Abordagem diagnóstica e terapêutica do prurido em gatos M.V., Phd., Alessandra Vieira Pereira Rio de Janeiro- Brasil
Abordagem diagnóstica e terapêutica do prurido em
gatos
M.V., Phd., Alessandra Vieira PereiraRio de Janeiro- Brasil
Cães X Gatos
Gatos se lambem mais ( “Grooming”)
Infecções secundárias são menos frequentes
Alterações crônicas cutâneas são raras
Não deixam vestígios de pulgas
Diferentes apresentações clínicas
Triagem diagnóstica mais difícil
Se escondem para coçar!
Dermatopatias pruriginosas
Alergopatias
DAPE
HS alimentar
HS não induzida por pulgas e alimentos
HS picada de mosquito
Outras causas
Demodiciose (D.gatoi)
Sarna notoédrica
Otoacaríase
Pediculose/Lynksacaríase
Pênfigo Foliáceo
Clinical characteristics and causes of pruritus in cats:a multicentre study on feline hypersensitivity-associated dermatoses
Stefan Hobi*, Monika Linek†, GenevieveMarignac‡, Thierry Olivry§, Luc Beco¶, ClaudiaNett**, Jacques Fontaine††, Petra Roosje‡‡,Kerstin Bergvall§§, Sveta Belova¶¶, StefanieKoebrich***, DidierPin†††,MarcelKovalik‡‡‡,SabrinaMeury*,SylvieWilhelm*,1andClaudeFavrot*,1
*Dermatology Department, Clinic for Small Animal Internal Medicine,
Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
†Tierarztliche Spezialisten, Hamburg, Germany
‡Unite de Parasitologie, Ecole Nationale Veterinaire d’Alfort,
Maisons-Alfort Cedex, France
§Department of Clinical Sciences and Center for Comparative
Medicine and Translational Research, North Carolina State
University, Raleigh, NC, USA
¶Clinique Veterinaire, Spa, Belgium
**Dermatologie und Allergologie fur Tieren, Kleintierklinik Rigiplatz,
Cham, Switzerland
††Clinique Veterinaire, Bruxelles, Belgium
‡‡Division of Clinical Dermatology, Department of Clinical Veterinary
Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
§§Department Clinical Sciences, Swedish University of Agricultural
Sciences, Uppsala, Sweden
¶¶Department of Therapy, Institute of Veterinary Medicine and
Animal Science, Estonian University of Life Sciences, Tartu, Estonia
***Bruchweg 3, D- 68809, Neulussheim, Germany
†††Unite de Dermatologie, VetAgro Sup Campus Veterinaire, Marcy
L’Etoile, France
‡‡‡The University of Edinburgh, Veterinary Dermatology Unit,
Division of Veterinary Clinical Sciences, The Hospital for Small Ani-
mals, The Royal (Dick) School of Veterinary Studies, Edinburgh, UK
Correspondence: Claude Favrot, Dermatology Department, Clinic for
Small Animal Internal Medicine, Vetsuisse Faculty, University of
Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
E-mail: [email protected] the authors contributed equally to this work.
Sources of Funding
Novartis Animal Health, Basel, Switzerland and research funds from
the University of Zurich financed this study.
Conflict of Interest
No conflicts of interest have been declared.
Abstract
Hypersensitivity dermatitides (HD) are often sus-pected in cats. Cats with HD are reported to presentwith one or more of the following patterns: miliarydermatitis, eosinophilic dermatitis, self-induced sym-metrical alopecia or head and/or neck excoriations.Previous reports on feline HD included small numbersof animals, took place in geographically restrictedareas or did not compare these conditions with othercauses of pruritus. The goal of the present study was
to analyse 72 parameters covering signalment, clini-cal, laboratory and treatment characteristics from alarge group of pruritic cats from different geographi-cal areas. Of the 502 cats, the following diagnoseswere made: flea HD (29% of cases), food HD (12%)nonflea ⁄ nonfood HD (20%) and other diseases inwhich pruritus was a feature (24%). Cats with signsconsistent with a HD but which did not complete afood trial were not analysed further (15% of cases).Most cats with nonflea HD exhibited signs compatiblewith one or more of the four typical lesional patterns,but none of these patterns was found to be patho-gnomonic for any specific diagnosis. Food HD andnonflea ⁄ nonfood HD were found to be clinicallyundistinguishable. Young adult, purebred and femalecats appeared predisposed to nonflea/nonfood HD.As many diagnoses presented with similar lesionalpatterns, a thorough clinical work-up is required forestablishment of a specific diagnosis.
Accepted 13 January 2011
Introduction
Hypersensitivity dermatitides (HD) are often suspected in
companion animals, and these include flea bite hypersen-
sitivity dermatitis, cutaneous adverse food reactions,
urticaria, angioedema and atopic dermatitis (AD).1 The
use of the term ‘feline AD’ remains debatable, however,
because its clinical presentation and histological features
differ markedly from those of its human and canine coun-
terparts. Furthermore, the use of the adjective ‘atopic’
(meaning ‘IgE-mediated’) itself is questionable for this
disease, because the importance of IgE in its pathogenesis
has not been firmly demonstrated.2,3 Very few studies
have investigated the role of IgE in the development of
HD in cats.2,4–6 Additionally, there is evidence suggesting
the heterogeneity of feline IgE and that allergen-specific
IgE serum levels do not correlate with clinical signs of HD
in cats.7–9 Finally, one study reported that up to 35% of
cats with HD have negative allergen-specific intradermal
and serological tests.2 Therefore, and following the current
nomenclature of human and canine allergic skin dis-
eases,10,11 as long as the importance of IgE has not been
firmly demonstrated in cats with pruritic allergic skin dis-
eases, the authors of this paper will not use the term ‘feline
AD’ and replace it with the more generic term of ‘HD’.
The diagnosis of feline nonflea HD (i.e. nonflea bite-
associated HD) is usually based on the exclusion of
ª 2011 The Authors. Veterinary Dermatology
406 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
DOI: 10.1111/j.1365-3164.2011.00962.x
Clinical characteristics and causes of pruritus in cats:a multicentre study on feline hypersensitivity-associated dermatoses
Stefan Hobi*, Monika Linek†, GenevieveMarignac‡, Thierry Olivry§, Luc Beco¶, ClaudiaNett**, Jacques Fontaine††, Petra Roosje‡‡,Kerstin Bergvall§§, Sveta Belova¶¶, StefanieKoebrich***, DidierPin†††,MarcelKovalik‡‡‡,SabrinaMeury*,SylvieWilhelm*,1andClaudeFavrot*,1
*Dermatology Department, Clinic for Small Animal Internal Medicine,
Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
†Tierarztliche Spezialisten, Hamburg, Germany
‡Unite de Parasitologie, Ecole Nationale Veterinaire d’Alfort,
Maisons-Alfort Cedex, France
§Department of Clinical Sciences and Center for Comparative
Medicine and Translational Research, North Carolina State
University, Raleigh, NC, USA
¶Clinique Veterinaire, Spa, Belgium
**Dermatologie und Allergologie fur Tieren, Kleintierklinik Rigiplatz,
Cham, Switzerland
††Clinique Veterinaire, Bruxelles, Belgium
‡‡Division of Clinical Dermatology, Department of Clinical Veterinary
Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
§§Department Clinical Sciences, Swedish University of Agricultural
Sciences, Uppsala, Sweden
¶¶Department of Therapy, Institute of Veterinary Medicine and
Animal Science, Estonian University of Life Sciences, Tartu, Estonia
***Bruchweg 3, D- 68809, Neulussheim, Germany
†††Unite de Dermatologie, VetAgro Sup Campus Veterinaire, Marcy
L’Etoile, France
‡‡‡The University of Edinburgh, Veterinary Dermatology Unit,
Division of Veterinary Clinical Sciences, The Hospital for Small Ani-
mals, The Royal (Dick) School of Veterinary Studies, Edinburgh, UK
Correspondence: Claude Favrot, Dermatology Department, Clinic for
Small Animal Internal Medicine, Vetsuisse Faculty, University of
Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
E-mail: [email protected] the authors contributed equally to this work.
Sources of Funding
Novartis Animal Health, Basel, Switzerland and research funds from
the University of Zurich financed this study.
Conflict of Interest
No conflicts of interest have been declared.
Abstract
Hypersensitivity dermatitides (HD) are often sus-pected in cats. Cats with HD are reported to presentwith one or more of the following patterns: miliarydermatitis, eosinophilic dermatitis, self-induced sym-metrical alopecia or head and/or neck excoriations.Previous reports on feline HD included small numbersof animals, took place in geographically restrictedareas or did not compare these conditions with othercauses of pruritus. The goal of the present study was
to analyse 72 parameters covering signalment, clini-cal, laboratory and treatment characteristics from alarge group of pruritic cats from different geographi-cal areas. Of the 502 cats, the following diagnoseswere made: flea HD (29% of cases), food HD (12%)nonflea ⁄ nonfood HD (20%) and other diseases inwhich pruritus was a feature (24%). Cats with signsconsistent with a HD but which did not complete afood trial were not analysed further (15% of cases).Most cats with nonflea HD exhibited signs compatiblewith one or more of the four typical lesional patterns,but none of these patterns was found to be patho-gnomonic for any specific diagnosis. Food HD andnonflea ⁄ nonfood HD were found to be clinicallyundistinguishable. Young adult, purebred and femalecats appeared predisposed to nonflea/nonfood HD.As many diagnoses presented with similar lesionalpatterns, a thorough clinical work-up is required forestablishment of a specific diagnosis.
Accepted 13 January 2011
Introduction
Hypersensitivity dermatitides (HD) are often suspected in
companion animals, and these include flea bite hypersen-
sitivity dermatitis, cutaneous adverse food reactions,
urticaria, angioedema and atopic dermatitis (AD).1 The
use of the term ‘feline AD’ remains debatable, however,
because its clinical presentation and histological features
differ markedly from those of its human and canine coun-
terparts. Furthermore, the use of the adjective ‘atopic’
(meaning ‘IgE-mediated’) itself is questionable for this
disease, because the importance of IgE in its pathogenesis
has not been firmly demonstrated.2,3 Very few studies
have investigated the role of IgE in the development of
HD in cats.2,4–6 Additionally, there is evidence suggesting
the heterogeneity of feline IgE and that allergen-specific
IgE serum levels do not correlate with clinical signs of HD
in cats.7–9 Finally, one study reported that up to 35% of
cats with HD have negative allergen-specific intradermal
and serological tests.2 Therefore, and following the current
nomenclature of human and canine allergic skin dis-
eases,10,11 as long as the importance of IgE has not been
firmly demonstrated in cats with pruritic allergic skin dis-
eases, the authors of this paper will not use the term ‘feline
AD’ and replace it with the more generic term of ‘HD’.
The diagnosis of feline nonflea HD (i.e. nonflea bite-
associated HD) is usually based on the exclusion of
ª 2011 The Authors. Veterinary Dermatology
406 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
DOI: 10.1111/j.1365-3164.2011.00962.x
Clinical characteristics and causes of pruritus in cats:a multicentre study on feline hypersensitivity-associated dermatoses
Stefan Hobi*, Monika Linek†, GenevieveMarignac‡, Thierry Olivry§, Luc Beco¶, ClaudiaNett**, Jacques Fontaine††, Petra Roosje‡‡,Kerstin Bergvall§§, Sveta Belova¶¶, StefanieKoebrich***, DidierPin†††,MarcelKovalik‡‡‡,SabrinaMeury*,SylvieWilhelm*,1andClaudeFavrot*,1
*Dermatology Department, Clinic for Small Animal Internal Medicine,
Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
†Tierarztliche Spezialisten, Hamburg, Germany
‡Unite de Parasitologie, Ecole Nationale Veterinaire d’Alfort,
Maisons-Alfort Cedex, France
§Department of Clinical Sciences and Center for Comparative
Medicine and Translational Research, North Carolina State
University, Raleigh, NC, USA
¶Clinique Veterinaire, Spa, Belgium
**Dermatologie und Allergologie fur Tieren, Kleintierklinik Rigiplatz,
Cham, Switzerland
††Clinique Veterinaire, Bruxelles, Belgium
‡‡Division of Clinical Dermatology, Department of Clinical Veterinary
Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
§§Department Clinical Sciences, Swedish University of Agricultural
Sciences, Uppsala, Sweden
¶¶Department of Therapy, Institute of Veterinary Medicine and
Animal Science, Estonian University of Life Sciences, Tartu, Estonia
***Bruchweg 3, D- 68809, Neulussheim, Germany
†††Unite de Dermatologie, VetAgro Sup Campus Veterinaire, Marcy
L’Etoile, France
‡‡‡The University of Edinburgh, Veterinary Dermatology Unit,
Division of Veterinary Clinical Sciences, The Hospital for Small Ani-
mals, The Royal (Dick) School of Veterinary Studies, Edinburgh, UK
Correspondence: Claude Favrot, Dermatology Department, Clinic for
Small Animal Internal Medicine, Vetsuisse Faculty, University of
Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
E-mail: [email protected] the authors contributed equally to this work.
Sources of Funding
Novartis Animal Health, Basel, Switzerland and research funds from
the University of Zurich financed this study.
Conflict of Interest
No conflicts of interest have been declared.
Abstract
Hypersensitivity dermatitides (HD) are often sus-pected in cats. Cats with HD are reported to presentwith one or more of the following patterns: miliarydermatitis, eosinophilic dermatitis, self-induced sym-metrical alopecia or head and/or neck excoriations.Previous reports on feline HD included small numbersof animals, took place in geographically restrictedareas or did not compare these conditions with othercauses of pruritus. The goal of the present study was
to analyse 72 parameters covering signalment, clini-cal, laboratory and treatment characteristics from alarge group of pruritic cats from different geographi-cal areas. Of the 502 cats, the following diagnoseswere made: flea HD (29% of cases), food HD (12%)nonflea ⁄ nonfood HD (20%) and other diseases inwhich pruritus was a feature (24%). Cats with signsconsistent with a HD but which did not complete afood trial were not analysed further (15% of cases).Most cats with nonflea HD exhibited signs compatiblewith one or more of the four typical lesional patterns,but none of these patterns was found to be patho-gnomonic for any specific diagnosis. Food HD andnonflea ⁄ nonfood HD were found to be clinicallyundistinguishable. Young adult, purebred and femalecats appeared predisposed to nonflea/nonfood HD.As many diagnoses presented with similar lesionalpatterns, a thorough clinical work-up is required forestablishment of a specific diagnosis.
Accepted 13 January 2011
Introduction
Hypersensitivity dermatitides (HD) are often suspected in
companion animals, and these include flea bite hypersen-
sitivity dermatitis, cutaneous adverse food reactions,
urticaria, angioedema and atopic dermatitis (AD).1 The
use of the term ‘feline AD’ remains debatable, however,
because its clinical presentation and histological features
differ markedly from those of its human and canine coun-
terparts. Furthermore, the use of the adjective ‘atopic’
(meaning ‘IgE-mediated’) itself is questionable for this
disease, because the importance of IgE in its pathogenesis
has not been firmly demonstrated.2,3 Very few studies
have investigated the role of IgE in the development of
HD in cats.2,4–6 Additionally, there is evidence suggesting
the heterogeneity of feline IgE and that allergen-specific
IgE serum levels do not correlate with clinical signs of HD
in cats.7–9 Finally, one study reported that up to 35% of
cats with HD have negative allergen-specific intradermal
and serological tests.2 Therefore, and following the current
nomenclature of human and canine allergic skin dis-
eases,10,11 as long as the importance of IgE has not been
firmly demonstrated in cats with pruritic allergic skin dis-
eases, the authors of this paper will not use the term ‘feline
AD’ and replace it with the more generic term of ‘HD’.
The diagnosis of feline nonflea HD (i.e. nonflea bite-
associated HD) is usually based on the exclusion of
ª 2011 The Authors. Veterinary Dermatology
406 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
DOI: 10.1111/j.1365-3164.2011.00962.x
Clinical characteristics and causes of pruritus in cats:a multicentre study on feline hypersensitivity-associated dermatoses
Stefan Hobi*, Monika Linek†, GenevieveMarignac‡, Thierry Olivry§, Luc Beco¶, ClaudiaNett**, Jacques Fontaine††, Petra Roosje‡‡,Kerstin Bergvall§§, Sveta Belova¶¶, StefanieKoebrich***, DidierPin†††,MarcelKovalik‡‡‡,SabrinaMeury*,SylvieWilhelm*,1andClaudeFavrot*,1
*Dermatology Department, Clinic for Small Animal Internal Medicine,
Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
†Tierarztliche Spezialisten, Hamburg, Germany
‡Unite de Parasitologie, Ecole Nationale Veterinaire d’Alfort,
Maisons-Alfort Cedex, France
§Department of Clinical Sciences and Center for Comparative
Medicine and Translational Research, North Carolina State
University, Raleigh, NC, USA
¶Clinique Veterinaire, Spa, Belgium
**Dermatologie und Allergologie fur Tieren, Kleintierklinik Rigiplatz,
Cham, Switzerland
††Clinique Veterinaire, Bruxelles, Belgium
‡‡Division of Clinical Dermatology, Department of Clinical Veterinary
Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
§§Department Clinical Sciences, Swedish University of Agricultural
Sciences, Uppsala, Sweden
¶¶Department of Therapy, Institute of Veterinary Medicine and
Animal Science, Estonian University of Life Sciences, Tartu, Estonia
***Bruchweg 3, D- 68809, Neulussheim, Germany
†††Unite de Dermatologie, VetAgro Sup Campus Veterinaire, Marcy
L’Etoile, France
‡‡‡The University of Edinburgh, Veterinary Dermatology Unit,
Division of Veterinary Clinical Sciences, The Hospital for Small Ani-
mals, The Royal (Dick) School of Veterinary Studies, Edinburgh, UK
Correspondence: Claude Favrot, Dermatology Department, Clinic for
Small Animal Internal Medicine, Vetsuisse Faculty, University of
Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
E-mail: [email protected] the authors contributed equally to this work.
Sources of Funding
Novartis Animal Health, Basel, Switzerland and research funds from
the University of Zurich financed this study.
Conflict of Interest
No conflicts of interest have been declared.
Abstract
Hypersensitivity dermatitides (HD) are often sus-pected in cats. Cats with HD are reported to presentwith one or more of the following patterns: miliarydermatitis, eosinophilic dermatitis, self-induced sym-metrical alopecia or head and/or neck excoriations.Previous reports on feline HD included small numbersof animals, took place in geographically restrictedareas or did not compare these conditions with othercauses of pruritus. The goal of the present study was
to analyse 72 parameters covering signalment, clini-cal, laboratory and treatment characteristics from alarge group of pruritic cats from different geographi-cal areas. Of the 502 cats, the following diagnoseswere made: flea HD (29% of cases), food HD (12%)nonflea ⁄ nonfood HD (20%) and other diseases inwhich pruritus was a feature (24%). Cats with signsconsistent with a HD but which did not complete afood trial were not analysed further (15% of cases).Most cats with nonflea HD exhibited signs compatiblewith one or more of the four typical lesional patterns,but none of these patterns was found to be patho-gnomonic for any specific diagnosis. Food HD andnonflea ⁄ nonfood HD were found to be clinicallyundistinguishable. Young adult, purebred and femalecats appeared predisposed to nonflea/nonfood HD.As many diagnoses presented with similar lesionalpatterns, a thorough clinical work-up is required forestablishment of a specific diagnosis.
Accepted 13 January 2011
Introduction
Hypersensitivity dermatitides (HD) are often suspected in
companion animals, and these include flea bite hypersen-
sitivity dermatitis, cutaneous adverse food reactions,
urticaria, angioedema and atopic dermatitis (AD).1 The
use of the term ‘feline AD’ remains debatable, however,
because its clinical presentation and histological features
differ markedly from those of its human and canine coun-
terparts. Furthermore, the use of the adjective ‘atopic’
(meaning ‘IgE-mediated’) itself is questionable for this
disease, because the importance of IgE in its pathogenesis
has not been firmly demonstrated.2,3 Very few studies
have investigated the role of IgE in the development of
HD in cats.2,4–6 Additionally, there is evidence suggesting
the heterogeneity of feline IgE and that allergen-specific
IgE serum levels do not correlate with clinical signs of HD
in cats.7–9 Finally, one study reported that up to 35% of
cats with HD have negative allergen-specific intradermal
and serological tests.2 Therefore, and following the current
nomenclature of human and canine allergic skin dis-
eases,10,11 as long as the importance of IgE has not been
firmly demonstrated in cats with pruritic allergic skin dis-
eases, the authors of this paper will not use the term ‘feline
AD’ and replace it with the more generic term of ‘HD’.
The diagnosis of feline nonflea HD (i.e. nonflea bite-
associated HD) is usually based on the exclusion of
ª 2011 The Authors. Veterinary Dermatology
406 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
DOI: 10.1111/j.1365-3164.2011.00962.x
Somali, sphinx, Chartreux and British blue were also repre-
sented but in low numbers. There were 225 male (45%)
and 277 female cats (55%).
One hundred and forty-six cats were diagnosed with
flea HD (29%), 61 with food HD (12%), 100 with non-
flea ⁄ nonfood HD (20%), 74 with an undetermined HD
(15%) and 121 (24%) with other diseases (Figure 2).
These pruritic cats with other diseases were diagnosed
as having one of 31 different conditions of the following
categories: parasitic (n = 35; 29%), autoimmune (15;
12%), fungal (13; 11%), neoplastic (8; 7%), psychogenic
(6; 5%), viral (5; 4%), isolated otitis externa (5; 4%) bacte-
rial (4; 3%), and miscellaneous or idiopathic conditions
(38; 31%). There were a total of 129 cats – some with
more than one disease.
Clinical features of cats with nonflea HDResults are presented in Tables 1–4 and Figure 3.
Forty-three of 161 cats with nonflea HD (27%) were
purebred cats; all Abyssinian cats included in this study
belonged to this group. Males represented 41% of cats
diagnosed with nonflea HD. The mean age of onset of
pruritus was 3.4 years, and 82 cats with nonflea HD
(51%) were younger than 3 years of age when they had
their first pruritic episode.
Most cats with nonflea HD exhibited one of the follow-
ing lesional patterns: self-induced symmetric alopecia
(83; 52%), head and neck pruritus (95; 59%), eosinophilic
diseases (41; 25%) or miliary dermatitis (30; 19%). Most
cats (152 of 161; 94%) were affected with at least one of
these patterns, while 74 (46%) presented with more than
one. In the remaining nine cats (5%), erythema, nonsym-
metrical alopecia and ⁄ or crusts were observed. Of cats
evaluated prospectively, the mean pruritus score was 6.4
of 10, and 119 of 136 cats (88%) had a pruritus score of 5
or greater [correction added on 1st April 2011 after online
publication: ‘119 of 161 cats (74%)’ changed to ‘119 of
136 cats (88%)’].
Interestingly, two body areas were affected in more
than half of the cats with nonflea HD: the head or face
and the abdomen (Table 3 and Figure 3). Additionally,
ears and neck were affected in more than one-third of
cats included in this group. Conversely, paws, sternum or
axilla and mouth were affected in <10% of these cats.
Sixty-seven cats with nonflea HD presented with non-
dermatological signs (42%). Among these 67 cats, 22
(33%) exhibited digestive signs (e.g. diarrhoea, vomiting,
soft tools or increased defecation), 24 (36%) had otitis
externa, 13 (19%) had conjunctivitis and 10 (15%) had
respiratory signs.
Comparisons between cats with nonflea HD andthose with flea HDFemale and purebred cats were over-represented in the
nonflea HD group compared with cats having flea HD
(P < 0.0001 and P = 0.003, respectively; Table 1). In fact,
How itchy is your cat?This scale is designed to measure the severity of itching in cats. Itching can include scratching, biting,licking, chewing, nibbling, rubbing and/or sudden run away. Read all the descriptions below starting from the bottomThen use a marker pen to place a mark anywhere on the vertical line that runs down the left hand side toIndicate the point at which you think your cat’s level of itchiness lies.
.
Extremely severe itching/almost continuous
Itching does not stop whatever is happening, even in the consulting room(needs to be physically restrained from itching)
Severe itching/prolonged episodesItching might occur at night (if observed) and also when eating, playing, exercising or being distracted
Moderate itching/regular episodesItching might occur at night (if observed), but not when eating, playing, exercising or being distracted
Mild itching/a bit more frequentWould not itch when sleeping, eating, playing, exercising or being distracted
Very mild itching/only occasional episodes
The cat is slightly more itchy than it was before the skin problem started
Normal cat – I don’t think itching is a problem
Figure 1. Pruritus scale.
588 pruritic cats
502 cats analysed86 cats excluded
235 nonflea HD cats 146 flea HD cats 121 other diseases
100 nonflea, nonfoodHD cats
74 undeterminedHD cats61 food HD cats
Figure 2. Assignment of cats into study groups.
ª 2011 The Authors. Veterinary Dermatology
408 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
Hobi et al.
Alergopatias381gatos
Clinical characteristics and causes of pruritus in cats:a multicentre study on feline hypersensitivity-associated dermatoses
Stefan Hobi*, Monika Linek†, GenevieveMarignac‡, Thierry Olivry§, Luc Beco¶, ClaudiaNett**, Jacques Fontaine††, Petra Roosje‡‡,Kerstin Bergvall§§, Sveta Belova¶¶, StefanieKoebrich***, DidierPin†††,MarcelKovalik‡‡‡,SabrinaMeury*,SylvieWilhelm*,1andClaudeFavrot*,1
*Dermatology Department, Clinic for Small Animal Internal Medicine,
Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
†Tierarztliche Spezialisten, Hamburg, Germany
‡Unite de Parasitologie, Ecole Nationale Veterinaire d’Alfort,
Maisons-Alfort Cedex, France
§Department of Clinical Sciences and Center for Comparative
Medicine and Translational Research, North Carolina State
University, Raleigh, NC, USA
¶Clinique Veterinaire, Spa, Belgium
**Dermatologie und Allergologie fur Tieren, Kleintierklinik Rigiplatz,
Cham, Switzerland
††Clinique Veterinaire, Bruxelles, Belgium
‡‡Division of Clinical Dermatology, Department of Clinical Veterinary
Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
§§Department Clinical Sciences, Swedish University of Agricultural
Sciences, Uppsala, Sweden
¶¶Department of Therapy, Institute of Veterinary Medicine and
Animal Science, Estonian University of Life Sciences, Tartu, Estonia
***Bruchweg 3, D- 68809, Neulussheim, Germany
†††Unite de Dermatologie, VetAgro Sup Campus Veterinaire, Marcy
L’Etoile, France
‡‡‡The University of Edinburgh, Veterinary Dermatology Unit,
Division of Veterinary Clinical Sciences, The Hospital for Small Ani-
mals, The Royal (Dick) School of Veterinary Studies, Edinburgh, UK
Correspondence: Claude Favrot, Dermatology Department, Clinic for
Small Animal Internal Medicine, Vetsuisse Faculty, University of
Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
E-mail: [email protected] the authors contributed equally to this work.
Sources of Funding
Novartis Animal Health, Basel, Switzerland and research funds from
the University of Zurich financed this study.
Conflict of Interest
No conflicts of interest have been declared.
Abstract
Hypersensitivity dermatitides (HD) are often sus-pected in cats. Cats with HD are reported to presentwith one or more of the following patterns: miliarydermatitis, eosinophilic dermatitis, self-induced sym-metrical alopecia or head and/or neck excoriations.Previous reports on feline HD included small numbersof animals, took place in geographically restrictedareas or did not compare these conditions with othercauses of pruritus. The goal of the present study was
to analyse 72 parameters covering signalment, clini-cal, laboratory and treatment characteristics from alarge group of pruritic cats from different geographi-cal areas. Of the 502 cats, the following diagnoseswere made: flea HD (29% of cases), food HD (12%)nonflea ⁄ nonfood HD (20%) and other diseases inwhich pruritus was a feature (24%). Cats with signsconsistent with a HD but which did not complete afood trial were not analysed further (15% of cases).Most cats with nonflea HD exhibited signs compatiblewith one or more of the four typical lesional patterns,but none of these patterns was found to be patho-gnomonic for any specific diagnosis. Food HD andnonflea ⁄ nonfood HD were found to be clinicallyundistinguishable. Young adult, purebred and femalecats appeared predisposed to nonflea/nonfood HD.As many diagnoses presented with similar lesionalpatterns, a thorough clinical work-up is required forestablishment of a specific diagnosis.
Accepted 13 January 2011
Introduction
Hypersensitivity dermatitides (HD) are often suspected in
companion animals, and these include flea bite hypersen-
sitivity dermatitis, cutaneous adverse food reactions,
urticaria, angioedema and atopic dermatitis (AD).1 The
use of the term ‘feline AD’ remains debatable, however,
because its clinical presentation and histological features
differ markedly from those of its human and canine coun-
terparts. Furthermore, the use of the adjective ‘atopic’
(meaning ‘IgE-mediated’) itself is questionable for this
disease, because the importance of IgE in its pathogenesis
has not been firmly demonstrated.2,3 Very few studies
have investigated the role of IgE in the development of
HD in cats.2,4–6 Additionally, there is evidence suggesting
the heterogeneity of feline IgE and that allergen-specific
IgE serum levels do not correlate with clinical signs of HD
in cats.7–9 Finally, one study reported that up to 35% of
cats with HD have negative allergen-specific intradermal
and serological tests.2 Therefore, and following the current
nomenclature of human and canine allergic skin dis-
eases,10,11 as long as the importance of IgE has not been
firmly demonstrated in cats with pruritic allergic skin dis-
eases, the authors of this paper will not use the term ‘feline
AD’ and replace it with the more generic term of ‘HD’.
The diagnosis of feline nonflea HD (i.e. nonflea bite-
associated HD) is usually based on the exclusion of
ª 2011 The Authors. Veterinary Dermatology
406 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
DOI: 10.1111/j.1365-3164.2011.00962.x
Infecciosas/A.I121gatos
Somali, sphinx, Chartreux and British blue were also repre-
sented but in low numbers. There were 225 male (45%)
and 277 female cats (55%).
One hundred and forty-six cats were diagnosed with
flea HD (29%), 61 with food HD (12%), 100 with non-
flea ⁄ nonfood HD (20%), 74 with an undetermined HD
(15%) and 121 (24%) with other diseases (Figure 2).
These pruritic cats with other diseases were diagnosed
as having one of 31 different conditions of the following
categories: parasitic (n = 35; 29%), autoimmune (15;
12%), fungal (13; 11%), neoplastic (8; 7%), psychogenic
(6; 5%), viral (5; 4%), isolated otitis externa (5; 4%) bacte-
rial (4; 3%), and miscellaneous or idiopathic conditions
(38; 31%). There were a total of 129 cats – some with
more than one disease.
Clinical features of cats with nonflea HDResults are presented in Tables 1–4 and Figure 3.
Forty-three of 161 cats with nonflea HD (27%) were
purebred cats; all Abyssinian cats included in this study
belonged to this group. Males represented 41% of cats
diagnosed with nonflea HD. The mean age of onset of
pruritus was 3.4 years, and 82 cats with nonflea HD
(51%) were younger than 3 years of age when they had
their first pruritic episode.
Most cats with nonflea HD exhibited one of the follow-
ing lesional patterns: self-induced symmetric alopecia
(83; 52%), head and neck pruritus (95; 59%), eosinophilic
diseases (41; 25%) or miliary dermatitis (30; 19%). Most
cats (152 of 161; 94%) were affected with at least one of
these patterns, while 74 (46%) presented with more than
one. In the remaining nine cats (5%), erythema, nonsym-
metrical alopecia and ⁄ or crusts were observed. Of cats
evaluated prospectively, the mean pruritus score was 6.4
of 10, and 119 of 136 cats (88%) had a pruritus score of 5
or greater [correction added on 1st April 2011 after online
publication: ‘119 of 161 cats (74%)’ changed to ‘119 of
136 cats (88%)’].
Interestingly, two body areas were affected in more
than half of the cats with nonflea HD: the head or face
and the abdomen (Table 3 and Figure 3). Additionally,
ears and neck were affected in more than one-third of
cats included in this group. Conversely, paws, sternum or
axilla and mouth were affected in <10% of these cats.
Sixty-seven cats with nonflea HD presented with non-
dermatological signs (42%). Among these 67 cats, 22
(33%) exhibited digestive signs (e.g. diarrhoea, vomiting,
soft tools or increased defecation), 24 (36%) had otitis
externa, 13 (19%) had conjunctivitis and 10 (15%) had
respiratory signs.
Comparisons between cats with nonflea HD andthose with flea HDFemale and purebred cats were over-represented in the
nonflea HD group compared with cats having flea HD
(P < 0.0001 and P = 0.003, respectively; Table 1). In fact,
How itchy is your cat?This scale is designed to measure the severity of itching in cats. Itching can include scratching, biting,licking, chewing, nibbling, rubbing and/or sudden run away. Read all the descriptions below starting from the bottomThen use a marker pen to place a mark anywhere on the vertical line that runs down the left hand side toIndicate the point at which you think your cat’s level of itchiness lies.
.
Extremely severe itching/almost continuous
Itching does not stop whatever is happening, even in the consulting room(needs to be physically restrained from itching)
Severe itching/prolonged episodesItching might occur at night (if observed) and also when eating, playing, exercising or being distracted
Moderate itching/regular episodesItching might occur at night (if observed), but not when eating, playing, exercising or being distracted
Mild itching/a bit more frequentWould not itch when sleeping, eating, playing, exercising or being distracted
Very mild itching/only occasional episodes
The cat is slightly more itchy than it was before the skin problem started
Normal cat – I don’t think itching is a problem
Figure 1. Pruritus scale.
588 pruritic cats
502 cats analysed86 cats excluded
235 nonflea HD cats 146 flea HD cats 121 other diseases
100 nonflea, nonfoodHD cats
74 undeterminedHD cats61 food HD cats
Figure 2. Assignment of cats into study groups.
ª 2011 The Authors. Veterinary Dermatology
408 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
Hobi et al.
O quanto seu gato coça??
Extremamente severo/quase contínuoPrurido não cessa mesmo no consultório
Prurido severo/ episódios longosPrurido moderado/ episódios regulares
Prurido moderado/se mordiscam com frequênciaPrurido em episódios ocasionais
Não pensa que prurido é o problema0
10
Clinical characteristics and causes of pruritus in cats:a multicentre study on feline hypersensitivity-associated dermatoses
Stefan Hobi*, Monika Linek†, GenevieveMarignac‡, Thierry Olivry§, Luc Beco¶, ClaudiaNett**, Jacques Fontaine††, Petra Roosje‡‡,Kerstin Bergvall§§, Sveta Belova¶¶, StefanieKoebrich***, DidierPin†††,MarcelKovalik‡‡‡,SabrinaMeury*,SylvieWilhelm*,1andClaudeFavrot*,1
*Dermatology Department, Clinic for Small Animal Internal Medicine,
Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
†Tierarztliche Spezialisten, Hamburg, Germany
‡Unite de Parasitologie, Ecole Nationale Veterinaire d’Alfort,
Maisons-Alfort Cedex, France
§Department of Clinical Sciences and Center for Comparative
Medicine and Translational Research, North Carolina State
University, Raleigh, NC, USA
¶Clinique Veterinaire, Spa, Belgium
**Dermatologie und Allergologie fur Tieren, Kleintierklinik Rigiplatz,
Cham, Switzerland
††Clinique Veterinaire, Bruxelles, Belgium
‡‡Division of Clinical Dermatology, Department of Clinical Veterinary
Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
§§Department Clinical Sciences, Swedish University of Agricultural
Sciences, Uppsala, Sweden
¶¶Department of Therapy, Institute of Veterinary Medicine and
Animal Science, Estonian University of Life Sciences, Tartu, Estonia
***Bruchweg 3, D- 68809, Neulussheim, Germany
†††Unite de Dermatologie, VetAgro Sup Campus Veterinaire, Marcy
L’Etoile, France
‡‡‡The University of Edinburgh, Veterinary Dermatology Unit,
Division of Veterinary Clinical Sciences, The Hospital for Small Ani-
mals, The Royal (Dick) School of Veterinary Studies, Edinburgh, UK
Correspondence: Claude Favrot, Dermatology Department, Clinic for
Small Animal Internal Medicine, Vetsuisse Faculty, University of
Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
E-mail: [email protected] the authors contributed equally to this work.
Sources of Funding
Novartis Animal Health, Basel, Switzerland and research funds from
the University of Zurich financed this study.
Conflict of Interest
No conflicts of interest have been declared.
Abstract
Hypersensitivity dermatitides (HD) are often sus-pected in cats. Cats with HD are reported to presentwith one or more of the following patterns: miliarydermatitis, eosinophilic dermatitis, self-induced sym-metrical alopecia or head and/or neck excoriations.Previous reports on feline HD included small numbersof animals, took place in geographically restrictedareas or did not compare these conditions with othercauses of pruritus. The goal of the present study was
to analyse 72 parameters covering signalment, clini-cal, laboratory and treatment characteristics from alarge group of pruritic cats from different geographi-cal areas. Of the 502 cats, the following diagnoseswere made: flea HD (29% of cases), food HD (12%)nonflea ⁄ nonfood HD (20%) and other diseases inwhich pruritus was a feature (24%). Cats with signsconsistent with a HD but which did not complete afood trial were not analysed further (15% of cases).Most cats with nonflea HD exhibited signs compatiblewith one or more of the four typical lesional patterns,but none of these patterns was found to be patho-gnomonic for any specific diagnosis. Food HD andnonflea ⁄ nonfood HD were found to be clinicallyundistinguishable. Young adult, purebred and femalecats appeared predisposed to nonflea/nonfood HD.As many diagnoses presented with similar lesionalpatterns, a thorough clinical work-up is required forestablishment of a specific diagnosis.
Accepted 13 January 2011
Introduction
Hypersensitivity dermatitides (HD) are often suspected in
companion animals, and these include flea bite hypersen-
sitivity dermatitis, cutaneous adverse food reactions,
urticaria, angioedema and atopic dermatitis (AD).1 The
use of the term ‘feline AD’ remains debatable, however,
because its clinical presentation and histological features
differ markedly from those of its human and canine coun-
terparts. Furthermore, the use of the adjective ‘atopic’
(meaning ‘IgE-mediated’) itself is questionable for this
disease, because the importance of IgE in its pathogenesis
has not been firmly demonstrated.2,3 Very few studies
have investigated the role of IgE in the development of
HD in cats.2,4–6 Additionally, there is evidence suggesting
the heterogeneity of feline IgE and that allergen-specific
IgE serum levels do not correlate with clinical signs of HD
in cats.7–9 Finally, one study reported that up to 35% of
cats with HD have negative allergen-specific intradermal
and serological tests.2 Therefore, and following the current
nomenclature of human and canine allergic skin dis-
eases,10,11 as long as the importance of IgE has not been
firmly demonstrated in cats with pruritic allergic skin dis-
eases, the authors of this paper will not use the term ‘feline
AD’ and replace it with the more generic term of ‘HD’.
The diagnosis of feline nonflea HD (i.e. nonflea bite-
associated HD) is usually based on the exclusion of
ª 2011 The Authors. Veterinary Dermatology
406 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
DOI: 10.1111/j.1365-3164.2011.00962.x
Table 1. Signalment and history data
(1) Nonflea
HD
(2) Nonflea HD ⁄nonfood HD (3) Food HD (4) Flea HD (5) OD (1) versus (4) (1) versus (5) (2) versus (3)
n 161 100 61 146 121
Male cats (%) 66 (41) 42 (42) 24 (39) 83 (57) 48 (40) <0.0001 n.s. n.s.
Purebred cats (%) 43 (27) 22 (22) 21 (34) 22 (15) 35 (29) 0.003 n.s. n.s.
Siamese 8 (5) 5 3 5 3 n.s. n.s. n.s.
Persian 11 (7) 4 7 7 12 n.s. n.s. n.s.
Abyssinian 5 (3) 3 2 0 0 n.s. n.s. n.s.
Maine coon 4 (2) 2 2 3 3 n.s. n.s. n.s.
Mean age at onset (years) 3.4 3 4 4.4 4.9 0.001 0.001 n.s.
Indoor:outdoor ratio* 76 ⁄ 64 46 ⁄ 42 30 ⁄ 22 49 ⁄ 73 53 ⁄ 53 0.02 n.s. n.s.
Rural:urban ratio* 55/103 37/67 18/36 45/96 42/72 n.s. n.s. n.s.
Seasonality (%) 14 (9) 12 (12) 2 (3) 13 (9) 9 (7) n.s. n.s. n.s.
Pruritus mean 6.4 6.4 6.4 5.7 4.9 0.001 0.0001 n.s.
Pruritus < 5 (%) 17 (13) 10 (11) 7 (14) 32 (24) 45 (45) 0.008 <0.0001 n.s.
Pruritus > 5 (%) 98 (72) 64 (73) 34 (69) 79 (57) 42 (42) n.s. <0.0001 n.s.
Pruritus = 5 (%) 22 (16) 14 (16) 8 (16) 26 (19) 13 (13) n.s. n.s. n.s.
Means and proportions were analysed using Mann–Whitney U-test and Fisher’s exact test, respectively.
HD, hypersensitivity dermatis; n.s., not significant; OD, other disease.
*Cats living in both environments were not taken into account.
[Corrections to Table data added on 1st April 2011 after online publication: ‘Rural:urban ratio*’ row data were changed, as were data in the bottom
3 rows of ‘(1) Nonflea HD’ column].
Table 2. Pattern and pattern associations
(1) Nonflea
HD
(2) Nonflea HD ⁄nonfood HD (3) Food HD (4) Flea HD (5) OD (1) versus (4) (1) versus (5) (2) versus (3)
n 161 100 61 146 121
Miliary dermatitis (%) 30 (19) 18 (18) 12 (20) 51 (35) 11 (9) 0.001 0.02 n.s.
Eosinophilic granuloma
complex (%)
41 (25) 26 (26) 15 (25) 20 (14) 3 (2) 0.01 <0.0001 n.s.
Erosions ⁄ ulcerations face
and neck (%)
95 (59) 56 (56) 39 (64) 55 (38) 66 (55) 0.0002 n.s. n.s.
Symmetrical alopecia (%) 83 (52) 57 (57) 26 (43) 57 (39) 22 (18) 0.02 <0.0001 n.s.
At least one of previous four
presentations (%)
152 (94) 95 (95) 57 (94) 133 (91) 90 (74) n.s. <0.0001 n.s.
Multiple patterns (%) 74 (46) 46 (46) 28 (46) 41 (28) 9 (7) 0.007 <0.0001 n.s.
Proportions were analysed using Fisher’s exact test.
[Correction to Table data added on 1st April 2011 after online publication: ‘At least one of previous four presentations (%)’ row data were changed
under column ‘(3) Food HD’].
Table 3. Localizations
(1) Nonflea HD
(2) Nonflea HD ⁄nonfood HD (3) Food HD (4) Flea HD (5) OD (1) versus (4) (1) versus (5) (2) versus (3)
n 161 100 61 146 121
Head ⁄ face (%) 93 (58) 56 (56) 37 (61) 62 (42) 57 (47) 0.008 n.s. n.s.
Ears (%) 54 (34) 32 (32) 22 (36) 31 (21) 58 (48) 0.02 0.02 n.s.
Chin (%) 28 (17) 17 (17) 11 (18) 21 (14) 15 (12) n.s. n.s. n.s.
Lips (%) 23 (14) 15 (15) 8 (13) 8 (5) 7 (6) 0.01 0.05 n.s.
Oral ⁄ mouth (%) 11 (7) 2 (2) 9 (15) 6 (4) 3 (2) n.s. n.s. n.s.
Neck (%) 66 (40) 36 (36) 30 (50) 52 (36) 27 (22) n.s. 0.001 n.s.
Rump ⁄ tail (%) 24 (15) 18 (18) 6 (10) 78 (53) 10 (8) <0.0001 n.s. n.s.
Forelimbs (%) 42 (26) 34 (34) 8 (13) 30 (21) 18 (15) n.s. 0.03 0.003
Hindlimbs (%) 51 (32) 40 (40) 11 (18) 31 (21) 14 (12) 0.04 <0.0001 0.005
Forepaws (%) 11 (7) 6 (6) 5 (8) 5 (4) 14 (12) n.s. n.s. n.s.
Hindpaws (%) 9 (6) 1 (1) 8 (13) 6 (4) 9 (7) n.s. n.s. 0.002
Lateral thorax (%) 24 (15) 17 (17) 7 (11) 14 (10) 12 (10) n.s. n.s. n.s.
Sternum ⁄ axilla (%) 17 (11) 10 (10) 7 (11) 12 (8) 9 (7) n.s. n.s. n.s.
Flanks (%) 16 (10) 14 (14) 3 (5) 28 (20) 8 (7) 0.02 n.s. n.s.
Abdomen (%) 85 (53) 59 (59) 26 (43) 73 (50) 27 (22) n.s. <0.0001 0.05
Perineum (%) 20 (12) 14 (14) 6 (10) 18 (12) 5 (4) n.s. 0.02 n.s.
Dorsum (%) 30 (19) 23 (23) 7 (11) 61 (42) 18 (15) <0.0001 n.s. n.s.
Proportions were analysed using Fisher’s exact test.
[Correction to Table data added on 1st April 2011 after online publication: ‘Neck (%)’ row data were changed under column ‘(5) OD’].
ª 2011 The Authors. Veterinary Dermatology
ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413. 409
Feline hypersensitivity dermatitisIntensidade do prurido
Clinical characteristics and causes of pruritus in cats:a multicentre study on feline hypersensitivity-associated dermatoses
Stefan Hobi*, Monika Linek†, GenevieveMarignac‡, Thierry Olivry§, Luc Beco¶, ClaudiaNett**, Jacques Fontaine††, Petra Roosje‡‡,Kerstin Bergvall§§, Sveta Belova¶¶, StefanieKoebrich***, DidierPin†††,MarcelKovalik‡‡‡,SabrinaMeury*,SylvieWilhelm*,1andClaudeFavrot*,1
*Dermatology Department, Clinic for Small Animal Internal Medicine,
Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
†Tierarztliche Spezialisten, Hamburg, Germany
‡Unite de Parasitologie, Ecole Nationale Veterinaire d’Alfort,
Maisons-Alfort Cedex, France
§Department of Clinical Sciences and Center for Comparative
Medicine and Translational Research, North Carolina State
University, Raleigh, NC, USA
¶Clinique Veterinaire, Spa, Belgium
**Dermatologie und Allergologie fur Tieren, Kleintierklinik Rigiplatz,
Cham, Switzerland
††Clinique Veterinaire, Bruxelles, Belgium
‡‡Division of Clinical Dermatology, Department of Clinical Veterinary
Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
§§Department Clinical Sciences, Swedish University of Agricultural
Sciences, Uppsala, Sweden
¶¶Department of Therapy, Institute of Veterinary Medicine and
Animal Science, Estonian University of Life Sciences, Tartu, Estonia
***Bruchweg 3, D- 68809, Neulussheim, Germany
†††Unite de Dermatologie, VetAgro Sup Campus Veterinaire, Marcy
L’Etoile, France
‡‡‡The University of Edinburgh, Veterinary Dermatology Unit,
Division of Veterinary Clinical Sciences, The Hospital for Small Ani-
mals, The Royal (Dick) School of Veterinary Studies, Edinburgh, UK
Correspondence: Claude Favrot, Dermatology Department, Clinic for
Small Animal Internal Medicine, Vetsuisse Faculty, University of
Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
E-mail: [email protected] the authors contributed equally to this work.
Sources of Funding
Novartis Animal Health, Basel, Switzerland and research funds from
the University of Zurich financed this study.
Conflict of Interest
No conflicts of interest have been declared.
Abstract
Hypersensitivity dermatitides (HD) are often sus-pected in cats. Cats with HD are reported to presentwith one or more of the following patterns: miliarydermatitis, eosinophilic dermatitis, self-induced sym-metrical alopecia or head and/or neck excoriations.Previous reports on feline HD included small numbersof animals, took place in geographically restrictedareas or did not compare these conditions with othercauses of pruritus. The goal of the present study was
to analyse 72 parameters covering signalment, clini-cal, laboratory and treatment characteristics from alarge group of pruritic cats from different geographi-cal areas. Of the 502 cats, the following diagnoseswere made: flea HD (29% of cases), food HD (12%)nonflea ⁄ nonfood HD (20%) and other diseases inwhich pruritus was a feature (24%). Cats with signsconsistent with a HD but which did not complete afood trial were not analysed further (15% of cases).Most cats with nonflea HD exhibited signs compatiblewith one or more of the four typical lesional patterns,but none of these patterns was found to be patho-gnomonic for any specific diagnosis. Food HD andnonflea ⁄ nonfood HD were found to be clinicallyundistinguishable. Young adult, purebred and femalecats appeared predisposed to nonflea/nonfood HD.As many diagnoses presented with similar lesionalpatterns, a thorough clinical work-up is required forestablishment of a specific diagnosis.
Accepted 13 January 2011
Introduction
Hypersensitivity dermatitides (HD) are often suspected in
companion animals, and these include flea bite hypersen-
sitivity dermatitis, cutaneous adverse food reactions,
urticaria, angioedema and atopic dermatitis (AD).1 The
use of the term ‘feline AD’ remains debatable, however,
because its clinical presentation and histological features
differ markedly from those of its human and canine coun-
terparts. Furthermore, the use of the adjective ‘atopic’
(meaning ‘IgE-mediated’) itself is questionable for this
disease, because the importance of IgE in its pathogenesis
has not been firmly demonstrated.2,3 Very few studies
have investigated the role of IgE in the development of
HD in cats.2,4–6 Additionally, there is evidence suggesting
the heterogeneity of feline IgE and that allergen-specific
IgE serum levels do not correlate with clinical signs of HD
in cats.7–9 Finally, one study reported that up to 35% of
cats with HD have negative allergen-specific intradermal
and serological tests.2 Therefore, and following the current
nomenclature of human and canine allergic skin dis-
eases,10,11 as long as the importance of IgE has not been
firmly demonstrated in cats with pruritic allergic skin dis-
eases, the authors of this paper will not use the term ‘feline
AD’ and replace it with the more generic term of ‘HD’.
The diagnosis of feline nonflea HD (i.e. nonflea bite-
associated HD) is usually based on the exclusion of
ª 2011 The Authors. Veterinary Dermatology
406 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
DOI: 10.1111/j.1365-3164.2011.00962.x
Como diagnosticar?
Procedência?
Idade do aparecimento das lesões
Tempo de evolução
Ambiente/Acesso a rua?/Contactantes?
Prurido?
Ectoparasitas?
Alimentação
Comorbidades
Banho? Produto?
Terapia prévia? CORTICOTERAPIA? Resposta?
História Clínica
História clínica
Filhotes
Parasitárias
Fúngicas
Alérgicas
História clínica
Adultos
Alérgicas
Parasitárias
Fúngicas
PF e psicogênicas e outras
! Derma&te(Miliar(
! Dermatoses(eosino/licas(
! Alopecia(Simétrica(auto(induzida(
! Lesões(erodo:(ulceradas(em(cabeça(e(
pescoço(
!
Exame Físico Padrões de reação cutânea
19
M.V . Tatiane Pirani
M.V . Tatiane Pirani
Pontos chave no Exame Físico
Paciência!!!
Inspeção da cavidade oral
Pente fino
Lâmpada de Wood
Ectoparasitas?
POSITIVO NEGATIVO
!!!NÃO SIM
RASPADO'TRICOGRAMA'
FITADE'ACETATO''SWABS'
CULTURA'FÚNGICA'HISTOPATO'
DAPE
ALERGIA ALIMENTAR DIETA!
"ATOPIA "
ESCABIOSE/DEMODICIOSE
OTOACARÍASE
CHEYLETIELLOSIS
DERMATOFITOSE
SIM
!!!NÃO
ESPOROTRICOSE
PÊNFIGO FOLIÁCEO
RESPOSTA'AO'TRATAMENTO?'
SIM!
PARCIAL!
Anti-ectop. a cd 15d/3aplic???
Research ArticleEfficacy of Spinosad Tablets Administered to a Colony of15 Indoor Cats Naturally Infested with Fleas
Marie-Christine Cadiergues and Charline Pressanti
INP-ENVT, 23 Chemin des Capelles, 31076 Toulouse Cedex 3, France
Correspondence should be addressed to Marie-Christine Cadiergues; [email protected]
Received 12 November 2013; Accepted 30 December 2013; Published 5 February 2014
Academic Editors: A. Anadon and K. Y. Mumcuoglu
Copyright © 2014 M.-C. Cadiergues and C. Pressanti. This is an open access article distributed under the Creative CommonsAttribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work isproperly cited.
The aims of the study were (i) to describe adult fleas distribution in a strictly indoor cat colony composed of cats with flea allergydermatitis (FAD) and non-FAD cats and (ii) to evaluate the efficacy of spinosad used alone. Skin lesions were scored accordingto the SCORing Feline Allergic Dermatitis lesion severity scale (SCORFAD) on days 0, 15, 30, 45, 60, and 90. Cats were combedprior to the treatment (days 0, 30, and 60) and on days 15, 45, and 90; collected fleas were replaced on the animals. All cats receivedflavored spinosad tablets (Comfortis) at a dosage of 50–75mg/kg on days 0, 30, and 60. Cats were fed immediately afterwards. Onday 0, a total of 60 fleas were collected (mean: 4 ± 4). Cats with FAD had a SCORFAD of 6, 8, 12, and 13 and harbored 0, 2, 1, and0 fleas, respectively. Tablets were taken voluntarily by 8, 11, and 12 cats on days 0, 30, and 60, respectively. No adverse event wasrecorded. From day 15 to day 90, no fleas could be collected. SCORFAD was reduced by 40%, 71%, 80%, 89%, and 98% on days 15,30, 45, 60, and 90, respectively.
1. Introduction
Fleas remain the most common parasites in cats [1–4]. Inaddition to potentially carry zoonotic diseases [5], fleas causeskin irritations due to their bites, including in some animalsan allergic dermatitis (the so-called flea allergic dermatitis orFAD) [6, 7]. FAD is the most common allergic skin diseaseof dogs and cats, although its frequency varies according togeographical location. The past twenty years have broughtimportant advances in flea biology as well as better insec-ticides [8]. Nevertheless, flea control in general, and morespecifically in cats with FAD, remains a real challenge forveterinarians and owners. The goal is to minimize flea bites,that is, to minimize the amount of saliva injected by fleas inorder to be under the allergic threshold.
Spinosad is an aerobic fermentation product of the soilbacterium, Saccharopolyspora spinosa. Spinosad kills insectsthrough activation of the acetylcholine nervous systemthrough nicotinic receptors. A chewable tablet is indicatedfor the treatment and prevention of flea infestations causedby Ctenocephalides felis; it was first introduced for dogs tothe USA market in 2007 after approval by the Food and
Drug Administration. The European Commission granteda marketing authorisation valid throughout the EuropeanUnion in 2011 after approval by the European MedicinesAgency. Subsequently, it was approved for cats in USA,Canada, and Japan in 2012 and in the European Union in2013. Its excellent efficacy against fleas and its rapid killingeffect that are observed in dogs [9–12] are also reported incats [13, 14].
We had the opportunity to observe a colony of fifteencats, housed strictly indoors and naturally infested with fleas;it included cats with clinical signs of FAD. We aimed todescribe the distribution of fleas in a strictly indoor cat colonycomposed of FAD cats and non-FAD cats. We also aimed toevaluate the efficacy of spinosad used alone, both on the adultflea population and on the skin lesions.
2. Materials and Methods
Within a laboratory colony of fifteen strictly indoor, adultdomestic shorthair cats, receiving no ectoparasiticide, fourof them presented with excessive licking and alopecia, which
Hindawi Publishing Corporation
ISRN Veterinary Science
Volume 2014, Article ID 484308, 4 pages
http://dx.doi.org/10.1155/2014/484308
2 ISRN Veterinary Science
had progressed over the past month. Advice was sought fromthe dermatology clinics of the Small Animal Hospital ofthe Toulouse Veterinary School. Clinical examination, testprocedures, treatment, and followup of the cats were doneafter obtaining a written consent from the people responsibleof the cat colony.
Coat brushing had allowed demonstration of flea infes-tation (adult fleas and/or flea dirt). Ctenocephalides feliswas identified after microscopical examination of severaladult specimens [15]. Skin scrapings and hair plucks hadbeen negative for Demodex mites and dermatophytes. Tapeimpressions from the skin surface had not shown evidence ofsecondary bacterial or yeast infections.
Domestic shorthair cats (7 females spayed and 8 malesneutered) between 4.7 and 6.7 years of age andweighing from3 to 4.7 kg were housed in a stone-floored four-room space,measuring 23m2 and having an additional surface of 8m2of cat tree furniture. No outdoor access was allowed. Theyhad been living in this space for more than one year. Theywere fed a commercial cat diet and water was supplied adlibitum. Temperature was maintained at 19 ± 2∘C and airwas renewed 20 times per hour. Cats were vaccinated againstfeline panleukopenia virus, feline herpesvirus 1 (FHV-1), andfeline calicivirus (FCV) and had no medical history.
Each animal was submitted to a full clinical exami-nation on days 0, 15, 30, 45, 60, and 90. Skin lesionswere scored according to the SCORing Feline Allergic Der-matitis lesion severity scale (SCORFAD) [16]. SCORFADreduction was calculated at each time point ! using thearithmetic mean of SCORFAD according to the followingformula: SCORFAD reduction (%) = 100 × (meanday 0 −mean")/meanday 0.
Cats were combed for 10 minutes prior to the treatment(days 0, 30, and 60) and additionally on days 15, 45, and90. The combing procedure was standardized and appliedsimilarly to every single cat. Two operators were involvedin the assessment of a specific animal. One person handledand restrained gently the cat; the second combed the cat,quantified the fleas recovered from each comb, and recordedthe data. During combing, an extra-fine flea comb (11.4teeth/cm, http://www.easypets.fr) was used to recover fleaspresent in the cat’s fur. The method of combing includedseveral strokes of the comb in each area of the animal, eachtime moving in the same direction, following the pattern ofthe hair coat. Movement from one part of the cat’s fur to thenext was via strokes overlapping each other, so that no area offur was missed. After completion of the combing procedurefor all body areas, the whole procedure was repeated so thatall areas were combed twice [17]. Fleas which were collectedwere counted and were replaced on the animal. Efficacywas calculated at each time point ! using the arithmeticmean numbers of fleas according to the following formula:Efficacy (%) = 100 × (meanday 0 −mean")/meanday 0.
All cats received flavored spinosad tablets (Comfortis, EliLilly and Company Ltd., Basingstoke, UK) at a dosage of 50–75mg/kg on days 0, 30, and 60. The tablet was first offeredto the cat; in case of nonimmediate voluntary reception, thetablet was given with a pilling device. Cats were fed their
60
50
40
30
20
10
0D0 D15 D30 D45 D60 D90
Total number of fleas in non-FAD catsTotal number of fleas in FAD catsTotal SCORFAD of non-FAD catsTotal SCORFAD of FAD cats
Figure 1: Progression of the total number of fleas (pale blue: non-FAD cats, pink: FAD cats) and the total SCORFAD (blue: non-FADcats, red: FAD cats) over time.
usual ration immediately afterwards. All cats were observedfor 2 hours posttreatment to record any adverse event.The environment was routinely cleaned, but no insecticideor insect growth regulator was applied. No inflammatorytreatment was prescribed.
3. Results
On day 0, prior to the initial treatment, a total of 60 fleaswere collected (mean: 4 ± 4, min: 0, max: 12). Two catshad self-induced alopecia, mainly on the dorsolumbar anddorsal tail regions. Two cats suffered frommiliary dermatitis,principally of the dorsum and self-induced alopecia. Thefour cats with FAD had a SCORFAD of 6, 8, 12, and 13 andharbored 0, 2, 1, and 0 fleas, respectively. Additionally, verymild lesions were observed on five other cats (SCORFAD of1 or 2) (Figure 1). Non-FAD cats harbored a total of 57 fleas(mean: 5.2 ± 4.1, min: 0, max: 12).
Tablets were taken immediately and voluntarily by 8, 11,and 12 cats on days 0, 30, and 60, respectively. No adverseevent was recorded. From D15 to D90, no fleas could becollected (100% efficacy). SCORFAD was reduced by 40%,71%, 80%, 89%, and 98% on days 15, 30, 45, 60, and 90,respectively (Figure 1).
4. Discussion
Flea infestation in strictly indoor animals, particularly cats, isfrequently overlooked, possibly denied. In a study conductedin 2007 in UK, 48% of the owners whose pets had signs of anactive flea infestation were unaware that their pet had fleas[1]. Cat owners may think that because they have an indoor-only cat, it is impossible for their pet to get fleas. Initiallyone or two fleas may be introduced from a pant leg, sock,
Cura clínica leva tempo!!!0,75 pulgas/gato DAPP
5,2 pulgas/gato sem DAPP
Ectoparasitas?
POSITIVO NEGATIVO
!!!NÃO SIM
RASPADO'TRICOGRAMA'
FITADE'ACETATO''SWABS'
CULTURA'FÚNGICA'HISTOPATO'
DAPE
ALERGIA ALIMENTAR DIETA!
"ATOPIA "
ESCABIOSE/DEMODICIOSE
OTOACARÍASE
CHEYLETIELLOSIS
DERMATOFITOSE
SIM
!!!NÃO
ESPOROTRICOSE
PÊNFIGO FOLIÁCEO
RESPOSTA'AO'TRATAMENTO?'
SIM!
PARCIAL!
Anti-ectop. a cd 15d/30 dias /90 dias!!
Excluindo parasitárias, fúngicas, dermatofitose...
Alergopatias (DAPE/H.A./“Atopia”)
Responsivo a corticoterapia...
Possuem os mesmos sinais clínicos... Mas não na mesma frequência!!!
Clinical characteristics and causes of pruritus in cats:a multicentre study on feline hypersensitivity-associated dermatoses
Stefan Hobi*, Monika Linek†, GenevieveMarignac‡, Thierry Olivry§, Luc Beco¶, ClaudiaNett**, Jacques Fontaine††, Petra Roosje‡‡,Kerstin Bergvall§§, Sveta Belova¶¶, StefanieKoebrich***, DidierPin†††,MarcelKovalik‡‡‡,SabrinaMeury*,SylvieWilhelm*,1andClaudeFavrot*,1
*Dermatology Department, Clinic for Small Animal Internal Medicine,
Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
†Tierarztliche Spezialisten, Hamburg, Germany
‡Unite de Parasitologie, Ecole Nationale Veterinaire d’Alfort,
Maisons-Alfort Cedex, France
§Department of Clinical Sciences and Center for Comparative
Medicine and Translational Research, North Carolina State
University, Raleigh, NC, USA
¶Clinique Veterinaire, Spa, Belgium
**Dermatologie und Allergologie fur Tieren, Kleintierklinik Rigiplatz,
Cham, Switzerland
††Clinique Veterinaire, Bruxelles, Belgium
‡‡Division of Clinical Dermatology, Department of Clinical Veterinary
Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
§§Department Clinical Sciences, Swedish University of Agricultural
Sciences, Uppsala, Sweden
¶¶Department of Therapy, Institute of Veterinary Medicine and
Animal Science, Estonian University of Life Sciences, Tartu, Estonia
***Bruchweg 3, D- 68809, Neulussheim, Germany
†††Unite de Dermatologie, VetAgro Sup Campus Veterinaire, Marcy
L’Etoile, France
‡‡‡The University of Edinburgh, Veterinary Dermatology Unit,
Division of Veterinary Clinical Sciences, The Hospital for Small Ani-
mals, The Royal (Dick) School of Veterinary Studies, Edinburgh, UK
Correspondence: Claude Favrot, Dermatology Department, Clinic for
Small Animal Internal Medicine, Vetsuisse Faculty, University of
Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
E-mail: [email protected] the authors contributed equally to this work.
Sources of Funding
Novartis Animal Health, Basel, Switzerland and research funds from
the University of Zurich financed this study.
Conflict of Interest
No conflicts of interest have been declared.
Abstract
Hypersensitivity dermatitides (HD) are often sus-pected in cats. Cats with HD are reported to presentwith one or more of the following patterns: miliarydermatitis, eosinophilic dermatitis, self-induced sym-metrical alopecia or head and/or neck excoriations.Previous reports on feline HD included small numbersof animals, took place in geographically restrictedareas or did not compare these conditions with othercauses of pruritus. The goal of the present study was
to analyse 72 parameters covering signalment, clini-cal, laboratory and treatment characteristics from alarge group of pruritic cats from different geographi-cal areas. Of the 502 cats, the following diagnoseswere made: flea HD (29% of cases), food HD (12%)nonflea ⁄ nonfood HD (20%) and other diseases inwhich pruritus was a feature (24%). Cats with signsconsistent with a HD but which did not complete afood trial were not analysed further (15% of cases).Most cats with nonflea HD exhibited signs compatiblewith one or more of the four typical lesional patterns,but none of these patterns was found to be patho-gnomonic for any specific diagnosis. Food HD andnonflea ⁄ nonfood HD were found to be clinicallyundistinguishable. Young adult, purebred and femalecats appeared predisposed to nonflea/nonfood HD.As many diagnoses presented with similar lesionalpatterns, a thorough clinical work-up is required forestablishment of a specific diagnosis.
Accepted 13 January 2011
Introduction
Hypersensitivity dermatitides (HD) are often suspected in
companion animals, and these include flea bite hypersen-
sitivity dermatitis, cutaneous adverse food reactions,
urticaria, angioedema and atopic dermatitis (AD).1 The
use of the term ‘feline AD’ remains debatable, however,
because its clinical presentation and histological features
differ markedly from those of its human and canine coun-
terparts. Furthermore, the use of the adjective ‘atopic’
(meaning ‘IgE-mediated’) itself is questionable for this
disease, because the importance of IgE in its pathogenesis
has not been firmly demonstrated.2,3 Very few studies
have investigated the role of IgE in the development of
HD in cats.2,4–6 Additionally, there is evidence suggesting
the heterogeneity of feline IgE and that allergen-specific
IgE serum levels do not correlate with clinical signs of HD
in cats.7–9 Finally, one study reported that up to 35% of
cats with HD have negative allergen-specific intradermal
and serological tests.2 Therefore, and following the current
nomenclature of human and canine allergic skin dis-
eases,10,11 as long as the importance of IgE has not been
firmly demonstrated in cats with pruritic allergic skin dis-
eases, the authors of this paper will not use the term ‘feline
AD’ and replace it with the more generic term of ‘HD’.
The diagnosis of feline nonflea HD (i.e. nonflea bite-
associated HD) is usually based on the exclusion of
ª 2011 The Authors. Veterinary Dermatology
406 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
DOI: 10.1111/j.1365-3164.2011.00962.x
Clinical characteristics and causes of pruritus in cats:a multicentre study on feline hypersensitivity-associated dermatoses
Stefan Hobi*, Monika Linek†, GenevieveMarignac‡, Thierry Olivry§, Luc Beco¶, ClaudiaNett**, Jacques Fontaine††, Petra Roosje‡‡,Kerstin Bergvall§§, Sveta Belova¶¶, StefanieKoebrich***, DidierPin†††,MarcelKovalik‡‡‡,SabrinaMeury*,SylvieWilhelm*,1andClaudeFavrot*,1
*Dermatology Department, Clinic for Small Animal Internal Medicine,
Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
†Tierarztliche Spezialisten, Hamburg, Germany
‡Unite de Parasitologie, Ecole Nationale Veterinaire d’Alfort,
Maisons-Alfort Cedex, France
§Department of Clinical Sciences and Center for Comparative
Medicine and Translational Research, North Carolina State
University, Raleigh, NC, USA
¶Clinique Veterinaire, Spa, Belgium
**Dermatologie und Allergologie fur Tieren, Kleintierklinik Rigiplatz,
Cham, Switzerland
††Clinique Veterinaire, Bruxelles, Belgium
‡‡Division of Clinical Dermatology, Department of Clinical Veterinary
Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
§§Department Clinical Sciences, Swedish University of Agricultural
Sciences, Uppsala, Sweden
¶¶Department of Therapy, Institute of Veterinary Medicine and
Animal Science, Estonian University of Life Sciences, Tartu, Estonia
***Bruchweg 3, D- 68809, Neulussheim, Germany
†††Unite de Dermatologie, VetAgro Sup Campus Veterinaire, Marcy
L’Etoile, France
‡‡‡The University of Edinburgh, Veterinary Dermatology Unit,
Division of Veterinary Clinical Sciences, The Hospital for Small Ani-
mals, The Royal (Dick) School of Veterinary Studies, Edinburgh, UK
Correspondence: Claude Favrot, Dermatology Department, Clinic for
Small Animal Internal Medicine, Vetsuisse Faculty, University of
Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
E-mail: [email protected] the authors contributed equally to this work.
Sources of Funding
Novartis Animal Health, Basel, Switzerland and research funds from
the University of Zurich financed this study.
Conflict of Interest
No conflicts of interest have been declared.
Abstract
Hypersensitivity dermatitides (HD) are often sus-pected in cats. Cats with HD are reported to presentwith one or more of the following patterns: miliarydermatitis, eosinophilic dermatitis, self-induced sym-metrical alopecia or head and/or neck excoriations.Previous reports on feline HD included small numbersof animals, took place in geographically restrictedareas or did not compare these conditions with othercauses of pruritus. The goal of the present study was
to analyse 72 parameters covering signalment, clini-cal, laboratory and treatment characteristics from alarge group of pruritic cats from different geographi-cal areas. Of the 502 cats, the following diagnoseswere made: flea HD (29% of cases), food HD (12%)nonflea ⁄ nonfood HD (20%) and other diseases inwhich pruritus was a feature (24%). Cats with signsconsistent with a HD but which did not complete afood trial were not analysed further (15% of cases).Most cats with nonflea HD exhibited signs compatiblewith one or more of the four typical lesional patterns,but none of these patterns was found to be patho-gnomonic for any specific diagnosis. Food HD andnonflea ⁄ nonfood HD were found to be clinicallyundistinguishable. Young adult, purebred and femalecats appeared predisposed to nonflea/nonfood HD.As many diagnoses presented with similar lesionalpatterns, a thorough clinical work-up is required forestablishment of a specific diagnosis.
Accepted 13 January 2011
Introduction
Hypersensitivity dermatitides (HD) are often suspected in
companion animals, and these include flea bite hypersen-
sitivity dermatitis, cutaneous adverse food reactions,
urticaria, angioedema and atopic dermatitis (AD).1 The
use of the term ‘feline AD’ remains debatable, however,
because its clinical presentation and histological features
differ markedly from those of its human and canine coun-
terparts. Furthermore, the use of the adjective ‘atopic’
(meaning ‘IgE-mediated’) itself is questionable for this
disease, because the importance of IgE in its pathogenesis
has not been firmly demonstrated.2,3 Very few studies
have investigated the role of IgE in the development of
HD in cats.2,4–6 Additionally, there is evidence suggesting
the heterogeneity of feline IgE and that allergen-specific
IgE serum levels do not correlate with clinical signs of HD
in cats.7–9 Finally, one study reported that up to 35% of
cats with HD have negative allergen-specific intradermal
and serological tests.2 Therefore, and following the current
nomenclature of human and canine allergic skin dis-
eases,10,11 as long as the importance of IgE has not been
firmly demonstrated in cats with pruritic allergic skin dis-
eases, the authors of this paper will not use the term ‘feline
AD’ and replace it with the more generic term of ‘HD’.
The diagnosis of feline nonflea HD (i.e. nonflea bite-
associated HD) is usually based on the exclusion of
ª 2011 The Authors. Veterinary Dermatology
406 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
DOI: 10.1111/j.1365-3164.2011.00962.x
Clinical characteristics and causes of pruritus in cats:a multicentre study on feline hypersensitivity-associated dermatoses
Stefan Hobi*, Monika Linek†, GenevieveMarignac‡, Thierry Olivry§, Luc Beco¶, ClaudiaNett**, Jacques Fontaine††, Petra Roosje‡‡,Kerstin Bergvall§§, Sveta Belova¶¶, StefanieKoebrich***, DidierPin†††,MarcelKovalik‡‡‡,SabrinaMeury*,SylvieWilhelm*,1andClaudeFavrot*,1
*Dermatology Department, Clinic for Small Animal Internal Medicine,
Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
†Tierarztliche Spezialisten, Hamburg, Germany
‡Unite de Parasitologie, Ecole Nationale Veterinaire d’Alfort,
Maisons-Alfort Cedex, France
§Department of Clinical Sciences and Center for Comparative
Medicine and Translational Research, North Carolina State
University, Raleigh, NC, USA
¶Clinique Veterinaire, Spa, Belgium
**Dermatologie und Allergologie fur Tieren, Kleintierklinik Rigiplatz,
Cham, Switzerland
††Clinique Veterinaire, Bruxelles, Belgium
‡‡Division of Clinical Dermatology, Department of Clinical Veterinary
Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
§§Department Clinical Sciences, Swedish University of Agricultural
Sciences, Uppsala, Sweden
¶¶Department of Therapy, Institute of Veterinary Medicine and
Animal Science, Estonian University of Life Sciences, Tartu, Estonia
***Bruchweg 3, D- 68809, Neulussheim, Germany
†††Unite de Dermatologie, VetAgro Sup Campus Veterinaire, Marcy
L’Etoile, France
‡‡‡The University of Edinburgh, Veterinary Dermatology Unit,
Division of Veterinary Clinical Sciences, The Hospital for Small Ani-
mals, The Royal (Dick) School of Veterinary Studies, Edinburgh, UK
Correspondence: Claude Favrot, Dermatology Department, Clinic for
Small Animal Internal Medicine, Vetsuisse Faculty, University of
Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
E-mail: [email protected] the authors contributed equally to this work.
Sources of Funding
Novartis Animal Health, Basel, Switzerland and research funds from
the University of Zurich financed this study.
Conflict of Interest
No conflicts of interest have been declared.
Abstract
Hypersensitivity dermatitides (HD) are often sus-pected in cats. Cats with HD are reported to presentwith one or more of the following patterns: miliarydermatitis, eosinophilic dermatitis, self-induced sym-metrical alopecia or head and/or neck excoriations.Previous reports on feline HD included small numbersof animals, took place in geographically restrictedareas or did not compare these conditions with othercauses of pruritus. The goal of the present study was
to analyse 72 parameters covering signalment, clini-cal, laboratory and treatment characteristics from alarge group of pruritic cats from different geographi-cal areas. Of the 502 cats, the following diagnoseswere made: flea HD (29% of cases), food HD (12%)nonflea ⁄ nonfood HD (20%) and other diseases inwhich pruritus was a feature (24%). Cats with signsconsistent with a HD but which did not complete afood trial were not analysed further (15% of cases).Most cats with nonflea HD exhibited signs compatiblewith one or more of the four typical lesional patterns,but none of these patterns was found to be patho-gnomonic for any specific diagnosis. Food HD andnonflea ⁄ nonfood HD were found to be clinicallyundistinguishable. Young adult, purebred and femalecats appeared predisposed to nonflea/nonfood HD.As many diagnoses presented with similar lesionalpatterns, a thorough clinical work-up is required forestablishment of a specific diagnosis.
Accepted 13 January 2011
Introduction
Hypersensitivity dermatitides (HD) are often suspected in
companion animals, and these include flea bite hypersen-
sitivity dermatitis, cutaneous adverse food reactions,
urticaria, angioedema and atopic dermatitis (AD).1 The
use of the term ‘feline AD’ remains debatable, however,
because its clinical presentation and histological features
differ markedly from those of its human and canine coun-
terparts. Furthermore, the use of the adjective ‘atopic’
(meaning ‘IgE-mediated’) itself is questionable for this
disease, because the importance of IgE in its pathogenesis
has not been firmly demonstrated.2,3 Very few studies
have investigated the role of IgE in the development of
HD in cats.2,4–6 Additionally, there is evidence suggesting
the heterogeneity of feline IgE and that allergen-specific
IgE serum levels do not correlate with clinical signs of HD
in cats.7–9 Finally, one study reported that up to 35% of
cats with HD have negative allergen-specific intradermal
and serological tests.2 Therefore, and following the current
nomenclature of human and canine allergic skin dis-
eases,10,11 as long as the importance of IgE has not been
firmly demonstrated in cats with pruritic allergic skin dis-
eases, the authors of this paper will not use the term ‘feline
AD’ and replace it with the more generic term of ‘HD’.
The diagnosis of feline nonflea HD (i.e. nonflea bite-
associated HD) is usually based on the exclusion of
ª 2011 The Authors. Veterinary Dermatology
406 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
DOI: 10.1111/j.1365-3164.2011.00962.x
Clinical characteristics and causes of pruritus in cats:a multicentre study on feline hypersensitivity-associated dermatoses
Stefan Hobi*, Monika Linek†, GenevieveMarignac‡, Thierry Olivry§, Luc Beco¶, ClaudiaNett**, Jacques Fontaine††, Petra Roosje‡‡,Kerstin Bergvall§§, Sveta Belova¶¶, StefanieKoebrich***, DidierPin†††,MarcelKovalik‡‡‡,SabrinaMeury*,SylvieWilhelm*,1andClaudeFavrot*,1
*Dermatology Department, Clinic for Small Animal Internal Medicine,
Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
†Tierarztliche Spezialisten, Hamburg, Germany
‡Unite de Parasitologie, Ecole Nationale Veterinaire d’Alfort,
Maisons-Alfort Cedex, France
§Department of Clinical Sciences and Center for Comparative
Medicine and Translational Research, North Carolina State
University, Raleigh, NC, USA
¶Clinique Veterinaire, Spa, Belgium
**Dermatologie und Allergologie fur Tieren, Kleintierklinik Rigiplatz,
Cham, Switzerland
††Clinique Veterinaire, Bruxelles, Belgium
‡‡Division of Clinical Dermatology, Department of Clinical Veterinary
Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
§§Department Clinical Sciences, Swedish University of Agricultural
Sciences, Uppsala, Sweden
¶¶Department of Therapy, Institute of Veterinary Medicine and
Animal Science, Estonian University of Life Sciences, Tartu, Estonia
***Bruchweg 3, D- 68809, Neulussheim, Germany
†††Unite de Dermatologie, VetAgro Sup Campus Veterinaire, Marcy
L’Etoile, France
‡‡‡The University of Edinburgh, Veterinary Dermatology Unit,
Division of Veterinary Clinical Sciences, The Hospital for Small Ani-
mals, The Royal (Dick) School of Veterinary Studies, Edinburgh, UK
Correspondence: Claude Favrot, Dermatology Department, Clinic for
Small Animal Internal Medicine, Vetsuisse Faculty, University of
Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
E-mail: [email protected] the authors contributed equally to this work.
Sources of Funding
Novartis Animal Health, Basel, Switzerland and research funds from
the University of Zurich financed this study.
Conflict of Interest
No conflicts of interest have been declared.
Abstract
Hypersensitivity dermatitides (HD) are often sus-pected in cats. Cats with HD are reported to presentwith one or more of the following patterns: miliarydermatitis, eosinophilic dermatitis, self-induced sym-metrical alopecia or head and/or neck excoriations.Previous reports on feline HD included small numbersof animals, took place in geographically restrictedareas or did not compare these conditions with othercauses of pruritus. The goal of the present study was
to analyse 72 parameters covering signalment, clini-cal, laboratory and treatment characteristics from alarge group of pruritic cats from different geographi-cal areas. Of the 502 cats, the following diagnoseswere made: flea HD (29% of cases), food HD (12%)nonflea ⁄ nonfood HD (20%) and other diseases inwhich pruritus was a feature (24%). Cats with signsconsistent with a HD but which did not complete afood trial were not analysed further (15% of cases).Most cats with nonflea HD exhibited signs compatiblewith one or more of the four typical lesional patterns,but none of these patterns was found to be patho-gnomonic for any specific diagnosis. Food HD andnonflea ⁄ nonfood HD were found to be clinicallyundistinguishable. Young adult, purebred and femalecats appeared predisposed to nonflea/nonfood HD.As many diagnoses presented with similar lesionalpatterns, a thorough clinical work-up is required forestablishment of a specific diagnosis.
Accepted 13 January 2011
Introduction
Hypersensitivity dermatitides (HD) are often suspected in
companion animals, and these include flea bite hypersen-
sitivity dermatitis, cutaneous adverse food reactions,
urticaria, angioedema and atopic dermatitis (AD).1 The
use of the term ‘feline AD’ remains debatable, however,
because its clinical presentation and histological features
differ markedly from those of its human and canine coun-
terparts. Furthermore, the use of the adjective ‘atopic’
(meaning ‘IgE-mediated’) itself is questionable for this
disease, because the importance of IgE in its pathogenesis
has not been firmly demonstrated.2,3 Very few studies
have investigated the role of IgE in the development of
HD in cats.2,4–6 Additionally, there is evidence suggesting
the heterogeneity of feline IgE and that allergen-specific
IgE serum levels do not correlate with clinical signs of HD
in cats.7–9 Finally, one study reported that up to 35% of
cats with HD have negative allergen-specific intradermal
and serological tests.2 Therefore, and following the current
nomenclature of human and canine allergic skin dis-
eases,10,11 as long as the importance of IgE has not been
firmly demonstrated in cats with pruritic allergic skin dis-
eases, the authors of this paper will not use the term ‘feline
AD’ and replace it with the more generic term of ‘HD’.
The diagnosis of feline nonflea HD (i.e. nonflea bite-
associated HD) is usually based on the exclusion of
ª 2011 The Authors. Veterinary Dermatology
406 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
DOI: 10.1111/j.1365-3164.2011.00962.x
when compared with the rest of the study population,
males were over-represented in the flea HD group, while
females dominated the nonflea HD group. Among pure-
bred cats, Abyssinians were only present in the nonflea
HD group. The mean age at onset was also lower in the
nonflea HD group (3.4 years) when compared with the
flea HD group (4.4 years; P = 0.001). The pruritus was
also more intense in cats with nonflea HD (6.4 versus 5.7
grade; P = 0.001).
Cats from both groups presented with one of the four
main lesional patterns, but the frequencies of each
pattern varied significantly between groups (Table 2);
cats with flea HD presented more frequently than cats
with nonflea HD with miliary dermatitis (35 versus 19%;
P = 0.001) and less commonly with eosinophilic diseases
(14 versus 25%; P = 0.01), head and neck excoriations
(38 versus 59%; P = 0.0002) and symmetrical alopecia
(39 versus 52%; P = 0.02). Interestingly, cats with
nonflea HD (46%) presented more often with two or
more lesional patterns compared with cats having flea
HD (46 versus 28%; P = 0.007).
The distribution of skin lesions was also different
between groups (Table 3). The head or face (P = 0.008),
the ears (P = 0.02), the lips (P = 0.01) and the hindlimbs
(P = 0.04) were more frequently affected in cats with non-
flea HD, while those with flea HD presented more often
with changes affecting the rump or tail (P < 0.0001), the
flanks (P = 0.02) or the dorsum (P < 0.0001).
Comparisons between cats with food HD and thosewith nonflea ⁄ nonfood HDThere were few significant differences between cats of
these two groups. The mean ages of pruritus onset were
similar in both groups; 72 cats with nonflea ⁄ nonfood HD
(72%) and 32 cats with food HD (52%) exhibited their first
pruritus manifestation before 3 years of age (P = 0.04). In
Table 4. Associated clinical signs
(1) Nonflea
HD
(2) Nonflea HD ⁄nonfood (3) Food HD (4) Flea HD (5) OD
(1) versus
(4)
(1) versus
(5)
(2) versus
(3)
n 161 100 61 146 121
Nondermatological signs (%) 67 (42) 42 (42) 25 (41) 44 (30) 49 (40) 0.02 n.s. n.s.
Digestive signs (%) 22 (14) 9 (9) 13 (21) 17 (12) 10 (8) n.s. n.s. 0.03
Respiratory signs (%) 10 (6) 6 (6) 4 (7) 5 (3) 5 (4) n.s. n.s. n.s.
Otitis (%) 24 (15) 20 (20) 4 (7) 4 (3) 23 (19) 0.0002 n.s. 0.02
Conjunctivitis (%) 13 (8) 8 (8) 5 (8) 4 (3) 8 (7) 0.04 n.s. n.s.
Proportions were analysed using Fisher’s exact test.
Figure 3. Silhouettes depicting the proportion of distribution of lesions in cats with nonflea HD, nonfood HD, food HD and flea HD. NFIHD, non
food induced hypersensitivity dermatitis; NFNFIHD, non flea, non food induced hypersensitivity dermatitis; FIHD, food induced hypersensitivity
dermatitis; FBH, flea bite hypersensitivity.
ª 2011 The Authors. Veterinary Dermatology
410 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 406–413.
Hobi et al.
Como tratar?
Tratar ou controlar a causa base
Terapia Tópica Terapia Sistêmica
ConsideraçõesTerapia Tópica?
Terapia Sistêmica?
Proprietário X Gato
Comorbidades?
Obeso?
Glicocorticóides
Prednisolona oral (1 a 3 mg/kg/SID/ 7 a 30 dias)
Deflazacort oral (0,3 mg/kg/ cada 48h/ 7 a 30 dias
Acetato de metil prednisolona I.M. (4 mg/kg)
Grupos de risco
Sobrepeso
Idosos a partir de 10 anos
Nefropatas
Anormalidades na ausculta cardíaca
FiV e FelV ??
Anti-histamínicos
Hidroxizine (2,0 mg/kg ou 10 mg/gato BID)
Cetirizina (1,0 mg/Kg ou 5mg/gato SID)
Ciproheptadina (1,0-2,0 mg/sid/gato)
Loratidina (5 mg/gato)
The efficacy of cetirizine hydrochloride on the pruritusof cats with atopic dermatitis: a randomized, double-blind, placebo-controlled, crossover study
Kerstin Wildermuth*,†, Sonja Zabel‡ and Rod A. W. Rosychuk*
*Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, 300 West Drake, Fort
Collins, CO 80523, USA
†Tierdermatologie Dr. Wildermuth, Borsigstraße 7a, 65205 Wiesbaden, Germany
‡Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, 501 DW Brooks Drive, Athens, GA
30602, USA
Correspondence: Kerstin Wildermuth, Tierdermatologie Dr. Wildermuth, Borsigstraße 7a, 65205 Wiesbaden, Germany. E-mail: kerstinw@
tierdermatologie-wildermuth.de
Background – Various antihistamines have been used in the management of feline atopic dermatitis, with vari-
able reported benefit. To date, there have been no randomized, double-blind, placebo-controlled, crossover clini-
cal trials on the use of this drug class in cats.
Hypothesis/Objectives – To evaluate the clinical efficacy of cetirizine hydrochloride for the control of pruritus
and dermatitis in cats diagnosed with atopic dermatitis.
Methods – In this randomized, double-blind, placebo-controlled crossover clinical trial, 21 client-owned cats diag-
nosed with mild to moderate nonseasonal atopic dermatitis were randomly assigned to two groups. Cats in each
group received either 1 mg/kg cetirizine hydrochloride or placebo once daily per os for 28 days followed by a
14 day wash-out period. Treatments were then crossed over, and cats received placebo or cetirizine hydrochlor-
ide for another 28 days. Owners marked a pruritus severity scale before inclusion in the study and weekly
throughout the entire study period. Lesions were scored by the clinician using a Canine Atopic Dermatitis Extent
and Severity Index (CADESI)-03 modified for the cat before enrolment and at day 28 of each treatment.
Results – Nineteen cats completed the study. There were no statistically significant differences between treat-
ment with cetirizine hydrochloride and placebo for modified CADESI-03 or pruritus scores.
Conclusion and clinical importance – This study suggests that cetirizine hydrochloride cannot be recom-
mended for the management of feline atopic dermatitis.
Introduction
Atopic dermatitis (AD) is a common skin disorder in cats,
with pruritus being one of the most characteristic signs.1
Glucocorticoids are commonly used for the management
of feline AD. Although glucocorticoid therapy is effective,
high-dose or long-term therapy may be associated with
adverse effects, including diabetes mellitus or skin atro-
phy.2 Ciclosporin has been shown to be effective but is
also potentially associated with significant adverse
effects and is relatively expensive.3 Allergen-specific
immunotherapy is considered to be a safe treatment in
cats but may take several months before obvious benefit
is noted, is relatively expensive and is usually given by
subcutaneous administration.4 Essential fatty acids are
also a safe alternative but have not been shown to be
effective as a single treatment.5 Antihistamines have
been used to treat feline AD.6–8 Histamine receptors, spe-
cifically H1 receptors, are found on mast cells, basophils,
macrophage/dendritic cells, T lymphocytes, neutrophils,
eosinophils, blood vessel endothelial cells and airway epi-
thelial and smooth muscle cells.9 The H1 antihistamines
stabilize the inactive configuration of H1 receptors and
thus inhibit histamine binding to the receptor and mast
cell degranulation.10 They appear to be well tolerated in
cats and are relatively affordable for pet owners.6–8,11
There are only a few open clinical trials investigating the
efficacy of antihistamines in cats with allergic pruritus.
These clinical trials showed an improvement of pruritus in
50% of the cats treated with clemastine, 45% of cats
treated with cyproheptadine and 77% of cats treated with
chlorpheniramine.6–8
Cetirizine is a second-generation antihistamine and an
active metabolite of hydroxyzine. Second-generation anti-
histamines do not cross the blood–brain barrier and, in
humans, are associated with less potential for sedation.12
A recent pharmacokinetic study in cats has shown that a
single dose of cetirizine of approximately 1 mg/kg results
in high plasma concentrations and a long half-life, compat-
ible with once daily dosing.11 In a recent open clinical trial,
Accepted 25 June 2013
Sources of Funding: This study was funded by the American
College of Veterinary Dermatology (ACVD) Resident’s Research
Award, Royal Canin USA Inc. and Heska Corporation.
Conflict of Interest: No conflicts of interest have been declared.
Results of this study were presented as a poster at the 7th World
Congress of Veterinary Dermatology (WCVD) 2012; Vancouver,
Canada. Vet Dermatol 2012; 23 Suppl 1: 66.
© 2013 ESVD and ACVD, Veterinary Dermatology , 24, 576–e138.576
Vet Dermatol 2013; 24: 576–e138 DOI: 10.1111/vde.12067
The efficacy of cetirizine hydrochloride on the pruritusof cats with atopic dermatitis: a randomized, double-blind, placebo-controlled, crossover study
Kerstin Wildermuth*,†, Sonja Zabel‡ and Rod A. W. Rosychuk*
*Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, 300 West Drake, Fort
Collins, CO 80523, USA
†Tierdermatologie Dr. Wildermuth, Borsigstraße 7a, 65205 Wiesbaden, Germany
‡Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, 501 DW Brooks Drive, Athens, GA
30602, USA
Correspondence: Kerstin Wildermuth, Tierdermatologie Dr. Wildermuth, Borsigstraße 7a, 65205 Wiesbaden, Germany. E-mail: kerstinw@
tierdermatologie-wildermuth.de
Background – Various antihistamines have been used in the management of feline atopic dermatitis, with vari-
able reported benefit. To date, there have been no randomized, double-blind, placebo-controlled, crossover clini-
cal trials on the use of this drug class in cats.
Hypothesis/Objectives – To evaluate the clinical efficacy of cetirizine hydrochloride for the control of pruritus
and dermatitis in cats diagnosed with atopic dermatitis.
Methods – In this randomized, double-blind, placebo-controlled crossover clinical trial, 21 client-owned cats diag-
nosed with mild to moderate nonseasonal atopic dermatitis were randomly assigned to two groups. Cats in each
group received either 1 mg/kg cetirizine hydrochloride or placebo once daily per os for 28 days followed by a
14 day wash-out period. Treatments were then crossed over, and cats received placebo or cetirizine hydrochlor-
ide for another 28 days. Owners marked a pruritus severity scale before inclusion in the study and weekly
throughout the entire study period. Lesions were scored by the clinician using a Canine Atopic Dermatitis Extent
and Severity Index (CADESI)-03 modified for the cat before enrolment and at day 28 of each treatment.
Results – Nineteen cats completed the study. There were no statistically significant differences between treat-
ment with cetirizine hydrochloride and placebo for modified CADESI-03 or pruritus scores.
Conclusion and clinical importance – This study suggests that cetirizine hydrochloride cannot be recom-
mended for the management of feline atopic dermatitis.
Introduction
Atopic dermatitis (AD) is a common skin disorder in cats,
with pruritus being one of the most characteristic signs.1
Glucocorticoids are commonly used for the management
of feline AD. Although glucocorticoid therapy is effective,
high-dose or long-term therapy may be associated with
adverse effects, including diabetes mellitus or skin atro-
phy.2 Ciclosporin has been shown to be effective but is
also potentially associated with significant adverse
effects and is relatively expensive.3 Allergen-specific
immunotherapy is considered to be a safe treatment in
cats but may take several months before obvious benefit
is noted, is relatively expensive and is usually given by
subcutaneous administration.4 Essential fatty acids are
also a safe alternative but have not been shown to be
effective as a single treatment.5 Antihistamines have
been used to treat feline AD.6–8 Histamine receptors, spe-
cifically H1 receptors, are found on mast cells, basophils,
macrophage/dendritic cells, T lymphocytes, neutrophils,
eosinophils, blood vessel endothelial cells and airway epi-
thelial and smooth muscle cells.9 The H1 antihistamines
stabilize the inactive configuration of H1 receptors and
thus inhibit histamine binding to the receptor and mast
cell degranulation.10 They appear to be well tolerated in
cats and are relatively affordable for pet owners.6–8,11
There are only a few open clinical trials investigating the
efficacy of antihistamines in cats with allergic pruritus.
These clinical trials showed an improvement of pruritus in
50% of the cats treated with clemastine, 45% of cats
treated with cyproheptadine and 77% of cats treated with
chlorpheniramine.6–8
Cetirizine is a second-generation antihistamine and an
active metabolite of hydroxyzine. Second-generation anti-
histamines do not cross the blood–brain barrier and, in
humans, are associated with less potential for sedation.12
A recent pharmacokinetic study in cats has shown that a
single dose of cetirizine of approximately 1 mg/kg results
in high plasma concentrations and a long half-life, compat-
ible with once daily dosing.11 In a recent open clinical trial,
Accepted 25 June 2013
Sources of Funding: This study was funded by the American
College of Veterinary Dermatology (ACVD) Resident’s Research
Award, Royal Canin USA Inc. and Heska Corporation.
Conflict of Interest: No conflicts of interest have been declared.
Results of this study were presented as a poster at the 7th World
Congress of Veterinary Dermatology (WCVD) 2012; Vancouver,
Canada. Vet Dermatol 2012; 23 Suppl 1: 66.
© 2013 ESVD and ACVD, Veterinary Dermatology , 24, 576–e138.576
Vet Dermatol 2013; 24: 576–e138 DOI: 10.1111/vde.12067
19 gatos1 mg/kg/dia/28 dias
Ausência de efeitos adversos
Results
CatsTwenty-one cats (10 male castrated and 11 female
spayed) met the inclusion criteria and were enrolled in
the study. They showed the following clinical signs in
addition to pruritus: self-induced alopecia (10 of 21
cats), self-induced alopecia with dermatitis (7 of 21
cats), facial dermatitis (2 of 21 cats) and self-induced
alopecia with facial dermatitis (2 of 21 cats). Nineteen
cats completed the study. One cat was excluded after
day 28 of the first treatment period due to severity of
clinical signs. One cat was lost to follow-up after
day 28 of the first treatment period for unknown
reasons. The owners of this cat did not return the
forms with the pruritus scales for any of the visits and
therefore only the modified CADESI-03 data on days 0
and 28 of the first treatment period were available for
analysis.
The age range of the study cats was 2–16 years (mean
7.9 years, median 7 years). The cats weighed between
3.1 and 6.6 kg (mean 5.8 kg, median 5.5 kg).
Modified CADESI-03 and pruritus scoresUpon inclusion in the study, the modified CADESI-03scores ranged from 26 to 112 (mean 45.5). Two of the 19
cats (10.5%) showed a modified CADESI-03 score
improvement of >50% at day 28 of treatment with CTZ.
In one cat (5.3%), the modified CADESI score worsened
by >50% at day 28 of treatment with CTZ. Four of 19 pla-
cebo-treated cats (21%) showed improvement of >50%at day 28. In one placebo-treated cat (5.3%), the modified
CADESI-03 score worsened by >50% at day 28. There
were no statistical differences in modified CADESI-03scores between the CTZ- or PBO-treated cats when data
were either evaluated continuously or dichotomized.
Pruritus scores at the beginning of the study ranged
from 4.0 to 7.5 (mean 5.1). In two of 19 CTZ-treated cats
(10.5%), pruritus scores improved by >50% at day 28.
None of the CTZ-treated cats had an increase in pruritus
score of >50%.
One PBO-treated cat (5.2%) showed an improvement
of >50% at day 28. One PBO-treated cat (5.2%) showed
an increase of pruritus score by >50% at day 28; this cat
was one of the patients that showed a > 50% improve-
ment in pruritus score and also a > 50% improvement in
the modified CADESI-03 score while being treated with
CTZ.
There were no significant statistical differences
between the CTZ- and PBO-treated cat pruritus scores
when the data were considered continuously or dichoto-
mized. Changes in modified CADESI-03 and pruritus
scores over time are shown in Figures 3 and 4.
Adverse eventsNone of the cats showed adverse effects to CTZ during
the study period.
Discussion
In this study, CTZ-treated cats showed a >50% improve-
ment of modified CADESI-03 scores and pruritus scores
Extremely severe itching/ almost continuous. Itching doesn't stop whatever is happening, even inexam room (needs to be physically restrained from itching)
Severe itching/ prolonged episodes. Itching might occur at night (if observed) and also when eating,playing, exercising or being distracted
Moderate itching/ regular episodes. Itching might occur at night (if observed) and also when eating,playing, exercising or being distracted
Mild itching/ a bit more frequent. Wouldn't itch when sleeping, eating, playing, exercising or beingdistracted
Very mild itching/ only occasional episodes. The cat is slightly more itchy than before the skinproblem started
Normal cat - I don't think itching is a problem
Figure 2. Scale used by owners to evaluate level of pruritus.
Figure 3. Modified CADESI-03 scores before and after treatment
with cetirizine hydrochloride (CTZ; n = 19) and placebo (PBO;
n = 21). Values are means ! SD.
© 2013 ESVD and ACVD, Veterinary Dermatology , 24, 576–e138. 579
Cetirizine in feline atopic dermatitis
Não é recomendada para controle de prurido em gatos atópicos!
Feline atopic dermatitis: a retrospective study of 45cases (2001–2012)Philippa A. Ravens*, Bei J. Xu† and Linda J. Vogelnest*
*Small Animal Specialist Hospital, Level 1, 1 Richardson Place, North Ryde, NSW 2113, Australia
†University of Sydney Veterinary Teaching Hospital, 410 Werombi Road, Brownlow Hill, NSW 2570, Australia
Correspondence: Philippa A. Ravens, Small Animal Specialist Hospital, Level 1, 1 Richardson Place, North Ryde, NSW 2135, Australia.
E-mail:[email protected]
Background – Atopic dermatitis (AD) is recognized as a common cause of pruritus in cats, but it remains incom-
pletely characterized.
Hypothesis/Objectives – The aim of the study was to evaluate cases of confirmed feline AD.
Animals – Fourty-five cats from a dermatology referral practice (2001–2012).
Methods – A retrospective case record review was carried out using strict diagnostic criteria, including exclusion
of flea-bite hypersensitivity and adverse food reaction.
Results – Disease prevalence was 12.5%, with domestic mixed (n = 24), Abyssinian (n = 6) and Devon rex
(n = 3) cat breeds predisposed. Median age of onset was 2 years (62% <3 years; 22% >7 years; range
3 months to 12 years). Common presentations were severe (82%), nonseasonal (82%), waxing/waning (36%)
pruritus, with alopecia/crusting/excoriations and/or erosions/ulceration (73%). Miliary dermatitis (20%) and eosin-
ophilic granuloma complex lesions (27%) occurred. The face/head (71%), ventral abdomen (51%), neck (51%),
limbs (38%), pinnae (31%), dorsum/rump (31%) and feet (16%) were frequently affected sites; lesions were
restricted to the head/neck in only five cats (11%). Concurrent otitis externa (16%), superficial bacterial pyo-
derma (49%), Malassezia dermatitis (7%), flea-bite hypersensitivity (24%) and adverse food reaction (13%)
occurred. Strong reactions on intradermal allergen testing were common (68%; 19 of 30), most frequently to pol-
lens (61%) and/or insects (46%). Good response to ciclosporin (100%; 10 of 10), systemic glucocorticoids (55%;
22 of 40) and allergen-specific immunotherapy (57%; 13 of 23) and good/partial response to antihistamines
(67%; 22 of 33) were reported.
Conclusions and clinical importance – The prevalence of feline AD was higher than previously suggested, and
breed predispositions were confirmed. Severe nonseasonal pruritus was most common, with a varied spectrum
of lesions affecting a range of body areas.
Introduction
Feline atopic dermatitis (AD) is suggested to be the sec-
ond most common allergic dermatosis in cats.1 Despite
reported clinical similarities to canine and human AD and
being referenced as feline AD in textbooks2 and reviews,3
there is some recent disagreement on nomenclature due
to limited current understanding of the pathogenesis.4
Increased CD4+ T cells, interleukin-4+ cells and CD1a+dendritic cells in lesional and/or nonlesional skin and in
affected compared with healthy cats are similar to findings
in canine and human AD, supporting a role for T-helper 2-
mediated immune dysfunction.3 However, a confirmed
role for immunoglobulin E (IgE) in feline AD is more con-
troversial,5 and despite numerous recent advancements
in the understanding of canine AD, very little research has
focused on the pathogenesis of feline AD to date.
Feline AD is anecdotally characterized by seasonal or
nonseasonal pruritus, and affected cats are reported com-
monly to exhibit one or more lesional patterns, including
symmetrical alopecia, miliary dermatitis, focused head
and neck pruritus and eosinophilic granuloma complex
(EGC) lesions.2,4 Young cats are reported to be predis-
posed, with clinical signs often developing before 3 years
of age, although a wide age range is noted.2,6 No sex or
breed predilections have been identified, and evidence of
inheritance is restricted to a single report of AD occurring
in three domestic short hair (DSH) littermates,7 in
contrast to canine and human AD, for which there are
well-established genetic links.2
The disease is currently diagnosed based upon a com-
patible history and clinical presentation, with exclusion of
other pruritic dermatoses.2 However, there are no widely
established clinical diagnostic criteria as there are in
dogs.8 Studies and case reports focusing on detailed
descriptions of feline AD are also limited,4,7,9,10 with only
one report of three cats that provides trial details for
exclusion of both flea-bite hypersensitivity (FBH) and
adverse food reactions (AFRs),7 which are recognized as
Accepted 28 November 2013
Sources of Funding: This study was self-funded.
Conflict of Interest: No conflicts of interest have been declared.
© 2014 ESVD and ACVD, Veterinary Dermatology 1
Vet Dermatol 2014 DOI: 10.1111/vde.12109
BOA$RESPOSTA=$6%$
RESPOSTA$PARCIAL=$59%$
RESPOSTA$POBRE=$34%$
n=19=>$Lora:dina$$5$mg/gato$ n=18=>$Ce:rizina$5$mg/gato$
Ciclosporina
Dose: 7mg/kg/sid/VO
Pode ser administrado junto a refeição!
Ciclosporina
CONTRA'INDICAÇÕES.! Gatos.com.histórico.de.doença.crônica.ou.
suspeita.de.malignidade.(neoplasia).
! Gatos.FIV.ou.FeLV.++.! Dermatofitose/Esporotricose.
INDICAÇÕES*! Controle*de*prurido*a*longo*prazo*! Refratários*a*corticoterapia*! Diabéticos**
Ciclosporina
INTERAÇÕES*MEDICAMENTOSAS*! Cetoconazol*! Itraconazol*! Claritromicina*
A randomized double-blinded placebo-controlled studyto evaluate an effective ciclosporin dose for thetreatment of feline hypersensitivity dermatitis
Stephen King*, Claude Favrot†, Linda Messinger‡, Tim Nuttall§, Jean Steffan*, Sophie Forster*and Wolfgang Seewald*
*Novartis Animal Health, Schwarzwaldallee 214, Basel, Switzerland
†Dermatology Department, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
‡Veterinary Referral Center of Colorado – Dermatology ⁄ Allergy, 3550 South Jason Street, Englewood, CO 80110, USA
§Department of Infection Biology, School of Veterinary Science, The University of Liverpool, Leahurst Campus, Neston, UK
Correspondence: Stephen King, Novartis Animal Health, Schwarzwaldallee 214, Basel, Switzerland. E-mail: [email protected]
Background – Hypersensitivity dermatitides (HD) are frequently suspected in cats, but there are few clinical
studies on safe and effective treatments in the published literature.
Objectives – To establish a safe and effective dose of ciclosporin in the treatment of feline HD.
Animals – One hundred client-owned cats with feline HD.
Methods – Double-blind study, with cats randomly assigned to receive ciclosporin at either 7.0 mg ⁄ kg once daily
(n = 33) or 2.5 mg ⁄ kg once daily (n = 32) or a placebo (n = 35) for 6 weeks.
Results – Mean Total Lesion Scores with 7.0 mg ⁄ kg ciclosporin were significantly lower than with 2.5 mg ⁄ kg
ciclosporin (P = 0.0047) or placebo (P = 0.0003) at study end. Individual Total Lesion Scores improved by >50%
in 70% of the 7.0 mg ⁄ kg group, compared with 47% in the 2.5 mg ⁄ kg group and 23% in the placebo group
(P = 0.0006). The investigators’ Global Assessment of Improvement was ‘excellent’ or ‘good’ in 61% of cats
treated with 7.0 mg ⁄ kg ciclosporin, compared with 47% of cats given 2.5 mg ⁄ kg and 23% given placebo. The
improvement in Investigator Pruritus Scores was significantly greater in cats treated with 7.0 mg ⁄ kg ciclosporin
(54%) compared with both 2.5 mg ⁄ kg ciclosporin (32%; P = 0.0232) and placebo (21%; P = 0.0063). Mild gas-
trointestinal disorders were the most common adverse events, but these did not require cessation of therapy.
Conclusions and clinical importance – Results suggest that 7.0 mg ⁄ kg ciclosporin once daily in food or per os
for 6 weeks is effective and well tolerated in feline HD.
Introduction
Hypersensitivity dermatitides (HD) are frequently sus-
pected in cats, but there are few published clinical studies
and most of the data have been drawn from the
observations of individual dermatologists.1–4 Hypersensi-
tivity dermatitis is a general term that usually encom-
passes flea-bite hypersensitivity, urticaria, angioedema,
food-induced hypersensitivity dermatitis, contact dermati-
tis and atopic dermatitis.4 It is usually accepted that aller-
gic cats exhibit pruritus and at least one of the following
pattern of lesions: head and neck excoriations or ulcer-
ations; self-induced alopecia; eosinophilic granuloma
complex (eosinophilic plaque, eosinophilic granuloma,
indolent ulcers and fat chin); and miliary dermatitis. It is,
however, worth noting that none of these signs or pat-
terns is pathognomonic of an allergic disease.2,5
Treatment of HD in cats generally relies on glucocortic-
oids, antihistamines, allergen-specific immunotherapy,
fatty acids, special diets selected following food elimina-
tion diet trials, flea control ⁄ avoidance and, more
infrequently, megestrol acetate.1 Treatment with corti-
costeroids and megestrol acetate is not always satisfac-
tory because adverse effects are not uncommon. The
efficacy of antihistamines has not been clearly demon-
strated, having been assessed only in an open single-arm
study.6 Hyposensitization has been evaluated in several
open studies, and success has been reported in 50–75%
of cases.7,8 Despite this, hyposensitization may not com-
monly be used, because identification of the offending
allergens can be difficult. The use of ciclosporin in the
treatment of feline HD with clinical signs of pruritus,
excoriation ⁄ ulceration, self-induced alopecia and eosino-
philic granuloma complex has been reported in small
uncontrolled pilot studies9 and retrospective studies.10 In
these studies, feline HD-associated pruritus and lesions
responded well (improvement in the range of 50–75%
after 30–60 days) to ciclosporin with greater than half of
Accepted 1 June 2012
Sources of Funding: This study was funded by Novartis Animal
Health, Basel, Switzerland.
Conflict of Interest: Stephen King, Jean Steffan, Sophie Forster
and Wolfgang Seewald are full-time employees of Novartis Ani-
mal Health. Tim Nuttall and Claude Favrot have received related
and unrelated consultancy fees, lecture fees and funding from
Novartis Animal Health.
ª 2012 The Authors. Veterinary Dermatology
440 ª 2012 ESVD and ACVD, Veterinary Dermatology, 23, 440–e84.
Vet Dermatol 2012; 23: 440–e84 DOI: 10.1111/j.1365-3164.2012.01086.x
7 mg/kg/dia
Dose tapering for ciclosporin in cats withnonflea-induced hypersensitivity dermatitis
Jean Steffan*, Elizabeth Roberts†, Andrea Cannon‡, Pascal Pr!elaud§, Peter Forsythe¶, JacquesFontaine**, Stephen King† and Wolfgang Seewald*
*Novartis Animal Health, Schwarzwaldallee 214, Basel, Switzerland
†Novartis Animal Health US, Inc., 3200, Northline Ave., Greensboro, NC 27408, USA
‡Animal Dermatology & Allergy, 3924 Oakdale Road, Modesto, CA 95357, USA
§Clinique Advetia, 5 rue Dubrunfaut, 75012, Paris, France
¶Veterinary Dermatology Referrals, Glasgow, G51 1RN, UK
**Animalclinic, Avenue Brugmann 425, Brussels, 1180, Belgium
Correspondence: Jean Steffan, Novartis Animal Health, Schwarzwaldallee 214, Basel, Switzerland. E-mail: [email protected]
Background – Little information is available on the ciclosporin dose-tapering regimen and clinical response in
the treatment of feline hypersensitivity dermatitis.
Hypothesis/Objectives – To test a dose-tapering regimen and assess efficacy and clinical safety for up to
18 weeks.
Animals – Eighty-eight client-owned cats with feline hypersensitivity dermatitis.
Methods – Cats that received either a placebo or ciclosporin at 2.5 mg/kg or 7 mg/kg daily for 6 weeks were
given 7 mg/kg ciclosporin daily for 4 weeks. Depending on the clinical response, the dose was tapered from daily
to every other day over the next 4 weeks and further to twice a week for an additional 4 weeks.
Results – After all cats received 7 mg/kg for 4 weeks, the dose could be tapered to every other day for the
next 4 weeks in 70% of cats remaining in the study. During the next 4 weeks, 57, 15 and 22% of cats
remaining in the study could be treated at twice a week, every other day or daily, respectively. After the
first 4 weeks, the mean lesion score and owner-assessed pruritus improved over baseline by 69 and 61%,
respectively, and remained stable during the following 8 weeks. Approximately 65% of the cats in the study
were reported to have an adverse event (AE), very often mild and resolving spontaneously. The most fre-
quent AEs were gastrointestinal and included primarily vomiting and diarrhoea. Eighty per cent of AEs
occurred when cats were on daily treatment.
Conclusions and clinical importance – Results suggest that the induction dose of 7 mg/kg ciclosporin can be
tapered as soon as 4 weeks without deterioration of the clinical response. Establishment of the lowest effective
dosing regimen of ciclosporin reduced the frequency of AEs.
Introduction
Ciclosporin has been used for many years in the treat-
ment of feline hypersensitivity dermatitis at various
doses, generally ranging from 5 to 10 mg/kg.1–4 The dose
of 7 mg/kg given daily has recently been tested in a ran-
domized, blinded parallel group, placebo-controlled study
and was shown to be efficacious and well tolerated.5 In
cats with head and neck excoriations, self-induced alope-
cia, eosinophilic plaque and/or miliary dermatitis, the
administration of 7 mg/kg ciclosporin daily for 6 weeks
resulted in a decrease in total lesion and owner-assessed
pruritus severity scores. In cats receiving the 7 mg/kg
daily dose, the most common adverse events were mild
gastrointestinal disorders. That dose-determination study
was aimed at establishing an efficacious and safe dose.
Dosing duration was limited to 6 weeks and did not
address the long-term use of ciclosporin to treat feline
hypersensitivity dermatitis.
In cats, limited information is available about long-
term efficacy and safety of ciclosporin. Studies suggest
that feline hypersensitivity dermatitis can be well con-
trolled with dose tapering;2,6 however, the frequency
and response to dose tapering has not been docu-
mented in cats. The present study was designed to
assess the clinical response to a dose-tapering regimen
and the tolerability to ciclosporin administered for up to
18 weeks.
Materials and methods
Study designThe study was conducted in two phases. The first phase established
7 mg/kg as an effective dose of ciclosporin for the treatment of
hypersensitivity dermatitis.5 The present study presents the out-
come of the second phase, in which a dose-tapering regimen was
examined.
Accepted 14 January 2013
Sources of Funding: This study was funded by Novartis Animal
Health, Basel, Switzerland.
Conflict of Interest: J.S., E.R., S.K. and W.S. are full-time
employees of Novartis Animal Health. A.C., P.P., P.F. and J.F.
have received related and unrelated consultancy fees, lecture
fees or investigator fees from Novartis Animal Health.
© 2013 The Authors. Veterinary Dermatology
© 2013 ESVD and ACVD, Veterinary Dermatology 1
Vet Dermatol 2013 DOI: 10.1111/vde.12018
Dose: 7 mg/kg/SID/ 4 semanas
7 mg/kg/48h/4 sem (em15%)
7 mg/kg/ 2x/sem (em 57%)
88 gatos
Em até 70%
Veterinary Dermatology 2013; 24: 315–e70.
Adverse events in 50 cats with allergic dermatitisreceiving ciclosporin
Nicole A. Heinrich, Patrick J. McKeever andMelissa C. Eisenschenk
McKeever Dermatology Clinics, Inc., Eden Prairie,
MN, USA
Correspondence: Nicole A. Heinrich, McKeever Dermatology
Clinics, Inc. 7723 Flying Cloud Drive Eden Prairie, MN 55344, USA.
E-mail: [email protected]
Sources of Funding
This study is self-funded.
Conflict of Interest
No conflicts of interest have been declared.
Parts of this study were published as an abstract from the 25th North
American Veterinary Dermatology Forum in Portland, OR, USA; Vet-
erinary Dermatology 2010; 21: 326.
Abstract
Ciclosporin is an immunosuppressive drug thathas been used to treat allergies and other immune-mediated diseases in cats, dogs and humans. Infor-mation about the adverse effects of ciclosporin in catshas been limited to smaller studies and case reports.Adverse effects in dogs are mainly gastrointestinal innature, but humans can also experience hypertensionand altered renal function. The aim of this retrospec-tive case series study was to document the occur-rence and clinical appearance of adverse events incats receiving ciclosporin to treat allergic skin disease.The medical records of 50 cats with allergic dermatitistreated with oral ciclosporin (1.9–7.3 mg ⁄ kg ⁄ day)were reviewed. Adverse events occurred in 66% (33cats). Adverse events likely to be associated withciclosporin included the following: vomiting or diar-rhoea within 1–8 weeks of receiving ciclosporin(24%), weight loss (16%), anorexia and subsequenthepatic lipidosis (2%) and gingival hyperplasia (2%).Other adverse events less likely to be associated withciclosporin therapy included the following: weightgain (14%), dental tartar and gingivitis (10%), otitis(4%), chronic diarrhoea (4%), inflammatory boweldisease with indolent gastrointestinal lymphoma(2%), urinary tract infection (2%), cataract (2%), ele-vated liver enzymes (2%), hyperthyroidism and renalfailure (2%) and transient inappropriate urination(2%). Some cats experienced multiple adverse events.Case–control studies are needed to prove cause andeffect of ciclosporin with regard to these adverseevents.
Accepted 30 March 2011
Introduction
Feline allergic dermatitis is characterized by pruritus and
varying degrees of alopecia, erythema and crusting.1
These lesions generally affect the head, neck, forelegs,
groin, lateral thorax and caudal thighs.1 Feline allergic
dermatitis varies in severity; some cats require minimal
or no treatment, while other cats require intensive, daily
therapy.
Corticosteroids are often used to treat feline allergic
dermatitis, but adverse effects (such as diabetes mell-
itus2) associated with this therapy have stimulated inter-
est in alternative treatments.
The use of ciclosporin is gaining acceptance for treat-
ment of feline allergic dermatitis, as several studies and
anecdotal reports have demonstrated efficacy and appar-
ent safety.3,4 The true safety of this drug is of concern, as
only limited data are available that specifically address the
adverse effects of ciclosporin in cats.5–7
Ciclosporin treatment in cats has been associated with
toxoplasmosis,6,7 post-transplant malignant neoplasia,8,9
diarrhoea,3,4 vomiting, hyperactivity, increased appetite,4
anorexia10 and gingival hyperplasia.11 This is similar to
dogs, in which gingival hyperplasia12 and gastrointestinal
(GI) upsets13 have also been described. Humans have
also developed gingival hyperplasia, GI upsets and malig-
nancy in association with ciclosporin.14
In contrast to cats, dogs can also develop hirsutism, cuta-
neous papillomatous hyperplasia, hyperkeratosis of the
footpads, increase in nail growth and lymphoplasmatoid
dermatitis in association with ciclosporin.5 Adverse effects
associated with ciclosporin use in humans include hirsut-
ism, skin rash, neurological signs, hypertension, hepatic
dysfunction, impaired renal function and musculoskeletal
pain.5Theseadverseeffectshavenotbeenreported incats.
Ciclosporin affects a number of cells in the skin, includ-
ing T cells, dendritic cells and keratinocytes. Ciclosporin
is a calcineurin inhibitor;15 calcineurin causes dephosphor-
ylation of nuclear factor of activated T cells (NFAT). NFAT
promotes transcription of genes that encode for proin-
flammatory cytokines, including interleukin (IL)-2, IL-4,
interferon (IFN)-c and tumour necrosis factor (TNF)-a.16
Ciclosporin inhibition of gene transcription for these cyto-
kines has been specifically demonstrated in cats.17 These
cytokines lead to activation and proliferation of T cells.
Ciclosporin also specifically impairs the ability of dendritic
cells to stimulate proliferation of T cells,18 and blocks
calcineurin and NFAT in epidermal keratinocytes.19
Cats with allergic dermatitis have been shown to have
higher numbers of T cells (both CD4+ and CD8+) in
lesional skin compared with healthy cats.20 It has also
been demonstrated that these CD4+ T cells are the pri-
mary producers of IL-4.21
ª 2011 The Authors. Veterinary Dermatology
ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 511–520. 511
DOI: 10.1111/j.1365-3164.2011.00983.xAdverse events in 50 cats with allergic dermatitisreceiving ciclosporin
Nicole A. Heinrich, Patrick J. McKeever andMelissa C. Eisenschenk
McKeever Dermatology Clinics, Inc., Eden Prairie,
MN, USA
Correspondence: Nicole A. Heinrich, McKeever Dermatology
Clinics, Inc. 7723 Flying Cloud Drive Eden Prairie, MN 55344, USA.
E-mail: [email protected]
Sources of Funding
This study is self-funded.
Conflict of Interest
No conflicts of interest have been declared.
Parts of this study were published as an abstract from the 25th North
American Veterinary Dermatology Forum in Portland, OR, USA; Vet-
erinary Dermatology 2010; 21: 326.
Abstract
Ciclosporin is an immunosuppressive drug thathas been used to treat allergies and other immune-mediated diseases in cats, dogs and humans. Infor-mation about the adverse effects of ciclosporin in catshas been limited to smaller studies and case reports.Adverse effects in dogs are mainly gastrointestinal innature, but humans can also experience hypertensionand altered renal function. The aim of this retrospec-tive case series study was to document the occur-rence and clinical appearance of adverse events incats receiving ciclosporin to treat allergic skin disease.The medical records of 50 cats with allergic dermatitistreated with oral ciclosporin (1.9–7.3 mg ⁄ kg ⁄ day)were reviewed. Adverse events occurred in 66% (33cats). Adverse events likely to be associated withciclosporin included the following: vomiting or diar-rhoea within 1–8 weeks of receiving ciclosporin(24%), weight loss (16%), anorexia and subsequenthepatic lipidosis (2%) and gingival hyperplasia (2%).Other adverse events less likely to be associated withciclosporin therapy included the following: weightgain (14%), dental tartar and gingivitis (10%), otitis(4%), chronic diarrhoea (4%), inflammatory boweldisease with indolent gastrointestinal lymphoma(2%), urinary tract infection (2%), cataract (2%), ele-vated liver enzymes (2%), hyperthyroidism and renalfailure (2%) and transient inappropriate urination(2%). Some cats experienced multiple adverse events.Case–control studies are needed to prove cause andeffect of ciclosporin with regard to these adverseevents.
Accepted 30 March 2011
Introduction
Feline allergic dermatitis is characterized by pruritus and
varying degrees of alopecia, erythema and crusting.1
These lesions generally affect the head, neck, forelegs,
groin, lateral thorax and caudal thighs.1 Feline allergic
dermatitis varies in severity; some cats require minimal
or no treatment, while other cats require intensive, daily
therapy.
Corticosteroids are often used to treat feline allergic
dermatitis, but adverse effects (such as diabetes mell-
itus2) associated with this therapy have stimulated inter-
est in alternative treatments.
The use of ciclosporin is gaining acceptance for treat-
ment of feline allergic dermatitis, as several studies and
anecdotal reports have demonstrated efficacy and appar-
ent safety.3,4 The true safety of this drug is of concern, as
only limited data are available that specifically address the
adverse effects of ciclosporin in cats.5–7
Ciclosporin treatment in cats has been associated with
toxoplasmosis,6,7 post-transplant malignant neoplasia,8,9
diarrhoea,3,4 vomiting, hyperactivity, increased appetite,4
anorexia10 and gingival hyperplasia.11 This is similar to
dogs, in which gingival hyperplasia12 and gastrointestinal
(GI) upsets13 have also been described. Humans have
also developed gingival hyperplasia, GI upsets and malig-
nancy in association with ciclosporin.14
In contrast to cats, dogs can also develop hirsutism, cuta-
neous papillomatous hyperplasia, hyperkeratosis of the
footpads, increase in nail growth and lymphoplasmatoid
dermatitis in association with ciclosporin.5 Adverse effects
associated with ciclosporin use in humans include hirsut-
ism, skin rash, neurological signs, hypertension, hepatic
dysfunction, impaired renal function and musculoskeletal
pain.5Theseadverseeffectshavenotbeenreported incats.
Ciclosporin affects a number of cells in the skin, includ-
ing T cells, dendritic cells and keratinocytes. Ciclosporin
is a calcineurin inhibitor;15 calcineurin causes dephosphor-
ylation of nuclear factor of activated T cells (NFAT). NFAT
promotes transcription of genes that encode for proin-
flammatory cytokines, including interleukin (IL)-2, IL-4,
interferon (IFN)-c and tumour necrosis factor (TNF)-a.16
Ciclosporin inhibition of gene transcription for these cyto-
kines has been specifically demonstrated in cats.17 These
cytokines lead to activation and proliferation of T cells.
Ciclosporin also specifically impairs the ability of dendritic
cells to stimulate proliferation of T cells,18 and blocks
calcineurin and NFAT in epidermal keratinocytes.19
Cats with allergic dermatitis have been shown to have
higher numbers of T cells (both CD4+ and CD8+) in
lesional skin compared with healthy cats.20 It has also
been demonstrated that these CD4+ T cells are the pri-
mary producers of IL-4.21
ª 2011 The Authors. Veterinary Dermatology
ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 511–520. 511
DOI: 10.1111/j.1365-3164.2011.00983.x
Adverse events in 50 cats with allergic dermatitisreceiving ciclosporin
Nicole A. Heinrich, Patrick J. McKeever andMelissa C. Eisenschenk
McKeever Dermatology Clinics, Inc., Eden Prairie,
MN, USA
Correspondence: Nicole A. Heinrich, McKeever Dermatology
Clinics, Inc. 7723 Flying Cloud Drive Eden Prairie, MN 55344, USA.
E-mail: [email protected]
Sources of Funding
This study is self-funded.
Conflict of Interest
No conflicts of interest have been declared.
Parts of this study were published as an abstract from the 25th North
American Veterinary Dermatology Forum in Portland, OR, USA; Vet-
erinary Dermatology 2010; 21: 326.
Abstract
Ciclosporin is an immunosuppressive drug thathas been used to treat allergies and other immune-mediated diseases in cats, dogs and humans. Infor-mation about the adverse effects of ciclosporin in catshas been limited to smaller studies and case reports.Adverse effects in dogs are mainly gastrointestinal innature, but humans can also experience hypertensionand altered renal function. The aim of this retrospec-tive case series study was to document the occur-rence and clinical appearance of adverse events incats receiving ciclosporin to treat allergic skin disease.The medical records of 50 cats with allergic dermatitistreated with oral ciclosporin (1.9–7.3 mg ⁄ kg ⁄ day)were reviewed. Adverse events occurred in 66% (33cats). Adverse events likely to be associated withciclosporin included the following: vomiting or diar-rhoea within 1–8 weeks of receiving ciclosporin(24%), weight loss (16%), anorexia and subsequenthepatic lipidosis (2%) and gingival hyperplasia (2%).Other adverse events less likely to be associated withciclosporin therapy included the following: weightgain (14%), dental tartar and gingivitis (10%), otitis(4%), chronic diarrhoea (4%), inflammatory boweldisease with indolent gastrointestinal lymphoma(2%), urinary tract infection (2%), cataract (2%), ele-vated liver enzymes (2%), hyperthyroidism and renalfailure (2%) and transient inappropriate urination(2%). Some cats experienced multiple adverse events.Case–control studies are needed to prove cause andeffect of ciclosporin with regard to these adverseevents.
Accepted 30 March 2011
Introduction
Feline allergic dermatitis is characterized by pruritus and
varying degrees of alopecia, erythema and crusting.1
These lesions generally affect the head, neck, forelegs,
groin, lateral thorax and caudal thighs.1 Feline allergic
dermatitis varies in severity; some cats require minimal
or no treatment, while other cats require intensive, daily
therapy.
Corticosteroids are often used to treat feline allergic
dermatitis, but adverse effects (such as diabetes mell-
itus2) associated with this therapy have stimulated inter-
est in alternative treatments.
The use of ciclosporin is gaining acceptance for treat-
ment of feline allergic dermatitis, as several studies and
anecdotal reports have demonstrated efficacy and appar-
ent safety.3,4 The true safety of this drug is of concern, as
only limited data are available that specifically address the
adverse effects of ciclosporin in cats.5–7
Ciclosporin treatment in cats has been associated with
toxoplasmosis,6,7 post-transplant malignant neoplasia,8,9
diarrhoea,3,4 vomiting, hyperactivity, increased appetite,4
anorexia10 and gingival hyperplasia.11 This is similar to
dogs, in which gingival hyperplasia12 and gastrointestinal
(GI) upsets13 have also been described. Humans have
also developed gingival hyperplasia, GI upsets and malig-
nancy in association with ciclosporin.14
In contrast to cats, dogs can also develop hirsutism, cuta-
neous papillomatous hyperplasia, hyperkeratosis of the
footpads, increase in nail growth and lymphoplasmatoid
dermatitis in association with ciclosporin.5 Adverse effects
associated with ciclosporin use in humans include hirsut-
ism, skin rash, neurological signs, hypertension, hepatic
dysfunction, impaired renal function and musculoskeletal
pain.5Theseadverseeffectshavenotbeenreported incats.
Ciclosporin affects a number of cells in the skin, includ-
ing T cells, dendritic cells and keratinocytes. Ciclosporin
is a calcineurin inhibitor;15 calcineurin causes dephosphor-
ylation of nuclear factor of activated T cells (NFAT). NFAT
promotes transcription of genes that encode for proin-
flammatory cytokines, including interleukin (IL)-2, IL-4,
interferon (IFN)-c and tumour necrosis factor (TNF)-a.16
Ciclosporin inhibition of gene transcription for these cyto-
kines has been specifically demonstrated in cats.17 These
cytokines lead to activation and proliferation of T cells.
Ciclosporin also specifically impairs the ability of dendritic
cells to stimulate proliferation of T cells,18 and blocks
calcineurin and NFAT in epidermal keratinocytes.19
Cats with allergic dermatitis have been shown to have
higher numbers of T cells (both CD4+ and CD8+) in
lesional skin compared with healthy cats.20 It has also
been demonstrated that these CD4+ T cells are the pri-
mary producers of IL-4.21
ª 2011 The Authors. Veterinary Dermatology
ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 511–520. 511
DOI: 10.1111/j.1365-3164.2011.00983.x
One cat developed gingival hyperplasia after 1 year of
receiving generic modified ciclosporin daily. All three
raters agreed that the probability of an adverse drug
reaction was ‘probable’.
The authors all considered the next group of adverse
events unlikely to be caused by ciclosporin administration
and classified them as having ‘doubtful’ probability.
Seven cats (14%) developed dental tartar and gingivitis.
Five cats (10%) experienced 14–42% weight gain over
varying lengths of time. Two cats developed diabetes
mellitus while concurrently receiving oral dexametha-
sone, and two cats developed otitis. The following
adverse events were reported once each: transient
inappropriate urination, urinary tract infection (one author
rated this event as a ‘possible’ drug reaction), corneal
ulcer, constipation, transient coughing and sneezing, and
hyperthyroidism with subsequent chronic renal failure.
Discussion
This paper describes a case series, which is a study
design that cannot formally investigate causality. Case
series are important for detecting potential safety signals,
which need to be tested with more rigorous study
designs such as case–control or cohort studies.25
This case series lists every adverse event that occurred
in a population of 50 cats receiving ciclosporin to treat
allergic skin disease. Table 3 summarizes these events.
The authors offer expert opinion regarding causality usingTab
le1.
(Continued)
Cat
Age
star
ted
CS
A
Dia
gnose
sprior
tost
arting
CS
A
Typ
eof
CS
AD
ose
Initia
l
concu
rrent
medic
atio
ns
Mai
nte
nan
ce
dose
and
oth
er
medic
atio
ns
Tim
eon
CS
AFollo
wup
Adve
rse
eve
nts
and
dia
gnose
saf
ter
star
ting
CS
A
46
13
year
sA
DA
topic
a!
6m
g⁄k
gD
exa
meth
asone,1.5
mg
6m
g⁄k
geve
ry2
day
san
d
inte
rmitte
nt
ora
l
dexa
meth
asone
18
month
sA
nnual
exa
min
atio
n,
CB
C⁄c
hem
⁄tota
l
thyr
oxi
ne
Chro
nic
dia
rrhoea
1ye
ar
late
r
47
1ye
arA
DA
topic
a!
4.6
mg
⁄kg
None
4.6
mg
⁄kg
eve
ry2
day
san
d
inte
rmitte
nt
ora
l
dexa
meth
asone
3ye
ars
Annual
exa
min
atio
nD
iarr
hoea
3ye
ars
late
r
48
10
year
sA
D,eosi
nophili
c
pla
que
Ato
pic
a!
25
mg
per
cat
Dexa
meth
asone,1.5
mg
4.4
mg
⁄kg
eve
ry2
day
s2
year
sA
nnual
exa
min
atio
nU
rinar
ytr
act
infe
ctio
nonce
2ye
ars
late
r
49
11
year
sA
DA
topic
a!
3.4
mg
⁄kg
None
3.4
mg
⁄kg
eve
ry3–4
day
s14
month
sA
nnual
exa
min
atio
n,
CB
C⁄c
hem
Ele
vate
dliv
er
enzy
mes,
pro
gre
ssiv
ew
eig
ht
loss
1ye
arla
ter
50
12
year
sA
DA
topic
a!
25
mg
per
cat
Dexa
meth
asone,1.5
mg
25
mg
eve
ry2
day
s17
month
sA
nnual
exa
min
atio
n,
CB
C⁄c
hem
⁄to
talt
hyr
oxi
ne
Hyp
ert
hyr
oid
ism
,ch
ronic
renal
failu
re2
year
sla
ter
AD
,at
opic
derm
atitis
;A
DE
,ad
vers
eeve
nts
;A
FR
,ad
vers
efo
od
reac
tion;C
BC
,co
mple
teblo
od
count;
chem
,se
rum
chem
istr
y;C
SA
,ci
closp
orin;H
CM
,hyp
ert
rophic
card
iom
yopat
hy;
IBD
,in
flam
mat
ory
bow
eld
iseas
e;
UA
,urinal
ysis
.
Table 2. Statistical inter-rater agreement for gastrointestinal events
Gastrointestinal events j-value P-value Agreement
Overall 0.52 0.0001 Moderate
Definite reactions )0.09 0.59 Low
Probable reactions 0.48 0.004 Moderate
Possible reactions 0.84 <0.0001 High
Table 3. Number of adverse events by category
Adverse event
Number
of cats
Vomiting, diarrhoea and ⁄ or anorexia within 1–8 weeks
of starting ciclosporin
12
Weight loss 8
Dental tartar and gingivitis 7
Weight gain 5
Chronic diarrhoea after receiving ciclosporin for
12 months or more
2
Diabetes mellitus 2
Otitis 2
Severe inflammatory bowel disease, indolent
gastrointestinal lymphoma and mild hypertrophic
cardiomyopathy
1
Hepatic lipidosis 1
Elevated liver enzymes 1
Gingival hyperplasia 1
Transient inappropriate urination 1
Urinary tract infection 1
Corneal ulcer 1
Constipation 1
Transient coughing and sneezing 1
Hyperthyroidism with subsequent chronic renal failure 1
ª 2011 The Authors. Veterinary Dermatology
516 ª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 511–520.
Heinrich et al.
Subcutaneous administration of ciclosporin in 11allergic cats – a pilot open-label uncontrolled clinicaltrial
Sandra N. Koch* , Sheila M. F. Torres*, Sandra Diaz†, Sophie Gilbert§ and Aaron Rendahl‡
*Department of Veterinary Clinical Sciences, University of Minnesota, 1365 Gortner Avenue, Saint Paul, MN 55018, USA
†Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon Tharp Street, Columbus, OH 43210, USA,
§Centre V!et!erinaire Laval, 4530 Highway 440, Laval, Quebec Canada, H7T 2P7 and
‡Department of Veterinary and Biomedical Sciences, University of Minnesota, 1365 Gortner Avenue, Saint Paul, MN 55018, USA
Correspondence: Sheila M. F. Torres, Department of Veterinary Clinical Sciences, University of Minnesota, 1365 Gortner Avenue, Saint Paul, MN
55018, USA. E-mail: [email protected]
Background – Oral ciclosporin has been reported to be efficacious for feline inflammatory skin diseases; how-
ever, cats are often difficult to medicate orally.
Hypothesis/Objective – To evaluate the efficacy and tolerability of subcutaneous ciclosporin administered to
cats with allergic skin disease.
Animals – Eleven client-owned cats with nonseasonal clinical signs.
Methods – Prospective open label trial. Ciclosporin 50 mg/mL solution for injection (Sandimune!, Novartis; NJ,
USA) was administered subcutaneously for 60 days with initial doses ranging from 2.5 mg/kg once daily (one
cat) to every other day (five cats) and 5 mg/kg once daily (four cats) to every other day (one cat). Dosages
were adjusted monthly if needed based on clinical response. Clinical response was assessed using a modified
FeDESI (feline Dermatitis Extent and Severity Index) and PVAS (pruritus Visual Analog Scale) between days (D)
0, 30 and 60.
Results – Six cats completed the study and four of five cats withdrawn from the study were included in an inten-
tion-to-treat analysis. There was significant decrease in FeDESI and PVAS scores between D0 and D30, D0 and
D60 and D30 and D60 (P < 0.05) in all ten cats.
Conclusions and clinical importance – Ciclosporin administered subcutaneously at initial doses of 2.5-5 mg/
kg, once daily to alternate days, appears to be an efficacious therapy for feline allergic dermatitis and may be an
alternative therapy for cats that cannot be treated orally. Randomized and controlled long term studies which
include a larger number of cats are needed to confirm these findings.
Introduction
Feline dermatoses, including allergic diseases, are often
challenging to manage. Topical therapies are frequently
not well tolerated by cats, may pose risk of systemic
adverse effects due to drug ingestion and are typically
used as adjunctive therapies.1 Antihistamines and essen-
tial fatty acids are treatment options but the success rate
is variable and often low.1 Oral and injectable glucocorti-
coids are quite effective but have the potential for severe
long-term adverse effects, including diabetes mellitus.1
Oclacitinib maleate may be an alternative treatment for
cats with allergic skin disease, although in one pilot
study only five of 12 (41.6%) cats with nonflea- and
nonfood-induced hypersensitivity dermatitis treated
with oclacitinib, at the doses recommended for dogs,
showed good improvement after 30 days of therapy.2
Several studies have investigated the use of oral ciclos-
porin A (CsA) in cats with various skin disorders; the effi-
cacy and safety of CsA for the treatment of feline allergic
dermatoses has been reported in double-blinded and ran-
domized controlled trials.3–9 Additionally, CsA has been
reported in retrospective and case series reports to
be effective for other feline dermatological conditions
including eosinophilic granuloma complex, urticaria pig-
mentosa, plasmacytic stomatitis, acquired alopecia (pseu-
dopelade), pemphigus complex, idiopathic pruritus and
dirty face syndrome of Persian cats.7–9 Mild adverse
effects have been reported with oral CsA administration
in cats, including hypersalivation, headshaking, vomiting,
soft faeces, diarrhoea and gingival hyperplasia.10,11 Given
the reported efficacy and minimal adverse effects, oral
CsA appears to be a valid therapeutic approach for the
long-term control of feline allergic skin diseases. How-
ever, cats are often difficult to medicate orally which
could interfere with the efficacy of CsA and result in treat-
ment discontinuation by the owners. In addition, oral CsA
Abbreviations: CsA, ciclosporin; sCsA, subcutaneous injectedciclosporin.
Accepted 31 August 2017
Sources of funding: This study was self-funded
Conflict of interest: No conflicts of interest have been declared.
© 2017 ESVD and ACVD, Veterinary Dermatology 1
Vet Dermatol 2017 DOI: 10.1111/vde.12505
Subcutaneous administration of ciclosporin in 11allergic cats – a pilot open-label uncontrolled clinicaltrial
Sandra N. Koch* , Sheila M. F. Torres*, Sandra Diaz†, Sophie Gilbert§ and Aaron Rendahl‡
*Department of Veterinary Clinical Sciences, University of Minnesota, 1365 Gortner Avenue, Saint Paul, MN 55018, USA
†Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon Tharp Street, Columbus, OH 43210, USA,
§Centre V!et!erinaire Laval, 4530 Highway 440, Laval, Quebec Canada, H7T 2P7 and
‡Department of Veterinary and Biomedical Sciences, University of Minnesota, 1365 Gortner Avenue, Saint Paul, MN 55018, USA
Correspondence: Sheila M. F. Torres, Department of Veterinary Clinical Sciences, University of Minnesota, 1365 Gortner Avenue, Saint Paul, MN
55018, USA. E-mail: [email protected]
Background – Oral ciclosporin has been reported to be efficacious for feline inflammatory skin diseases; how-
ever, cats are often difficult to medicate orally.
Hypothesis/Objective – To evaluate the efficacy and tolerability of subcutaneous ciclosporin administered to
cats with allergic skin disease.
Animals – Eleven client-owned cats with nonseasonal clinical signs.
Methods – Prospective open label trial. Ciclosporin 50 mg/mL solution for injection (Sandimune!, Novartis; NJ,
USA) was administered subcutaneously for 60 days with initial doses ranging from 2.5 mg/kg once daily (one
cat) to every other day (five cats) and 5 mg/kg once daily (four cats) to every other day (one cat). Dosages
were adjusted monthly if needed based on clinical response. Clinical response was assessed using a modified
FeDESI (feline Dermatitis Extent and Severity Index) and PVAS (pruritus Visual Analog Scale) between days (D)
0, 30 and 60.
Results – Six cats completed the study and four of five cats withdrawn from the study were included in an inten-
tion-to-treat analysis. There was significant decrease in FeDESI and PVAS scores between D0 and D30, D0 and
D60 and D30 and D60 (P < 0.05) in all ten cats.
Conclusions and clinical importance – Ciclosporin administered subcutaneously at initial doses of 2.5-5 mg/
kg, once daily to alternate days, appears to be an efficacious therapy for feline allergic dermatitis and may be an
alternative therapy for cats that cannot be treated orally. Randomized and controlled long term studies which
include a larger number of cats are needed to confirm these findings.
Introduction
Feline dermatoses, including allergic diseases, are often
challenging to manage. Topical therapies are frequently
not well tolerated by cats, may pose risk of systemic
adverse effects due to drug ingestion and are typically
used as adjunctive therapies.1 Antihistamines and essen-
tial fatty acids are treatment options but the success rate
is variable and often low.1 Oral and injectable glucocorti-
coids are quite effective but have the potential for severe
long-term adverse effects, including diabetes mellitus.1
Oclacitinib maleate may be an alternative treatment for
cats with allergic skin disease, although in one pilot
study only five of 12 (41.6%) cats with nonflea- and
nonfood-induced hypersensitivity dermatitis treated
with oclacitinib, at the doses recommended for dogs,
showed good improvement after 30 days of therapy.2
Several studies have investigated the use of oral ciclos-
porin A (CsA) in cats with various skin disorders; the effi-
cacy and safety of CsA for the treatment of feline allergic
dermatoses has been reported in double-blinded and ran-
domized controlled trials.3–9 Additionally, CsA has been
reported in retrospective and case series reports to
be effective for other feline dermatological conditions
including eosinophilic granuloma complex, urticaria pig-
mentosa, plasmacytic stomatitis, acquired alopecia (pseu-
dopelade), pemphigus complex, idiopathic pruritus and
dirty face syndrome of Persian cats.7–9 Mild adverse
effects have been reported with oral CsA administration
in cats, including hypersalivation, headshaking, vomiting,
soft faeces, diarrhoea and gingival hyperplasia.10,11 Given
the reported efficacy and minimal adverse effects, oral
CsA appears to be a valid therapeutic approach for the
long-term control of feline allergic skin diseases. How-
ever, cats are often difficult to medicate orally which
could interfere with the efficacy of CsA and result in treat-
ment discontinuation by the owners. In addition, oral CsA
Abbreviations: CsA, ciclosporin; sCsA, subcutaneous injectedciclosporin.
Accepted 31 August 2017
Sources of funding: This study was self-funded
Conflict of interest: No conflicts of interest have been declared.
© 2017 ESVD and ACVD, Veterinary Dermatology 1
Vet Dermatol 2017 DOI: 10.1111/vde.12505
Ciclosporina 50 mg/ml SC
Dose: 2.5 a 5.0 mg /Kg/SID ou EDA
the study were 2.5 mg/kg every third day (two cats),
5 mg/kg once daily (two cats) and 5 mg/kg every other
day (four cats). Only six of 11 cats completed the study
and their dosages included 2.5 mg/kg every third day
(one cat), 5 mg/kg every 36 to 48 h (one cat), 5 mg/kg
every other day (three cats) and 5 mg/kg every third day
(one cat), (Table S1).
WithdrawalFive (45.45%) cats (cases 7, 8, 9, 10 and 11) were with-
drawn from the study per owners’ requests prior to trial
completion (D60). One cat (Case 8) was withdrawn due
to behaviour changes reported by the owner and lack of
response to therapy. Two cats (cases 9 and 11), although
improved, were withdrawn because of adverse effects at
injection sites reported by the owners. Two cats (cases 7
and 10) were withdrawn because the owners were not
comfortable to continue administering the injections.
Table S1 shows details of withdrawal times and reasons
for each cat.
Assessment of skin lesions (FeDESI)The Friedman test showed a significant (P = 0.0002)
impact of therapy on skin lesions. Pairwise analyses
showed significant skin lesion improvement between D0
and D30 (P = 0.008), D0 and D60 (P = 0.006) and D30
and D60 (P = 0.02). Figure 1 and Table S2 show the indi-
vidual scores. Figure S1 and Figure S2 show pictures of
two cats that completed the study.
Assessment of pruritus (PVAS)The Friedman test showed a significant (P = 0.0003)
impact of therapy on pruritus. Pairwise analyses showed
significant pruritus decrease between D0 and D30
(P = 0.028), D0 and D60 (P = 0.026) and D30 and D60
(P = 0.034). Figure 1 and Table S2 show the individual
scores.
Adverse effects and laboratory testsA total of six (54.5%) cats (4, 5, 6, 8, 9 and 11) devel-
oped adverse effects reported by the owners. Five cats
(4, 5, 6, 9 and 11) developed lesions associated with the
injection sites, seven to 10 days after starting therapy
(Table S1). Owners described the lesions as focal hair
loss, crusts, abscesses or swellings with or without ooz-
ing. These resolved in three of five cats (cases 4, 5 and
11) after changing the injection site, reviewing injection
administration instructions or discontinuing therapy.
Cases 4 and 11 had focal alopecia at the injection sites
observed by the investigators on D30 and presumed to
be sequelae of previous lesions. One cat (Case 8) devel-
oped behaviour changes and another cat (Case 9) was
licking the injection site and twitching her back after
each injection. None of the cats developed systemic
signs during the study duration or follow-up period. In
one cat (Case 4) the pre-diagnosed diabetes mellitus
remained clinically controlled during the follow-up period.
Table S1 shows details on adverse events for each cat.
Ten (90.9%) cats had chemistry profiles, complete CBC,
urinalyses and urine cultures before starting sCsA ther-
apy. Six (60%) cats had these tests repeated on D60.
There were no significant abnormalities reported at any
time for any of the cats.
Follow-up of cats after completion of the studySix cats (cases 1, 2, 3, 4, 5 and 6) continued to receive
sCsA therapy beyond D60, with therapy duration rang-
ing from three to 18 months (mean: 9.8 months). The
maintenance sCsA dose for these cases ranged from
2.5 to 5 mg/kg every two to three days. Any further
attempt to taper the frequency of injections failed with
recurrence of pruritus with or without skin lesions and
alopecia. No adverse reactions were reported during the
follow-up visits. Table S1 provides further details on
treatment duration.
Figure 1. Feline Dermatitis Extent and Severity Index and pruritus Visual Analog Scale (range 0-10) scores on days (D) 0, 30 and 60 in 10 cats with
allergic skin disease (Cat 10 not included).
© 2017 ESVD and ACVD, Veterinary Dermatology 3
Subcutaneous CsA for feline skin disease
Subcutaneous administration of ciclosporin in 11allergic cats – a pilot open-label uncontrolled clinicaltrial
Sandra N. Koch* , Sheila M. F. Torres*, Sandra Diaz†, Sophie Gilbert§ and Aaron Rendahl‡
*Department of Veterinary Clinical Sciences, University of Minnesota, 1365 Gortner Avenue, Saint Paul, MN 55018, USA
†Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon Tharp Street, Columbus, OH 43210, USA,
§Centre V!et!erinaire Laval, 4530 Highway 440, Laval, Quebec Canada, H7T 2P7 and
‡Department of Veterinary and Biomedical Sciences, University of Minnesota, 1365 Gortner Avenue, Saint Paul, MN 55018, USA
Correspondence: Sheila M. F. Torres, Department of Veterinary Clinical Sciences, University of Minnesota, 1365 Gortner Avenue, Saint Paul, MN
55018, USA. E-mail: [email protected]
Background – Oral ciclosporin has been reported to be efficacious for feline inflammatory skin diseases; how-
ever, cats are often difficult to medicate orally.
Hypothesis/Objective – To evaluate the efficacy and tolerability of subcutaneous ciclosporin administered to
cats with allergic skin disease.
Animals – Eleven client-owned cats with nonseasonal clinical signs.
Methods – Prospective open label trial. Ciclosporin 50 mg/mL solution for injection (Sandimune!, Novartis; NJ,
USA) was administered subcutaneously for 60 days with initial doses ranging from 2.5 mg/kg once daily (one
cat) to every other day (five cats) and 5 mg/kg once daily (four cats) to every other day (one cat). Dosages
were adjusted monthly if needed based on clinical response. Clinical response was assessed using a modified
FeDESI (feline Dermatitis Extent and Severity Index) and PVAS (pruritus Visual Analog Scale) between days (D)
0, 30 and 60.
Results – Six cats completed the study and four of five cats withdrawn from the study were included in an inten-
tion-to-treat analysis. There was significant decrease in FeDESI and PVAS scores between D0 and D30, D0 and
D60 and D30 and D60 (P < 0.05) in all ten cats.
Conclusions and clinical importance – Ciclosporin administered subcutaneously at initial doses of 2.5-5 mg/
kg, once daily to alternate days, appears to be an efficacious therapy for feline allergic dermatitis and may be an
alternative therapy for cats that cannot be treated orally. Randomized and controlled long term studies which
include a larger number of cats are needed to confirm these findings.
Introduction
Feline dermatoses, including allergic diseases, are often
challenging to manage. Topical therapies are frequently
not well tolerated by cats, may pose risk of systemic
adverse effects due to drug ingestion and are typically
used as adjunctive therapies.1 Antihistamines and essen-
tial fatty acids are treatment options but the success rate
is variable and often low.1 Oral and injectable glucocorti-
coids are quite effective but have the potential for severe
long-term adverse effects, including diabetes mellitus.1
Oclacitinib maleate may be an alternative treatment for
cats with allergic skin disease, although in one pilot
study only five of 12 (41.6%) cats with nonflea- and
nonfood-induced hypersensitivity dermatitis treated
with oclacitinib, at the doses recommended for dogs,
showed good improvement after 30 days of therapy.2
Several studies have investigated the use of oral ciclos-
porin A (CsA) in cats with various skin disorders; the effi-
cacy and safety of CsA for the treatment of feline allergic
dermatoses has been reported in double-blinded and ran-
domized controlled trials.3–9 Additionally, CsA has been
reported in retrospective and case series reports to
be effective for other feline dermatological conditions
including eosinophilic granuloma complex, urticaria pig-
mentosa, plasmacytic stomatitis, acquired alopecia (pseu-
dopelade), pemphigus complex, idiopathic pruritus and
dirty face syndrome of Persian cats.7–9 Mild adverse
effects have been reported with oral CsA administration
in cats, including hypersalivation, headshaking, vomiting,
soft faeces, diarrhoea and gingival hyperplasia.10,11 Given
the reported efficacy and minimal adverse effects, oral
CsA appears to be a valid therapeutic approach for the
long-term control of feline allergic skin diseases. How-
ever, cats are often difficult to medicate orally which
could interfere with the efficacy of CsA and result in treat-
ment discontinuation by the owners. In addition, oral CsA
Abbreviations: CsA, ciclosporin; sCsA, subcutaneous injectedciclosporin.
Accepted 31 August 2017
Sources of funding: This study was self-funded
Conflict of interest: No conflicts of interest have been declared.
© 2017 ESVD and ACVD, Veterinary Dermatology 1
Vet Dermatol 2017 DOI: 10.1111/vde.12505
Efeitos adversos em54.5% dos casos
5 gatos => lesões no local da aplicação 7 a 10 dias após.
1 gato => alteração comportamental
OclacitinibApoquel®
Oclacitinib in feline nonflea-, nonfood-inducedhypersensitivity dermatitis: results of a smallprospective pilot study of client-owned cats
Christian Ortalda*, Chiara Noli†, Silvia Colombo‡ and Stefano Borio§
*Servizi Dermatologici Veterinari, Strada Revigliasco 11, Moncalieri, 10024, Italy
†Servizi Dermatologici Veterinari, Strada Bedale della Ressia 2, Peveragno, 12016, Italy
‡Servizi Dermatologici Veterinari, via Felice Musazzi 24, Legnano, 20025, Italy
§Servizi Dermatologici Veterinari, via Italia 12, San Mauro Torinese, 10099, Italy
Correspondence: Chiara Noli, Servizi Dermatologici Veterinari, Strada Bedale della Ressia 2, 12016 Peveragno (CN), Italy. E-mail: info@dermatologia
veterinaria.it
Background – Oclacitinib is a Janus kinase inhibitor that decreases pruritus and lesions in allergic dogs. In cats,
it is able to inhibit interleukin-31-induced pruritus; no information is available on its clinical effectiveness.
Hypothesis/Objectives – To evaluate the efficacy, ease of administration and tolerability of oclacitinib in feline
nonflea-, nonfood-induced hypersensitivity dermatitis.
Methods – Cats >12 months of age and >3 kg body weight with a diagnosis of nonflea-, nonfood-induced hyper-
sensitivity dermatitis were treated with oclacitinib, 0.4–0.6 mg/kg orally (p.o.) twice daily for 2 weeks, then once
daily for an additional 14 days. Clinical lesions were evaluated with the Scoring Feline Allergic Dermatitis (SCOR-
FAD) system and pruritus was evaluated with a 10-cm-long visual analog scale (VAS) before and at the end of the
study. Owners assessed global efficacy, ease of administration and tolerability with a four-point scale.
Results – Twelve cats were treated with a mean initial oclacitinib dose of 0.47 mg/kg p.o. twice daily. There was
good improvement in SCORFAD and VAS pruritus scores in five of 12 cases, while the other cats were
unchanged, deteriorated or dropped out due to treatment failure. Owners scored global efficacy as good/excel-
lent in four of 12 cases and ease of administration and tolerability as good/excellent in 10 of 12.
Conclusions and clinical importance – Oclacitinib at 0.4–0.6 mg/kg p.o. may be an effective and safe drug for
some cats with nonflea-, nonfood-induced hypersensitivity dermatitis. Further studies are needed to identify the
most effective dose range for this species.
Introduction
Feline allergic dermatitis is a common disease in veteri-
nary dermatology and is the result of a cutaneous
hypersensitivity reaction to environmental, food and/or
flea allergens. Current therapies include allergen-spe-
cific immunotherapy, antihistamines, essential fatty
acids, palmitoylethanolamide, glucocorticoids and ciclo-
sporin.1,2 Oclacitinib (Apoquel; Zoetis, Rome, Italy) is a
Janus kinase inhibitor which has been registered for
the treatment of allergic pruritus and atopic dermatitis
in the dog. It may be an option for the treatment of
feline allergic diseases. When administered orally (p.o.)
to cats at a dose of 0.4 mg/kg it was able to reduce
pruritus induced by interleukin-31 significantly.3,4 There
is scant information about the use of oclacitinib in cats
and it is limited to experimentally induced asthma.5
Results of this preliminary trial demonstrated that a
dose of 0.5–1.0 mg/kg p.o. twice daily for 28 days was
safe and effective; serial clinical examinations and com-
plete blood count, serum biochemical profile and urinal-
ysis were performed; no adverse clinical signs or
clinically relevant laboratory abnormalities were
observed. The only report about the use of oclacitinib
in a cat with a dermatological condition described a lab-
oratory cat affected with mastocytosis that was suc-
cessfully treated with oclacitinib at 1 mg/kg p.o. twice
daily for 1 month.6
The aim of this small pilot study was to evaluate the
response to and safety of oclacitinib in cats with nonflea-,
nonfood-induced hypersensitivity dermatitis (NFNFIHD).
Primary outcome measures were changes in pruritus and
lesion scores. Secondary outcome measures were ease
of administration, tolerability and development of adverse
effects.
Materials and methods
This was an open multicentre study involving four clinics.
AnimalsCats >12 months of age and >3 kg body weight, diagnosed with
NFNFIHD following the standard procedures and fulfilling Favrot’s
feline allergy diagnostic criteria, were included in the study.7 Cats
were not included if ectoparasitic infestations, bacterial or fungal
infections, flea-allergy dermatitis or other diseases were diagnosed.
Accepted 9 March 2015
Sources of Funding: This study was self-funded.
Conflict of Interest: The authors have consulted for Zoetis and
for several other pharmaceutical companies. The drug manufac-
turer was not involved in the design or support of this study.
© 2015 ESVD and ACVD, Veterinary Dermatology, 26, 235–e52. 235
Vet Dermatol 2015; 26: 235–e52 DOI: 10.1111/vde.12218
Melhora em 5/12 gatosDose: 04-0.6 mg/kg/bid
Abstracts of the 29th Annual Congressof the ECVD-ESVD, 7-9th September 2015,
Lausanne, Switzerland
Novel serum biomarkers of oxidativestress in canine atopic dermatitis
R. M. ALMELA*, U. MAYER*, C. P. RUBIO†,A. ANS!ON‡, A. TICHY‡ and J. J. CER!ON†
*Kleintierspezialisten Augsburg €Uberweisungszentrum,Augsburg, Germany†Interdisciplinary Laboratory of Clinical Analysis, CampusExcellence Mare Nostrum, Murcia, Spain‡Veterin€armedizinische Universit€at Wien, Vienna, Austria
Atopic dermatitis (AD) is a disease with a highly complex
and not fully understood pathophysiology. Oxidative
stress (OS) has been shown to be involved in the patho-
genesis of human and canine AD by several distinct
mechanisms. Recently, novel serum biomarkers of OS
(sbOS) have been validated in normal dogs; they do not
appear to have been studied in dogs with AD, however.
The aim of this prospective, cohort-controlled study was
to compare a panel of novel sbOS (thiol [THIOL], ferric
reducing ability of the plasma [FRAP], cupric reducing
antioxidant capacity [CUPRAC], trolox equivalent antioxi-
dant capacity [TEAC], trolox equivalent antioxidant capac-
ity-B [TEAC-B], and ferrous oxidation-xylenol orange
[FOX]) in normal and atopic dogs. To evaluate the antioxi-
dant response, we assessed the levels of the THIOL,
FRAP, CUPRAC, TEAC and TEAC-B parameters, while
that of FOX was measured as a biomarker of oxidative
damage. We included 46 healthy dogs, nine client owned
dogs with nonfood-induced and three with food-induced
AD. The mean serum levels for THIOL, CUPRAC, TEAC
and TEAC-B were significantly lower in all categories of
dogs with AD (NFIAD + FIAD; NFIAD; FIAD) compared to
those of healthy dogs; whereas FOX and FRAP values
were significantly higher in the atopic group (two-tailed t-
tests/Mann–Whitney test, P < 0.05 for all). These find-
ings suggest that oxidative stress could play an important
role in the pathogenesis of canine AD. In addition, the
evaluation of sbOS could be useful to help detect subsets
of atopic dogs who might benefit of antioxidant therapies.
Source of funding: Self-funded.
Conflict of interest: None declared.
Use of RNAScope in situ hybridizationto assess the context-specificexpression of genes in canine tissues
G. BAMMERT, S. DUNHAM, C. HEDKE andA. GONZALESZoetis, Kalamazoo, MI, USA
Understanding disease pathogenesis often involves mon-
itoring differential gene expression through comparison
of RNA from healthy, model and diseased cell popula-
tions; such studies eventually lead to the examination of
protein-based cellular imbalances that are fundamental to
better understand disease mechanism. RNAScope in situ
hybridization (RNA-ISH) overcomes the technical chal-
lenges involved with signal amplification, as it allows sin-
gle gene expression to be monitored in the context of
cellular and tissue morphological changes. We describe
the use of RNA-ISH to probe the expression of selected
genes (il4r, il13ra1, il31ra, trpv1 and ntrk1) in normal bea-
gle skin, dorsal root ganglia (DRG) and spinal cord tissues:
these genes were chosen for their association with atopic
dermatitis or the neuronal signal transduction of itch and
pain sensations. Formalin-fixed, paraffin-embedded
(FFPE) tissues were probed using the Leica Bond Rx with
haematoxylin counter-staining to define nuclei, while
proximal sections were H&E-stained to capture cellular
and tissue morphology. Staining was qualified with a con-
stitutive positive (PPIB) and negative (DapB) controls. All
genes appeared similarly expressed in canine skin. While,
Il4r and il13ra1 were absent from dog DRGs, there was a
robust expression of il31ra, trpv1 and ntrk1 in these neu-
rons. Our results describe a step forward in understand-
ing a context-specific expression of genes relevant to
canine atopic dermatitis. These methods will likely play
an important role in understanding how a clinical disease
relates to tissue gene expression, and they may allow for
the development of relevant cellular models for assess-
ment of drug safety and efficacy.
Source of funding: Zoetis Global Therapeutics Research.
Conflict of interest: GB, SD, CH and AG are employees of
Zoetis.
© 2017 ESVD and ACVD, Veterinary Dermatology
1
Vet Dermatol 2017 DOI: 10.1111/vde.12468
their clinical manifestations of atopic dermatitis (AD).
Eighty one dogs that responded positively to the initial
three month lokivetmab treatment in a positive-controlled
field study were enrolled into this trial. These dogs were
continued on monthly subcutaneous injections with loki-
vetmab for up to six additional administrations at the mini-
mum dosage of 1 mg/kg. Prior to each monthly
treatment, the dog owners assessed pruritus levels using
a visual analog scale (VAS) while investigators assessed
skin lesions using the CADESI-03. Blood was drawn
monthly (clinical pathology, drug exposures) and urine col-
lected every three months (urinalysis). At the end of this
study, after nine months, the mean VAS (which reached
a low of 14) and CADESI-03 (reduced to 32) remained
similar to their respective values at the start of this exten-
sion trial. After nine months of lokivetmab injections, 45/
59 dogs (76%) were assessed as being “normal” with
regards to their pruritus levels (VAS score ≤ 19) and 35 of
these (59%) were deemed with skin lesions “in remis-
sion” (CADESI-03 ≤ 15). None of the observed adverse
events were attributable to lokivetmab; treatment-
induced immunogenicity (i.e. anti-lokivetmab antibody
development) was not seen in any dog. This study
demonstrated that lokivetmab injections were well toler-
ated for up to 9 months at a monthly minimum dose of
1 mg/kg, and it provided a continuous and robust efficacy
against both pruritus and skin lesions in dogs with AD.
Source of funding: Zoetis.
Conflict of interest: All authors are employees of Zoetis.
Laboratory evaluation of the speed ofkill of lotilaner against Ixodes ricinusticks on dogs
M. G. MURPHY, D. A. CAVALLERI, W. SEEWALD,J. J. DRAKE and S. NANCHENElanco, Basel, Switzerland
The novel isoxazoline lotilaner is rapidly absorbed follow-
ing administration of a chewable tablet formulation (Cre-
delio, Elanco, Greenfield, IN, USA) to dogs, and it
provides efficacy for a minimum of 1 month against fleas
and ticks. This study was conducted to determine its
speed of kill against ticks. Thirty two dogs were random-
ized to four groups: two received lotilaner tablets at a min-
imum dose rate of 20 mg/kg and two were left untreated.
Infestations with Ixodes ricinus were performed on Days
-2, 7, 14, 21, 28 and 35. Counts were completed 4 and
8 h on Day 0, and 8 and 12 h following the subsequent
infestations. All live ticks were incubated, without loti-
laner, for 24 h following removal. At 4 h post-treatment,
there was a 70% reduction in geometric mean live tick
counts in treated dogs compared to controls. After incu-
bation, this reduction increased to 97%. At 8 h after treat-
ment, pre- and post-incubation reductions were 99% and
100%, respectively. Following post-treatment challenges,
the post-incubation efficacy through Day 28 (at 8 and
12 h) was at least 94% and 98%, respectively, and 86
and 94% at 8 and 12 h after the last challenge on Day 35.
There were no treatment-related adverse events.Loti-
laner, at a minimum dose rate of 20 mg/kg, was well tol-
erated and began to kill ticks on dogs within 4 h of
treatment; its efficacy was 100% within 8 h. Lotilaner
sustained a rapid kill of I. ricinus ticks throughout this
35 day study.
Source of funding: Elanco.
Conflicts of interest: All authors are employed by Elanco.
Efficacy of oclacitinib in allergic cats: amulticentre randomised, blinded,methylprednisolone-controlled study
C. NOLI*, I. MATRICOTI* and C. SCHIEVANO†
*Servizi Dermatologici Veterinari, Peveragno, Italy†Universit!a di Padova, Padova, Italy
Oclacitinib is a Janus kinase inhibitor that decreases inter-
leukin-31-induced pruritus in cats. At 0.4-0.6 mg/kg/day
orally, it relieves pruritus and skin lesions in less than half
of allergic cats. We aimed to evaluate the efficacy and
safety of a higher dosage of oclacitinib in feline non-flea-
non-food-induced hypersensitivity dermatitis (NFNFIHD).
Affected cats were randomly assigned to receive oclac-
itinib (group A, 18 cats, 0.8–1.3 mg/kg) or methylpred-
nisolone (group B, 14, 0.5–1 mg/kg) orally, twice daily for
28 days. On Day 1 and 28, veterinarians evaluated lesions
with the Scoring Feline Allergic Dermatitis (SCORFAD)
scale, while owners assessed pruritus with a 10-cm
visual analogue scale (VAS) and quality of life (QoL) with a
validated questionnaire. Haematochemical tests were
performed before and after treatment. Results were anal-
ysed with a General Linear Mixed Model (significance:
P < 0.05). There were no significant differences between
parameters at baseline. In both groups, values improved
significantly over time. In cats treated with oclacitinib, the
mean percentage reduction in SCORFAD and VAS was
62 and 51%, respectively. In those treated with methyl-
prednisolone, decreases were 77% and 74%, respec-
tively; there was no significant difference between
groups at study end. No response was seen in five and
one cat from groups A and B, respectively. Scores of QoL
improved similarly in both groups (26 versus 23%). Hae-
matochemical changes were not noted on any cat. In con-
clusion, oclacitinib at 0.8–1.3 mg/kg twice daily orally
appears safe for 28 days, and it is as effective as methyl-
prednisolone for the treatment of feline NFNFIHD.
Source of funding: European Society of Veterinary Der-
matology.
Conflict of interest: None declared.
© 2017 ESVD and ACVD, Veterinary Dermatology
16
Abstracts ECVD-ESVD 2017
18 gatos tratados com 0.8 a 1.3 mg/kg /sid/28 dias
Redução lesões=> 62%Redução prurido =>51%
Conclusões
Necessidade de mais estudos na dermatologia felina
Sempre buscar a causa base
O sucesso do tratamento depende da cooperação do gato e seu serviçal
[email protected] Obrigada!!