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THE CASE

A 9-year-old intact male golden retriever was presented to his primary veterinarian for a year-long history of nonseasonal pruritus and recurrent pyoderma. Physical examination showed erythema, abrasions, and alopecia in the skin but was otherwise unremarkable. Blood work (ie, CBC, serum chemistry profile, total thyroxine) results were within normal limits.

Dietary History

A comprehensive nutritional evaluation1 was pursued. The patient (71.7 lb [32.5 kg]) had a BCS of 5/9. The nutritional history noted the patient was eating an adult canine maintenance diet. After ruling out flea allergy, the veterinarian suspected food allergy and sent a serum sample for ELISA antibody testing. Rice, soy, and corn were identified as potential antigens. 

Treatment Plan

The nutritional history uncovered potential sources of food allergens, prompting the veterinarian to change the current diet to one based on ingredients to which the patient had no known prior exposure (ie, fish and potato). This recommendation resulted in good control of pruritus, and the patient was diagnosed with suspected adverse food reaction (AFR). The patient ate this diet for 6 years without further issues. 

DIAGNOSIS:

ADVERSE FOOD REACTION

Follow Up

After 6 years, the dog was presented for acute vomiting and diarrhea. He was hospitalized and underwent supportive care. He was presumptively diagnosed with pancreatitis based on clinical signs and altered specific canine pancreatic lipase (cPLI) of 415 µg/L (range, 0-200 µg/L). His current fish and potato diet provided 35% fat calories; to prevent pancreatitis recurrence, the veterinarian changed the dog’s diet to a weight-loss formula providing 20% fat calories and with main ingredients of wheat, chicken, and turkey. The patient recovered from the presumptive pancreatitis episode, but his skin signs and pruritus returned 2 months later. 

After consultation with a dermatologist, the diet was changed to a hydrolyzed protein diet (based on chicken liver; 30% fat calories) to address the pruritus. The patient’s pruritus, however, did not decrease, and there was a recurrence of pancreatitis. Hydrolyzed diets are formulated to reduce the allergenicity of the protein source, but they do not completely eliminate it. Thus, a small percentage of patients intolerant to the original intact protein can also react to the hydrolyzate, which could have occurred in this case. The patient was offered a home-cooked diet based only on horsemeat and potato (no other ingredients or supplements), which provided 17% fat calories. Both his skin and GI signs resolved. 

Nutritional Consultation

A nutritional consultation was conducted to find a long-term dietary plan. The owners were willing to home cook if necessary but preferred a commercial diet. Thus, after a careful diet history, the goal was to use a veterinary elimination diet that was not chicken based (because the patient had been exposed to chicken and the hydrolyzed chicken diet had not managed the pruritus) and had <30% fat calories. Two options were identified, one based on hydrolyzed soy protein (22% fat calories) and one based on duck and tapioca (24% fat calories). The owners elected the duck-based diet. After >1 year of follow up, the patient had no recurrence of skin or intestinal disease and his cPLI remained within limits.

Parting Thought

This case underlines the importance of a good nutritional evaluation, especially a careful and accurate diet history, in the diagnosis and successful long-term management of suspected AFR. 

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Diet in Disease is a series developed by the World Small Animal Veterinary Association (WSAVA), the Academy of Veterinary Nutrition Technicians, and Clinician’s Brief.

AFR = adverse food reaction, CPLI = canine pancreatic lipase

References and author information Show
References
  1. World Small Animal Veterinary Association Global Nutrition Committee. Nutrition toolkit. WSAVA website. http://www.wsava.org/nutrition-toolkit. Accessed January 6, 2017.
  2. Gaschen FP, Merchant SR. Adverse food reactions in dogs and cats. Vet Clin North Am Small Anim Pract. 2011;41(2):361-379.
  3. Mueller RS, Olivry T, Prélaud P. Critically appraised topic on adverse food reactions of companion animals (2): common food allergen sources in dogs and cats. BMC Vet Res. 2016;12(1):9.
  4. Verlinden A, Hesta M, Millet S, Janssens GP. Food allergy in dogs and cats: a review. Crit Rev Food Sci Nutr. 2006;46(3):259-273.
  5. Wortinger A, Burns KM. Dermatology. In: Wortinger A, Burns KM, eds. Nutrition and Disease Management for Veterinary Technicians and Nurses. 2nd ed. Ames, IA: John Wiley & Sons; 2015:192-196.
  6. Bethlehem S, Bexley J, Mueller RS. Patch testing and allergen-specific serum IgE and IgG antibodies in the diagnosis of canine adverse food reactions. Vet Immunol Immunopathol. 2012;145(3-4):582-589.
  7. Olivry T, Mueller RS, Prélaud P. Critically appraised topic on adverse food reactions of companion animals (1): duration of elimination diets. BMC Vet Res. 2015;11:225.
  8. Raditic DM, Remillard RL, Tater KC. ELISA testing for common food antigens in four dry dog foods used in dietary elimination trials. J Anim Physiol Anim Nutr (Berl). 2011;95(1):90-97.
  9. Gross KL, Yamka RM, Khoo C, et al. Macronutrients. In: Hand MS, Thatcher CD, Remillard RL, Roudebush P, Novotny BJ, eds. Small Animal Clinical Nutrition. 5th ed. Topeka, KS: Mark Morris Institute; 2010:49-106. 
  10. National Research Council. Nutrient Requirements of Dogs and Cats. Washington, DC: The National Academies Press; 2006.
Authors

Jenifer Molina

DVM, ECVCN Resident Universitat Autònoma de Barcelona

Jenifer Molina, DVM, ECVCN Resident, is a small animal nutrition advisor at the Fundació Hospital Clínic Veterinari at Universitat Autònoma de Barcelona, where she is also a PhD student in the animal science department. Her research project investigates risk factors for malnutrition in hospitalized dogs and cats. Her research interests include critical care nutrition and undernutrition in animals with disease. She has presented at national and international congresses and has publications in national and international journals.

Marta Hervera

PhD, DECVCN Expert Pet Nutrition

Marta Hervera, PhD, DECVCN, is a veterinary nutrition advisor at Expert Pet Nutrition. She earned her PhD from Universitat Autònoma de Barcelona for her research in pet food evaluation. She has worked as a small animal nutrition advisor in the teaching hospitals at Universitat Autònoma de Barcelona in Spain and École Nationale Vétérinaire Nantes-Atlantique in France and has authored several publications on small animal nutrition. Her research interests include critical care nutrition and pet food evaluation.

Cecilia Villaverde

DVM, MSc, PhD, DACVN, DECVCN Universitat Autònoma de Barcelona

Cecilia Villaverde, DVM, MSc, PhD, DACVN, DECVCN, works in the Nutrition Support Service of the Veterinary Medical Teaching Hospital at University of California, Davis. She is also a consultant in clinical nutrition for Veterinary Information Network and Expert Pet Nutrition. Previously, she was an adjunct professor at Universitat Autònoma de Barcelona and the chief of service of the nutrition service at the teaching hospital. She is a member of the Global Nutrition Committee of the WSAVA and has authored several publications regarding small animal nutrition. Her research interests include critical care nutrition and obesity.

Kara M. Burns

MS, MEd, LVT, VTS (Nutrition), VTS-H (Internal Medicine, Dentistry) Academy of Veterinary Nutrition Technicians

Kara M. Burns, MS, MEd, LVT, VTS (Nutrition), VTS-H (Internal Medicine, Dentistry), is director of nursing for Brief Media, editor of Veterinary Team Brief, and founder and president of the Academy of Veterinary Nutrition Technicians. She teaches nutrition courses across the country and is a member of many national, international, and state associations. Ms. Burns has authored many articles, textbooks, and chapters on nutrition, leadership, and veterinary nursing.

FUN FACT: Kara admittedly has the best dog ever—Fribble, the French bulldog.

Gregg K. Takashima

DVM WSAVA Global Nutrition Committee Series Editor

Material from Clinician’s Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.

This article is published as part of the Global Edition of Clinician's Brief. Through partnership with the World Small Animal Veterinary Association, the Global Edition provides educational resources to practitioners around the world.

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