8:00 AM-9:00 AM Diet-Associated Cardiomyopathy in the Dog: An Update
9:05 AM-10:05 AM A Cardiologist’s Interpretation of Thoracic Radiographs
10:05 AM-10:30 AM 25-Minute Break
10:30 AM-11:30 AM Overview of Canine Congenital Cardiac Disease
11:35 AM-12:35 PM Cardiac Emergencies
Thank you for attending this year’s CVMA Fall Seminar. Please take a few minutes to complete the on-line survey that will be emailed to you on Sunday. Your evaluation is extremely important to help us maintain and/or improve our conference quality! See you next year in Monterey, California
Speaker Bio
Valerie Fadok, DVM, Ph.D., DACVD
Dr. Valerie Fadok earned her DVM degree from Washington State University and a Ph.D. in experimental pathology from the University of Colorado School of Medicine. She became board-certified in veterinary dermatology in 1982. Dr. Fadok worked in academic and private practices prior to joining Zoetis in 2016 as a field specialist. She retired in January of 2023 and now provides support to Nextmune, Zoetis Diagnostics, and the Veterinary Information Network (VIN).
Dr. Valerie Fadok
Dermatology
Understanding the Pathogenesis of Atopic Dermatitis: Why it Matters
Valerie Fadok, DVM, Ph.D., DACVD
Even More Subsets:
Are T helper cells as plastic as macrophages?
Reprogrammed Th2? Th22 Epidermal immunity Th?
Induced by IL4 + TGF : Repressed by IFN
Produce IL-9, IL10
Perpetuate Chronic inflammation In allergy
Infiltrate epidermis in inflammatory skin diseases
Produce IL-22, TNFw/o IL-17, FGFs ?
Inflammatory Skin diseases Epidermal hyperplasia and wound repair
Amplify TNFa
Induce IL-3, IL-6, TNFa InKC ?
But
IL-2, IL-4
IL-6, IL-13 IL-31
Dermatology
Diagnosis and Management of Atopic Dermatitis in Dogs
Valerie Fadok, DVM, Ph.D., DACVD
Diagnosis of AD History
Hints that your patient has atopic dermatitis
History
+Young age
+Breeds of predisposition
Clinical signs
+Itch!
+Distribution pattern
Atopic dogs need lifelong management
Parasite patterns are changing
Evidence of skin barrier defect
Her pyoderma lesions
CULTURE AND SENSITIVITY
Michele Rosenbaum
We ALL can have these success stories!
Dermatology
What’s New with Allergy Testing and Immunotherapy:
How to Incorporate it into Your Management of Allergies in Dogs and Cats
Valerie Fadok, DVM, Ph.D., DACVD
Food Allergy:
New Ideas About Diagnosis and Management
Valerie Fadok, DVM, Ph.D., DACVD
A Critically Appraised Topic is a standardized summary of research evidence organized around a clinical question, aimed at providing both a critique of the research and a statement of the clinical relevance of results. Critical Appraisals
Favrot C et al. Vet Dermatol 2019; 30:498.
Fischer N at al. Vet Dermatol 2012; 32:247
MEET SARA - SHE NEEDS A FOOD TRIAL
Sara gets put on glucocorticoids to control itch as the diet is implemented
The lesson of Sarah
HOW DOES IT GO?
The good news
Sara likes the kangaroo diet! Back in the day of Iam’s KO She is less itchy on the steroids
BUT Sara likes to sleep in the bed with her owner
WHY ULTAMINO?
10 dogs with known chicken allergy Fed Ultamino – no flares Fed Z/D – 4 dogs flares in 4-8 days
The bad news
As she sleeps in the bed with her owner, she wets the
She is urinating in the house frequently
She is bullying the sweet Golden cross by stealing
Feeding
practices
have
changed
No such thing as a naturally hypoallergenic protein Difficult to know!
Dogs Cats
HOW COMMON IS FOOD ALLERGY?
We need more data!
But food allergy not as common as our clients think
Tests evaluated in 24 papers (out of over 70k). Only 13 papers verifiedfoodallergywithprovocationtesting
Intradermal testing
Serum testing IgE
Serum testing IgG
Lymphocyte proliferation test
Patch testing
Conclusions: “Patch testing with food ingredients might be useful in some selected dogs to choose the ingredients for an elimination diet trial.Currently,all othertestscannot berecommended...” “Best diagnostic procedure . . . remains an elimination diet with subsequent provocation trials.”
17 articles and 1 abstract (out of over 200)
PCR, ELISA, mass spectrometry
Mislabeling of pet foods is common, even if labeled as “novel” or “limited.”
Unexpected added ingredients are more frequent than missing ingredients
Hydrolyzed diets may contain CHO proteins that are not hydrolyzed
The presence of an ingredient not included in a label does not mean an allergic animal will react to it.
How much allergen does a dog or cat have to eat to flare? We don’t know
47 (out of over 800) papers evaluated, using food allergy or food hypersensitivity as part of the search
Dogs
Diarrhea
Vomiting
Increased frequency of bowel movements
Tenesmus
Paroxysmal gluten-sensitive dyskinesia of Border terriers
Symmetric lupoid onychitis
Anaphylaxis
Conjunctivitis
Asthma
Sneezing
Cats
Diarrhea
Vomiting
Conjunctivitis
Salivating
Respiratory signs
Flatulence
Hyperactive behavior
Our question: what percentage of dogs with food allergy have non cutaneous signs?
Affected by who does the studies?
Dermatologists
261 dogs (71%) had skin only
10 dogs (3%) had GI only
97 dogs (27%) had both
89 cats (77%) had skin only
2 cats (2%) had GI only
23 cats (20%) both
BIAS
Internists
10 dogs (8%) had skin only
94 dogs (73%) had GI only
24 dogs (19%) had both
10 cats (26%) had skin only
19 cats (49%) had GI only
10 cats (26%) had both
312 dogs over 1 year of age 96% dogs have 1-3 bowel movements per day
95% healthy dogs have fecal score of 1-3
22 articles, 825 dogs (out of over 600 papers)
Other than itch, no clear consensus on cutaneous signs in dogs
Generalized itch, but ear, feet, abdomen; perineum not commonly reported
Recurrent pyoderma, recurrent otitis externa
Resembling atopic dermatitis
Age of onset 1-13 yrs, but juvenile dogs predominate
Breeds most often reported: G. shepherd, West Highland White Terrier, Labrador retrievers, Golden retrievers
210 cats, age of onset tended to be later
Pruritus of head, face, and ears but also abdomen and ear
Head and neck pruritus, miliary dermatitis, eosinophilic dermatitides
Overgrooming
Food allergy can start at any age
Dogs tend to start young
Cats a little later in life
No distinctive clinical signs
10 articles, 5 laboratory and 5 field studies
If pets are allergic to house dust mites, overgrowth of storage mites in their food could trigger flares
Storage mites in food could cause a false positive diagnosis of food allergy
Store commercial pet foods indoors and keep them sealed to prevent storage mite overgrowth
9 papers with 234 dogs, 4 papers with 83 cats
2 wks for dogs 1 week for cats I don’t believe these data
82.6% flared in 24 hrs
46/310 itchy dogs (15%) diagnosed with food allergy
93.5% flared in 72 hrs
Quality of the conclusions are directly proportional to the quality of the original papers.
Some of the referenced papers are very old
Dietary trends have changed
We need a lot more work on food allergy
KEEP IN MIND: DOGS AND CATS BECOME ALLERGIC TO WHAT THEY EAT REGULARLY NOT TO INTRODUCTION OF NEW FOODS
Shimakura H, Kawano K. Vet Dermatol 2021; 32:293
Consider Rayne Nutrition
Something New for Dogs
Dermatology
Allergies in Cats:
What Do We Know and What Do We Do?
Valerie Fadok, DVM, Ph.D., DACVD
Inherited predisposition toward developing hypersensitivity reactions to environmental antigens
Numerous gene polymorphisms
Environmental exposure
In dogs and humans dysregulated immune system and skin barrier defect
Interplay between skin, immune system, and nerves
Lifelong inflammatory disease
Andrea Cecilia Wolberg DVM and Alejandro Blanco, DVM - 08/05/2015
Eosinophilic Plaque
Pruritus and Dermatitis
Courtesy, John August
Dermatology
Updates from:
The World Congress Veterinary Dermatology
Tips for Your Practice
Valerie Fadok, DVM, Ph.D., DACVD
Speaker Bio
Heidi Kellihan, DVM, DACVIM (Cardiology)
Dr. Heidi Kellihan obtained her DVM degree from the University of Illinois, Urbana in 2002, after which she performed a small animal rotating internship at California Animal Hospital, Los Angeles and completed a cardiology residency at the University of Wisconsin, Madison. Dr. Kellihan is currently a clinical professor in cardiology at the University of Wisconsin, Madison. Her primary research and clinical interest focus is pulmonary hypertension.
