伴侣动物食物不良反应的批判性评价话题(2):犬、猫常见的...

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伴侣动物食物不良反应的批判性评价话题(2):犬、猫常见的食物过敏原

Critically appraised topic on adverse food reactions of companion animals (2): common food allergen sources in dogs and cats.

Ralf S. Mueller, Thierry Olivry and Pascal Prélaud

翻译：张亚飞

摘要

背景:为了诊断犬、猫

皮肤食物不良反应(CAFRs)，进行了食物排查-激发试验。了解这些物种最常见的食物过敏原有助于确定食物激发的顺序，从而优化诊断时间。

结果:对截止至2015年1月16日的最佳证据的研究、回顾和分析表明，最可能导致犬CAFRs的食物过敏原是牛肉、乳制品、鸡肉和小麦。猫最常见的食物过敏原是牛肉、鱼和鸡肉。

结论:在犬、猫中，经过一段时间的饮食限制使临床症状完全缓解后，诊断CAFR的食物激发应该从这两种动物中最常见的食物过敏原—牛肉和乳制品开始。

关键词:过敏原；过敏症；特应性皮炎；犬科；猫；日粮；犬；猫科；食物过敏

Abstract

Background: To diagnose cutaneous adverse food reactions (CAFRs) in dogs and cats, dietary restriction-provocation trials are performed. Knowing the most common offending food allergens for these species would help determining the order of food challenges to optimize the time to diagnosis.

Results: The search for, and review and analysis of the best evidence available as of January 16, 2015 suggests that the most likely food allergens contributing to canine CAFRs are beef, dairy products, chicken, and wheat. The most common food allergens in cats are beef, fish and chicken.

Conclusions: In dogs and cats, after a period of dietary restriction leading to the complete remission of clinical signs, food challenges to diagnose CAFR should begin with beef and dairy products, the most commonly recognized food allergens in these two species.

Keywords: Allergen, Allergy, Atopic dermatitis, Canine, Cat, Dietary, Dog, Feline, Food allergy

背景

Background

犬、猫皮肤食物不良反应(CAFRs)的诊断依赖于食物排查-激发试验。了解犬猫最常见的过敏原有助于确定应该先从哪些食物激发，从而更快地确诊CAFR。

The diagnosis of cutaneous adverse food reactions (CAFRs) in dogs and cats relies on the performance of dietary restriction-provocation trials. Knowing the most common offending allergens in these species would help determine which food challenges should be performed first to faster confirm the diagnosis of CAFR.

临床案例

Clinical scenarios

您有两个患畜:第一只是1岁、雄性拉布拉多寻回犬，有3个月的瘙痒史和反复的黏液性腹泻。这只犬已经吃了6个月的犬粮。身体检查中，除了直肠触诊时有软便外，无其它异常。第二只患畜是一只两岁大的雌性波斯猫，抓挠面部近一年。大剂量的泼尼松龙对这种自我损伤病变有效果。身体检查发现猫比预期的要瘦，头部和颈部有皮屑。您怀疑这两只患畜可能对他们的日粮有反应，但您想知道标签上列出的哪一种成分是最有可能的过敏原。

You have two patients: The first is a 1-year-old male Labrador retriever with a 3-month history of pruritus and recurrent mucous diarrhea. This dog has been eating a commercial diet for the last 6 months. On physical examination, you do not detect anomalies besides soft stools on rectal palpation. Your second patient is a 2-year-old female spayed Persian cat that has been scratching her face for the last year. This self-trauma only responds partially to high dose of prednisolone. Physical examination reveals the cat to be thinner than expected and to have excoriations on the head and neck. You suspect that both patients could be reactive to their commercial diets, but you wonder which one of the ingredients listed on the labels would be the most likely sources of allergens.

问题框架

Structured question

在疑似CAFR的犬、猫中，哪些食物来源最常被报道在激发试验时诱发临床症状?

In dogs and cats suspected of CAFR, which food sources are most often reported to induce clinical signs after challenge?

搜索方法

Search strategy

2015年1月16日，使用CAB文摘网和科学数据库网站（科学引文索引），检索以下内容:((犬或犬（复数）或犬科) 或(猫或猫（复数）)或猫科) 和 (食物或日粮*) 和(过敏* 或异位* 或超敏反应* 或不耐受)。搜索范围仅限于1985年至2015年。对已确定文章的参考文献再进一步搜索其他相关报告。

The CAB Abstracts and Web of Science (Science Citation Index Expanded) databases were searched on January 16, 2015, using the following string: ((dog or dogs or canine) or (cat or cats or feline)) and (food or diet*) and (allerg* or atop* or hypersens* or intolerance). The search was limited to the period 1985 to 2015. Bibliographies of identified articles were then further searched for additional relevant reports.

鉴定的证据

Identified evidence

我们的文献检索发现 CAB 文摘网和科学数据库网站中分别有140和1534条引文，其中分别包括3篇和15篇相关信息。未被选择的引用是那些没有明确识别出犬、猫有CAFR临床症状的过敏原的文章。六个相关的引文在电子检索找到的文章的参考书目中被确定，其中三个来源是近期会议记录的摘要。在犬猫食物不良反应临床症状的病例报告或病例分析中，在评估食物不良反应诊断技术的研究中，或(很少)评估由多种原因导致的反应模式的研究中，如血管炎或对称性狼疮甲床炎，均报道了过敏原。激发试验阳性被认为是明确过敏原的唯一可靠证据。从这些选定的发表文献中，我们汇总了各种食品成份出现激发试验阳性的病例数量，并计算了在犬总数中占的反应频率。

Our literature search identified 140 and 1534 citations in CAB Abstracts and Web of Science, of which three and 15 respectively contained relevant information. Citations that were not selected were those of articles not specifically identifying offending allergens in dogs and cats exhibiting clinical signs of CAFR. Six more relevant citations were identified in the bibliography of articles found with the electronic search , and three sources were abstracts of recent conference proceedings . Offending allergens were reported in case reports or case series of dogs and cats with clinical evidence of adverse food reaction , in studies evaluating diagnostic techniques for adverse food reactions or (rarely) in studies evaluating reaction patterns such as vasculitis or symmetrical lupoid onychitis with multiple causes . A positive rechallenge was considered the only solid evidence for identifying an offending allergen. From these selected publications, we added the number of cases in which positive challenges had occurred with the various food items, and the frequency of reaction among total number of dogs was calculated.

证据的评估

Evaluation of evidence

在所选研究的297只犬中，每只犬至少报告了一种食物过敏原，总结见表1。在犬CAFR中最常报道的食物过敏原有牛肉(102只犬,占34%)、乳制品(51只犬,占17%)、鸡肉(45只犬,占15%)、小麦(38只犬,占13%)和羊肉(14只犬， 占5%)。其他较少被报道的食物过敏原包括大豆(18只犬，占6%)、玉米(13只犬，占4%)、鸡蛋(11只犬，占4%)、猪肉(7只犬，占2%)、鱼肉和大米(各5只犬，占2%)。大麦、兔肉、巧克力、芸豆和西红柿，在某只犬中，也有作为食物过敏原的报道的。

Altogether, at least one offending food allergen source was reported in each of the 297 dogs included in the selected studies (Table 1). The most frequently reported food allergens involved in CAFRs in dogs were beef (102 dogs, 34 %), dairy products (51 dogs, 17 %), chicken (45 dogs, 15 %), wheat (38 dogs, 13 %) and lamb (14, 5 %). Other less commonly reported offending food sources were soy (18 dogs, 6 %), corn (13 dogs, 4 %), egg (11 dogs, 4 %), pork (7 dogs, 2 %), fish and rice (5 dogs each, 2 %). Barley, rabbit, chocolate, kidney bean and tomato were also reported as food allergens for single dogs.

在选定的文章中报道的78只猫中，每只猫至少有一种食物过敏原(表2)。食物来源最常导致猫CAFR的是牛肉(14只猫，18%)、鱼肉(13只猫，17%)、鸡肉(4只猫，5%)、小麦、玉米和乳制品(各3只猫，4%)和羊肉(2只猫，3%)。鸡蛋、大麦和兔肉在个别猫中也有作为食物过敏原的报道。

At least one food allergen was identified in each one of the 78 cats reported in selected articles  (Table 2) . The food sources most frequently causing CAFR in cats were beef (14 cats, 18 %), fish (13 cats, 17 %), chicken (4 cats, 5 %), wheat, corn and dairy products (3 cats each, 4 %) and lamb (2 cats, 3 %). Egg, barley and rabbit were also reported as offending allergens in individual cats.

在解释所提供的数据时有几个局限性。在大多数研究中，并没有提供单一过敏原激发的详情。此外，大多数报告只列出了与激发试验时症状复发有关的过敏原，而没有列出与激发试验阴性相关的过敏原;这可能会影响对过敏原流行率的评估。只有五项研究对犬使用了标准的激发试验。在这些研究中，文献中收集到的数据反应为牛肉、鸡肉、小麦、大豆和乳制品是最常见的过敏原。在猫上，只有一项研究尝试了这些相同的激发试验，而牛肉、鱼肉和鸡肉是该研究中最常见的过敏原。此外，一般不提供旧日粮，从而妨碍了对数据的临床相关解释。因此，在此收集的信息不允许一个过敏原的流行率的真实估计，也不允许任何关于旧日粮激发阳性的可能性的声明。最后，本文中发现的过敏原可能只是反映了过去几十年宠物的进食习惯，一旦新的宠物食品变得流行并被更频繁地使用，这些过敏原可能会改变。

There were several limitations in interpreting the data presented. In most studies details of the provocation with individual allergens were not provided. Furthermore, most reports only listed allergens associated with a deterioration of signs upon rechallenge, but not those associated with negative provocations; this could possibly bias the estimation of the prevalence of offending allergens. Only five studies had used a standardized rechallenge sequence in dogs. In these studies, beef, chicken, wheat, soy and dairy products were the most common involved allergens, reflecting the data gathered from the literature. In cats, only one study attempted those uniform provocations , and beef, fish and chicken were the allergens most commonly involved in that study. In addition the previous diet history was generally not provided, thereby preventing a clinically relevant interpretation of the data. Thus, the information gathered herein does not allow a true estimate of the prevalence of offending allergens nor any statement about the likelihood of positive provocations in relation to previously fed foods. Finally, the offending allergens found herein could merely reflect pet feeding habits in the preceding decades, and these allergens could change once new pet foods become fashionable and used more frequently.

结论和启示

Conclusion and implication for practitioners

对于生活在澳大利亚、欧洲或北美的犬来说，最有可能导致CAFRs的过敏原是牛肉、乳制品、鸡肉、小麦和羊肉。因此，这些食物应该是第一个用于过敏原激发的CAFR诊断。在猫中，最常见的导致CAFRs的过敏原是牛肉、鱼肉和鸡肉。

In a dog living in Australia, Europe or North America, the allergens most likely contributing to CAFRs are beef, dairy products, chicken, wheat and lamb. As a result, these foods should be the first used for allergen provocation for CAFR diagnosis. In cats, the most common allergens causing CAFRs are beef, fish and chicken.

重点是，已确定的证据不允许估计患有CAFR的犬和猫的实际过敏原流行率，因为动物通常只接受少量——但不是全部——过敏原的激发。因此，每种过敏原在犬、猫身上的实际患病率可能比上述报告的要高。

Importantly, the identified evidence does not allow an estimation of the real prevalence of offending allergens in the population of dogs and cats with CAFR, as animals were usually only challenged with a small number of—but not all— allergens. As a result, the true prevalence of each offending allergens in dogs and cats is likely to be higher than that reported above.

重要的是，所有这些患病率的评估都需要通过前瞻性研究进行重新评估，这些前瞻性研究对更多的动物进行了限制和再激发，并详细记录了它们的旧日粮。

Importantly, all these estimates of prevalence will need to be reevaluated with prospective studies performing controlled rechallenges in a larger number of animals with a detailed history of their previous dietary exposure.

笼中红细胞

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南海

曾医生