Dr. Reid Garfield: Received his Doctor of Veterinary Medicine degree from Texas A&M University in 1981. He practiced general veterinary medicine
in the Dallas area until 1990 when he began a dermatology residency at the Animal Dermatology Referral Clinic. Dr. Garfield
became a member of the American Academy of Veterinary Dermatology in 1992 and achieved Diplomate status in the American College
of Veterinary Dermatology in 1994. Dr. Garfield currently practices at the Animal Dermatology Referral Clinic in Dallas, Texas.
Dr. Reid Garfield
Dr. Dana Liska: Received her Doctor of Veterinary Medicine from Kansas State University in 1999. Following graduation she completed a rotating
internship in medicine, surgery, and critical care at Mission MedVet in Mission, Kansas. Dr. Liska then practiced general,
small animal, veterinary medicine for four years in Helena, Montana. In 2004 she began a dermatology residency at the University
of Florida College of Veterinary Medicine. Upon completion of her residency she remained at the University of Florida CVM
as a clinical instructor of Dermatology until she moved to the Dallas area to join the Animal Dermatology Referral Clinic.
She became a member of the American Academy of Veterinary Dermatology in 2001 while in private practice and achieved Diplomate
status in the American College of Veterinary Dermatology in 2006. Dr. Liska practices as a veterinary dermatologist at the
Animal Dermatology Referral Clinic in Dallas, Texas.
Dr. Dana Liska
Dr. Tim Strauss: Dr. Strauss received his Doctor of Veterinary Medicine degree from the University of Minnesota in 1999. He practiced general
veterinary medicine in the St. Paul area of Minnesota for two years before entering his dermatology residency program with
Dr. Patrick McKeever in 2001. He became a board certified Diplomate of the American Collage of Veterinary Dermatology in 2004.
He returned to his home state of Colorado in 2005 to practice dermatology at the Veterinary Referral Center of Colorado. Doctor
Strauss is now the owner of Rocky Mountain Veterinary Dermatology in Frederick, Colorado.
Dr. Tim Strauss
Dr. Valerie Fadok: Staff dermatologist at Gulf Coast Veterinary Specialists, Houston, Texas for three and a half years. Before that, Dr. Fadok
was at Veterinary Referral Center of Colorado in Denver. Dr. Valerie Fadok received her Doctor of Veterinary Medicine degree
from Washington State University in 1978, after which she completed an internship in small animal medicine and surgery at
the West Los Angeles Veterinary Medical Group. A residency in veterinary and comparative dermatology followed at the University
of Florida College of Veterinary Medicine, and Dr. Fadok became board certified in veterinary dermatology in 1982. Valerie
Fadok has worked on the faculties of University of Tennessee, University of Florida, and Texas A&M. She received her PhD in
experimental pathology at University of Colorado Health Sciences in 1991, and has served on the faculty in Department of Pediatrics
at National Jewish Medical and Research Center.
Dr. Valerie Fadok
Karen E. Felsted, CPA, MS, DVM, CVPM
Dr. Karen Felsted received a degree in marketing from the University of Texas at Austin. She spent the next twelve years in accounting and
business management, including 6 years with Ernst & Young. During this time she earned both her CPA and an MS degree in Management
and Administrative Science from the University of Texas at Dallas.
Dr. Karen Felsted
In 1996 Dr. Felsted graduated from the veterinary college at Texas A & M University and practiced both small animal and emergency
medicine for three years. For the last ten years she has provided financial and operational consulting services to veterinarians,
most recently with Brakke Consulting and Gatto McFerson CPAs.
Dr. Felsted joined the National Commission on Veterinary Economic Issues as Chief Executive Officer in June 2008. She has
written an extensive number of articles for a wide range of veterinary publications and speaks regularly at national and international
veterinary meetings. She is a founding director and current member of VetPartners, a past member of the Veterinary Economics
Editorial Advisory Board, and the current treasurer for the CATalyst Council.
Dr. Karen Felsted: I am Dr. Karen Felsted. I will be the moderator. Today, we are going to discuss diagnosing and treating
adverse food reactions. Lef s start by talking about how frequently you all see these kinds of cases.
Dr. Garfield: In food allergic patients, the symptoms are always non-seasonal. About a third of our patients in the Dallas area start out
with year-round or perennial symptoms. My guess is that about 20 percent of those with perennial symptoms are food allergic.
This would equate to about 6 percent or maybe as high as 10 percent of all the allergic patients we see.
Dr. Liska: I would agree with Dr. Garfield.
Dr. Strauss: I would agree with that for dogs. I think it is a pretty significant difference with cats. I would say food allergies or adverse
food reaction in cats represents about 40 percent of pruritic feline patients. I think there is a big difference between the
dog and the cat.
Dr. Fadok: I would be willing to wager 10-15 percent of the dogs we see have food allergy or an adverse food reaction. I suspect there
is a subset of those dogs that are atopic as well, maybe as much as 50 percent based on some data from Linda Messinger's practice
at Veterinary Referral Center of Colorado (VRCC). I would also estimate that 10 percent of our atopic dogs have food allergies
too. This can make sorting out the contributions of food compared to environmental allergens quite difficult!
Dr. Felsted: So how do you all go about diagnosing adverse food reactions? What clinical signs make you suspect a food allergy?
Dr. Garfield: Symptoms of food allergy and atopic dermatitis are indistinguishable, although food allergic individuals tend to be more severe
than atopic patients. Symptoms are always perennial and tend to be less responsive to symptomatic treatment. When we are trying
to control secondary infections and calm itch with antihistamines and even with steroids, food allergic patients tend to not
respond as completely or as quickly to those medications.
Dr. Liska: I would agree.
Dr. Strauss: I would just point out that there is very significant overlap in the clinical presentation of food allergic individuals and
atopic individuals. There is not any reliable distinguishing clinical sign to differentiate those. You really have to work
through the diagnosis to come to the conclusion of a food allergy.
Dr. Felsted: Any difference between dogs and cats?
Dr. Strauss: In canine patients, pruritus, of course, is the main thing that we see. I see erythema in the ears, axillae, feet (interdigitally,
palmar and plantar surfaces), around the eyes, ventral abdomen and under the tail. These patients have significant pruritis.
With cats the most common presentation is miliary dermatitis.
Dr. Fadok: I see 3 distinct patterns in dogs: itchy ears only, caudal half of the body and an atopic dermatitis-like pattern (foot and
axilla chewers, face rubbers, etc). The cats I see tend to exhibit severe head and neck pruritus, generalized itching, or
eosinophilic plaques and hair pulling.
Strauss: I would be interested to hear what the rest of the group thinks about concurrent GI signs. The incidence of concurrent enteric
disease with our food allergic patients, I think, is pretty high. Probably about one-third of them have some GI signs in my
experience. Would you guys agree with that?