Nutritional management of allergic skin disease: a roundtable discussion (Sponsored by Royal Canin)

Dr. Reid Garfield
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. Dana Liska
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. Tim Strauss
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. Valerie Fadok
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.

Karen E. Felsted, CPA, MS, DVM, CVPM

Dr. Karen Felsted
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.

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.

Dr. 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?