伴侣动物食物不良反应的批判性评价话题(1）:食物排查试...

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伴侣动物食物不良反应的批判性评价话题(1）:食物排查试验的持续时间

Critically appraised topic on adverse food reactions of companion animals (1): duration of elimination diets

作者：Thierry Olivry1, Ralf S. Mueller and Pascal Prélaud

翻译：张亚飞

摘要

背景:日粮限制(即排除)-激发试验仍然是犬、猫皮肤食物不良反应(CAFRs)的诊断标准。目前对于确诊伴侣动物CAFR敏感性最高的食物排查试验持续时间，仍未达成共识。

结果:对截至2014年12月14日的最有用证据的搜索、回顾和分析表明，在开始食物排查试验后的5周和6周内，80%以上的CAFR患病动物的临床症状均得到缓解。将食物排查试验持续时间延长至8周，90%以上的犬猫完全得到缓解。

结论:对于90%以上的犬猫，食物排查试验应至少持续8周。

关键词:过敏症；特应性皮炎；犬科；猫；犬；食物排查试验；猫科；食物过敏；痒；瘙痒

Abstract

Background: Restrictive (i.e. elimination)-provocation dietary trials remain the standard of care to diagnose cutaneous adverse food reactions (CAFRs) in dogs and cats. There is currently no consensus on the duration of elimination diet trials that would permit the highest sensitivity of diagnosis of CAFR in companion animals.

Results: The search for, and review and analysis of the best evidence available as of December 14, 2014 suggests that, by 5 weeks in dogs and 6 weeks in cats after starting an elimination diet, more than 80 % of patients had achieved a remission of clinical signs of CAFR. Increasing the diet trial duration to 8 weeks leads to a complete remission in more than 90 % of dogs and cats with CAFR.

Conclusions: For diagnosing CAFRs in more than 90 % of dogs and cats, elimination diet trials should last at least 8 weeks.

Keywords: Allergy, Atopic dermatitis, Canine, Cat, Dog, Elimination diet, Feline, Food allergy, Itch, Pruritus

背景

Background

目前诊断犬、猫皮肤食物不良反应(CAFRs)的标准是进行食物排查-激发试验。随着时间的推移，限制性日粮试验(即“食物排查试验”)建议的最佳持续时间从3周到12周不等;目前，关于此类试验对CAFRs最佳诊断的持续时间尚无共识。

The current standard for the diagnosis of cutaneous adverse food reactions (CAFRs) in dogs and cats involves the performance of dietary restriction-provocation tests. Over time, the recommendations for optimal duration of restrictive dietary trials (i.e. “elimination diets”) have varied from 3 to 12 weeks; there is currently no consensus on the duration of such trials for optimal diagnosis of CAFRs.

临床案例

Clinical scenario

您的客户是一只两岁大、雄性已去势的德国牧羊犬，非常痒。检查时，你会发现它腹部、腋窝和会阴部有红斑点、斑块和丘疹。它还有间歇性腹泻症状。由于这只犬已良好地控制跳蚤，您怀疑是食物反应导致了这些症状。您想做一个食物排查试验来证实这一点。并且您想知道这种排除法应该持续多久。

Your patient is a 2-year-old male castrated German shepherd dog that is very itchy. On examination, you notice erythematous macules, patches and papules on the abdomen, axillae and the perineum; it also suffers from intermittent diarrhea. As this dog is already on an optimized flea control regimen, you suspect that food reactions cause all these signs. You would like to perform an elimination dietary trial to confirm this. You wonder how long this elimination diet should last.

问题框架

Structured question

对于疑似患有CAFR的犬、猫，食物排查试验应持续多长时间才能达到诊断的最高敏感性?

In dogs and cats suspected of having a CAFR, how long should an elimination diet trial last for highest sensitivity of diagnosis?

搜索方法

Search strategy

2014年12月16日，在CAB 文摘网和科学数据库网站(科学引文索引),搜索以下内容:((犬或犬（复数）或犬科) 或 (猫或猫（复数）或猫科)) 和(食物或日粮*)和(反应或过敏*或超敏反应)和(试验或限制或排除)和(皮肤或皮肤的或痒或瘙痒)。我们将查找时间限制在25年内(1980年到2014年)，并且排除了会议记录和书籍章节。

The CAB Abstracts and Web of Science (Science Citation Index Expanded) databases were searched on December 16, 2014, using the following string: ((dog or dogs or canine) or (cat or cats or feline)) and (food or diet*) and (reaction or allerg* or hypersensitivity) and (trial or restriction or elimination) and (skin or cutaneous or itch or pruritus). We limited the search to 25 years (1980 to 2014) and we excluded congress proceedings notes and book chapters.

鉴定证据

Identified evidence

我们的文献检索分别在 CAB文摘网和科学数据库网站中确定了108条和78条引文;两个数据库共有45篇文章。阅读摘要和相关文章的全文。两种类型的原始文章提供了与感兴趣的问题相关的数据:这些文章要么报道了大量CAFR患犬或患猫，要么报道了用一种或多种试验日粮喂养患CAFR的伴侣动物的效果。其中，分别有5篇CAFR患犬的和3篇CAFR患猫，提供了饲喂限制日粮得到改善所需时间的具体数据。

Our literature search identified 108 and 78 citations in the CAB Abstract and Web of Science databases, re- spectively; 45 articles were common to both databases. Abstracts were read and pertinent articles were read in full. Two types of original articles provided data relevant to the question of interest: these articles either reported large case series of dogs or cats with CAFRs or the effect of feeding one or more test diets to companion animals with CAFRs. Among these papers, five and three respectively provided specific data on the time needed for manifestations of CAFR to improve in dogs and cats fed a restrictive diet.

证据的评估

Evaluation of evidence

在选定的文章中,犬猫CAFR的确诊方法通常是，具有非季节性瘙痒，先前排除了瘙痒的其他相关病因，并且饲喂限制性（排除）日粮后，即包括新奇蛋白或部分水解蛋白成份的日粮，临床症状完全消失或明显减轻(至少50%)。部分瘙痒减轻的病例在接受旧日粮或成份激发后症状复发，则确诊为CAFR。

In the selected articles, the diagnosis of CAFR was generally made in dogs and cats with nonseasonal pruritus after the exclusion of other relevant causes of pruritus and a complete or marked (at least 50 %) reduction of clinical signs after feeding a restrictive (elimination) diet, the latter consisting of novel or partially hydrolyzed ingredients. Cases with partial reduction of itch were then confirmed as having CAFR after recurrence of signs after provocation with previous diets or ingredients.

图1显示了在饲喂限制日粮时，犬CAFR临床症状完全或接近完全缓解的比例。根据从209只CAFR患犬身上收集的信息，我们可以估计，在3周的日粮改变后，大约一半的犬的症状有了明显的减轻。从5周开始，超过85%的犬恢复了正常，如果将食物排查试验延长到8周，这一比例将上升到95%以上。只有不到5%的犬需要长达13周的食物排查试验CAFR症状才能完全缓解。

The cumulative percentages of complete, or near complete, remission of clinical signs of CAFR in dogs fed a restrictive diet are depicted on Fig. 1. Based on the information gathered from 209 dogs with CAFR, we can estimate that, after 3 weeks of a diet change, approximately half of dogs had achieved a marked reduction of their signs. From 5 weeks onward, signs had returned to normal in more than 85 % of dogs, and this percentage increased to over 95 % if extending the dietary trial to 8 weeks. Fewer than 5 % of dogs needed an elimination diet of up to 13 weeks for a complete remission of signs of CAFR to occur.

40只患有CAFR的猫的临床症状缓解的比例如图2所示。大约4周、6周和8周的限制日粮分别使50%、80%和90%的猫的临床症状得到缓解。

Cumulative percentages of clinical sign remission in 40 cats with CAFR are illustrated on Fig. 2. It took approximately 4, 6 and 8 weeks of a restriction diet for 50, 80 and 90 % of cats to achieve a remission of their clinical signs, respectively.

结论与启示

Conclusion and implication for practitioners

为至少80%的犬猫能确诊CAFR，犬的限制性(排除性)日粮试验应该至少持续5周，猫的至少持续6周。将限制日粮试验的时间延长到8周，90%以上的犬猫能提高诊断敏感性。

To diagnose CAFR in at least 80 % of dogs and cats, a restrictive (elimination) dietary trial should last a minimum of 5 weeks in dogs and 6 weeks in cats. Increasing the duration of the restrictive diet to 8 weeks will increase the sensitivity of diagnosis to more than 90 % of cases in both species.

食物排查试验的最终目标是通过对可疑食品的激发使CAFR得到阳性确诊结果。因此，兽医可能会选择在病例症状缓解后不久进行激发试验，即使这种缓解发生在开始食物排查试验后的8周之内。

The ultimate goal of an elimination diet is to enable the positive confirmation of a CAFR with a provocation with suspected food items. As a result, veterinarians might elect to perform provocation tests soon after a remission of signs is achieved in a patient, even if such remission were to happen before 8 weeks after starting the elimination diet.

Ryohei

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