确保兽医团队和客户在给药、治疗持续时间和随访检查方面达成一致。应在开始治疗后14天评估对治疗的效果，最好是通过亲自复查进行评估。然而，如果客户无法进行体格检查，那适合申请远程医疗预约。如果医师开出了多种药物，则建议每次停用其中一种药物，以帮助确定是哪种药物(如果有的话)起效。同时停止止痒和抗微生物治疗是不理想的，因为这样会使模糊不清，使你无法解释是什么引起了患病动物的瘙痒——感染还是过敏性炎症。

 

 

TABLE 1 Antipruritic and Anti-inflammatory Medications for Dogs

表1犬的止痒药和抗炎药

药物名称	奥拉替尼	洛基维特单抗	环孢素	糖皮质激素
作用机理	JAK-STAT抑制剂，阻断促炎和致痒细胞因子的信号传导	中和致痒细胞因子IL-31的犬源单克隆抗体	调节T细胞功能的钙抑制剂	影响促炎细胞因子的基因表达
给药方式	口服 每12小时一次连用14天，随后减量至每24小时一次	门诊皮下注射 每4-8周一次	口服 每24小时一次	口服 不建议注射
起效时间	数小时	数小时至3天	4-6周	数小时
年龄	＞1岁	任何年龄	＞6月龄	任何年龄
体重	＞3kg	任何体重	＞1.8公斤	任何体重
健康限制	蠕形螨病史 肿瘤病史 严重感染	无	肿瘤病史 肾功能不全	充血性心衰 糖尿病 肾上腺机能亢进 高血压
副反应	呕吐 腹泻 非特异性皮肤肿物 蠕形螨病 脓皮病	呕吐 腹泻 嗜睡 注射部位疼痛 罕见：过敏反应（荨麻疹、面部水肿、超敏反应）	呕吐 腹泻 牙龈增生 多毛症 皮肤乳头瘤 药物相互作用	多尿/多饮 多食 喘 肥胖 肌肉流失 医源性肾上腺机能亢进 充血性心衰

 

If the dog shows a full response to treatment (i.e,resolution of pruritus,resolution of infection,skin lesions,etc.)after being weaned off antipruritic therapy at the time of reassessment:

如果犬在重新评估时停止止痒治疗后对治疗表现完全有效(即瘙痒消退，皮肤病变、感染消退等):

 

1.The diagnosis may be one of three things:ectoparasitism that has now resolved,secondary infections that have now resolved,and/or seasonal atopy.

1.诊断可能是以下三种情况之一:现已解决体外寄生虫病，现已解决继发感染和/或季节性特应性。

 

 

2.If a secondary infection was present,it may have been the primary cause of the pruritus.Primary diagnoses to consider then include:

a.Ectoparasites

b.Seasonal atopy

c.Endocrinopathy

i.If other clinical signs are present

ii.Note that these conditions are not pruritic unless secondary infection is present

2.如果存在继发性感染，则可能存在引起瘙痒的原发病因。需要考虑的原发病因诊断包括:

a.体外寄生虫

b.季节性特应性皮炎

c.内分泌病

i.如果有其他临床症状

ii。注意，除非存在继发性感染，否则这些疾病不会引起瘙痒

 

Next Steps

下一步骤

1.Continue routine use of flea/tick preventives.

2.If receiving antimicrobial therapy and the infection has resolved, continue antimicrobial therapy for 7 days beyond clinical and cytological resolution(see Section 2 for more information).

3.If the history supports seasonal atopy,discuss management options (see Section 2).

4.If the history supports an endocrinopathy,recommend additional diagnostics.

5.If there is no history of previous skin or ear disease or an uncertain history,propose observing for recurrence,but also discuss the possibility of a future diagnosis of allergic disease.

1.继续常规使用跳蚤/蜱虫驱虫药。

2.如果接受抗微生物治疗，感染消退，则在临床和细胞学消退后继续抗微生物治疗7日(更多信息见第二部分)。

3.如果病史支持季节性特应性皮炎，则讨论治疗方案(见第二部分)。

4.如果病史支持内分泌疾病，建议进行其他诊断。

5.如果没有既往皮肤或耳病病史或病史不确定，建议观察是否复发，但也要讨论可能是过敏性疾病。

 

If the dog is showing partial or no response while on an appropriate antipruritic agent:

如果犬在合理使用止痒药时表现出部分有效或无效:

1.Repeat cytology.

1.重复细胞学检查。

 

2.If evidence of bacterial infection is present (Figure 3)and a systemic antibiotic has already been used:

a.Perform an aerobic bacterial culture and withhold systemic antibiotics pending culture and susceptibility results.

b.Choosing a second antibiotic empirically is strongly discouraged owing to the risk of increasing incidence of antimicrobial drug resistance.The cost of using the wrong antibiotic can exceed the cost of culture.

c.If you MUST choose a second antibiotic,be sure to change the  class of antibiotic (e.g,do not change from one beta lactam antibiotic to another).See Table 4 for guidance on choosing first- and second-tier antibiotics.

2.如果存在细菌感染的证据(图3)，并且已经使用了全身性抗生素:

a.进行需氧细菌培养，在细菌培养和药敏试验结果出来之前，持续使用全身性抗生素。

b.强烈不鼓励凭经验选择第二种抗生素，因为有增加抗生素耐药性发生率的风险。使用错误抗生素的成本可能会超过细菌培养的成本。

c.如果你必须选择第二种抗生素，一定要改变抗生素的类别(例如，不要从一种β-内酰胺类抗生素切换到另一种β-内酰胺类抗生素)。一级和二级抗生素的选择指南见表4。

 

3.Discuss the owner's ability to increase the frequency of topical anti microbial treatment—often,more intense topical treatment eliminates the need for systemic antibiotics.

3.讨论宠主是否有能力增加外部抗微生物治疗的频率——通常外部治疗更频繁可以不需要使用全身性抗生素。

 

4.If Malassezia yeasts are identified cytologically from lesioned skin (Figure 3),then antifungal treatment should be initiated topically and/or systemically based on clinician discretion.The number of Malassezia yeasts noted cytologically does not necessarily correlate with the severity of the disease.

4.如果从细胞学检查上从病变皮肤中鉴定出马拉色菌(图3)，则应根据临床医生的判断开始外部和/或全身抗真菌治疗。细胞学上注意到的马拉色菌数量与疾病的严重程度不一定相关。

 

Addressing Malassezia is imperative,especially in individuals with a hypersensitivity response to these organisms,which in turn worsens clinical signs.

处理马拉色菌是必要的，特别是对这些微生物有过敏反应的个体，过敏反应会恶化临床症状。

 

 

 

5.If lesions and/or infections have resolved but pruritus persists,the dog has either atopy or food allergy.

a.Treatment for allergic skin disease is individualized for THIS dog and THIS client.

b.In general,food allergy is less steroid responsive than atopy.

c.If a diet trial is not possible (e.g.,the client is not able to comply

or the environment of the dog is not conducive),then symptomatic treatment for atopy should be initiated and response to therapy should be assessed.

5.如果病变和/或感染已经消退，但瘙痒持续存在，则犬为特应性皮炎或食物过敏。

a.过敏性皮肤病的治疗是针对这只犬和这个患病动物的个体化治疗。

b.一般来说，食物过敏对激素的反应不如特应性皮炎。

c.如果不可能进行食物试验(例如，客户不能遵守或犬的环境不利于食物试验)，则应开始对症治疗，并评估对治疗的效果。

 

The guidelines task force acknowledges that a properly performed diet trial is difficult to conduct and client compliance can be challenging. The task force recommends considering a consultation with or referral to a veterinary dermatologist before beginning a diet trial.

指南工作组承认，正确执行食物试验是困难的，客户的依从性可能具有挑战性。工作组建议在开始食物试验之前考虑咨询或转诊兽医皮肤科医生。

 

Step Six:Diet Trial

第6步：食物试验

Because there are no historical or physical examination findings that can differentiate atopy from food allergy,a diet trial is an important step in the diagnostic process.Other than the seasonality associated with atopy,a higher incidence of gastrointestinal signs in food-allergic animals,and the possibility that the pruritus may be less steroid responsive in food-allergic dogs,there are no differences between the diseases.The previously held observation that an“ears and rears” pruritic pattern indicates a food allergy is no longer accurate.!Serum tests,saliva tests,and hair tests are of no value in the diagnosis and management of food allergy.

因为特应性皮炎和食物过敏不能通过病史或体格检查结果进行区分，所以食物试验是鉴别诊断的重要步骤。除了季节性发病是与特应性皮炎相关，食物过敏的动物胃肠道症状的发生率较高，以及食物过敏犬的瘙痒可能对激素反应较低之外，两种疾病之间没有差异。以前认为的“耳道和臀部”的瘙痒模式表明食物过敏已经不再准确。血清检测、唾液检测和毛发检测在食物过敏的诊断和治疗中毫无价值!

 

Diet trials should be conducted for 4-12 wk and a food challenge performed to confirm the diagnosis of food allergy if there is a positive response.Recent studies show that a fair number of food- allergic dogs may respond to strict prescription diet trials in 30 days, however,8 weeks may be needed to capture a diagnosis in >90%of food-allergic dogs,and there is a small subset of dogs that may require 12 weeks for complete resolution of pruritus.?

食物试验应进行4-12周，并进行食物激发，以确认食物过敏的诊断，是否有阳性反应。最近的研究表明，相当一部分对食物过敏的犬可能在30天内对严格的处方食物试验有效，然而，对90%的食物过敏的犬来说，可能需要8周才能诊断出来，还有一小部分犬可能需要12周才能完全解决瘙痒问题。

 

Antipruritic treatment is frequently needed to give relief during the initial stage of the diet trial.The guidelines task force considers glucocorticoids or oclacitinib to be appropriate choices to  control pruritus.If a client is unable to give oral medication during the diet trial,lokivetmab can be considered as an alternative;however, because of the long-acting nature of this injection,the diet trial must be extended more than 60 days to allow for individual variation in duration of action.The exact  length of time  a diet trial must be extended is not known,and for this reason,the task force does not recommend using lokivetmab during diet trials unless absolutely necessary—for example,in a young,growing puppy where glucocorticoids are not ideal and oclacitinib is off label.

在食物试验的初始阶段，常需要止痒治疗来缓解症状。指南工作组认为糖皮质激素或奥拉替尼是控制瘙痒的合适选择。如果患病动物在食物试验期间无法给予口服药物，则可考虑使用洛基维特单抗;然而，由于该注射剂的长效特性，食物试验必须延长60天以上，以考虑到作用持续时间的个体差异。食物试验必须延长的确切时间尚不清楚，因此，工作组不建议在食物试验期间使用洛基维特单抗，除非绝对必要，例如在糖皮质激素不理想的幼犬和奥拉替尼超出说明书范围的情况下。

 

Diet Choices

食物选择

Numerous prescription hydrolyzed or novel protein diets are available in a multitude of formulations,and the option to home cook a highly limited-ingredient novel protein diet is also available.Although home- cooked diets potentially offer the strictest formulation,it may be impractical for many clients in terms of labor and cost of ingredients. The choice of diet will depend on the dog's clinical and diet history, the dog's dietary preferences,and the owner's financial constraints.At present,there is no one-size-fits-all diet that is appropriate for all patients.Prescription veterinary diets,compared with over-the-counter(OTC)diets,are less likely to contain  unidentified protein sources and therefore are the only acceptable commercial diet choices for a true elimination diet trial.

多种配方的水解蛋白或新型蛋白饮食可供选择，也可选择在家烹饪高度有限的新奇蛋白饮食。尽管家庭烹饪可能提供最严格的配方，但从劳动力和配料成本方面考虑，这对许多客户来说可能是不切实际的。饮食的选择将取决于犬的临床和饮食史，犬的饮食偏好，以及主人的经济拮据。目前，还没有一种适合所有患病动物的通用饮食。与非处方(OTC)食物相比，处方饮食不太可能含有不明蛋白质来源，因此是真正食物排查试验中唯一可接受的商业食物选择。

 

Use of OTC diets should not be recommended when conducting a diet trial. Ingredients not declared on the label have been detected in OTC diets, possibly negating the results of the trial.However, the guidelines task force agrees that an OTC novel protein diet can be used if financial constraints make other diets impossible. The client should be warned that an OTC diet may not provide optimal results and should be considered a diet change, not a true diet trial.

开展食物试验时不建议使用非处方食物。OTC食物中检测到标签上未声明的成分，这可能会导致试验结果阴性。然而，指南工作组同意，如果经济拮据导致其他饮食无法使用，可以使用OTC新奇蛋白饮食。应提醒客户OTC食物可能不能提供最佳结果，应认为是改变食物，而不是真正食物试验。

 

During the diet trial,monthly oral flavored heartworm and flea and tick preventives should be avoided.Topical or long-lasting isoxazolines administered at the very beginning of a diet trial along with topical or injectable heartworm preventives  should be considered.It is imperative to explain that the chosen diet must be the only thing to “pass the lips”of the dog during the 4 to 12 wk trial.This includes pill pockets,treats,flavored toys,cat food or feces,shared water bowls,table scraps,etc.

在食物试验期间，应避免每月口服有风味剂的心丝虫和跳蚤和蜱虫驱虫药。应考虑在食物试验开始时外部用药或长期用药异恶唑啉，同时外部用药或注射用药预防心丝虫。必须说明的是，在4 - 12周的试验中，唯一能“接触嘴唇”的食物必须只能是挑选的食物。这包括药丸口袋、零食、调味玩具、猫粮或粪便、共用的水碗、餐桌残羹剩饭等。

 

Veterinary technicians can play an important role in discussing the choice of an appropriate diet with owners, as well as addressing any questions regarding compliance with the trial diet. A follow-up call 2–3 wk into the diet trial can be beneficial and allows the veterinary team to address any challenges or client concerns.

兽医技术人员可以在与宠主讨论选择合适的饮食以及解决有关遵守食物试验的任何问题方面发挥重要作用。食物试验后2-3周的后续电话可能是有益的，并允许兽医团队解决任何挑战或客户的担忧。

 

 

 

 

 

 

 

Assessing a Diet Trial

评估食物试验

The final step in performing a diet trial is to challenge the patient by reintroducing the original diet.This is essential in patients that have responded well to the diet trial and is the sole means of confirming a diagnosis of food allergy.Misdiagnosis can result in unnecessary expense to the owner(due to long-term use of expensive therapeutic diets)and the potential for ongoing dermatologic problems (due to missed diagnosis of seasonal atopy or other pruritic condition). Figure 4 illustrates the steps of assessing a diet trial.

进行食物试验的最后一步是饲喂旧食物进行激发。这一步对于对食物试验有效的患病动物是至关重要的，也是确诊食物过敏的唯一手段。误诊可能会给宠主带来不必要的费用(由于长期使用昂贵的治疗性食物)和潜在的持续皮肤问题(由于漏诊季节性特应性皮炎或其他瘙痒疾病)。图4说明评估食物试验的步骤。

 

Remember that a properly performed diet trial is time-consuming for the veterinarian and client to manage, and a discussion of a referral to a veterinary dermatologist should be brought up with the client and considered.

请记住，正确执行饮食物试验对于兽医和客户来说是耗时的，因此应该与客户讨论并考虑转诊给兽医皮肤科医生。

 

Seasonal or Nonseasonal with Seasonal Fluctuation(Atopy)

季节性或有伴有季节性加重的非季节性(特应性皮炎)

Because atopy is a diagnosis of exclusion,if the dog is on an appropriate treatment for ectoparasites and a food allergy has not been demonstrated,then a diagnosis of atopy has been established.Intradermal and serum allergy testing are NOT used to diagnose atopy.It should only be used if the client is interested in administering allergy immunotherapy.

因为特应性皮炎是一种排除性的诊断，如果犬对外寄生虫进行了适当的治疗，并且证明没有食物过敏，那么就确诊特应性皮炎。皮内和血清过敏试验不用于诊断特应性皮炎。只有当客户对过敏原免疫治疗感兴趣时才可以进行检测。

 

Section 2:Treating the Allergic Canine  Patient

第二部分:过敏症患犬的治疗

Top 3  Takeaways:

三大要点：

1.Treating the allergic dog is not one-size-fits-all,and a multimodal approach often yields the best results.

2.Client education,communication,and  compliance is critical in the success of any treatment plan.

3.If previously successful management protocols stop working,first perform a thorough history and physical examination and return to the minimum dermatologic database to determine whether anything has changed.

1.治疗过敏症患犬并不是一刀切的，多模式的方法往往能获得最好的效果。

2.客户教育、沟通和依从性是任何治疗计划成功的关键。

3.如果先前成功的治疗方案无效，首先进行彻底的病史和体格检查，并返回皮肤病学最小数据库，以确定是否有任何改变。

 

 

Overview

概述

The clinical management of the allergic canine patient is often viewed as frustrating by veterinarians and clients alike,as there is no one-size-fits-all treatment.In addition to the need to manage secondary infections,inflammatory flares,and individual patient responses, veterinary teams must consider client compliance,finances,and other factors like time availability and access to transportation. Atopic patients need lifelong medical care that will require routine veterinary visits and an active working relationship with the client. Tailoring a communication-rich,multimodal approach for each individual patient will provide the best path to success.

对过敏症患犬的临床管理通常被兽医和客户都认为是令人沮丧的，因为没有一刀切的治疗方法。除了需要管理继发性感染、炎症发作和患病动物的个体治疗效果外，兽医团队还必须考虑客户的依从性、资金和其他因素，如是否有时间和是否有交通工具。特应性疾病患病动物需要终生的医疗护理，需要定期的兽医探视，并与客户建立积极的工作关系。为每一位患病动物量身定制一种丰富沟通的多模式方法将提供最佳的成功之路。

 

Flea Allergy

跳蚤过敏

Flea allergy dermatitis is one of the most common causes of pruritus in canine patients,and successful management relies on a three- tiered approach.

跳蚤过敏性皮炎是犬瘙痒症最常见的病因之一，成功的管理依赖于三个层次的方法。

 

Step One:Choose the appropriate preventive.

第1步:选择合适的驱虫管理。

Preventives that have potent adulticide activity should be used.Isoxazolines are now widely considered the gold standard in prevention and are recommended for initial consideration.It has been demonstrated in recent years that dogs with flea allergy dermatitis may be successfully managed with the routine administration of an oral isoxazoline!The effectiveness of the preventive chosen is closely tied to accurate application of the product.

应使用具有强效杀成虫活性的驱虫管理。目前，异恶唑啉被广泛认为是预防的金标准，并被建议早期考虑使用。近年来的研究表明，常规口服异恶唑啉可以成功治疗跳蚤过敏性皮炎患犬!所选择的驱虫管理的有效性与产品的准确应用密切相关。

 

Step Two:Use the preventive year-round in all in-contact animals.

第2步:对所有有接触的动物全年使用驱虫管理。

 

Step Three:Treat the environment in severe infestation situations.

第3步:严重虫害情况下的环境治理。

 

Food Allergy

食物过敏

Avoiding all offending allergens,based on the diet challenge trials,is the goal for patients and clients.Here the client has two options:a veterinary prescription diet or OTC food.

根据食物排查试验，避免所有致敏过敏原是患病动物和客户的目标。在这里，客户有两种选择:兽医处方食物或OTC食物。

 

An unfortunate consequence of maintaining a patient on a pre-scription diet is the potential for backorders.Consider other prescription diets that avoid the offending allergen or have similar ingredients. Pet food companies can provide excellent technical support and may have additional recommendations.A helpful tip is to have clients keep extra dog food bags on hand to avoid temporary backorder issues.

维持患病动物按处方饮食的一个不幸后果是可能出现缺货。考虑其他处方饮食，避免致敏过敏原或有类似的成分。宠物食品公司可以提供优秀的技术支持，并可能有额外的建议。一个有用的建议是让客户多准备犬粮袋，以避免临时的缺货问题。

 

For some patients,control may be maintained by feeding an OTC diet that does not claim to contain the offending allergen.In a small subset of dogs,however,their severe sensitivity prohibits the use of OTC diets because of potential contamination with unlabeled proteins.

对于一些患病动物，可以通过喂食不声称含有致病过敏原的OTC饮食来维持控制。然而，在一小部分犬中，它们的严重敏感性禁止使用OTC饮食，因为它们可能被未标记的蛋白质污染。

 

If a flare occurs in a patient on an OTC diet,inquire whether they were fed from a new bag of food as the formulation may have changed or the batch may contain unlabeled proteins.Investigate whether they are now displaying clinical signs of atopy in conjunction  with food allergy and consider ectoparasites,as they are the leading cause for acute-onset pruritus.

如果在OTC饮食的患病动物中出现急性发作，询问他们是否喂了一袋新粮，因为配方可能已经改变，或者批次中可能含有未标记的蛋白质。调查他们现在是否表现出与食物过敏相关的特应性皮炎的临床症状，并考虑外寄生虫，因为它们是急性瘙痒的主要病因。

 

Atopy

特应性皮炎

Initial Management

早期管理

When choosing a management protocol,the clinician must take into consideration the level of inflammation and pruritus  present and whether any secondary  infections  are  present.If a patient is 10/10 pruritic with severely inflamed skin,aglucocorticoid may offer an effective initial treatment and a short course may effectively manage a single atopic episode.Many veterinary dermatologists would recommend the use of glucocorticoids over oclacitinib in severely inflamed skin;however,there is evidence to show that oclacitinib can have the same anti-inflammatory benefits as prednisolone in certain cases. Lokivetmab may be an appropriate choice when inflammation is less severe.

在选择治疗方案时，临床医师必须考虑炎症和瘙痒的程度，以及是否存在继发性感染。如果患病动物有10/10的瘙痒和严重的皮肤炎症，糖皮质激素可能提供早期有效的治疗，短疗程可能有效控制单次特应性皮炎发作。许多兽医皮肤科医师会建议在严重炎症的皮肤中使用糖皮质激素，而不是奥拉替尼;然而，有证据表明，在某些病例，奥拉替尼可具有与泼尼松龙相同的抗炎效果。当炎症较轻时，洛基维特单抗可能是一个合适的选择。

 

For mild to moderate inflammation and pruritus,oclacitinib and/or lokivetmab(see Table 1 and Table 2)may be administered. Multiple factors should be considered when choosing one of these drugs as neither medication is 100%effective,and there is significant  variation in individual patient response.Oclacitinib is more effective in some patients,and lokivetmab is more effective in others.

对于轻度至中度炎症和瘙痒，可以使用奥拉替尼和/或洛基维特单抗(见表1和表2)。在选择其中一种药物时应考虑多种因素，因为两种药物都不是100%有效的，而且患病动物的个体反应也有很大差异。奥拉替尼对一些患病动物更有效，而洛基维特单抗对另一些患病动物更有效。

 

If the patient is presenting for extremely mild clinical signs,an antihistamine(see Table 3)trial may be appropriate;however,it is imperative to remember that antihistamines are best used as preventive medicine,do not perform well as  monotherapy,and  are  not effective in treating moderate to severe inflammation or pruritus.

如果患病动物的临床症状非常轻微，则抗组胺药(见表3)试验可能适合;然而，必须记住，抗组胺药最好用作预防药物，单药治疗效果不佳，并且对中度至重度炎症或瘙痒无效。

 

Long-term Management

长期管理

A multimodal approach can promote successful long-term management,but it will take patience while assessing which option works for each patient.

多模式方法可以促进长期管理成功，但在评估哪种选择对每个患病动物有效时需要耐心。

 

If adequate control of clinical signs cannot be achieved by the third veterinary visit, then referral to a veterinary dermatologist should be presented as an option to the owner to provide more effective treatment and less cost to the client in the long run. Referral could be discussed even earlier, but this may not always be necessary. Availability to be evaluated by a veterinary dermatologist could be markedly delayed in certain geographic areas, in which case more acute management by a general practitioner would be needed.

如果到第三次兽医就诊时仍不能充分控制临床症状，则应将转诊给兽医皮肤科医生作为一种选择，以便为客户提供更有效的治疗，并从长远来看降低成本。转诊可以更早讨论，但这可能并不总是必要的。在某些地区，由兽医皮肤科医生进行评估的时间可能明显延迟，在这种病例中，将需要由全科医生进行更紧急的管理。

 

If the veterinary team moves forward with treatment,the following steps are recommended.

如果兽医团队继续进行治疗，建议采取以下步骤。

 

1.Continue antipruritic/anti-inflammatory therapy and use routinely in a preventive manner.If oclacitinib and lokivetmab have been found ineffective,cyclosporine may be considered,with the understanding that it will take 4-6 wk to be maximally effective.

1.持续抗瘙痒/抗炎治疗，并以预防的方式常规使用。如果发现奥拉替尼和洛基维特单抗无效，可以考虑使用环孢素，但需要4-6周才能达到最大效果。

 

Some patients are glucocorticoid-responsive-only and/or some clients cannot afford other treatments; therefore, chronic management with glucocorticoids may be appropriate. A thorough discussion of the potential long-term side effects and recommended monitoring must take place.

一些患病动物仅对糖皮质激素有效，和/或一些客户负担不起其他治疗;因此，长期使用糖皮质激素治疗可能是合适的。必须对潜在的长期副作用和建议的监测进行彻底的讨论。

 

2.Consider adjunctive therapies such as veterinary-formulated essential fatty acid supplementation,specially formulated dermatologic diets,nutraceuticals,palmitoylethanolamide,probiotics,and products aimed at improving epidermal barrier dysfunction.These are  all excellent options to consider in atopic patients.

2.考虑辅助疗法，如兽医配制的必需脂肪酸补充剂、特殊配制的皮肤病饮食、营养品、十六酰胺乙醇、益生菌和旨在改善表皮屏障功能障碍的产品。这些都是特应性皮炎患病动物的优先选择。

 

3.Topical therapy:routine bathing using shampoos with moisturizing factors (i.e,fatty acids,oatmeal,ceramides,and lipids)can be helpful as adjunctive therapy.Particularly with dogs experiencing recurrent bacterial pyoderma and/or Malassezia dermatitis,anti-infective shampoos,mousses,or sprays can be used routinely to help reduce the recurrence of secondary infections.

3.外部治疗:使用含有保湿因子的香波常规洗澡(即脂肪酸，燕麦片，神经酰胺和脂质)可以作为辅助治疗。特别是对于反复出现细菌性脓皮病和/或马拉色菌性皮肤病的犬，可以常规使用抗感染香波、摩丝或喷剂来帮助减少继发感染的复发。

 

4.Allergen-specific immunotherapy(ASIT)is a safe,drug-free treatment that is effective in ~50-100% of canine patients.Clinical benefit may not appear for up to a year,and routine antipruritic/ anti-inflammatory management will be required in the interim.Successful ASIT protocols again require diligent,educated clients who recognize that it is not a quick fix.

4.过敏原特异性免疫疗法(ASIT)是一种安全、非药物治疗方法，对大约50% -100%的患犬有效。出现临床疗效可能超过一年，在此期间需要常规的止痒/抗炎治疗。ASIT成功条件是需要反复勤奋告知客户，让他们意识到这不是一个快速缓解的方案。

 

For allergy testing and ASIT management, referral to a veterinary dermatologist is highly recommended as tailoring individual protocols increases positive response rates. The preferred method of testing, whether intradermal allergy testing or serum allergy testing, is highly controversial and has not yet been established in the literature. Injectable immunotherapy is considered the standard; however, sublingual immunotherapy has also been shown to be effective.

对于过敏测试和ASIT管理，强烈建议转诊给兽医皮肤科医生，因为量身定制的个人方案可以增加治疗有效率。首选的测试方法，是皮内过敏试验还是血清过敏试验，是高度争议的，尚未在文献中建立。注射免疫疗法被认为是标准的;然而，舌下免疫疗法也被证明是有效的。

 

Management of Acute Flares

急性发作管理

All atopic dogs will experience allergic flares regardless of how well managed they are.When a flare occurs,collect a thorough history and a minimum dermatologic database to  determine  whether there have been any changes in the patient's lifestyle.Look for evidence of ectoparasitism or secondary infections.If the flare is mild and secondary issues have been identified,managing the secondary issues should resolve the increased pruritus.

所有的特应性皮炎患犬都会经历过敏症发作，不管它们管理方法如何。当急性发作发生时，收集完整的病史和皮肤病学最小数据库，确定患病动物的生活方式是否有任何改变。寻找体外寄生虫或继发感染的证据。如果发作轻微，确定有继发感染，管理继发感染能改善瘙痒加重情况。

 

If the infammatory flare is severe,the addition of a short course of glucocorticoids may be beneficial in regaining control. If glucocorticoids are contraindicated,administering twice-daily oclacitinib for a limited time (e.g.,up to 14 days)or adding lokivetmab may be appropriate.Cyclosporine is not appropriate  for an acute flare.

如果炎症发作严重，加用短疗程的糖皮质激素可能有助于恢复控制。如果糖皮质激素是禁忌症，每天两次给予奥拉替尼一段时间(例如，最多14天)或添加洛基维特单抗可能是合适的。环孢素不适用于急性发作。

 

Acute Flare Factors • Secondary infections • Ectoparasites (fleas/mites) • Environmental/seasonal changes • Food challenges (holidays!) 急性发病因素 •继发性感染 •体外寄生虫(跳蚤/螨虫) •环境/季节改变 •食物激发(假期!)

 

 

 

TABLE 2 Acute Flare and Long-term Management Therapies in Dogs

表2犬急性发作和长期治疗管理

药物名称	急性发作	长期管理	优势/劣势
奥拉替尼	√	√	非常快速起效（数小时） 不干扰皮内过敏原试验和免疫治疗 止痒和抗炎
			不用于＜1岁患犬 不用于深层皮肤感染、全身性感染、肿瘤或有肿瘤病史的患犬 在使用其他长期管理的抗过敏药物的患犬上没有测试过，例糖皮质激素和环孢素
洛基维特单抗	√	√	幼犬和有共病（肿瘤、感染、系统性疾病）患犬上使用安全 不干扰皮内过敏原测试和免疫治疗 生物学复合物 与其他药物联用安全
			必须在兽医诊所使用 起效时间多变（数小时至3天）
糖皮质激素	√	√	快速起效 止痒和抗炎
			副作用常见
过敏原特异性免疫治疗	×	√	与其他药物联用安全 仅引发免疫反应的管理策略 生物学复合物
			起效缓慢（数月至1年） 需要皮内或血清学过敏原测试
环孢素	×	√	不干扰皮内过敏原测试
			起效缓慢（数周） 副作用常见（消化道、多毛症、牙龈增生、乳头瘤） 需要定期检测肝酶和血细胞计数
EFA	×	√	可能减少激素用量
			起效缓慢（数周至数月）
抗组胺药	×	√	副作用不常见
			疗效可疑-可能仅对轻度瘙痒动物有效

 

 

TABLE 3 Oral Antihistamine Doses for Dogs

表3犬口服抗组胺剂量

药物名称	剂量
羟嗪	2mg/kg q 12 hr
西替利嗪	1-2mg/kg q 24 hr
扑尔敏	0.4mg/kg q 12 hr
赛庚啶	0.3-2mg/kg q 12 hr
克立马丁	0.05-1mg/kg q 12 hr
氯雷他定	1mg/kg q 12 hr
非索非那定	5-15mg/kg q 24 hr
阿米替林	1-2mg/kg q 12 hr
苯海拉明	2–3mg/kg q 12 hr 口服有效性可疑

 

 

Considerations in Treating Secondary Infections

治疗继发性感染的注意事项

When superficial bacterial folliculitis(SBF)is identified,there are three guidelines to follow: correct antibiotic,correct dose,and correct duration. Table 4 provides a tiered approach to appropriate antibiotic choices including recommended doses for managing SBF. The golden rule for duration of antibiotic therapy is 7 days past clinical and cytologic resolution.As such,the current recommended course for oral antibiotics in treating SBF is typically 21 days.

当发现浅表性细菌性毛囊炎(SBF)时，应遵循三个原则:抗生素使用正确、剂量使用正确和持续时间正确。表4提供了抗生素合理使用分级方法，包括管理SBF的推荐剂量。抗生素治疗持续时间的黄金法则是临床恢复和细胞学检查恢复后7天。因此，目前推荐的治疗SBF的口服抗生素疗程通常为21天。

 

 

 

TABLE 4 Antimicrobials for Skin Infections in Dogs

表4犬皮肤感染的抗生素

一线抗生素
克林霉素	5.5-11mg/kg PO q12hr
头孢氨苄	22-30mg/kg PO q12hr
阿莫西林克拉维酸	14-25mg/kg PO q12hr
磺胺甲氧嘧啶/磺胺甲恶唑	15-30mg/kg PO q12hr
一线或二线
头孢泊肟	5-10mg/kg PO q24hr
头孢维星	8mg/kg SC 每14天一次
二线仅根据细菌培养和药敏试验结果使用
四环素	5-10mg/kg PO q12hr
多西环素	5-10mg/kg PO q12hr
恩诺沙星	5-20mg/kg PO q24hr
马坡沙星	2.75-5.5mg/kg PO q24hr
普多沙星	3mg/kg PO q24hr
氯霉素	40-50mg/kg PO q8hr
利福平	3-6mg/kg PO q24hr
不用于葡萄球菌感染
阿莫西林
青霉素
呋喃妥因

 

Topical therapy is an integral part of managing SBF,and many infections will resolve with topical therapy alone. As this requires advanced client compliance,prescribing more user-friendly formulations (spot-ons,sprays,or mousses)may encourage more effective usage. Topical antimicrobial therapy also acts as an excellent adjunctive therapy to oral  antibiotics.

外部治疗是管理SBF的一个组成部分，许多感染将通过外部治疗单独解决。由于这需要优质的客户依从性，制定客户友好的治疗(滴剂、喷剂或摩丝)可能会鼓励更有效的治疗方法。外部抗菌治疗也是口服抗生素的一种很好的辅助治疗。

 

Malassezia dermatitis is a common flare factor and may dramatically increase pruritus in atopic dogs.In many cases,appropriate treatment for Malassezia significantly increases the effectiveness of antipruritic/anti-inflammatory therapy.Topical treatment for Malassezia may be useful,however,some cases of deep or chronic Malassezia dermatitis(such as Malassezia in the claw folds or in severely lichenified skin) necessitate oral antifungal therapy with ketoconazole,fluconazole,itraconazole,or terbinafine (Table 5).The golden rule of 7 days past clinical and cytologic resolution applies here,too

马拉色菌性皮肤病是一种常见的发病因素，可显著增加特应性皮炎患犬的瘙痒。在许多病例中，合理治疗马拉色菌可显著提高止痒/抗炎疗法的有效性。马拉色菌的外部治疗可能有用，然而，一些深部或慢性马拉色菌皮肤病病例(如爪褶处或重度苔藓化皮肤有马拉色菌)需要口服抗真菌治疗，包括酮康唑、氟康唑、伊曲康唑或特比萘芬(表5)

 

 

 

 

TABLE 5 Oral Antifungal Medication Doses for Dogs

表5犬口服抗真菌药物剂量

药物名称	剂量
酮康唑	5–10 mg/kg q 24 hr
氟康唑	5–10 mg/kg q 24 hr
伊曲康唑	5 mg/kg q 24 hr
特比萘芬	30–40 mg/kg q 24 hr

 

 

 

Section 3:Diagnosing the Feline Patient

第三部分:诊断过敏症患猫

Top 3 Takeaways:

三大要点：

1.Cats,unlike dogs,have a more varied clinical presentation of allergic dermatitis,including scratching,over-grooming,and several cutaneous inflammatory reaction patterns.

2.Treating all pruritic cats for fleas/mites is not only a potentially important therapeutic measure but also a key diagnostic step on the path to determining the primary cause of pruritus.

3.There are no accurate allergy tests for diagnosing feline atopic skin syndrome (environmental allergies)in cats.This diagnosis is determined through diligently ruling out all other causes of pruritus.

1.猫与犬不同，过敏性皮肤病的临床表现更为多样，包括抓伤、过度理毛和几种皮肤炎性反应模式。

2.治疗所有瘙痒症患猫的跳蚤/螨虫不仅是一种潜在的重要治疗措施，也是确定瘙痒症的原发病因的关键诊断步骤。

3.目前还没有准确的过敏原测试来诊断猫的特应性皮肤综合征(环境过敏)。确诊方法通过努力排除所有其他引起瘙痒的病因。

 

Overview

概述

Compared with dogs,the pathogenesis of skin diseases in cats is not as well understood.Recently,there has been a resurgence in investigation for this species and attempts to clarify and classify the feline allergic profile.

与犬相比，猫皮肤病的发病机制尚不清楚。最近，对猫的调查兴起，试图明确和分类猫过敏症。

 

Feline atopic syndrome has been proposed as the umbrella nomenclature describing allergic dermatitis involving environmental allergens,food allergy(gastrointestinal manifestation),and allergic asthmas (respiratory disease)often associated  with immunoglobulin  E antibodies.Feline atopic skin syndrome (FASS)refers to the entity associated with inflammatory and pruritic allergic skin disease from environmental allergens.?

猫特应性综合征被认为是描述过敏性皮肤病的总称，包括环境过敏原、食物过敏(胃肠道表现)和过敏性哮喘(呼吸道疾病)，通常与免疫球蛋白E抗体相关。猫特应性皮肤综合征(FASS)是指由环境过敏原引起的炎性和瘙痒性过敏性皮肤病。

 

Presentation of the Feline Patient

患猫表现

Four distinct clinical patterns of allergic dermatitis have been described in the cat:miliary dermatitis,head and neck pruritus,self-induced alopecia,and eosinophilic granuloma complex(eosinophilic plaques,granulomas,and indolent ulcers)(see Figure 5).Pruritus, from mild to severe,is typically present in cats with allergic dermatitis, whether due to food allergy,flea allergy,and/or FASS(environmental allergies).Exceptions include indolent ulcers or eosinophilic granulomas,which can occur without pruritus.

猫的过敏性皮炎有四种不同的临床模式:粟粒性皮炎、头颈部瘙痒、自损性脱毛和嗜酸性肉芽肿复合物(嗜酸性斑块、嗜酸性肉芽肿和无痛性溃疡)(见图5)。无论是由食物过敏、跳蚤过敏和/或FASS(环境过敏)引起，患过敏性皮炎的猫通常存在从轻度到重度的瘙痒。无痛性溃疡或嗜酸性肉芽肿是例外，可无瘙痒表现。

 

None of the feline cutaneous reaction  patterns are pathognomonic for any particular pruritic disease,emphasizing the need  to perform a thorough diagnostic workup,3"including an accurate clinical history,dermatologic physical examination,and a minimum dermatologic database.Atypical or non-treatment-responsive lesions may require a skin biopsy for definitive diagnosis.

没有一种猫的皮肤反应模式是任何特定瘙痒性疾病的病理特征，强调需要进行彻底的诊断检查，包括准确的临床病史，皮肤病学体检和皮肤病学最小数据库。非典型或无治疗反应的病变可能需要皮肤活检来明确诊断。

 

Step One:Clinical History and Dermatologic Physical Examination

第1步:临床病史和皮肤学体格检查

Clinical History

临床病史

When inquiring about the presence and intensity of pruritus in the cat,it is important to educate the client that feline pruritus can manifest as scratching(head,neck,ears)with the hind paws and/or over-grooming(licking/biting/chewing)of specific areas such as the ventral abdomen,lumbar region,tail,and along the front and hind limbs.In addition,clients should know that some cats are“closet groomers"and may engage in over-grooming when clients are not directly supervising them.A trichogram demonstrating sharply broken hair shafts is an excellent way to  confirm  self-trauma as  the cause of hair loss.A validated scoring method for pruritus has been published recently for cats, which provides the client with detailed direction on ranking both scratching and licking behaviors by marking responses along a series of descriptions.This should be used at the initial appointment and then at each subsequent appointment after starting ectoparasite treatment,an elimination diet trial,courses of glucocorticoids,or long-term therapies for FASS(i.e.,allergy immunotherapy or cyclosporine).

询问猫是否有瘙痒和瘙痒程度时，重要的是要告知瘙痒症患猫客户可以表现为后爪抓挠(头部、颈部、耳道)和/或特定部位过度理毛(舔/咬/咀嚼)，如腹部、腰部、尾部和前后肢。此外，客户应该知道，有些猫是“隐藏理毛”，当客户不直接关注时，它们可能会过度理毛。毛发检查发现毛干断裂是一个很好的确定自损性脱毛的方式。最近发表了一种经过验证的猫瘙痒评分方法，该方法通过一系列描述对患病动物的反应进行标记，为其对搔抓和舔舐行为进行评分，从而提供详细的指导。初诊时先进行毛发检查，之后在开始体外寄生虫治疗、食物排查试验、糖皮质激素疗程或FASS长期治疗（例：过敏原免疫疗法或环孢素)。

 

Having technicians take the history is an excellent way for them to build client trust and relationships that can carry through treatment follow-ups, client education, and ongoing control measures.

让技术人员了解病史是他们建立客户信任和关系的好方法，可以进行治疗随访、客户教育和持续的控制措施。

 

 

 

 

Key Clinical History Questions

主要临床病史问题

1.At what age did the pruritus start?

2.Is it seasonal?

3.Are other cats or dogs in the house itchy?

4.How much time is spent indoors versus outdoors?

5.Was the cat recently housed in a shelter/cattery/boarding facility? 6.Has there been any exposure to new or stray cats?

7.How often is ectoparasite control applied?

8.Has there been a response to other treatments,including antibiotics or antipruritic medications?

9. What previous diagnostic tests have been performed?

1.开始出现瘙痒年龄?

2.是否有季节性?

3.家中其他猫或犬是否瘙痒?

4.室内和户外时间占多少?

5.猫最近是否去收容所/猫舍/寄宿?

6.有没有接触过新猫或流浪猫?

7.多久进行一次体外寄生虫控制?

8.是否对其他治疗有效，包括抗生素或止痒药物?

9.以前进行过哪些诊断性测试?

 

Dermatologic Physical Examination

皮肤学体格检查

Evaluation should include the most commonly affected areas including the head,neck,and ventral abdomen;however,any area of haired skin could potentially be involved,such as along the dorsum, sternum,axillae,medial thighs,forelimbs/hindlimbs,paws,perineum, and tail. The oral cavity should be examined to look for granulomas of the tongue/palate and indolent ulcers of the upper lip.Flea combing is a crucial part of the examination to identify live fleas and/or flea dirt to support a diagnosis of a flea infestation or allergy.

评估应包括最常见的患病区域，包括头部、颈部和腹侧;然而，任何有毛皮肤区域都可能患病，例如沿背、胸骨、腋窝、大腿内侧、前肢/后肢、爪子、会阴和尾巴。应检查口腔，以寻找舌/腭肉芽肿和上唇的无痛性溃疡。跳蚤梳理是重要检查，以确定活跳蚤和/或跳蚤粪便，以支持诊断跳蚤感染或跳蚤过敏症。

 

Otitis externa can occur in 20%of cats with feline atopic skin syndrome, but it can also occur in cats with food allergy.Evaluation of the pinnae and otoscopic examination of the ear canals is an integral part of the complete dermatologic examination.

20%特应性皮肤综合征患猫会出现外耳炎，但食物过敏患猫也会出现外耳炎。耳廓的评估和耳道的耳镜检查是皮肤科检查的一个完整组成部分。

 

Step Two:Minimum Dermatologic Database

第2步:皮肤学最小数据库

The minimum dermatologic database should be collected based on reaction patterns (Figure 6).

应根据皮肤反应模式进行皮肤病学最小数据库采样(图6)。

·Cytology of skin and ear (if evidence of ear disease is present).

·皮肤和耳道细胞学检查

Superficial bacterial skin infections and Malassezia infections can be present with all cutaneous reaction patterns,and thus,all skin lesions on the cat should be sampled for secondary infection,placing this diagnostic higher on the  priority list.The  exception to  this rule would be self-induced alopecia without overt evidence of cutaneous inflammation,as alopecia alone is not as likely to harbor infection.

所有皮肤反应模式中都可能出现浅表细菌性皮肤感染和马拉色菌感染，因此，应对猫的所有皮肤病变进行继发性感染采样，将这一诊断放在优先列表上。没有明显皮肤炎症证据的自损性脱毛是个例外，因为仅有脱毛表现不太可能有感染。

 

·Superficial and deep skin scrapings.Ideal in all cases of pruritic skin disease in cats to potentially provide a definitive diagnosis.When broad-spectrum ectoparasiticides are used (i.e.,isoxazolines), keep in mind that treatment failures could still occur.

·皮肤浅刮和皮肤深刮。理想的在所有瘙痒性皮肤病的患猫，潜在地提供一个明确的诊断。当使用广谱杀外寄生虫药(即异恶唑啉类)时，请记住，治疗失败仍可能发生。

 

·±DTM culture. Considering that pruritus is typically minimal to absent in most cases of dermatophytosis,performing a fungal culture(DTM)and/or dermatophyte polymerase chain reaction  test may not be necessary in all cases of cats with cutaneous reaction patterns.This reflects the majority opinion of the guidelines task force;however,not all members agreed on the overall ranking of screening for dermatophytosis.One task force member felt that although dermatophytosis is  not typically pruritic(or at least not severely),it should  e ranked higher on the  differential list because of its likelihood of occurrence.Consideration of dermatophytosis may rank higher on the differential list under certain circumstances,including indoor/outdoor cats,recently adopted kittens,older immunocompromised cats,and Persians and other long-haired felines.In some cases,such as miliary dermatitis and self-induced alopecia,DTM ±dermatophyte polymerase chain reaction test may be more highly considered if parasites have been ruled out.

·±DTM培养。考虑到在大多数皮肤癣菌病病例中，瘙痒通常是轻微的或没有的，可能没有必要对所有有皮肤反应模式的猫进行真菌培养(DTM)和/或皮肤癣菌PCR试验。这反映了指南工作组的大多数意见;然而，并非所有成员都同意筛查皮肤癣菌病。一名工作组成员认为，虽然皮肤癣菌病不是典型的瘙痒(或至少不是严重的)，但由于其发生的可能性，它应在鉴别列表中排名较高。在某些情况下，考虑皮肤癣菌病可能在鉴别列表中排名较高，包括室内/室外猫、最近收养的小猫、老年免疫功能低下的猫以及波斯猫和其他长毛猫。在某些病例中，如粟粒性皮炎和自损性脱毛，如果寄生虫已被排除，则可以更高度地考虑DTM±皮肤癣菌PCR检测。

 

Skin scrapings and otic preparations for mites could be prioritized lower on the list with costconcerned clients, as pruritic mites are already likely being treated if isoxazolines have been prescribed.

对于考虑成本的客户来说，皮肤刮片和治疗螨虫的药物可以优先考虑在清单上较低的位置，因为如果开了异恶唑啉，瘙痒性螨虫可能已经得到了治疗。

 

Step Three:Treat Pruritus During the Diagnostic Period

第3步:在诊断期间进行瘙痒治疗

Many itchy cats require glucocorticoids because of their rapid and reliable benefits for immediate treatment,especially when  moderate to severe pruritus and/or infammatory lesions  are  present.Antihistamines are not s reliable at controlling  itch and  do not have   enough    anti-inflammatory properties   to    reduce severely inflamed    lesions.Cyclosporine,although effective for long-term treatment,does not typically provide immediate relief from pruritus.

许多发痒的猫需要糖皮质激素，因为它们可以快速可靠地立即治疗，特别是当出现中度到重度瘙痒和/或炎症病变时，抗组胺药在控制瘙痒方面不可靠，而且没有足够的抗炎特性来减少严重的炎症病变。环孢素虽然对长期治疗有效，但通常不能立即缓解瘙痒。

 

It is recommended to consider oral glucocorticoids(prednisolone 2 mg/kg/day,methylprednisolone 0.8-1.5 mg/kg/day,or dexamethasone 0.2 mg/kg/day tapered over a 3 wk period)rather than injectable repositol glucocorticoids,given the inability to  rapidly withdraw the medication in the event of side effects (e.g.,congestive heart failure,diabetes,and  skin fragility).

建议考虑口服糖皮质激素(泼尼松龙2mg /kg/天，甲基泼尼松龙0.8-1.5 mg/kg/天，或地塞米松0.2 mg/kg/天，在3周内逐渐减量)，而不是改变部位注射糖皮质激素，因为在发生副作用(如充血性心衰、糖尿病和皮肤虚弱)时无法迅速停药。

 

Step Four:Treat Ectoparasites and Secondary Infections

第4步:治疗体外寄生虫和继发感染

Ectoparasite  Treatment

体外寄生虫治疗

It is essential to rule out external parasites (i.e.,fleas and mites)in all cases of feline pruritus with reliable parasite control measures.Discussion of all available flea treatment products is beyond the scope of these guidelines;however,the guidelines task force generally recommends the use of isoxazolines(fluralaner,sarolaner,and lotilaner) owing to their relatively rapid flea adulticidal properties in addition

to off-label broad-spectrum ectoparasite coverage (i.e.,Demodex cati,

Demodexrgatoi,and Otodectes).

在所有瘙痒症患猫病例中，必须通过可靠的寄生虫控制措施排除外寄生虫(即跳蚤和螨虫)。对现有所有跳蚤治疗产品的讨论超出了这些指南的范围;然而，指南工作组一般建议使用异恶唑啉类药物(氟雷拉纳、沙罗拉纳和洛替拉纳)，因为它们除覆盖标签外范围的广谱体外寄生虫(即猫蠕形螨、戈托依蠕形螨和耳螨)外，还具有相对快速的杀跳蚤成虫特性。

 

 

When reviewing the known or suspected clinical picture with clients,it is important to discuss therapy durations.Be  candid  that treating mites takes 6-8 wk on average,whereas a flea infestation takes closer to 3 mo to treat under ideal conditions.Openly discussing client constraints(e.g.,time,ability to comply,and finances)in initial appointments will inform treatment choices and expectations for the veterinary team and clients.

当与客户回顾已知或怀疑的临床情况时，讨论治疗时间是很重要的。坦白地说，治疗螨虫平均需要6-8周，而在理想条件下，治疗跳蚤感染需要近3个月。公开讨论客户的局限性(例如:(时间、依从能力和财务状况)将为兽医团队和客户的治疗选择和期望提供信息。

 

 

 

Treat Secondary Infections

继发感染的治疗

Superficial skin cytology is the diagnostic method of choice to identify the presence of secondary infection with either bacteria or Malassezia and can be performed using a microscope slide  (for  a  direct impression smear of exudative lesions)and acetate tape (for scaling, crusting,and   erythema).

浅表皮肤细胞学检查是确定细菌或马拉色菌继发感染的诊断方法，可使用显微镜载玻片(用于渗出性病变的直接印痕涂片)和醋酸胶布(用于结垢、结痂和红斑)进行检查。

 

Treatment for bacterial infection(amoxicillin-clavulanic acid 12.5-20 mg/kg orally twice daily;clindamycin 11-33 mg/kg orally once daily;cefovecin 8 mg/kg  subcutaneously)should be based  on the presence of degenerate neutrophils with cocci-shaped bacteria. Bacterial culture and susceptibility testing may be needed  in more  complicated  cases involving rod-shaped bacteria.Finding more than one Malassezia per high-power field suggests yeast overgrowth and may  warrant  systemic therapy. For Malassezia dermatitis,itraconazole,fluconazole,or terbinafine should be selected (Table  9).Ketoconazole may cause severe hepatotoxicity in cats.

细菌感染的治疗(阿莫西林-克拉维酸12.5-20 mg/kg，口服，每日2次;克林霉素11-33 mg/kg，口服，每日1次;头孢维星8 mg/kg，皮下给药)应基于细胞学检查存在退行性中性粒细胞伴有球菌。涉及杆菌的较复杂病例，可能需要进行细菌培养和药敏试验。在每个高倍镜视野中发现超过一种马拉色菌表明酵母过度增殖，可能需要全身性治疗。马拉色菌皮肤病应选择伊曲康唑、氟康唑或特比萘芬(表9)。酮康唑可能对猫造成严重的肝毒性。

 

Although topical antimicrobial therapies are ideal to reduce the overall exposure  to systemic antibiotics,the grooming behavior  of cats and their decreased tolerance for topical applications often limits their use.

虽然外部抗菌药物治疗是理想的，以减少全身抗生素的整体使用，但猫的梳理行为和它们对外用药耐受性下降往往限制了它们的使用。

 

If diagnostics cannot be performed because of client financial constraints, then it would be most advantageous to use a broad-spectrum external parasite treatment in addition to a tapering course of oral glucocorticoids.

如果由于客户的财政限制而无法进行诊断，那么除了口服糖皮质激素的减量疗程外，使用广谱外寄生虫治疗将是最有利的。

 

Step Five:Recheck,Assess Response to Antiparasitic/Antipruritic Therapy

第5步:复查，对抗寄生虫/止痒治疗效果的评估

In flea-endemic areas,consistent flea prevention should be continued in all cats year-round regardless of their flea history to reduce the possible burden of flea allergy leading to worsening dermatitis and pruritus.If there is no improvement or only partial improvement of pruritus and clinical lesions after ectoparasiticide treatment  and addressing secondary infections,then other causes of pruritus should be investigated.A skin biopsy is recommended in cases with atypical lesions to rule out other pruritic dermatoses (eg,pemphigus foliaceus),especially in cases of crusting dermatitis without cytologic evidence of bacterial or  yeast.With nonseasonal pruritus,a  restrictive diet trial should be pursued to rule out food allergies.

在跳蚤流行地区，无论猫是否有跳蚤病史，应全年对所有猫进行持续的跳蚤预防，以减少由跳蚤过敏导致的皮肤病和瘙痒恶化。如果进行外寄生虫治疗和处理继发感染后，瘙痒和临床病变无改善或仅部分改善，则应调查引起瘙痒的其他病因。对于不典型病变的病例，建议进行皮肤活检，以排除其他瘙痒性皮肤病(例：落叶型天疱疮)，特别是对于细胞学检查无细菌或酵母菌的结痂性皮肤病病例。对于非季节性瘙痒，应进行食物排查试验，以排除食物过敏。

 

 

Superficial bacterial skin infection due to Staphylococcus spp. on the lateral neck of a cat. Note the alopecia, exudate, crusting, erythema, and erosions.

一只猫颈侧葡萄球菌引起浅表细菌性皮肤感染。注意脱毛、分泌物、结痂、皮肤发红和糜烂。

 

Step Six:Diet Trial

第6步：食物试验

Food allergies in cats can only be diagnosed with an elimination diet rial,by feeding either a hydrolyzed or a novel protein  diet.Definitive diagnosis is ultimately confrmed if the pruritus and/or skin lesions return after challenging the cat with the previous diet  and then  resolve again once returning to the restrictive diet.It is recommended to conduct the elimination diet trial for 8 wk,as 90% of food-allergic cats resolve their clinical signs by this time point, whereas 50% of feline food-allergic cases resolve at 4 wk.

猫的食物过敏只能通过食物排查试验来诊断，即喂食水解食物或新型蛋白质食物。如果用之前的饮食挑战猫后，瘙痒和/或皮肤病变再次出现，并且在恢复限制性饮食后再次缓解，则最终确认明确诊断。建议进行8周的消除食物试验，因为90%的食物过敏猫的临床症状在这一时间点消失，而50%的猫食物过敏病例在4周时消失。

 

Use of OTC diets should not be recommended when conducting a diet trial in cats. Ingredients not declared on the label (e.g., chicken) have been detected in up to 82% of OTC feline diets, possibly negating the results of the trial. However, the guidelines task force agrees that an OTC novel protein diet can be used if financial constraints make other diets impossible. The client should be warned that an OTC diet may not provide optimal results and should be considered a diet change, not a true diet trial.

在对猫进行食物试验时，不建议使用非处方药食物。在高达82%的OTC猫粮中检测到标签上未声明的成分(例：鸡肉)，这可能导致阴性试验结果。然而，指南工作组同意，如果经济拮据导致其他饮食无法使用，可以使用OTC新型蛋白饮食。应提醒客户OTC饮食可能不能提供最佳结果，应考虑食物改变，而不是真正的食物试验。

 

Systemic glucocorticoids can be withdrawn at the 3 wk point of a diet trial and/or parasite treatment trial and again at the 6 wk point to assess response to diet alone.

全身性糖皮质激素可在食物试验和/或寄生虫治疗试验的第3周时停用，并在第6周时再次停用，以评估仅食物管理的效果。

 

Feline Atopic Skin Syndrome Diagnosis

FASS的诊断

FASS can only be diagnosed based on compatible history and clinical signs and by ruling out all other diseases that can look similar to this disease  (i.e.flea allergy,food allergy,external parasites,bacterial skin infection,and dermatophytosis).Up to 25-30%of cats with FASS will exhibit seasonal patterns,which supports a diagnosis of  environmental allergies without the need for an  elimination  diet trial,if external parasites and secondary skin infections have been treated and/or ruled out.Otherwise,lack of response to a restrictive diet trial would indicate FASS in the nonseasonal pruritic cat.

FASS的诊断只能基于相符的病史和临床症状，并排除所有其他可能与该疾病相似的疾病(即跳蚤过敏、食物过敏、体外寄生虫、细菌皮肤感染和皮肤癣菌病)。多达25-30%的FASS猫会表现出季节性发病特征，如果体外寄生虫和继发性皮肤感染已经被治疗和/或排除，那么无需进行食物排查试验，就可以诊断为环境过敏。否则，对限制性食物试验无反应将表明这只非季节性瘙痒猫有FASS。

 

Once a diagnosis of FASS has been achieved by process of elimination, intradermal or serum allergy testing by a veterinary dermatologist is then a useful tool to identify which specific environmental allergens should be included in allergy immunotherapy.

一旦通过排除方法诊断出FASS，由兽医皮肤科医生进行皮内或血清过敏原试验是确定应将哪些特异性环境过敏原纳入过敏原免疫治疗的有用工具。

 

 

 

TABLE 6 Antipruritic and Anti-inflammatory Medications for Cats

表6猫的止痒药和抗炎药

药物名称	环孢素	糖皮质激素
作用机理	调节T细胞功能的钙抑制剂	影响促炎细胞因子的基因表达
给药方式	口服 每24小时	口服 不建议注射
起效时间	4-6周	数小时
年龄	＞6月龄	任何年龄
体重	＞1.4公斤	任何体重
健康限制	肿瘤病史 肾功能不全	充血性心衰 糖尿病 肾上腺机能亢进 高血压
副反应	呕吐 腹泻 牙龈增生 流涎 嗜睡 药物相互作用	多尿/多饮 多食 糖尿病 肥胖 肌肉流失 医源性肾上腺机能亢进 充血性心衰

 

 

Section 4: Managing Feline Chronic Allergic Conditions

第四部分:猫慢性过敏性疾病的管理

Top 3 Takeaways:

三大要点:

1.Ectoparasites and infections need to be ruled in/out and addressed before treating allergic skin disease in cats.

2.Flea allergy dermatitis is the most common allergic skin disease; diligent adulticidal flea prevention is key in any pruritic feline patient as this can be a complicating concurrent factor.

3.FASS has different management considerations compared with canine atopic dermatitis; partnership with a veterinary dermatoloist can be beneficial for these patients.

1.在治疗猫的过敏性皮肤病之前，需要排除体外寄生虫和感染并加以处理。

2. 跳蚤过敏性皮炎是最常见的过敏性皮肤病;勤勉的杀虫跳蚤预防是关键在任何搔痒的猫患病动物，因为这可能是一个复杂的并发因素。

3.与犬特应性皮炎相比，FASS有不同的治疗考虑;与兽医皮肤科医生合作可能对这些患病动物有益。

 

Overview

概述

Identifying the cause(s) of an allergic condition can be a long, often frustrating process of trial and error for both clients and veterinary staff. Although ultimately discovering the source brings relief, this is actually just the beginning of another stage that will last the cat’s lifetime—that of managing a chronic condition. Before launching into what will be required next, however, pausing to congratulate the client for seeing the diagnosis process through speaks volumes about a practice’s compassion and desire to cultivate long-lasting relationships.

确定过敏疾病的病因可能是一个漫长的，经常令人沮丧的过程，客户和兽医工作人员的试验和错误。虽然最终找到了病因，但这实际上只是另一个阶段的开始，即终生控制患猫的慢性疾病。然而，在开始下一步需要做什么之前，停下来祝贺客户看到了诊断过程，这充分说明了诊所的同情心和培养长期关系的愿望。

 

Treating Flea Allergy

跳蚤过敏治疗

Flea allergy dermatitis is the most common allergic skin disease, seen solely or concurrently with other allergic conditions. Diligent adulticidal flea prevention must continue long term and consists of the following considerations:

跳蚤过敏性皮炎是最常见的过敏性皮肤病，可单独或与其他过敏性疾病同时发生。勤勉灭跳蚤成虫预防工作必须长期进行，并包括以下注意事项:

 

1.Use FDA-approved products for cats.

2.Recommend isoxazoline medications for broad coverage (fluralaner, sarolaner, lotilaner, ± selamectin or moxidectin).

3.Treat for the proper duration and response for fleas versus mites.

4.If there are multiple cats or the client has difficulty medicating, consider imidacloprid/flumethrin collars.

5.Ensure other animals are treated and on year-round prevention as well.

6.Consider environmental treatment.

7.Educate clients on the life cycle of fleas, including the time it takes to see treatment response.

8.Symptomatic antipruritic therapy:  

Prednisolone 2 mg/kg/day per os (PO) tapered over 3 wk

Methylprednisolone 0.8–1.5 mg/kg/day PO tapered over 3 wk

Dexamethasone 0.2 mg/kg/day PO tapered over 3 wk

1.使用FDA批准的猫用产品。

2.推荐广谱异恶唑啉类药物(氟雷拉纳、沙罗拉纳、洛替拉纳±赛拉菌素或莫昔克丁)。

3.治疗跳蚤和螨虫的适当时间和反应。

4.如果有多只猫或患病动物用药有困难，可考虑使用吡虫啉/氟氯菊酯项圈。

5.确保其他动物得到治疗，并进行全年预防。

6.考虑环境管理。

7.教育客户了解跳蚤的生命周期，包括看到治疗效果所需的时间。

8.对症止痒治疗:

·泼尼松龙：2mg/kg/day/os(PO)在3周内逐渐减少

·甲基泼尼松龙：0.8-1.5mg/kg/天PO在3周内逐渐减少

·地塞米松：0.2mg/kg/d PO在3周后逐渐减少

 

 

Technicians can discuss treatment of other pets in the households, explain parasite life cycles, and reinforce the importance of year-round prevention with clients.

技术人员可以讨论家庭中其他宠物的治疗方法，解释寄生虫的生命周期，并向客户强调全年预防的重要性。

 

Treating Food Allergy

食物过敏治疗

Food allergy (at least anecdotally) seems to be more common in cats than dogs. For cats, palatability of a diet and securing the preferred formulation (e.g., dry only versus wet) are important considerations, especially if the patient is a picky eater. Ideally, a prescription veterinary diet should be fed long term with either a novel protein diet (e.g., rabbit, kangaroo, or alligator) or a hydrolyzed diet (hydrolyzed soy, hydrolyzed fish, or hydrolyzed poultry feather). If a specific allergen is identified, an OTC diet that does not contain this allergen may be an effective choice for long-term management. Once an appropriate diet has been identified, clients must stick to the regimen and understand this will be a commitment for the rest of the cat’s life.

食物过敏(至少据传闻)似乎在猫比犬更常见。对于猫来说，饮食的适口性和确保优选配方(例如，干配方vs湿配方)是重要的考虑因素，特别是如果患病动物挑食的话。理想情况下，兽医处方饲料应长期喂食新型蛋白食物(例：兔子、袋鼠或鳄鱼肉)或水解食物(例：水解大豆、水解鱼或水解家禽羽毛)。如果确定了特异性过敏原，不含该过敏原的OTC饮食可能是长期治疗的有效选择。一旦确定了合适的饮食，客户必须坚持这个方案，并明白这将是猫余生的固定饮食。

 

During client education, technicians or members of the veterinary team should advise clients to plan for possible shortages or backorders of special diets. Keeping extra bags or cans of food on hand is one strategy. Considering different brands with similar or identical ingredients is another. Choosing a home-cooked diet in consultation with a veterinary nutritionist is a third strategy, but it should be done with extreme caution to account for the specific nutritional needs of cats.

在客户教育期间，技术人员或兽医团队成员应建议客户为可能出现的特殊饮食短缺或缺货做好准备。在手边多备几袋或几罐食物是一种策略。考虑不同品牌的相似或相同的成分是另一回事。第三种策略是与兽医营养师协商选择家庭烹饪的饮食，但应该非常谨慎地考虑到猫的特定营养需求。

 

Treating Feline Atopic Skin Syndrome

FASS治疗

A diagnosis of FASS is an excellent juncture in treatment to consider referral to a veterinary dermatologist if this has not occurred already. Finding the proper therapeutic regimen for a feline patient and client can be challenging, and “tinkering” with options that do not provide sufficient improvement tends to lead to client frustration and potential loss of trust. Even for clients with cost concerns, a veterinary dermatologist can provide more targeted treatment to bring the patient relief. Moreover, there may be time and cost savings in the long run with more targeted treatments.

如果还没有转诊，可以考虑转诊给兽医皮肤科医生进行FASS耳道诊断和治疗。为FASS患猫和客户寻找合适的治疗方案可能是具有挑战性的，“修修补补”没有提供充分改善的选项往往会导致客户失望和潜在的信任丧失。即使是担心费用问题的客户，兽医皮肤科医生也可以提供更有针对性的治疗，为患病动物带来缓解。此外，从长远来看，更有针对性的治疗可能会节省时间和成本。

 

If referral is not possible or desired, establishing a baseline level of pruritus at this point is helpful to assess response to various therapeutic interventions. Because glucocorticoids tend to provide relief for most allergic cats, they should be considered as a first test intervention to determine the degree of improvement. If FASS is seasonal, they may be an option for continued management.

如果不能转诊或不想转诊，在此时建立瘙痒的基线水平有助于评估对各种治疗干预措施的反应。因为糖皮质激素倾向于为大多数过敏症患猫提供缓解，它们应该被认为是一线用药选择，以确定改善程度。如果FASS是季节性的，它们可能是持续管理的选择。

 

Once pruritus surpasses 6 out of 12 mo in a given year, alternative options should be discussed with the clients (see Table 7).

一旦一年12个月中瘙痒超过6个月，应与客户讨论替代方案(见表7)。

 

Cyclosporine is a labeled treatment for feline allergy and comes in liquid form; however, its palatability is questionable, and many owners struggle with administration. It takes time to reach therapeutic levels (4–6 wk), but at that point, most cats can have the frequency decreased to every other day (or possibly less). This should not be recommended for cats that go outside owing to the increased risk of infectious disease exposure that may be fatal on this medication (e.g., toxoplasmosis). Cats on this medication should be fed a cooked diet and maintained on effective internal and external parasite control measures.

环孢素是一种用于治疗猫过敏症的药物，呈液体形式;然而，它的适口性是值得怀疑的，许多宠主喂药有难度。药物需要一段时间才能达到治疗水平(4-6周)，但起效后，大多数猫的频率可以减少到隔日一次(或更少)。不建议外出的猫使用这种药物，因为使用这种药物可能会增加感染疾病的风险(如弓形虫病)。服用这种药物的猫应食用熟食，并保持有效的内外驱虫控制。

 

Oclacitinib is not labeled for cats and has not been thoroughly assessed in this species with regard to long-term safety and dosing. The task force does not recommend the use of oclacitinib in cats at this time.

奥拉替尼不是猫的标签用药，也没有对猫的长期安全性和剂量进行全面评估。工作组目前不建议在猫上使用奥拉替尼。

 

Lokivetmab should not be used in cats; this caninized monoclonal antibody can potentially be fatal if administered to a non-dog species.

洛基维特单抗不应用于猫;这种犬化单克隆抗体如果用于非犬种，可能是致命的。

 

Immunotherapy can be an excellent option for cats with FASS as this species tends to respond more favorably than not. Keep in mind that allergy tests, both serum and intradermal, do not diagnose allergy but rather support the clinical diagnosis and aid in immunotherapy formulation; they should not be used as “allergic or not” diagnostics, as they can be positive in animals with no clinical signs of allergy. Both injectable and sublingual immunotherapy may be considered depending on client and patient preference. Most owners elect injections first due to ease of administration, but the oral option is also effective in cat.

免疫疗法对FASS患猫来说可能是一个很好的选择，因为该物种往往会有更好的效果。请记住，过敏试验(包括血清和皮内试验)不能诊断过敏，而是支持临床诊断并帮助制定免疫疗法;它们不应用作“是否过敏”的诊断方法，因为它们在没有过敏临床症状的动物中可能呈阳性。根据客户和患病动物的偏好，可以考虑注射和舌下免疫治疗。大多数猫的主人会首先选择注射，因为注射更方便，但口服方法对猫也有效。

 

Opting for immunotherapy is another treatment juncture where veterinary dermatologists may be more adept at the intricacies of testing, formulations, and making appropriate adjustments.

选择免疫疗法是另一种治疗方法，兽医皮肤科医生可能更擅长复杂的测试、配方和适当的调整。

 

Alternative or adjunct therapies to consider in the allergic feline include the following:  

对于过敏猫，可考虑的替代或辅助疗法包括:

·Antihistamines. Can be helpful in cats with concurrent upper respiratory manifestation of allergy, but they do not provide much pruritus relief (Table 8).  

·抗组胺药。对同时出现上呼吸道过敏症状的猫有帮助，但不能缓解瘙痒(表8)。

 

·Nutraceuticals (e.g., ultra-micronized palmitoylethanolamide and essential fatty acids). These can be administered separately as supplements, or some clients may appreciate the benefit from a “skin support” diet that includes these ingredients as opposed to another oral therapy.  

·营养保健品(例如，超微化棕榈酰乙醇酰胺和必需脂肪酸)。这些可以作为补充剂单独使用，或者一些客户可能会欣赏包含这些成分的“皮肤支持”日粮的好处，而不是另一种口服疗法。

 

·Topical skin barrier support (e.g., fatty acid/essential oil spot-on formulations). The benefits of these interventions to allergic cats are somewhat uncertain owing to the lack of information supporting the impact of barrier dysfunction in feline allergy. They may at least be good options for mildly affected cats or as adjunct therapy to reduce other medication requirements.

·外部皮肤屏障支持(例如脂肪酸/精油的点状配方)。由于缺乏支持屏障功能障碍在猫过敏中的影响的信息，这些干预措施对过敏猫的益处有些不确定。它们可能至少是轻度受影响的猫的良好选择或作为辅助治疗，以减少其他药物的需求。

 

 

Treating Flares

治疗急性发作

As with dogs, even the best-managed allergic cat can experience episodes of pruritic flare. It is imperative to reassess the presence of ectoparasites and secondary bacterial and yeast infections in this situation, as these remain common complications in the face of allergy. Additionally, remind owners that treatment does not just stop working once it has been determined to be beneficial; rather, the cat may need a bit of extra support during these episodes.

和犬一样，即使是管理得最好的过敏症患猫也会出现瘙痒发作。在这种情况下，必须重新评估体外寄生虫和继发细菌和酵母菌感染的存在，因为这些仍然是过敏症的常见并发症。此外，提醒宠主，治疗并不是一旦确定是有效的就停止治疗;相反，在这些事件中，猫可能需要一点额外治疗。

 

To provide antipruritic and anti-inflammatory benefit during acute flares, a tapering course of systemic glucocorticoids should be considered, such as prednisolone (2 mg/kg PO q 24 hr), methylprednisolone (0.8–1.5 mg/kg PO q 24 hr), or dexamethasone (0.2 mg/kg PO q 24 hr). In addition, in cases in which cats have been receiving lower-dose cyclosporine (i.e., every-other-day dosing or twice-weekly dosing), a temporary increase to once-daily dosing can be recommended for 3–4 wk.

为了在急性发作期间提供止痒和抗炎效果，应考虑逐渐减少全身性糖皮质激素的使用，如泼尼松龙(2mg /kg PO每24小时一次)、甲基泼尼松龙(0.8-1.5 mg/kg PO每24小时一次)或地塞米松(0.2 mg/kg PO每24小时一次)。此外，患猫已经接受低剂量环孢素(即隔日一次或每周两次)的病例，可以建议暂时增加到每日一次，持续3-4周。

 

 

TABLE 7 Acute Flare and Long-term Management Therapies in Cats

表7猫的急性发作和长期治疗管理

药物名称	急性发作	长期管理	优势/劣势
皮质类固醇	√	√	快速起效
			副作用常见
环孢素	×	√	不干扰皮内过敏原检测
			起效缓慢（数周） 副作用常见（消化道症状、流涎、嗜睡、牙龈增生） 需要定期检测肝酶和血细胞计数
过敏原特异性免疫治疗	×	√	可安全与其他药物联用 仅引发免疫反应的管理策略 生物学复合物
			起效缓慢（数月至1年） 需要皮内测试或血清学检测
EFA	×	√	可能节省激素用量
			起效缓慢（数周至数月）
抗组胺药	×	√	副作用不常见
			疗效可疑-可能仅对轻度瘙痒动物有效

 

 

TABLE 8 Oral Antihistamine Doses for Cats

表8猫口服抗组胺药剂量

药物名称	剂量
羟嗪	5–10 mg/cat (NOT mg/kg) q 12 hr
西替利嗪	5–10 mg/cat (NOT mg/kg) q 24 hr
扑尔敏	2–4 mg/cat (NOT mg/kg) q 12 hr
赛庚啶	2 mg/cat (NOT mg/kg) q 12 hr
克立马丁	0.68 mg/cat (NOT mg/kg) q 12 hr
氯雷他定	2.5–5 mg/cat (NOT mg/kg) PO q 24 hr
非索非那定	30–60 mg/cat (NOT mg/kg) PO q 24 hr
阿米替林	2.5–7.5 mg/cat PO (NOT mg/kg) q 12 hr
苯海拉明	2–3 mg/kg q 12 hr

 

 

TABLE 9 Oral Antifungal Medication Doses for Cats

表9猫口服抗真菌药物剂量

药物名称	剂量
酮康唑	禁忌症:引起严重肝毒性
氟康唑	5–10 mg/kg q 24 hr
伊曲康唑	5 mg/kg q 24 hr
特比萘芬	30–40 mg/kg q 24 hr

 

 

Section 5: Otitis Externa

第五部分:外耳炎

Top 3 Takeaways:

三大要点:

1. Recurrent otitis externa is commonly caused by underlying allergic disease, and in some patients, it may be the only clinical manifestation of allergy.

2. Cytology should be performed in every case of otitis externa.

3. The goal of short-term treatment is to reduce inflammation and treat secondary infection (where present), while long-term management aims to control inflammation and maintain ear health.

1. 复发性外耳炎通常是由潜在的过敏性疾病引起的，在一些患病动物中，它可能是过敏症的唯一临床表现。

2. 每一例外耳炎都应进行细胞学检查。

3.短期治疗的目标是减少炎症和治疗继发感染(如果存在)，而长期治疗的目标是控制炎症和保持耳部健康。

 

Overview

概述

Allergic otitis externa (AOE) is a common manifestation of allergy in animals and in some cases is the only clinical sign. AOE is an inflammatory condition of the ear and should not be confused with infection—which commonly occurs secondary to AOE. Although it is important to identify and treat secondary infections, identification of the primary (underlying) cause of otitis externa is critical to the prevention of recurrent otitis. More than half of dogs and 20% of cats with allergies have AOE.Other primary causes of otitis externa include parasites, foreign body, neoplasia, endocrinopathy, and keratinization disorders and should be ruled out in every case. AOE occurs frequently in patients with atopic dermatitis and food allergy but is not a feature of flea allergy dermatitis.

过敏性外耳炎(AOE)是动物过敏症的常见表现，在某些病例中是唯一的临床症状。AOE是耳道的一种炎症状态，不应与感染相混淆，后者通常继发于AOE。虽然识别和治疗继发性感染很重要，但识别外耳炎的原发(潜在)病因对于预防复发性耳炎至关重要。超过一半的过敏症患犬和20%的过敏症患猫有AOE。外耳炎的其他原发病因包括寄生虫、异物、肿瘤、内分泌病和角化性疾病，应在所有病例中排除。AOE常见于特应性皮炎和食物过敏患病动物，但不是跳蚤过敏性皮炎的特征。

 

Clinical Presentation

临床表现

Most cases of AOE present as bilateral ear disease—although disease severity may differ between ears. Otic pruritus manifests as head shaking, scratching at the ears, and rubbing the face/head.Clinical signs of AOE include pruritus, pain, erythema, ceruminous (waxy) exudate, periauricular alopecia, and excoriation. When secondary infection is present, otic exudate (±malodorous), crusting/scaling, erosions, and asymmetric ear carriage may also occur. Otitis media/interna should be suspected in animals presenting with hearing loss, head tilt, vestibular disturbances, Horner’s syndrome, and/or temporomandibular joint pain.

大多数AOE病例表现为双耳疾病，但两耳的疾病严重程度可能不同。耳部瘙痒表现为摇头、搔耳道、揉脸/头。AOE的临床症状包括瘙痒、疼痛、发红、耵聍（蜡样）分泌物、耳周脱毛和抓痕。当出现继发性感染时，也可能出现耳道渗出物(±恶臭)、结痂/皮屑、糜烂和耳部不对称。对于出现听力下降、头倾斜、前庭障碍、霍纳综合征和/或颞下颌关节疼痛的动物，应怀疑中耳炎/内耳炎。

 

Diagnosis

诊断

The importance of a thorough evaluation of the ears in any patient presenting with dermatologic disease cannot be overemphasized. This includes examination of the periauricular region and pinna, palpation of the canals, and otoscopic examination. Pliability of the cartilaginous structures of the ear canals provide clues to pathologic changes that can result from chronic inflammation, which can ultimately lead to calcification. Otoscopy not only is important for examination of deeper ear structures but also helps to rule out most other primary causes of otitis externa. Chronic inflammation can lead to ceruminous gland hyperplasia within the ear canals causing a cobblestone-like appearance. Stenosis of the ear canals occurs because of edema and inflammation and/or pathologic changes to the ear over time.

对任何表现为皮肤病的患病动物进行耳部彻底评估的重要性再怎么强调也不过分。这包括耳周区域和耳廓的检查、耳道的触诊和耳镜检查。耳道软骨结构的柔韧性为慢性炎症可能导致的病理变化提供了线索，慢性炎症最终可能导致钙化。耳镜检查不仅对检查耳深部结构很重要，而且有助于排除外耳炎的大多数其他原发病因。慢性炎症可导致耳道内的耵聍腺增生，造成鹅卵石样外观。耳道狭窄是由于耳部随时间的水肿和炎症和/或病理变化所致。

 

Secondary infection is common in animals with AOE. Alterations of the skin’s natural flora have been demonstrated in dogs with atopic dermatitis, and a similar dysbiosis has also been observed within the ear canals of atopic dogs having increased amounts of Staphylococcus spp. relative to normal dogs.Inflammation causes changes to the ear canal microenvironment, altering the bacterial population and creating an ideal environment for yeast (Malassezia spp.) overgrowth. Therefore, it is imperative that ear cytology be performed in every case of AOE. Diagnostic evaluation should include both a stained, dry-mounted sample to assess for microbial infection and an unstained, mineral oil wet mount to rule out otic ectoparasites. This is of particular importance in cats because of the prevalence of Otodectes in this species.

AOE动物常继发感染。在特应性皮炎患犬身上已经证明了皮肤天然菌群的改变，在葡萄球菌属数量相对于正常犬增加的特应性皮炎患犬的耳道内也观察到类似的菌群失调。炎症导致耳道微环境发生变化，改变了细菌群，为酵母菌(马拉色菌属)过度生长创造了理想环境。因此，对每例AOE患病动物进行耳细胞学检查是非常必要的。诊断评估应包括染片样本(用于评估微生物感染)和未染片矿物油样本(用于排除耳外寄生虫)。这在猫中特别重要，因为猫易患耳螨。

 

Training technicians to obtain and interpret ear cytology facilitates increased efficiency when seeing appointments.

培训技术人员获取和解释耳部细胞学有助于提高预约时的效率。

 

Treatment

治疗

Topical therapy should always be guided by cytologic findings. In cases with abundant exudate, an in-clinic ear flush should be performed to aid in the removal of exudate and facilitate a more thorough otoscopic examination. Caution should be exercised in cases of a ruptured tympanic membrane, with careful selection of antimicrobial agents and cleaning solutions that are safe for use in the middle ear. Discussion of specific products and ingredients is beyond the scope of these guidelines.

外部治疗应始终以细胞学结果为指导。在有大量渗出物的病例，应在门诊进行耳部冲洗，以帮助清除渗出物并促进更彻底的耳镜检查。在鼓膜破裂的病例应谨慎操作，注意选择对中耳安全的抗菌药和清洁溶液。对具体产品和成分的讨论超出了本指南的范围。

 

In difficult cases of otitis externa in which the patient has failed numerous treatment protocols and/or there is no resolution after 3–6 mo of treatment, collaborative care with a board-certified dermatologist is recommended as this has been shown to significantly improve resolution of chronic otitis with infection.

在外耳炎的困难病例中，患病动物多次治疗失败和/或治疗3-6个月后仍未解决，建议与委员会认证的皮肤科医生合作护理，因为这已被证明可以显着改善慢性耳炎伴有感染的解决。

 

Treatment recommendations for secondary infections in AOE are beyond the scope of these guidelines.

AOE中继发感染的治疗建议超出了本指南的范围。

 

Short-term and Long-term Management of AOE

AOE的短期管理和长期管理

The short-term goal of therapy is to reduce inflammation and treat secondary microbial infection (where present). Oral corticosteroids in a short, tapering course at anti-inflammatory doses or oclacitinib may be used for control of inflammation and pruritus. Corticosteroids applied topically are also effective.

治疗的短期目标是减少炎症和治疗继发性微生物感染(如果存在)。短期内口服皮质类固醇，逐渐减少抗炎剂量，或可用奥拉替尼控制炎症和瘙痒。外部使用皮质类固醇也是有效的。

 

The long-term goal of therapy focuses on control of inflammation and maintenance of ear health. Managing the underlying allergy is key to minimizing AOE. When crafting an allergy management plan in patients with AOE, one must be mindful that medications used to manage atopic dermatitis have varying efficacy against AOE and individual patient response must be assessed.

治疗的长期目标是控制炎症和维持耳部健康。控制潜在的过敏是最小化AOE的关键。在制定AOE患病动物的过敏管理计划时，必须注意用于治疗特应性皮炎的药物对AOE的疗效各不相同，必须评估个体患病动物的反应。

 

Routine, topical maintenance therapies are often very helpful in reducing the recurrence of AOE. Routine ear cleaning based on an individual patient’s needs is useful to maintain a healthy microenvironment and remove debris and ceruminous material from the ear canals. Cleansing agents that promote epidermal barrier function are useful to reduce microbial adherence to the epithelium and should be considered in individuals prone to secondary infection. Topical glucocorticoids (e.g., hydrocortisone and dexamethasone) aid the management of inflammation in the ear canal and may help prevent allergic flares and secondary infections as well.

常规的外部维持治疗对减少AOE的复发非常有帮助。根据患病动物个人需要进行常规耳部清洁有助于维持健康的微环境，并清除耳道中的碎片和耵聍。促进表皮屏障功能的清洗剂有助于减少微生物对上皮的粘附，在容易继发感染的个体中应考虑使用。外用糖皮质激素(如氢化可的松和地塞米松)有助于治疗耳道炎症，还可能有助于预防过敏性发作和继发性感染。

 

Referral is indicated if the patient has AOE that is complicated with secondary infection that is not responding to empiric treatment, if it involves a resistant organism, and/or if the patient has otitis media.

如果患病动物的AOE并发继发感染，对经验性治疗无效，如果涉及耐药菌，和/或患病动物患有中耳炎，则需要转诊。

 

Demonstration of ear cleaning technique and topical medication application is vital to success and should be the responsibility of a veterinary technician. Veterinary technicians can also conduct interim follow-up with the client via telephone, text message, video chat, or email.

示范耳道清洁技术和外用药使用方法是成功的关键，应该是兽医技术人员的责任。兽医技术人员也可以通过电话、短信、视频聊天或电子邮件与客户进行临时随访。

 

Section 6: Spectrum of Care Considerations in Managing Allergic Skin Diseases

第六部分:管理过敏性皮肤病的体系护理注意事项

Top 3 Takeaways:

三大要点:

1.Gather a thorough and relevant history and use pattern recognition and probabilistic clinical reasoning.

2.Recognize when diagnostics and referral are necessary.

3.Use efficient but effective client communication to manage client expectations.

1.详细的病史调查，并使用模式识别和概率临床推理。

2.认识到什么时候需要诊断和转诊。

3.使用高效的客户沟通来管理客户期望。

 

Overview

概述

Spectrum of care (SOC) is the practice of providing a continuum of acceptable care that considers available evidence-based medicine while remaining responsive to client expectations and financial limitations.SOC considerations are highly relevant to allergic skin disease in dogs and cats because skin allergies, ear infections, and skin infections were in the top 10 medical conditions submitted for Nationwide pet insurance claims in 2021.

体系护理(SOC)是提供连续的可接受的护理的做法，考虑现有的循证医学，同时保持响应客户的期望和财政限制。SOC考虑与犬和猫的过敏性皮肤病高度相关，因为皮肤过敏，耳部感染和皮肤感染是2021年全国宠物保险索赔中提交的十大医疗疾病。

 

The key components of successfully practicing SOC are gathering a thorough and relevant history, using pattern recognition and probabilistic clinical reasoning, recognizing when diagnostics and referral are necessary, and communicating with clients efficiently but effectively to manage expectations.

成功实践SOC的关键组成部分是收集全面和相关的病史，使用模式识别和概率临床推理，识别诊断和转诊的必要性，并与客户进行有效的沟通，以有效地管理期望。

 

Step One: Clinical History

第1步:临床病史

During the history-taking process, it is critical to focus on previous diagnostics, response to therapies, seasonality, signalment, and realistic compliance from the client. Compliance can be affected not only by financial limitations but also by the level of ability to give medications and administer topical therapies, perform strict diet trials, and/or have the time and access to return for recheck appointments. All of these factors are important to understand and balance when developing diagnostic and treatment plans.

在记录病史的过程中，重点关注既往诊断、治疗效果、季节性、特征和患病动物的实际依从性是至关重要的。依从性不仅会受到经济限制的影响，还会受到给予药物和外部治疗的能力水平的影响，执行严格的食物试验，和/或有时间和机会复诊重新检查预约。在制定诊断和治疗计划时，了解和平衡所有这些因素都很重要。

Owing to the need for efficiency in general practice, having a specific dermatologic history form sent to clients ahead of time can be very helpful, as can training technical staff on proper history taking and client education. Also, consider an easily accessible area in your records for recording the history of treatment successes and failures to eliminate digging through previous records.

由于全科医疗效率的需要，提前将特定的皮肤病史表发送给客户非常有帮助，对技术人员进行适当的病史记录和客户教育也很有帮助。此外，在记录中考虑一个易于访问的区域，用于记录治疗成功和失败的历史，以避免挖掘以前的记录。

 

Step Two: Physical Examination

第2步：体格检查

The practice of SOC relies heavily on pattern recognition and using a probabilistic clinical reasoning approach to determine the most likely diagnosis. This requires understanding common clinical presentations, as well as using therapy trials to confirm or deny a suspected diagnosis.

SOC的实践在很大程度上依赖于模式识别和使用概率临床推理方法来确定最可能的诊断。这需要了解常见的临床表现，以及使用治疗试验来确认或否认可疑的诊断。

 

Training technicians on collection of samples for cytology, skin scrapings, flea combing, etc. can contribute to a more thorough and efficient appointment.

培训技术人员细胞学检查采样，皮肤刮片，跳蚤梳理等可以有助于更彻底和有效的预约。

 

Step Three: Treatment

第3步:治疗

Communicating the pros and cons of all therapeutic options to clients before treatment choices are made is vital for clients to be able to make educated decisions. When developing a plan:  

在做出治疗选择之前，与客户沟通所有治疗方案的利弊对客户能够做出明智的决定至关重要。制定计划时:

 

·Acknowledge that rising costs of many products to manage allergic disease, from oclacitinib to lokivetmab, immunotherapy, and prescription diets, continue to make allergic management financially challengin；

·Explain that using cost-effective therapies is at times necessary, including steroids, antihistamines, and/or limited-ingredient diets for SOC, but that the cat or dog is not getting substandard medicine ；

·Consider adjustments of monitoring protocols for certain medications as an area of cost that may need to be discussed, too.

·承认从奥拉替尼到洛基维特单抗、免疫疗法和处方饮食等许多过敏性疾病管理产品的成本不断上升，继续使过敏性疾病管理面临财务挑战;

·解释使用成本效益高的疗法有时是必要的，包括类固醇、抗组胺药和/或SOC的食物限制试验。但猫或犬没有批准用药;

·考虑调整某些药物的监测方案，这也是一个可能需要讨论的费用领域。

 

Recognizing treatment failures and/or poor medical management should trigger a change to a more standardized clinical approach if possible. This shift in clinical approach often must start with helping clients maintain realistic expectations and explaining why the need now is for diagnostics and/or more aggressive therapies. Continued conversations about SOC are essential for removing the substandard care stigma associated with meeting clients where they are.

认识到治疗失败和/或不良的医疗管理应促使我们在可能的情况下转变为更标准化的临床方法。这种临床方法的转变通常必须首先帮助患病动物保持现实的预期，并解释为什么现在需要诊断和/或更积极的治疗。持续的关于SOC的对话对于消除与客户所在地点会面相关的不规范医疗的污名至关重要。

 

Step Four: When to Refer

第4步：何时转诊

A significant part of financial considerations for managing both the short- and long-term costs associated with allergic skin disease is recognizing when early diagnostics or referral may have better clinical and financial outcomes. For example, early referral for chronic AOE to specialists resulted in improved clinical outcomes and reduced recurrence. Other considerations would be an early recommendation for referral to a specialist for suspected canine atopy in young patients who will require therapy for 5＋ yr, versus waiting until the patients fail all medical management options offered in general practice. A survey performed by the American College of Veterinary Dermatologists revealed that 82% of clients would have felt better about their primary care veterinarian if they had been referred earlier. Seventy-three percent of clients reached a “tipping point of frustration” if they visited their primary care veterinarian more than three times for a dermatologic issue, and 15% of these clients stopped visiting their primary care veterinarian for their pets’ routine care as well.

管理与过敏性皮肤病相关的短期和长期成本的财务考虑的一个重要部分是认识到何时早期诊断或转诊可能有更好的临床和财务结果。例如，慢性AOE的早期转诊专科医师可改善临床结果并减少复发。其他考虑因素包括，对于怀疑犬特应性皮炎的年轻患病动物，如果需要治疗5年以上，应尽早建议其转诊到专科医师处，而不是等到患病动物在全科医学中所有治疗方案都失败后再进行治疗。美国兽医皮肤科医师学会进行的一项调查显示，82%的客户如果能更早地被他们的初级保健兽医转诊，他们对兽医的感觉会更好。如果他们因为皮肤问题去初级保健兽医那里看了三次以上，73%的客户达到了“沮丧的临界点”，其中15%的客户不再为他们的宠物进行常规护理。

 

Step Five: Using Telehealth

第5步:使用远程医疗 

Because the management of allergic disease is so dependent on frequent communication, the use of telehealth technologies can cut costs and save both clients’ and veterinarians’ valuable time. Most practices are already using phone and email follow-ups. Photographs or videos sent from clients can be reviewed for progress in an asynchronous manner, allowing technicians to assist in the triage process. Video calling and communication platforms like FaceTime and Zoom can provide real-time visuals and conversations. It is important to remember, however, that many dermatologic conditions may be infectious in nature, and telehealth may have limited applications as it does not afford the opportunity to perform cytologic evaluations or otoscopic examination to detect occult cases of otitis externa. When using telehealth, it is important to follow all applicable laws and regulations regarding the establishment of a veterinarian-clientpatient relationship when required. For information about state-level requirements, contact the state board of veterinary medicine.

因为过敏性疾病的管理非常依赖频繁的沟通，使用远程医疗技术可以降低成本，节省客户和兽医的宝贵时间。大多数诊所已经使用电话和电子邮件跟进。客户发送的照片或视频可以非同步方式进行审查，以确定进展情况，从而允许技术人员协助分诊流程。像FaceTime和Zoom这样的视频通话和通信平台可以提供实时的视觉效果和对话。然而，重要的是要记住，许多皮肤疾病可能具有感染性，而且远程医疗的应用可能有限，因为它无法提供进行细胞学评估或耳镜检查以发现隐匿性外耳炎病例的机会。在使用远程医疗时，重要的是在需要时遵守有关建立兽医-客户-患病动物关系的所有适用法律和法规。有关州一级要求的信息，请联系州兽医委员会。

 

The use of teleconsulting to bridge the gap between the client and a specialist is also an increasingly available option to improve access to specialty care. Teleconsulting can be useful when access to specialists is limited by distance, wait times, or finances as this modality allows access to a wider number of specialists.

使用远程咨询让客户与专家之间得以沟通，也是一种越来越多的选择，可以改善获得专业护理机会。当获得专家的机会受到距离、等待时间或资金的限制时，远程咨询是有用的，因为这种方式允许与更多的专家沟通。

 

To learn more about integrating telehealth options into veterinary practice, refer to the 2021 AAHA/AVMA Telehealth Guidelines for Small-Animal Practice at aaha.org/telehealth.

要了解有关将远程医疗选项整合到兽医实践中的更多信息，请参阅2021年AAHA/AVMA小动物实践远程医疗指南aaha.org/telehealth。

 

Section 7: Technician Utilization in Managing Allergic Skin Diseases

第七部分:技术人员在处理过敏性皮肤病中的作用

Top 3 Takeaways:

三大要点:

1.Empower technicians to do everything within state regulations that does not require a veterinary medical degree.

2.Spend time training technicians on how to conduct diagnostic tests and the best way to explain procedures and treatments to clients.

3.Allowing technicians to do more will enable the veterinarian to see more patients more efficiently.

1.授权技术人员在国家规定的范围内做任何不需要兽医学位的事情。

2.花时间培训技术人员如何进行诊断测试，以及向客户解释程序和治疗的最佳方式。

3.允许技术人员做更多的事情将使兽医更有效地接诊更多的患病动物。

 

Overview

概述 

Credentialed veterinary technicians play essential roles in clinics that strive for outstanding client service, quality patient care, and efficient workflow. The only limiting factors are state regulations and a veterinarian’s willingness to train technicians to take over specific duties within defined parameters.

有资格的兽医技术人员在诊所中发挥着至关重要的作用，努力为客户提供卓越的服务，优质的患病动物护理和高效的工作流程。唯一的限制因素是国家法规和兽医愿意培训技术人员在规定的参数内接管特定职责。

 

Many technicians want more responsibility commensurate with their training, and empowering them to assume additional job duties is a wise investment of time for veterinarians. For more information on the many and varied roles technicians can take to streamline practice and improve patient care, see the 2023 AAHA Technician Utilization Guidelines at aaha.org/technician-utilization.

许多技术人员希望承担与他们所受培训相称的更多责任，对兽医来说，授权他们承担额外的工作职责是明智的时间投资。有关技术人员在简化实践和改善患病动物护理方面可以扮演的多种角色的更多信息，请参阅2023年AAHA技术人员使用指南，网址为aaha.org/technician-utilization。

 

Key Duties During the Examination

检查期间的主要职责

·Technicians are essential in many aspects of a veterinary dermatologic consultation, starting with a detailed dermatologic history, physical examination, and setting expectations.

·Technicians can collect, process, and interpret basic cytology. Training a technician on cytologic interpretation will take time, but once training is complete, the technician should be able to analyze slides very quickly. A single technician proficient in cytology can train the rest of the staff.

·Blood and urine can also be collected and processed by the technical staff.

·在兽医皮肤科会诊的许多方面，技术人员都是必不可少的，从详细的皮肤病病史、体格检查开始，并设定预期。

·技术人员可以收集、处理和解读基本的细胞学检查。对技术人员进行细胞学判读的培训需要时间，但一旦培训完成，技术人员应该能够非常快速地分析玻片。

·一名精通细胞学的技术人员可以对其余工作人员进行培训。血液和尿液也可由技术人员采集处理。

 

Key Veterinary Technician Duties During Patient Discharge

主要兽医技术员在患病动物出院期间的职责

·Discharge patients and review treatment plans with clients, including showing clients how to do treatments, such as ear cleanings or topical therapies, which greatly improves client compliance and therapy success rates.

·让患病动物出院，并与客户一起回顾治疗计划，包括向客户展示如何进行治疗，如耳道清洁或外部治疗，这大大提高了客户的依从性和治疗成功率。

·Double-check that medications have clear directions and are sent home with explanations.

·仔细检查药物是否有明确的说明，并在送回家时附有说明。

·Emphasize to clients how multiple types of therapies work together to achieve results; therefore, all need to be part of the comprehensive plan.

·向客户强调多种疗法如何协同工作以达到效果;因此，一切都需要成为综合计划的一部分。

·Remind clients to have realistic expectations when it comes to results. Most treatments do not work overnight, and it will take several weeks to see improvement. Technicians can help clients understand that they are beginning a long journey while reassuring them that they have the support of the veterinary team.

·提醒客户对结果要有现实的期望。大多数治疗都不会在一夜之间起作用，需要几周的时间才能看到好转。技术人员可以帮助客户了解他们正在开始一段漫长的旅程，同时向他们保证他们有兽医团队的支持。

 

Being aware of state regulations is the responsibility of the credentialed technician and the management team, and all actions taken must fall within the scope of their license. The entire veterinary team should become familiar with the scope of practice for credentialed technicians in their state 了解国家规定是持证技术人员和管理团队的责任，所有行为都必须在他们的许可范围内。整个兽医团队应该熟悉他们所在州的执业范围

 

 

Essential Duties During Follow-up and Ongoing Treatment

在随访和持续治疗期间的基本职责

Early interaction during appointments helps clients feel comfortable talking with technicians throughout follow-up and in instances in which the veterinarian is unavailable. Involving technicians in client education both in-clinic and once the patient leaves decreases the time the veterinarian spends on the phone or in the examination rooms.

预约期间的早期互动有助于客户在整个随访过程中以及兽医不在的情况下与技术人员交谈。让技术人员在诊所和患病动物离开后对客户进行教育，可以减少兽医花在电话或诊室上的时间。

 

Day-after calls to check on the patient(s) and ensure clients can complete all treatments as directed is one area where technicians can be involved. Phone follow-up is also beneficial at other times, such as 2–3 wk into a diet trial or 1 wk after starting anti-pruritic therapies. However, a caveat for risk management is that technicians must always document client discussions in the patient’s medical records, and “spoke with client” is inadequate. Thorough summaries of client discussions help protect the technician’s and veterinarian’s licenses should anyone ever question what was said.

技师可以隔天打电话回访患病动物，并确保患病动物能按指示完成所有治疗。电话随访在其他时间也有益，例如食物试验开始后2-3周或开始止痒治疗后1周。然而，风险管理需要注意的是，技术人员必须始终将客户的讨论记录在患病动物的病历中，而“与客户交谈”是不够的。彻底的客户讨论总结有助于保护技术员和兽医的执照，任何人都可以质疑他们所说的。

 

Practice Tip: Technicians can be involved in preparing short instructional videos that can be sent to clients or linked to the practice’s website.

临床提示:技术人员可以参与准备简短的教学视频，这些视频可以发送给客户或链接到临床网站。

 

Resources to Assist in Training Technicians

协助培训技术人员的资源

Resources that can be valuable to the veterinary team include the following:  

对兽医团队有价值的资源包括:

·Teaching sets of cytologic samples collected for training purposes

·Training videos, particularly if technicians have on-demand access

·A dedicated space for telehealth consultations that is well lit and quiet with a computer camera

·Locally offered continuing education courses or sessions put on by colleges and/or associations

·In-house continuing education for the whole veterinary team, including technicians and the veterinarian(s)

·为培训目的而采集细胞学样本教学集

·培训视频，特别是技术人员可按需访问的情况

·一个远程医疗咨询的专用空间，光线充足且有电脑摄像头

·本地提供继续教育课程或由大学和/或协会举办的课程

·内部为整个兽医团队(包括技术人员和兽医)提供继续教育

 

A veterinarian working with two technicians can see two appointments in the time it would otherwise take to see one. As Figure 7 shows, technicians can interface with clients from the beginning of an appointment through discharge and beyond. Having established a relationship with clients, they can be trusted team members for follow-up checks and maintenance program assistance. Working this way, a diagnostic plan can be developed for multiple patients in the time it could have taken to see only one patient.

与两名技术人员一起工作的兽医可以在看一次预约的时间内看两次预约。如图7所示，技术人员可以从预约开始一直到出院甚至更长时间与客户进行沟通。与客户建立了良好的关系，他们可以成为值得信赖的团队成员，进行后续的检查和维护项目的协助。通过这种方式，可以在只看一个病例的时间内为多个患病动物制定诊断计划。

 

Section 8: Client Communication

第八部分:客户沟通

Top 3 Takeaways:

三大要点:

1.Be clear about timelines and expectations—diagnosing and finding the right combination of treatments may take 2–4 mo or sometimes longer.

2.Openly discuss any client constraints at the first appointment, including time, work schedule, household environment, and financial concerns, so a realistic plan can be made.

3.Prepare clients for the fact that flares occur even in well-managed cases so that they do not get frustrated when they happen.

1.明确时间表和预期-诊断和找到正确的治疗组合可能需要2-4个月或有时更长时间。

2.首诊时，公开讨论客户的任何限制，包括时间、工作安排、家庭环境和财务问题，以便制定一个现实的计划。

3.让客户做好准备，即使在管理良好的情况下也会突然发作，这样他们就不会在突然发作时感到沮丧。

 

Overview

概述

Effective client communication is vital in every aspect of a practice. However, client communication becomes even more paramount when initially explaining diagnostic options, time frames, and treatment variables for allergic dogs and cats. With most of these patients, this is the start of a long journey, and clients should be informed that there are likely no quick fixes or cures, only lifetime management strategies.

有效的客户沟通在临床各个方面都是至关重要的。但是，在早期与客户沟通过敏症患犬和患猫的诊断选择、时间框架和治疗变化更为重要。对于大多数患病动物来说，这是一个漫长旅程的开始，应告知客户，不太可能有快速恢复或治愈，只有终身管理策略。

 

How effectively the veterinary team explains short-term and long-term steps toward relief and healing will set up the client’s expectations for what lies ahead.

兽医团队如何有效地解释缓解和治疗的短期和长期方法，将建立客户对未来的期望。

 

Communication should start at the first appointment and carry on throughout all follow-up visits. It is important to openly, and without judgment, discuss any constraints (e.g., time, work schedules, transportation, finances, and/or inability to administer specific treatments) to better negotiate a plan that cares for the patient and is within the client’s capability.

沟通应从首诊预约开始，并在所有复诊期间进行。重要的是，公开地、不加评判地讨论任何限制条件(例如，时间、工作安排、交通、财务和/或无法实施特定治疗)，以便更好地协商出一个既关心患病动物又在客户能力范围内的计划。

 

10 Key Messaging Points When Talking to Clients

与客户交谈时的10个关键信息要点

Each dog and cat will need a specifically tailored plan for the pet and client. Although there are basic steps to follow, some pets will respond to one approach and others to another. Keep in mind that diagnosing allergic skin diseases can be a long process that can become frustrating and confusing for clients.

每只犬和猫都需要为宠物和客户量身定制一个计划。虽然有一些基本的步骤可以遵循，但有些宠物会对一种方法有效，而另一些则会对另一种方法有效。请记住，诊断过敏性皮肤病可能是一个漫长的过程，可能会让客户感到沮丧和困惑。

 

1.Be clear about goals: The goal is to bring the pet relief as soon as possible, which often requires clearing any secondary infections that may be present, possibly even before the source of the allergy is determined.

2.Be clear about the costs associated with diagnosis and treatment. Emphasize that altering strategies to meet the client’s current capacities does not mean substandard care. Offer referral as an option and allow the client to make an informed decision.

3.Provide timelines for clients. Determining the best long-term treatment plan for an individual patient may take 2–4 mo. Be clear about the stages of diagnosis/treatment and what needs to happen concurrently.

4.Let clients know that management of the allergy is for the pet’s life and medication adjustments will likely be needed over time. Alert the client that flares are not uncommon, even if their pet is well managed.

5.Strive for empathetic and nonjudgmental communication so that clients feel comfortable expressing concerns, bringing up constraints, and asking questions if they do not understand something. Encourage clients to be active partners in determining the health of their pets.

6.Recognize that clients may suffer from information overload and become overwhelmed during appointments. Provide clear written instructions and repetition, and if necessary, take a break so they can process the information.

7.Ask the client how they prefer to receive information, for example, verbally, written, or on video. Provide several options and always send home written or recorded instructions they can refer to later.

8.Precise wording and label instructions are keys to good compliance and secondary infection control. For example, to maintain an adequate serum concentration level of cefpodoxime, be sure to say, “Administer one tablet by mouth at the same time once every 24 hours,” instead of saying, “Administer one tablet daily.”

9.Praise clients for compliance when they bring their pets for rechecks, even if the improvement is slight.

10.Be sure to talk to clients about ongoing monitoring, like blood work, depending on what medications their animal is receiving.

1.明确目标:目标是尽快缓解宠物的症状，这通常需要清除可能存在的继发性感染，甚至可能在确定过敏源之前。

2.要清楚与诊断和治疗相关的费用。强调改变策略以满足客户目前的能力并不意味着不合格的治疗。将推荐作为一种选择，并允许客户做出明智的决定。

3.为客户提供时间表。为每个患病动物确定最佳的长期治疗计划可能需要2-4个月。明确诊断/治疗的阶段以及同时需要进行的工作。

4.让客户知道对过敏的管理是为了宠物的生活，且药物调整可能需要一段时间。提醒客户，即使他们的宠物管理得很好，也常见出现突然发作。

5.努力进行有同理心的和非评判性的沟通，这样客户可以放心地表达担忧，提出限制，并在他们不理解某事时提出问题。鼓励客户积极参与决定宠物的健康状况。

6.要认识到客户可能会遭受信息超载的困扰，并在预约期间变得不知所措。提供清晰的书面指示和重复，如果有必要，休息一下，让他们可以处理信息。

7.询问客户他们喜欢如何接收信息，例如，口头、书面或视频。提供几种选择，并总是把书面或录制的说明寄回家，他们以后可以参考。

8.准确的措辞和写说明是良好依从性和继发感染控制的关键。例如，为了维持足够的头孢泊肟血清浓度水平，一定要说“每24小时口服一片，服药时间相同”，而不是说“每天服用一片”。

9.当客户带着他们的宠物来复查时，表扬他们的依从性，即使改善很小。

10.一定要和客户谈论持续的监测，如血液检查，根据他们的动物正在接受的药物。

 

Summary

总结

Managing allergic skin diseases in dogs and cats requires a multimodal, communication-rich approach to ensure positive outcomes. A detailed history must be taken, including response to previous treatment, and a physical examination must be performed with particular attention to ears, skin folds, and paws. A minimum dermatologic database should be collected (cytology of skin and ears, skin scrapings, ± DTM). Optimal technician utilization can result in more efficient intake, management, and follow-up of cases. Effective communication with clients is crucial for these often-frustrating cases. Clients must be prepared for the fact that these cases require lifelong maintenance and treatment for the occasional flares that will occur even in the most well-managed patients. Collaborative care with dermatology specialists has been shown to increase client satisfaction and speed resolution of cases and should be considered early for some patients. SOC considerations entail “meeting clients where they are” and providing viable options, while emphasizing that these options do not mean the pet is getting substandard care.

管理犬和猫的过敏性皮肤病需要一种多模式、充分沟通的方法，以确保效果良好。必须详细询问病史，包括对以前治疗的反应，必须进行体格检查，特别注意耳道、皮肤皱褶和爪子。应收集最少的皮肤病学数据库(皮肤和耳道的细胞学、皮肤刮片、±DTM)。优化技术人员的使用可以使病例就诊、管理和随访更加有效。对于这些经常令人沮丧的案例，与客户的有效沟通至关重要。客户必须做好准备，这些病例需要终生维持和治疗，即使是管理最良好的患病动物也会偶尔发作。与皮肤科专家的合作治疗已被证明可以提高患病动物的满意度和病例的快速解决，对于一些患病动物应及早考虑专科会诊。SOC的考虑包括“在客户所在的地方面诊”，并提供可行的选择，同时强调这些选择并不意味着宠物得到了不合格的护理。

 

 

 

 

 

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刘双元

丢丢王

太棒啦！受益匪浅！

丁上阳

"全身性糖皮质激素可在食物试验和/或寄生虫治疗试验的第3周时停用，并在第6周时再次停用，以评估仅食物管理的
老师，这句话是什么意思呀？有点不理解，3周停药了，为何6周再次停药

杨先生

萌萌爸

学习了