Nutritional management of allergic skin disease: a roundtable discussion (Sponsored by Royal Canin)
Dr. Felsted: Novel protein diets used to be available only at veterinary practices but they are now more commercially available, for example at retail outlets where pet owners can buy them without veterinary advice. Do you think that has made your job more difficult in diagnosing and treating this condition?
Dr. Fadok: Yes, it ruins those meat sources for us.
Dr. Strauss: I think it is reflected in what proteins pets are exposed to by the time they get to us. Many times they, as Dr. Garfield pointed out, have tried some of these diets. This eliminates several proteins that can be used for a novel protein diet trial.Dr. Felsted: Do you think clients are buying those diets because they recognize the hypoallergenic aspect or because it just sounds interesting and "Fluffy" might like this better?
Dr. Liska: I think oftentimes owners are given nonspecific recommendations such as, "Your dog needs to be on a venison-based diet." or "I would recommend a venison-based diet." They go shopping, see a venison-based diet and they think that is what their veterinarian has recommended
Dr. Felsted: They don't recognize all the other ingredients that have an impact unless somebody tells them.
Dr. Liska: There is one diet available over the counter, it is labeled as a venison based diet, but the second or third ingredient is chicken. The owner feels like they are buying a novel protein diet but it is not truly a pure diet.
Dr. Fadok: I try to tell them that it's not what you eat, it's what you don't eat.
Dr. Strauss: I emphasize to my clients what it says on the front of the bag may bear no resemblance to what the ingredient list shows. You have to read the label.
Dr. Fadok: We have clients who are not medically trained buying food without understanding what the hypoallergenic diet is meant to accomplish. They have the mistaken notion that feeding a novel protein diet has a dominant effect, and will negate the effects of treats, rawhide chew toys, etc. With an OTC brand, we don't know the quality control. We just don't know what came down the production line right before and how thoroughly the production equipment has been cleaned.
Dr. Liska: And as was pointed out by Dr. Fadok, what came down the production line prior to the production of the diet in question.
Dr. Felsted: Do you think that clients are starting to believe that they can diagnose this themselves? Are they educated enough to do that? What is the long term impact of these diets being available over the counter on diagnosis and treatment?
Dr. Liska: I would like referring veterinarians to embrace the idea that a dietary elimination trial is a diagnostic test. Just as they strive to run a low dose dexamethasone suppression test with precision, so should they perform a diet trial with high standards. The term hypoallergenic is a medical claim so appropriate diets must come from a medical office. I would like veterinarians to feel confident saying; "There is a medical basis for using prescription diets and not using over the counter brand dog foods."
Dr. Garfield: To answer your question, "Are clients educated enough to go in and make these decisions themselves?" I think the majority are certainly not able to do that.
Dr. Felsted: But they probably think they are to some extent because they only have one piece of the puzzle.
Dr. Garfield: Clients can go into the pet store and ask five different employees what food to buy for their pet with skin disease and get five different opinions. They know that veterinarians are using novel protein diets so they have some of these available there. Either the diets they purchase are not restricted enough to be of diagnostic value, or the client does not get the educational information they need to do a restricted diet trial accurately. Changing the food to a truly novel protein diet, with only one animal protein or one vegetable protein and a single carbohydrate is critical. But just as important, is that the client be educated that they cannot feed multi-ingredient dog biscuits, raw hides, table food, flavored heartworm preventatives, and cannot use "Pill Pockets" for administering medications during the food trial. The client has to understand that one bite, one lick of the other pet's food bowl, one piece of pizza crust, can exacerbate their pet's symptoms for 30 days or more. The availability of unique novel protein-containing diets over the counter has made it more difficult as a veterinary dermatologist to design an appropriate food trial for our patients. If venison and rabbit and kangaroo are put out there in the general marketplace we are going to lose those as novel proteins to be able to use as one of our main tools for diagnosing food allergy. I would like to see novel proteins not be widely available over the counter.