Elimination Food Trial in a Puppy: Addressing Allergy & Growth

Sponsored by Hill's Pet Nutrition

Adverse food reactions (AFRs) pose special diagnostic and management challenges when they occur in puppies. A targeted approach designed specifically for growing puppies is necessary for best outcomes.

The Case: Hopper’s Itch

Hopper, a 6-month-old, neutered male Labrador retriever puppy, was presented for a 1-month history of severe itching that was keeping the owner up at night and disrupting play time. The owner trialed diphenhydramine and fish oils for 2 weeks, with no improvement. Hopper was eating a commercial chicken and rice puppy food, was the only pet in the household, and was receiving monthly parasite prevention (selamectin).

On physical examination, Hopper was bright, alert, and responsive and scratching his neck occasionally. Erythema, excoriations, and epidermal collarettes were observed in the inguinal region. No evidence of ectoparasites (eg, fleas, flea dirt) was identified.

A flea comb was negative, as were skin scrapes for mites. An impression smear of the lesions showed cocci and neutrophils, confirming superficial bacterial pyoderma. Hopper was prescribed antibiotics and an antimicrobial shampoo. After 3 weeks, his lesions resolved and a negative skin impression was obtained, but pruritus remained.

Allergic dermatitis was suspected. Because atopy is a diagnosis of exclusion, a food elimination trial (FET) was recommended next to rule out an AFR. Hopper’s owner did not know Hopper’s dietary history prior to adoption, so a novel protein for an FET could not be identified. Hill’s Prescription Diet Derm Complete Puppy was selected for its avoidance of 96% of AFRs, innovative skin support formula, and balanced nutrition formulated for growth.¹

After 4 weeks on Derm Complete Puppy, Hopper showed a reduction in pruritus. At 6 weeks, his pruritus had resolved. Within 1 day of challenge with his previous food, Hopper’s pruritus recurred, confirming an AFR. Hopper was maintained on Derm Complete Puppy until he turned 16 months of age, when he was determined to be fully grown, at which point he was transitioned uneventfully to Derm Complete adult dog food, a complete and balanced maintenance food.

Adverse Food Reactions & Puppies

Prevalence & Signalment

AFRs affect 15% to 20% of all pruritic dogs, often occurring concurrently with atopy, such that almost one-third of all atopic dogs are affected by AFRs as well.² The proteins most likely to cause AFRs in dogs are beef (34% of AFRs), dairy (17%), chicken (15%), and wheat (13%).³ Although the mean age of onset is ≈3 years, studies have shown that 22% of dogs with AFRs present by 6 months of age, and ≈40% of dogs present by 1 year of age.⁴

Diagnosis

AFRs typically present with pruritus, along with recurring or chronic bacterial and/or yeast infections and otitis externa.⁴ Concurrent GI signs (eg, vomiting, diarrhea, increased frequency of defecation) are possible as well.⁵ FETs followed by a challenge are considered the gold standard and only reliable method for diagnosing AFRs.⁶ In vitro and in vivo tests (eg, serum IgE testing, patch testing) have not been shown to correlate well with clinical reactivity.⁶

FET food options include therapeutic hydrolyzed-protein foods and novel, limited-ingredient foods. When choosing a food for an FET, a thorough nutritional history should be obtained to guide selection and identify novel ingredients for that patient.⁷ Unfortunately, this may be impossible in puppies that have been recently adopted. In addition, therapeutic commercial foods available for use in FETs may be problematic in puppies because they may not meet nutritional requirements for healthy growth.

Derm Complete Puppy: Controlling Allergies & Supporting Growth

Derm Complete Puppy is an appropriate diet choice not only for puppies suffering from AFR but also for those suspected of having atopic dermatitis and those for which an FET has not yet been completed. Its single intact protein is egg, a safe choice for a novel-ingredient food for dogs without a complete nutritional history, as eggs have been shown to cause only 4% of AFRs in adult dogs.^1,3 Furthermore, Derm Complete helps manage environmental allergies, benefiting dogs with atopy as well. HistaGuard Complex, a proprietary blend of bioactives and phytonutrients, helps inhibit proinflammatory cytokine production and suppress or reduce inflammation, skin redness, and itching.¹

The efficacy of Derm Complete, which has the same dermatologic benefits as Derm Complete Puppy, has been demonstrated in 2 multicenter, blinded, controlled, longitudinal studies of client-owned dogs with food allergies.^8,9 Dogs with food allergies that were well-controlled on their current food were transitioned to Derm Complete or a hydrolyzed control food. Over a 21-day period, Derm Complete maintained control of AFR clinical signs, including pruritus, skin lesions, and owner satisfaction.^8,9

The nutrition in Derm Complete Puppy is derived from Derm Complete but is specially formulated to support the caloric and nutritional needs of puppies.¹⁰ It contains DHA from fish oil for healthy brain and eye development, high-quality protein for building lean muscle, and balanced minerals for healthy bone and teeth development.¹⁰ This allows clinicians to perform an effective FET without sacrificing nutrition needed for healthy growth. Derm Complete Puppy can be fed to puppies of all sizes, including large breeds, until growth is deemed to be over, at which point the patient can be transitioned to Derm Complete adult dog food.¹⁰

Conclusion

AFRs may appear in puppies as young as 6 months of age and must be ruled out whenever atopy is suspected.⁴ Along with providing relief, therapeutic foods chosen to perform FETs and treat AFRs in puppies must meet the nutritional requirements for growth. Hill’s Prescription Diet Derm Complete Puppy allows puppy owners to safely take advantage of a breakthrough nutritional formula designed to avoid 96% of food allergies in dogs.¹