Feline allergic diseases: introduction and proposed nomenclature
Richard Halliwell*, Cherie M. Pucheu-Haston† , Thierry Olivry‡ , Christine Prost§, Hilary Jackson¶, Frane Banovic** , Tim Nuttall* , Domenico Santoro†† , Petra Bizikova‡ and Ralf S. Mueller‡‡ 翻译：董婉君，校对：刘欣 背景-猫过敏性疾病对临床医生来说是一个具有挑战性的问题，尤其是因为猫皮肤病大量的表现形式，这些都不是过敏所特有的。此外，关于其描述中使用的术语也存在一些争议。 Background – Feline allergic diseases present as challenging problems for clinicians, not least because of the number of reaction patterns of the feline skin, none of which are specific for allergy. Furthermore, there is some controversy over the nomenclature that should be used in their description. 目的-回顾文献，评估对于这些疾病的主题和内容的认知水平，将其归类为特应性疾病，谨提出命名建议。 Objectives – To review the literature, assess the status of knowledge of the topic and the extent to which these diseases could be categorized as atopic in nature, and make recommendations concerning nomenclature.方法-研究人类和猫的特应性疾病。然后对两个物种的基本特征进行比较。 Methods – Atopic diseases in humans and cats were researched. A comparison then was made of the essential features in the two species 结果-人类特应性疾病和推测为过敏性疾病猫的临床症状有足够的相似性，即证明使用“特应性”描述影响皮肤、呼吸道和胃肠道的一些猫的疾病是合理的。 Results – There were sufficient similarities between human atopic diseases and the manifestations of feline diseases of presumed allergic aetiology to justify the use of “atopic” to describe some of the feline conditions affecting the skin, respiratory and gastrointestinal tract. However, none of the allergic skin diseases showed features consistent with atopic dermatitis as described in man and the dog. 结论和临床重要性—拟定术语“猫特应性综合征”(FAS)包括皮肤、胃肠道和呼吸道过敏性疾病，拟定术语“猫特应性皮肤综合征”(FASS)描述与环境相关的过敏性皮肤病。我们尚不清楚除了食物引起的免疫反应以外其他的食物不良反应。因此，我们提议用“食物过敏”(FA)病因学的定义来描述这些病例。 Conclusions and clinical importance – The term “Feline Atopic Syndrome” (FAS) is proposed to encompass allergic diseases of the skin, gastrointestinal tract and respiratory tract, and “Feline atopic skin syndrome” (FASS) proposed to describe allergic skin disease associated with environmental allergies. We are not aware of any adverse food reactions in cats that are attributable to causes other than immunological reactions against the food itself. We therefore propose an aetiological definition of “Food Allergy” (FA) to describe such cases. 引言 Introduction 推测为过敏的猫皮肤病研究远远落后于犬。部分原因可能是犬特应性皮炎(AD)与人类对应的疾病具有惊人的相似性，许多研究将犬疾病作为人的实验模型。猫皮肤病学区别于其他物种的另一个原因是，猫的炎症性皮肤病表现为一系列的反应模式，其中一些模式似乎是该物种所独有的，而且每种反应模式又可能有多种激发原因。因此，不能期望任何特定的猫疾病在犬或人中有类似的症状。用于描述猫皮肤病的术语也缺乏一致性，一些人倾向于采用病因学方法1，而其他作者倾向于使用与人和犬相似的术语2。此外，关于影响胃肠道和呼吸道的自发性过敏反应疾病的数据很少，尽管猫哮喘的实验模型特征明显3。 Research into feline skin diseases of presumed allergic aetiology has lagged far behind that in allergic dogs. In part, this may be due to the fact that canine atopic dermatitis (AD) has striking similarities with its human counterpart, and much research has focussed on the canine disease as an experimental model of the latter. Another issue that sets feline dermatology apart from that in other species is that inflammatory skin diseases of the cat present with a spectrum of reaction patterns, some of which appear to be unique for this species, and the fact that each reaction pattern may in turn have a wide range of inciting causes. Thus, one cannot expect that any particular feline condition will show similar manifestations to the disease homologues in dogs or in people. There also is a lack of agreement regarding the nomenclature used to describe feline skin diseases, with some favouring an aetiological approach,1 whereas other authors prefer to employ a terminology that as far as possible parallels that used in humans and dogs.2 Furthermore there is a paucity of data on the spontaneous hypersensitivity disorders affecting the gastrointestinal and respiratory tracts, although the experimental model of feline asthma has been well-characterized.3 这篇论文是猫过敏性皮肤病系列中的第一篇，适时回顾了相关主题的已发表文献。本引言先从历史性回顾人类过敏性疾病的基本特征开始，随后评估各种猫过敏性疾病，这些均可被视为与人病相同的临床病理病种。如果使用相同的描述不合理，则建议使用替代术语。随后的三篇论文根据最新知识，回顾了关于猫皮肤和呼吸道过敏性疾病的免疫发病机制、临床症状和诊断特征，最后是治疗选择。 This paper, the first in a series on feline allergic skin diseases, is timely, as it reviews the relevant published literature on these topics. This introduction commences with a historical review of the essential features of human allergic diseases, which is followed by an assessment of the extent to which the various feline allergic disorders can be considered as equivalent clinicopathological entities. Where the use of the same descriptors does not appear justified, alternative terminology is proposed. The ensuing three papers review the current knowledge regarding the immunopathogenesis of allergic diseases affecting the feline skin and lungs, their clinical signs and diagnostic features, and, finally, the therapeutic options. 人的特应性疾病 Atopic diseases of man 1“特应性”的定义和皮肤致敏抗体的性质 1 The definition of “atopy” and the nature of skin-sensitizing antibody. 许多术语和我们对人类过敏的基本理解都来自于20世纪20年代和30年代的开创性工作。“特应性”一词取自希腊语“怪病”，1923年由Coca和Cooke4提出，描述他们认为有很多共同点的两种疾病，即哮喘和花粉病—或过敏性鼻炎。Sulzberger5提出了AD的特征，1934年，Coca在他对“特应性”定义时纳入了这种情况6。特应性疾病的基本特征定义为具有影响皮肤、呼吸道和/或胃肠道的过敏性疾病的家族倾向。Prausnitz和Kustner的早期开创性研究发现了它们与皮肤致敏抗体的相关性7。后者对煮熟的鱼非常敏感，对生鱼不敏感。反应性抗体不结合补体，不与抗原沉淀，无法致敏豚鼠皮肤。然而，它能够使不过敏人类的皮肤致敏。将Kustner血清皮内注射到Prausnitz手臂后，之后用熟鱼抗原激发时出现风团和潮红反应。Prausnitz本人患有季节性花粉症，对黑麦草表现出很强的刺激反应。然而，矛盾的是，他的血清不能以类似的方式使Kustner的皮肤致敏。 Much of the terminology and our basic understanding of allergy in humans resulted from pioneering work undertaken in the 1920s and 1930s. The term “atopy”, taken from the Greek meaning “strange disease”, was introduced in 1923 by Coca and Cooke4 to describe two diseases that they believed had much in common, namely asthma and hay-fever – or allergic rhinitis. The characterization of AD was attributed to Sulzberger,5 and in 1934, Coca included this condition under his definition of “atopic”.6 The essential features of an atopic disease were defined as a familial predisposition to allergic disease affecting the skin, respiratory and/or gastrointestinal tract. The discovery of their association with skin-sensitizing antibodies resulted from the earlier seminal studies of Prausnitz and Kustner. 7 The latter was exquisitely sensitive to cooked fish and not to raw fish. The antibody responsible did not fix complement, did not precipitate with antigen and was not able to passively sensitize guinea pig skin. However, it was able to sensitize the skin of a nonallergic human recipient. Following the injection of Kustner’s serum intradermally into the arm of Prausnitz, a wheal-and-flare reaction developed on subsequent challenge with cooked fish antigen. Prausnitz himself suffered from seasonal hay-fever and showed strong pricktest reactivity to ryegrass. However, paradoxically his serum was not able to sensitize the skin of Kustner in a similar manner. Coca和Grove进一步研究了这一现象，他们为这种皮肤致敏抗体引入了术语“反应素”8。他们证实，该物质不耐热，将血清加热到56℃30 min后，皮肤致敏能力大量丧失。进一步研究显示11%个体的皮肤对被动致敏完全无反应，另外5%仅部分有反应。 因此，在使用被称为Prausnitz–Kustner（或PK）试验进行定量研究方面存在困难。在随后的四十年中，花费了大量的精力来进一步验证反应素的性质，并确定其属于哪种抗体类型。最后，在20世纪60年代末，夫妻团队Ishizakas的艰苦工作表明，它属于一个迄今未被描述的抗体类型，他们将其命名为cE，后来被称为免疫球蛋白(Ig)E9。 This phenomenon was further investigated by Coca and Grove8 who introduced the term “reagin” for this skin-sensitizing antibody. They confirmed that it was heat labile and that the skin-sensitizing ability was largely lost after heating the serum to 56°C for 30 min. They further showed that the skin of 11% of individuals was wholly nonreceptive to passive sensitization, and a further 5% were only partially receptive. There were difficulties, therefore, in using what came to be known as the Prausnitz–Kustner (or PK) test for quantitative studies. Much effort was expended over the ensuing four decades in characterizing further the nature of the reagin, and in determining to which antibody class it belonged. Finally, in the late 1960s the painstaking work of the Ishizakas, a husband and wife team, showed that it belonged to a hitherto undescribed antibody class that they designated cE, or as it later became known, immunoglobulin (Ig)E.9 2外源性和内源性特异性疾病 2 Extrinsic and intrinsic atopic diseases 在发现IgE后仅几年，明显发现并非所有哮喘病例均与过敏原特异性IgE升高相关10，并且在AD和鼻炎方面也观察到相似情况。由此定义了三种特应性疾病的两种不同变体-“外源性”（与环境和/或食物过敏原的IgE水平升高相关）和“内源性”（未检测到IgE致敏）11。也分别被称为“过敏”和“非过敏”。后者的发病机制尚不清楚，尽管所有的炎症通路显示高度活化（包括Th12），但术语“非过敏性”似乎缺乏依据12。这些变体不仅显示免疫学差异，还显示不同的临床光谱。在人上，约16-45%13,14的AD病例和10-33%15,16的哮喘病例是内源性的，同样，9-42%的鼻炎病例与IgE无相关性17。 Only a few years after the discovery of IgE it became clear that not all cases of asthma were associated with elevated allergen-specific IgE,10 and similar observations were made in relation to AD and rhinitis. This has led to the definition of two distinct variants of the three atopic diseases –“extrinsic”, which is associated with elevated IgE levels to environmental and/or food allergens, and “intrinsic” which has no detectable IgE sensitization.11 These also have been referred to respectively as “allergic” and “nonallergic”. The pathogenesis of the latter is unclear, although as higher activation of all inflammatory pathways assessed – including Th2 – has been shown in the latter,12 the term “nonallergic” appears to lack justification. These variants show not only immunological differences, but also differing clinical spectra.11 In humans, it is estimated that 16–45% of cases of AD are intrinsic,13,14 10–33% of cases of asthma are intrinsic15,16and, likewise, 9–42% patients with rhinitis lack any association with IgE.17 3特应性疾病并行 3 The atopic march 病患可同时出现一种以上的特应性疾病症状，特应性个体倾向于在幼年表现AD症状，然后发展为哮喘和/或过敏性鼻炎。在英国进行的一项研究中，对来自特应性家庭的100名婴儿进行了为期22年的随访19。到1岁时，20%的儿童已发生AD，到研究结束时发病率降至5%。在同一时期，过敏性鼻炎的发生率从3%增加到15%，提示哮喘的患者比例增加到40%19。然而，“特应性并行”一词的合法性最近受到质疑，随着时间的推移，不同因素导致了疾病谱系的变化20。 Patients can present with more than one manifestation of atopic disease at the same time, and there is a tendency for atopic individuals to first exhibit signs of AD in childhood, and then progress to develop asthma and/or allergic rhinitis.18 In one study conducted in the UK, 100 infants from atopic families were followed over a 22 year period.19 By 1 year of age, 20% of the children had developed AD, and the incidence had declined to 5% by the end of the study. Over the same period, the incidence of allergic rhinitis increased from 3% to 15%, and the proportion of patients that developed a wheeze indicative of asthma increased to 40%.19 However, the legitimacy of the term “atopic march” has recently been questioned and differing factors have been suggested to play a role in the changing spectrum of the diseases over time.20 猫过敏性疾病在多大程度上满足特应性标准？ To what extent do feline allergic diseases satisfy criteria as being atopic in nature? 1 是否有遗传性的证据？ 1 Is there evidence of a genetic basis? 猫遗传学的研究还处于起步阶段，然而一些证据表明猫过敏性疾病可能存在遗传基础。 The study of feline genetics is in its infancy, yet several pieces of evidence suggest a possible genetic basis for feline allergic diseases. 第一份报告显示匈牙利猫近交系26只猫中的8只(31%)，表现皮炎和呕吐伴嗜酸性粒细胞增多，归因于食物过敏21。吃低敏粮后，所有动物的临床症状均消退，并且在食物激发试验后，有4个病例复发。 The first is contained in a report of dermatitis and vomiting with accompanying eosinophilia in eight of 26 (31%) individuals in an inbred colony of cats from Hungary which was attributed to food allergy.21 The clinical signs in all eight resolved on feeding a hypoallergenic diet and a relapse was noted in four cases following dietary challenge. 第二份报告描述了3只12个月大的家养短毛猫同猫仔，均有抓挠面部、舔舐腹部、啃咬腿部的报道。6月龄发病，逐渐加重。就诊时可见面部胡须弯曲、断裂，嘴唇和皮肤结合处出现红斑。有轻度耵聍外耳炎，耳部和腹侧毛发变薄，四肢有局灶性脱毛区。1只猫的面部存在抓痕伴随结痂，有严重的耵聍性外耳炎。该病对食物过敏试验无反应。一年后皮内试验(IDTs)发现多种过敏原，三者对过敏原特异性免疫治疗(ASIT)均表现出良好的反应，花粉季节高峰期有轻微复发。这些特征与特应性的诊断完全相符。据报道，母猫还存在季节性头颈部结痂，但未能进一步调查。 The second was a description of three 12-month-old domestic short hair cat littermates, all of whom were reported to rub their faces, lick their abdomens, and bite and nibble their legs.22 The condition had gradually worsened from the onset at 6 months of age. Upon presentation, the facial whiskers were bent and broken, and the commissures of the mouth were erythematous. There was a mild ceruminous otitis externa, thinning of the hair on the ears and ventral abdomen, and focal areas of hair loss on the extremities. One cat was more severely affected with crusting lesions on the face with linear excoriations, and a severe ceruminous otitis externa. The condition was unresponsive to a hypoallergenic diet trial. A year later intradermal tests (IDTs) revealed multiple sensitivities, and all three showed a good response to allergen-specific immunotherapy (ASIT), with minor relapses at the height of the pollen season. These features are entirely compatible with a diagnosis of atopy. The mother of the cats also was reported to suffer seasonal outbreaks of crusting and scabs on the head and neck, yet further investigations were not permitted. 一系列病例报告的数据也确定了一些品种倾向。在588只瘙痒猫的多中心研究中，381只被诊断为患有过敏性皮肤病(HD)23。首先将其细分为患有跳蚤过敏性皮炎(FAD)(n = 146)和非跳蚤HD(n = 235)的病患，后一组包括食物HD和非跳蚤/非食物HD。与前一组相比，后一组中纯种猫（暹罗猫、波斯猫、阿比西尼亚猫和缅因猫）的比例显著过高，作者解释为这组可能为遗传性。来自澳大利亚的第二份报告描述了45例具有与AD相同症状的病例，所有病例对跳蚤控制和食物排查试验均无反应2。与基础诊所病例相比，国内混血猫、阿比西尼亚和德文卷毛猫易感。在教学医院就诊的194例AD病例的进一步报告中，阿比西尼亚猫、喜马拉雅猫和波斯猫为代表24，阿比西尼亚猫也参与了德国25的一份报告，该报告描述了5只发生心肌病的阿比西尼亚猫，其中3只出现瘙痒性皮炎。虽然没有充分证明，但其与AD相符。在2例病例中，皮肤病伴随鼻炎和结膜炎，血常规显示外周嗜酸性粒细胞增多。接种疫苗和给予青霉素后，两只猫发生了同样的过敏反应。 Data derived from reports of case series also have identified some breed predispositions. In a multicentre study of 588 pruritic cats, 381 were diagnosed as suffering from a hypersensitivity dermatosis (HD).23 They were first subdivided into those suffering from flea allergy dermatitis (FAD) (n = 146) and nonflea HD (n = 235), with the latter group comprising food HD and nonflea/nonfood HD. Pure-bred cats (Siamese, Persian, Abyssinian and Maine coon) were significantly over-represented in the latter group as compared with the former, which the authors interpreted as indicating a possible genetic basis for this group of diseases. The second report from Australia described 45 cases with signs compatible with AD, all of which failed to respond to flea control and hypoallergenic diet trials.2 Compared to the base clinic population, domestic mixed breeds, Abyssinian and Devon rex were predisposed. In a further report of 194 cases of AD seen at a teaching hospital, Abyssinians, Himalayans and Persians were over-represented,24 and the Abyssinian also was implicated in a report from Germany25 which described five related Abyssinian cats that developed cardiomyopathy, three of which that also developed a pruritic dermatitis. Although this was not fully characterised, it was compatible with AD. In two cases, the skin disease was accompanied by episodes of rhinitis and conjunctivitis and the cats showed peripheral eosinophilia. The same two cats developed anaphylaxis following both vaccination and administration of penicillin. 2是否有IgE参与的证据？ 2 Is there evidence for the involvement of IgE? IgE参与猫过敏性疾病的最明确证据来自猫皮炎伴随肠炎的早期描述(1968)26。IDT对牛奶抗原呈阳性，其血清PK检测结果为阳性。食物排查和激发试验证明了食物过敏。这只猫属于一位兽医，并由另外两名兽医进行免疫学检查，他们都是当前领先的免疫学家。人们想知道，多年来发生了多少类似的病例，但由于缺乏必要的专业知识而没有得到充分的记录。 The most definitive evidence for the involvement of IgE in a feline allergic disease comes from an early description (1968) of a cat presented with concomitant dermatitis and enteritis.26 An IDT was positive to cow’s milk antigen and its serum yielded a positive PK test. Hypoallergenic diet trials and subsequent challenges confirmed the diagnosis of food allergy. The cat belonged to a veterinarian, and the immunological workup was performed by two other veterinarians who were amongst the leading immunologists of the day. One wonders how many similar cases have occurred over the years, but were not fully characterized owing to the lack of requisite expertise. 后面详细讨论了IgE的作用，有疑似过敏性皮炎（不包括跳蚤过敏和蚊虫叮咬过敏反应）和哮喘猫研究的数据。提示IgE参与的参数有特异性贴片试验的反应，IDT阳性发生率，过敏原特异性IgE血清学阳性(与对照组相比)，避免过敏原的影响，对ASIT的反应，长期以来被认为是IgE介导的过敏性疾病的经典特征。陈述的总体结论是：“本文综述的证据支持IgE的作用-尽管不是很强烈。”但是如果猫中存在固有形式的过敏性皮炎和哮喘，人们不会认为会与过敏原IgE呈100%相关性。 The role of IgE is discussed in detail later in this series where data from studies of cats with suspected allergic dermatitis (excluding flea allergy and mosquito bite hypersensitivity) and asthma are examined. Parameters assessed as being suggestive of the involvement of IgE include responses to atopy patch tests, the incidence of positive IDT and positive serology for allergen-specific IgE (compared to control populations), the effects of allergen avoidance and also the response to ASIT, which has long been regarded as a classical feature of IgE-mediated allergic diseases. The stated overall conclusion is that: “the evidence reviewed in this paper is supportive of the role of IgE – albeit not strongly so.” However, if an intrinsic form of allergic dermatitis and/or asthma were to exist in the cat, one would not expect 100% correlation with the presence of allergen-specific IgE. 3猫的过敏性疾病是否与人类的特应性疾病相似，该物种是否存在“特应性并行”？ 3 Is the spectrum of allergic diseases in cats similar to the atopic diseases of man, and has an “atopic march” been shown to exist in this species? 假定患有过敏性皮炎的猫表现出不同的症状-但与人和犬疾病相比，均不能称为AD的“典型”表现。这可能源于猫表现的反应模式谱有限，相同的表现来自多种不相关的原因。病患可能患有肠炎，有时似乎是过敏性，哮喘在临床上也经常遇到。哮喘的病因存在争议，在某些情况下可能是内在的，已在猫中研发了过敏性哮喘模型，与人类的自发性疾病密切相关3。另一个例子是，一只日本家猫中描述了季节性过敏性鼻炎病例，其临床症状与人类季节性鼻炎（或“花粉热”）非常相似27，并且通过血清学和PK检测，血清中抗日本雪松(Cryptomeria japonica)的IgE呈阳性。 Cats suffering from dermatitis of presumed allergic origin exhibit varying presentations – yet none of them can be termed “classic” for AD when compared to the human and canine diseases. This perhaps stems from the limited spectrum of reaction patterns exhibited by cats, with apparently identical presentations arising from a wide range of unrelated causes. They also may suffer from enteritis that sometimes appears to be allergic in origin, and asthma is frequently encountered in clinical practice. Although the aetiology of the latter is controversial and could in some instances be intrinsic, a model of allergic asthma has been developed in cats, which closely parallels the spontaneous disease of humans.3 As a further example, a case of seasonal allergic rhinitis has been described in a Japanese domestic cat whose clinical signs were strikingly similar to those seen in seasonal rhinitis (or “hay-fever”) in humans,27 and the serum was positive for IgE against Japanese Cedar (Cryptomeria japonica) both by serology and PK testing. 如果在同一病患中观察到一种以上疑似的特应性疾病，并且如果有“特应性并行”的证据，则进一步怀疑“特应性疾病”。在上述2例食物过敏报告中观察到伴随的皮肤和胃肠道疾病-1例发生在独居猫26，1例发生在群居猫21-在新西兰的一项研究中22例食物反应病例中的5例(23%)也观察到相同情况28。在所有这些病例中，胃肠道和皮肤症状均与食物反应相关。然而，低敏食物对部分病例有反应。在一份早期报告中，可能诊断为特应性的90只猫中的5只(6%)对饮食试验有部分反应，表明对食物和环境过敏原的相关性29，在上述一个系列病例中，45例诊断为AD的病例中的6例(13%)伴有食物过敏2。此外，在兽医教学医院对194例诊断为AD的病例进行的回顾性分析中，9只猫(4.5%)被判定为伴随食物过敏24。 Justification for the existence of an “atopic state” in the cat would be strengthened if more than one of these possible atopic diseases were seen in the same patient, and if there was evidence of an “atopic march”. Concomitant skin and gastrointestinal disease was seen in the two reports of food allergy noted above–one in a single cat26 and one in a colony of cats21 – and also in five of 22 (23%) diet-responsive cases in a study from New Zealand.28 In all of these cases the gastrointestinal and dermatological signs both responded completely to the dietary change. However, partial responses to a hypoallergenic diet also may be encountered. In one early report, five of 90 cats (6%) evaluated with a possible diagnosis of atopy responded partially to the diet trial indicating concomitant reactivity to foods and environmental allergens,29 and in one of the case series noted above, food allergy accompanied six of 45 (13%) of cases diagnosed with AD.2 Also in a retrospective analysis of 194 cases accorded a diagnosis of AD at a veterinary teaching hospital, nine cats (4.5%) were adjudged to have concomitant food allergy.24 还报告了伴随皮肤病症状和上呼吸道或下呼吸道疾病。在另两篇论文中，一个病例系列的10例特应性中的5例中观察到鼻炎29，在诊断为AD和非跳蚤/非食物HD的45例病例中的2例(4.4%)2和100例病例中的6例(6%)22例中分别并发结膜炎。在前面提到的两个病例系列中，以及在最近的一份病例报告中2,21，分别有3/45例(6.6%)和6/100例(6%)诊断为很可能或确诊哮喘伴AD的下呼吸道症状30。在另一篇出版物中，一所大学教学医院的心肺服务机构接诊了一些猫，用于评价是否为哮喘，诊断猫无皮肤病，这些猫被转诊至皮肤病服务机构进行IDT和过敏特异性IgE血清学检查。在皮肤科检查时，由于观察到与过敏性皮肤病相符的症状，因此必须从研究中删除“一部分病例”（未定量）31。因此，涉及一个以上系统的共存症状，可能比报告的更常见，因为一些病例可能没有进行足够严格的检查。然而，此时，没有迹象表明该种属发生了“特应性并行”。 Concomitant dermatological signs and upper or lower respiratory tract disease also have been reported. Rhinitis was noted in five of 10 cases of atopy in one case series,29 and conjunctivitis was reported in two of 45 cases (4.4%)2 and six of 100 (6%)22 cases diagnosed as AD and nonflea/nonfood HD, respectively, in two other papers. Lower respiratory signs diagnosed as probable or definite asthma accompanied AD in three of 45 (6.6%) and six of 100 (6%), respectively, in the two case series noted earlier,2,21 and also in one recent case report.30 In another publication, a series of cats seen by the cardiopulmonary service of a university teaching hospital for evaluation of probable asthma, and stated to be free of skin disease, were referred to the dermatology service for performance of IDTs and for allergy-specific IgE serology. Upon dermatological examination “a number” (not quantified) had to be removed from the study, as signs compatible with allergic skin disease were observed.31 It is possible, therefore, that the co-existence of signs involving more than one system might be more common than is reported, as some cases may have been denied a sufficiently rigorous workup. Nevertheless, at this time, there is no indication that an “atopic march” occurs in this species. 结论和拟定命名 Conclusions and proposed nomenclature 根据上述文献综述，可以得出结论，推测有过敏性疾病的猫具有一些与人类特应性疾病和犬AD相似的特征。到目前为止，遗传基础缺乏有力的证据-猫遗传学还未进行必要的研究。尽管如此，猫患有过敏性皮炎、过敏性肠炎和哮喘三联症这一事实，再结合IgE的一些证据，为可能诊断为特应性疾病提供了依据。需要更详细的深入研究，以评估是否存在可以解释与IgE缺乏更强相关性的内在变体。考虑到所有这些局限性，提出了以下术语： From the literature reviewed above, it can be concluded that the feline diseases of presumed allergic aetiology have some features comparable to those seen in the human atopic diseases and canine AD. Strong evidence of a genetic basis is missing thus far – the state of feline genetics research has not yet permitted the necessary investigations. Despite this, the fact that cats can suffer from the triad of allergic dermatitis, allergic enteritis and asthma, often in combination and with some evidence for the involvement of IgE, provides justification for designating these as likely atopic diseases. More detailed in-depth investigations are needed in order to assess the existence or otherwise of intrinsic variants that would explain the lack of a stronger association with IgE. Bearing all of these limitations in mind, the following terminology is proposed: 猫特应性综合征(FAS) Feline atopic syndrome (FAS) 该描述包括与环境过敏原相关的过敏性皮炎、食物过敏和可能与IgE抗体相关的哮喘。食物过敏和跳蚤过敏既可以类似，也可以导致该综合征，在决定治疗方法之前，必须评估其潜在影响。 This description encompasses allergic dermatitis associated with environmental allergens, food allergy and asthma that may be associated with IgE antibodies. Food allergy and flea allergy can both either mimic and/or contribute to this syndrome, and their potential role must be assessed before deciding on the therapeutic approach. 猫特应性皮肤综合征(FASS) Feline atopic skin syndrome (FASS) 猫的炎症和瘙痒性皮肤综合征表现为一系列反应模式，都不是该综合征的特异性表现，可能与环境过敏原的IgE抗体有关。食物过敏和跳蚤过敏既可以类似，也可以导致该综合征，在决定治疗方法之前，必须评估其潜在影响。 An inflammatory and pruritic skin syndrome of cats manifested by a spectrum of reaction patterns, none of which are specific for this syndrome, and that may be associated with IgE antibodies to environmental allergens. Food allergy and flea allergy can both either mimic and/or contribute to this syndrome, and their potential role must be assessed before deciding on the therapeutic approach. 猫哮喘 Feline asthma 一种累及细支气管并导致自发性可逆性支气管收缩和气道重塑的嗜酸性粒细胞炎性疾病，表现为急性呼吸窘迫或慢性咳嗽和呼气哮鸣音，可能与吸入性过敏原的IgE抗体有关。 An eosinophilic inflammatory disease affecting the bronchioles and leading to spontaneous reversible bronchoconstriction and airway remodelling, manifested by acute respiratory distress or chronic coughing and expiratory wheezing, and that may be associated with IgE antibodies to inhaled allergens. 内在和外在疾病 Intrinsic and extrinsic diseases 应用于FASS和猫哮喘的定义不排除存在外源性和内源性（未证实相关IgE反应性）变体的可能性，内源性FASS类似于犬的特应性皮炎。 The definitions applied to FASS and to feline asthma do not preclude the possibility that extrinsic and intrinsic (in which no relevant IgE reactivity is demonstrable) variants of both may exist with intrinsic FASS being analogous to atopic-like dermatitis of dogs. 猫食物过敏 Feline food allergy 该病因学诊断是指由于摄入食物引起免疫反应性的所有临床症状，包括FASS的临床表现。 This aetiological diagnosis refers to any clinical manifestations, including those of FASS, that are attributable to immunological reactivity to an ingested food item. 从特应性名词中具体排除的是猫跳蚤过敏性皮炎和蚊虫叮咬过敏反应。 Specifically excluded from the atopic designation are feline flea allergy dermatitis and mosquito-bite hypersensitivity. 注：在本文和本系列后续文章中，过敏原特异性免疫治疗（简称ASIT）是指根据IDT或过敏原特异性IgE血清学结果组成的一系列过敏原注射液进行治疗。 Note: In this and subsequent papers in this series, allergen-specific immunotherapy (abbreviated as ASIT) refers to treatment with a series of allergen injections whose composition is based upon results of IDT and/or allergenspecific IgE serology. 参考文献 References 1. Favrot C, Steffan J, Seewall W et al. Establishment of diagnostic criteria for feline nonflea-induced hypersensitivity dermatitis. Vet Dermatol 2012; 23: 45–50. 2. Ravens PA, Xu BJ, Vogelnest LJ. Feline atopic dermatitis: a retrospective study of 45 cases (2001–2012). Vet Dermatol 2014; 25: 95–102. 3. Norris Reinero CR, Decile KC, Berghaus RD et al. An experimental model of allergic asthma in cats sensitized to house dust mite or Bermuda grass allergen. Int Arch Allergy Appl Immunol 2004; 135: 117–131. 4. Coca AF, Cooke RA. On the classification of the phenomenon of hypersensitiveness. J Immunol 1923; 8: 163–182. 5. Wise F, Sulzberger MB. The 1933 Year Book of Dermatology and Syphilology. Chicago, IL: Year Book Publishers Inc., 1933: 38–39. 6. Coca AF. Specific diagnosis and treatment of allergic disease of the skin: present status. J Am Med Assoc 1934; 103: 1,275– 1,277. 7. Prausnitz C, Kustner H. Studien | 
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