伴侣动物食物不良反应的批判性评价话题（6）：犬猫食物...

王帆

Critically appraised topic on adverse food reactions of companion animals (6): prevalence of noncutaneous manifestations of adverse food reactions in dogs and cats

伴侣动物食物不良反应的批判性评价话题（6）：犬猫食物不良反应的非皮肤性临床表现

Ralf S. Mueller and Thierry Olivry

翻译：侯宁

Abstract

Background: Many reports describe the cutaneous signs of adverse food reactions (AFR) in the dog and cat. However, various non-cutaneous clinical signs are less well described. Our objective was to systematically evaluate these non-cutaneous signs of AFR in small animals.

Results: We searched two databases (MEDLINE and Web of Science) for pertinent references on non-cutaneous signs of adverse food reactions. Among 117 and 764 articles found in the MEDLINE and Web of Science databases, respectively, we selected 47 articles that reported data related to non-cutaneous clinical signs of AFR. Gastrointestinal signs, symmetrical lupoid onychitis, conjunctivitis, sneezing, and anaphylaxis were reported to be associated with AFR in dogs and gastrointestinal and respiratory signs, conjunctivitis, and hyperactive behaviour in cats. In Border terriers with paroxysmal gluten-sensitive dyskinesia, an underlying AFR should be considered. Of these clinical signs diarrhoea and frequent defecation were most frequently reported to be diet-responsive in dogs; in the cat, these were vomiting and diarrhoea.

Conclusions: An elimination diet should be considered early in the work-up of dogs and cats with chronic vomiting and diarrhoea. Other non-cutaneous signs occur less commonly because of AFRs.

Keywords: Canine, Feline, Food allergy, Gastroenteritis, Vomiting, Diarrhoea

摘要

背景：许多文章描述了犬猫食物不良反应（AFR）的皮肤症状。但关于非皮肤性临床症状却鲜有提及。该文的目的是系统性地评估小动物AFR的非皮肤性临床症状。

结果：我们在两个数据库（MEDLINE和Web of Science）中搜索与食物不良反应的非皮肤临床症状相关的文献。分别在MEDLINE和Web of Science中找到117篇和764篇文献，其中我们选取了47篇描述了AFR的非皮肤性临床症状的文章。据报道，犬AFR包括胃肠道症状、对称性狼疮样甲床炎、结膜炎、打喷嚏、和过敏，猫AFR症状包括呼吸道症状、结膜炎和过度活跃。边境㹴阵发性谷蛋白敏感性运动障碍，应考虑潜在的AFR。在这些症状中腹泻和频繁排便是犬食物反应中最常见的；猫中最常见的是呕吐和腹泻。

结论：在对犬猫慢性呕吐和腹泻进行诊断时应在早期考虑食物排查试验。由于AFR。其他非皮肤性临床症状很少见。

关键词：犬、猫、食物过敏、胃肠炎、呕吐、腹泻

Background

背景

Atopic dermatitis and urticaria are well-recognised clinical features of adverse food reaction (AFR) in the dog . Cutaneous reaction patterns such as miliary dermatitis, variants of the so-called “eosinophilic granuloma complex” (including oral lesions ) and non-inflammatory alopecia have been reported with AFR in cats. Non-cutaneous clinical signs are mainly gastrointestinal, but a systematic review of reported non-cutaneous clinical signs is lacking. Our objective was to systematically evaluate those non-cutaneous signs of AFR in dogs and cats.

特应性皮炎和荨麻疹被认为是犬食物不良反应的最典型症状。皮肤反应模式如粟粒状皮炎、所谓“嗜酸性肉芽肿复合体”的变形（口腔病变）和非炎性脱毛在猫AFR中都有报道。非皮肤性临床症状包括胃肠道症状，但缺乏系统性的报道。该文章的目的在于对犬猫AFR的非皮肤性临床症状做出系统性的评价。

Clinical scenario

临床病例

Consider the example of two patients: A 15-month-old castrated male Jack Russell terrier with chronic diarrhoea and concurrent bilateral conjunctivitis and a six-year-old female spayed domestic shorthaired cat with flatulence and frequent vomiting. You inform the owners of both patients that you suspect that their clinical signs might be caused by a reaction to a component of their pet’s diet and you advise that an elimination diet with ingredients not previously fed is indicated for 8 weeks to evaluate a potential food involvement. The owners ask you what clinical signs besides itching and skin problems are frequently reported to be caused by an AFR.

以两只动物为例：一只15月大的雄性已去势的杰克罗素㹴，患有慢性腹泻和并发的双侧结膜炎。一只6岁雌性已绝育家养短毛猫，胃肠胀气和频繁呕吐。你告知主人这两只动物的临床症状可能是由于其饮食的某种成分导致，建议进行使用以前没有喂食过的成分进行8周的食物排查试验，以评估潜在的食物问题。主人询问除了瘙痒和皮肤问题外AFR还有什么常见的临床症状。

Search strategy

检索方法

We searched the Web of Science (Core Collection) and MEDLINE databases using the following string: ((dog* or canine or cat* or feline) and (food* or diet*) and (allerg* or hypersens*)) not (human* or child* or adult*). We limited the search to journal articles published from 1980 to 2017; there were no language restrictions. Bibliographies from selected articles and proceedings of recent conferences in veterinary dermatology and internal medicine were also searched.

我们通过以下字符在MEDLINE和Science（核心数据）数据库中检索：((dog* or canine or cat* or feline) and (food* or diet*) and (allerg* or hypersens*)) not (human* or child* or adult*)。我们限定搜索内容为1980到2017年发表的杂志期刊；没有语言限制。检索内容还包括所选文章的参考文献和最近兽医皮肤病和内科会议的会议记录。

Identified evidence

资料确认

Our literature search identified 117 and 764 articles in the MEDLINE and Web of Science (Core Collection) databases, respectively. Abstracts of relevant titles were screened and any potentially useful manuscript was downloaded and read. The bibliography of these articles was examined further for additional pertinent citations. In addition, proceedings of recent veterinary dermatology or internal medicine conferences were perused. Altogether, we selected 47 papers that provided usable information.

我们检索了MEDLINE和Science数据库，分别找到117篇和764篇文献（核心数据）。我们把与主题相关的摘要进行了筛选，下载并阅读了所有可能有用的文章。对这些文章的参考文献进一步研究以获得更多的相关引用。此外，还精读了近期兽医皮肤病和内科大会的会议。我们总共选出47篇有用的文章。

Evaluation of evidence

资料评估

In prospective studies, improvement of a clinical sign with an elimination diet, recurrence after a re-challenge with the previous diet and repeated improvement again when feeding the diet were considered to be strong evidence for an AFR causing that clinical sign. If those conditions were met, but the study was retrospective, we considered the evidence to be only of moderate strength. When improvement occurred upon a change in diet, but a re-challenge with the previous food was not performed, then the evidence was considered weak. The prospective or retrospective nature of some studies was unclear, and we deemed the evidence provided by those reports as of moderate strength. The non-cutaneous clinical signs of AFR, the number of animals affected, as well as the strength of evidence are listed in Table 1 for dogs and in Table 2 for cats.

在前瞻性研究中，若经食物排查试验临床症状改善，食物激发试验恢复之前饮食后临床症状复发，这些是AFR引发临床症状的有力证据。但是在回顾性研究中，如果满足以上条件，我们认为他们只具有中等力度。若改变饮食后症状改善，使用之前的食物进行激发试验时没有复发，则证据力度弱。但一些研究并不清楚是前瞻性还是回顾性，我们将其判定为中等力度证据。在表1中列出了犬AFR的非皮肤性临床表现，患病动物数量和证据力度，表2是关于猫的相关信息。

A high number of dogs and cats with AFR were reported to exhibit vomiting and/or diarrhoea. Although, in many publications, the evidence for a causative AFR was strong, some cohorts were only retrospective studies. Finally, in others groups of animals, the diagnosis of AFR was solely based on an improvement with diet change without report of a re-challenge with the previously fed diet. Unfortunately, in a number of articles, these two clinical signs were not listed separately, and patients were reported with “vomiting or diarrhoea” or “gastrointestinal signs” without specifying the number of animals having exhibited each individual sign . Similarly, defecation and tenesmus in dogs, and conjunctivitis and drooling in cats were not always clearly distinguished. Of the 395 dogs in which vomiting and diarrhoea were reported individually, 368 dogs (93%) had diarrhoea, six had vomiting (2%) and in 21 dogs (5%) both clinical signs were present . Of the 40 cats with individually reported vomiting and diarrhoea, 15 vomited (38%), 18 had diarrhoea (45%) and seven (18%) were reported with both clinical signs . These numbers suggest that AFR-associated vomiting is more prevalent in cats than in dogs. When comparing cutaneous with gastrointestinal signs in dogs and cats (where possible), a bias from authors was apparent. Cutaneous signs predominated when the study had been performed by dermatologists, where 261 dogs (71%) and 89 cats (77%) showed cutaneous signs only, ten dogs (3%) and two cats (2%) showed only gastrointestinal signs and 97 dogs (27%) and 23 cats (20%) showed both gastrointestinal and cutaneous signs. When the studies where performed by internists, 94 dogs (73%) and 19 cats (49%) showed gastrointestinal signs only, ten dogs (8%) and ten cats (26%) showed cutaneous signs only, and 24 dogs (19%) and ten cats (26%) showed both.

据报道，很多患有AFR的犬猫出现呕吐和/或腹泻症状，虽然在许多出版物中，属于引发AFR的有力证据，但有些分组属于回顾性研究。在其他组中，仅根据食物限制试验中症状的改善诊断AFR，没有关于食物激发试验的报道。不幸的是，在很多文章中，这两种临床症状并未单独列出，动物被描述为“呕吐或腹泻”或“胃肠道症状”，而没有具体标明出现每种症状的动物数量。同样，犬的排便和里急后重，猫的结膜炎和流涎也没有明显区分。在395只犬中分别统计了出现呕吐和腹泻的动物数量，368只犬（93%）出现腹泻，6只（2%）出现呕吐，21只（5%）同时出现两种症状。在40只猫中报道了分别出现腹泻和呕吐症状的动物数量，15只出现呕吐（38%），18只出现腹泻（45%），7只同时有两种症状（18%）。这些数据表明与犬相比，与AFR有关的呕吐在猫中较犬常见。当比较犬猫皮肤症状和胃肠道症状时（如果可能），明显具有作者的偏见性。皮肤专科医生的研究中皮肤症状更明显，其中261只犬（71%）和89只猫（77%）只出现皮肤症状，10只犬（3%）和2只猫（2%）只出现胃肠道症状，97只犬（27%）和23只猫（20%）同时出现皮肤和胃肠道症状。而内科医生的研究中，94只犬（73%）和19只猫（49%）仅表现出胃肠道症状，10只犬（8%）和10只猫（26%）只出现皮肤症状，24只犬（19%）和10只猫（26%）二者同时出现。

Conclusion and implication for practitioners

结论和对临床医生的启示

We evaluated 34 articles reporting dogs with noncutaneous clinical signs, 16 of those provided strong evidence, six moderate evidence and 12 weak evidence. In the cat, strong evidence was provided by only three reports, moderate by seven and weak evidence by two. One publication of moderate quality reported on both dogs and cats. Vomiting and diarrhoea were the non-cutaneous signs reported in more than 20% of dogs and cats with AFR, and an elimination diet with subsequent re-challenge is indicated for those animals early in the diagnostic work-up. In dogs, anaphylaxis, conjunctivitis, increased frequency of defecation, symmetric lupoid onychitis, and sneezing were reported less commonly. In cats, uncommon noncutaneous signs of AFR were conjunctivitis, salivating, flatulence, hyperactive behaviour and respiratory signs and all of these were more often associated with diseases other than an AFR. Depending on the patient’s history, other tests should possibly be conducted before an elimination diet or concurrently. The probability of AFR is likely to increase if patients exhibit more than one of the non-cutaneous signs described above.

我们评估了34篇关于犬非皮肤性临床症状的文章，其中16篇具有强有力的证据力度，6篇具有中等力度，12篇证据力度弱。在猫中，只有3篇文章提供了强有力的证据，7篇具有中等力度，2篇证据力度弱。一篇具有中等质量的文章包含犬和猫的内容。在超过20%的犬猫AFR中出现呕吐和腹泻的症状，在早期诊断中建议使用食物限制试验和食物激活试验。在犬中，过敏反应、结膜炎、排便频率增加、对称性狼疮样甲床炎和打喷嚏报道的较少。在猫中，AFR不常见的非皮肤性症状包括结膜炎、流涎、腹部胀气、过度活跃和呼吸道症状，而这些症状常与AFR之外的疾病有关。根据动物病史，应该在食物限制试验之前或同时进行其他检查。如果动物表现出一个以上的上述非皮肤性症状，其患有AFR的可能性会增加。

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