Helping Feline Allergy Patients: A Lifelong Collaboration

Sponsored by Royal Canin

Food allergies and atopic dermatitis can be frustrating for clinicians and pet owners alike. Because there’s no definitive cure for these conditions, owners must be educated on why long-term management for allergic skin disease is required, as well as what success looks like. Even after a diagnosis is made, effective communication between the clinician and pet owner is vital so the response to treatment can be monitored and adjusted as the pet’s clinical signs evolve.

Moony’s Case

Moony, a 6-year-old, neutered male, indoor-only Siamese crossbreed cat, is presented for pruritus and excoriations of ≈9 month’s duration around his head, neck, and ears. Recently, his signs have worsened.

His owner has heard Siamese cats are prone to food allergies and therefore tried feeding Moony a series of 3 different over-the-counter (OTC), limited-ingredient diets for ≈2 to 3 weeks at a time. He has yet to see improvement, and he’d like to see the issue resolved.

A Thorough History Is Vital in Dermatology Cases

Arriving at an accurate diagnosis in dermatology cases may rely on information only owners can provide. Seasonal vs nonseasonal signs, use of effective external parasite control, response to previous treatments and diets, a full dietary history, and age of onset are some of the vital data points that guide the diagnostic and treatment plan.¹

How patient history is obtained is important as well. Open-ended questions, avoiding interrupting owners as they answer, and using questionnaires are all methods that can improve the quality of the historical information provided.^2-4

On presentation, Moony’s owner notes that Moony is the only pet in the household, with no outdoor access, and is on a monthly flea preventive prescribed by a previous veterinarian. He also notes that his clinical signs have not changed with the seasons. All of these factors, combined with his breed and the locations of his skin lesions, indicate that food allergy and atopic dermatitis should be on the differential diagnoses list.¹

Collaboration Is Key to Long-Term Control

During wellness appointments, it is important to discuss the social aspects of pet care, like details of the home environment and the pet’s behavioral quirks. These questions are equally important to ask during examinations for illness to better cement the veterinarian–pet owner relationship and to uncover personal factors that may affect client compliance.⁵ Moony’s owner reports that Moony is not selective about food and shares that he is concerned about trying to administer oral medications. With these details in mind, a food trial is recommended.

The owner expresses apprehension regarding a food trial, as he has already tried several OTC limited-ingredient diets. The clinician takes this opportunity to explain that a significant percentage of OTC limited-ingredient diets have been found to be contaminated with proteins other than those listed on the ingredient list,⁶ whereas veterinary-exclusive diets such as Royal Canin’s Selected Protein line are produced in an environment designed to avoid contamination with ingredients not listed on the label.

Another option only available through veterinarians is the hydrolyzed protein diet. Royal Canin’s Hydrolyzed Protein HP and Ultamino diets are particularly useful for cats like Moony that have already been exposed to a large number of proteins.⁷

Educating clients on what to expect is a key factor in ensuring compliance. If clients hold incorrect assumptions as to the speed or efficacy of a food trial, they may not adhere to guidelines when they do not see an immediate response. Moony’s owner is informed that it is vital Moony be fed the recommended hydrolyzed protein diet exclusively for the length of the trial and that patience will be required. Eighty percent of pets on strict food elimination trials show improvement after 6 weeks, and >90% show improvement after 8 weeks.⁸

Not every food elimination trial results in complete resolution of signs; 20% to 30% of dogs and cats with food allergies also suffer from flea allergy and/or atopic dermatitis,⁹ and there have been reports of dogs reacting to proteins in hydrolyzed diets,¹⁰ which is why an extensively hydrolyzed diet like Ultamino should be considered if an initial food elimination trial is unsuccessful or if a pet has already been exposed to diets containing multiple protein sources.

Because successful long-term management of allergic dermatitis depends so much on how pets respond to diagnostics and treatment, communication between the veterinarian and client should not end after the examination. It is equally important that Moony’s owner monitor his response at home and share that response with the veterinarian so treatment can be adjusted as needed.

If success is achieved during a food trial, it is important to communicate to the owner that the patient still has a lifelong condition. After 5 weeks, Moony is reported to show clear improvement. His owner prefers to continue to feed the veterinary-exclusive diet for now but is open to doing a provocation challenge once Moony’s signs have been controlled for a prolonged period. The veterinary team and Moony’s owner agree to discuss it further at Moony’s next wellness visit.

Conclusion

With chronic conditions like food allergies, effective communication between the veterinary team and pet owner is important every step of the way—from history to diagnosis and treatment. Helping an owner bring their pet from uncomfortable and distressed to happy and healthy again can help cement the bond between the veterinary team and owner and engender loyalty, leading to better lifetime care.