Facial dermatitis and hypoallergenic diets in a cat

RE: Facial dermatitis and hypoallergenic diets in a cat

Emily Rainbow — Sun, 28 Jun 2020 12:16:16 GMT

Sorry for the turbo post but if you ‘disagree’ with me please discuss why rather than just hit the button!

RE: Facial dermatitis and hypoallergenic diets in a cat

Emily Rainbow — Sun, 28 Jun 2020 11:37:46 GMT

Edit not working in my phone...

‘repeat derm work up’

RE: Facial dermatitis and hypoallergenic diets in a cat

Emily Rainbow — Sun, 28 Jun 2020 11:37:14 GMT

Agree with everyone else re: repeat fern work up and a second diet trial. But could this be oro-facial pain syndrome? A gabapentin trial could be useful too?

RE: Facial dermatitis and hypoallergenic diets in a cat

Lucy Fleming — Sat, 20 Jun 2020 19:26:37 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29170/facial-dermatitis-and-hypoallergenic-diets-in-a-cat/223733"]Come on, "4 to 6 weeks of starting the EDT," crikey I've had some flea allergy cats visiting granny starting within 4 to 6 minutes!! [a bit more to be fair,,,,][/quote]

I can't tell for certain from the short snippet, but I'm guessing they in this context EDT stands for elimination diet trial? So this refers to how long on the diet it took for them to respond, then be challenged and relapse, I think? Not that they required 4-6 weeks back on the normal diet before they started to scratch again. Is that the point you were trying to make, that it shouldn't take that long for signs to relapse?

RE: Facial dermatitis and hypoallergenic diets in a cat

Anthony Todd — Sat, 20 Jun 2020 15:17:50 GMT

And then, whe you dig, there's this:

Results

Ten of 53 dogs (19%) had no relapse after two weeks off prednisolone: they were subsequently challenged with their regular food, had a relapse of signs and were diagnosed with a food‐induced AD within four to six weeks of starting the EDT . In the other dogs, signs remained uncontrolled without prednisolone or relapsed rapidly after its discontinuation: they were considered nonfood‐allergic after an eight week EDT .

Come on, "4 to 6 weeks of starting the EDT," crikey I've had some flea allergy cats visiting granny starting within 4 to 6 minutes!! [a bit more to be fair,,,,]

You've really got to read the papers! The leaps of logic make bob Beaumon's leap a step over a puddle!!

RE: Facial dermatitis and hypoallergenic diets in a cat

Anthony Todd — Sat, 20 Jun 2020 14:58:15 GMT

[quote userid="10320" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29170/facial-dermatitis-and-hypoallergenic-diets-in-a-cat/223728"]Well, the most common food allergens in cats are chicken, beef, fish and dairy products[/quote]

Happy to be corrected, have you some evidence of that and BTW, where does dried food come in??

[Had a cat that had had exhaustives, including biopsies that only vomited dried food.......

RE: Facial dermatitis and hypoallergenic diets in a cat

Stephen Shaw — Sat, 20 Jun 2020 14:16:40 GMT

P.S. Have you done cytology from the face for inflammation, bacteria and yeasts?

RE: Facial dermatitis and hypoallergenic diets in a cat

Stephen Shaw — Sat, 20 Jun 2020 14:13:24 GMT

Hi Janine

It is worth doing another food trial (if really possible), but if you want to reduce the steroids the ciclosporin would be a good option. There will be a lag before the CsA works so use the preds concurrently initially. What are you going to achieve by doing the biopsy? If the signs are consistent of allergy and you do not have herpes or calici as differentials I am unsure that this will help very much. If you get ciclosporin in place, equip the owner with a short course of steroids in case of a flare to try to catch things before they get going.

For the food, RC Anallergenic is now available for the cat and would be an option. Home-cooked choices should avoid chicken, fish and beef (including lamb and milk which likely cross-react). In dogs and people chicken and fish can cross-react. Whether food trials need to be as long as previously been reported is a moot point and 3 months is likely excessive unless you are looking for the return of intermittent pyoderma or otitis. If you use steroids early on in the trial to get the cat really settled, but the signs return despite being on the food for 6 weeks then I doubt food allergy.

Take a look at (admittedly a dog paper)

FAVROT, C., BIZIKOVA, P., FISCHER, N., ROSTAHER, A. & OLIVRY, T. 2019. The usefulness of short-course prednisolone during the initial phase of an elimination diet trial in dogs with food-induced atopic dermatitis. Vet Dermatol, 30, 498-e149.

Hope this helps. S

RE: Facial dermatitis and hypoallergenic diets in a cat

Lucy Fleming — Sat, 20 Jun 2020 13:41:52 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29170/facial-dermatitis-and-hypoallergenic-diets-in-a-cat/223727"]Chances of the cat being allergic to one or the other are pretty slim[/quote]

Well, the most common food allergens in cats are chicken, beef, fish and dairy products, so chicken or fish often aren't good initial choices.

RE: Facial dermatitis and hypoallergenic diets in a cat

Anthony Todd — Sat, 20 Jun 2020 13:28:32 GMT

Two things to add:

Er, I didn't mean long-acting depomed I meant your favourite short-acting injection as, if itis straight alleergy, the irritation usually stops literally overnight.

And I can't see why it isn't easier just to say "boiled chicken or fish" rather than a composite "hypoallergic" diet?

I wager some cats won't touch anything strange either!

Chances of the cat being allergic to one or the other are pretty slim. works well with odd diarrhoeas too.

RE: Facial dermatitis and hypoallergenic diets in a cat

David Bentley — Sat, 20 Jun 2020 13:05:57 GMT

There is conflicting evidence on how effective hydrolysed diets are at picking up cases of food allergy, with figures quoted as high as 95% of food allergic animals responding to as low as 50%. I have seen cases which have failed to respond to hydrolysed but have responded to home prepared novel protein diet (e.g Kangaroo), but if confirmed, you then have problem of making sure it is pefectly nutritionally balanced for long term. As Mark says, they are notoriously hard to perform in cats, although it would be nice to know if there is any food component before considering alternatives to pred (all except cyclosporin would be off licence and considerably more expensive than pred). If the cat will eat it, you may want to try Royal Canin Anallergenic, which is more hydrolysed than Purina HA and possibly more likely to pick up a case of food allergy. Agree biopsy is probably a waste of time. History over previous years suggests Feline Atopc Syndrome +/- Food with a bit of flea allergy thrown in!

RE: Facial dermatitis and hypoallergenic diets in a cat

Mark Craig — Sat, 20 Jun 2020 08:39:43 GMT

How strictly has the diet been conducted? It is notoriously hard to perform a restricted diet in cats, and harder still to interpret. Would either the owner or the cat have much of an appetite (sorry!) for another 3 months? If you feel comfortable with a diagnosis of allergy, and don't suspect other differentials such as neoplastic and auto-immune conditions, there seems little justification for invasive skin biopsies, especially when histopathological changes will possibly be masked, at least to some extent, by the prednisolone. If owners wished to pursue allergy testing, it might be worth trying cyclosporin, if there are no contra-indications, as part of a strategy to get her off steroids. Otherwise, if the cat is doing well on alternate-day preds, why change? Ensure optimal flea control for all in-contacts and the environment, and assess possible stress associated with indoor lifestyle, in-contacts and other factors.

RE: Facial dermatitis and hypoallergenic diets in a cat

Anthony Todd — Sat, 20 Jun 2020 08:29:02 GMT

[quote userid="10320" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29170/facial-dermatitis-and-hypoallergenic-diets-in-a-cat/223723"]Speaking as a GP who avoids derm cases like the plague..[/quote]

or me who loves 'em..

Some thoughts

A shot of depomed should always totally stop any allergic reaction, certainly any irritation [not a cure but an easy diagnostic aid.]

If the depomed response is equivocal I'd be suspicious of an actual skin "infection". The Dmed always stops an allergic reaction, doesn't cure anything of course, before the phobics jump in.

Biopsy will usually only give you lots of description and secondary changes unless they find a mite or a fungus.

I suppose you've checked for a fungus/ringworm?? Should be easyish to do a deep skin scrape.

No chance of a persistent contact with say a certain plant?

What were the previous generalised lesions like and where?

Please please let us know otherwise nobody gains anything.

PS FORGOT, no chance of a photo or two??

RE: Facial dermatitis and hypoallergenic diets in a cat

Lucy Fleming — Sat, 20 Jun 2020 07:36:37 GMT

Speaking as a GP who avoids derm cases like the plague...

If the owner is willing, then I think a second diet trial is worth doing. I know some dermatologists recommend novel protein rather than hydrolysed, for similar results - Hills d/d is venison and pea and seems a popular choice.

Demodex gatoi is more superficial, and can be found in faeces more readily than skin scrapes apparently, but Bravecto should be treating any demodex mites fairly effectively anyway (also doesn't sound like the typical presentation for gatoi)

Biopsy while on pred? I know the lab likes to moan, but if there are visible lesions you might get close to a diagnosis (one to discuss with owners beforehand to avoid disappointment though). Follow up with serological testing +/- desensitisation (for any non-food allergies)? I'd probably prefer a definitive diagnosis before starting ciclosporin, but don't know if I'd insist on it.

Make sure the owners are feeding from ceramic dishes to reduce bacteria lurking in scratches on the dish, and freeze dry food for 24 hours when first opening the bag to keep storage mite numbers low?