Nutritional management of allergic skin disease: a roundtable discussion (Sponsored by Royal Canin)
Dr. Garfield: For dogs I find it harder with comparing a vegetarian diet to the patient's dietary history to be able to say that I truly have a novel diet. I use less vegetarian diets because of that. Now, Dr. Crow in our office is using vegetarian diets quite a bit and is having some success with them.
Dr. Liska: And I am using vegetarian diets too. It was the recommendation from my peers at Gulf Coast that made me feel comfortable in utilizing those vegetarian diets.
Dr. Felsted: What do you like about vegetarian diets? What would be the advantage?Dr. Liska: Novel protein.
Dr. Fadok: Lower fat too, for those overweight dogs.
Dr. Strauss: I have used vegetarian diets a few times and had some success
Dr. Felsted: So aside from protein and carbohydrates, what other nutritional issues do you look at when you are selecting a diet?
Dr. Strauss: It is important that these diets are carefully made and that they have very limited ingredients. When I say carefully made I like to hear that the manufacturer does everything it can to prevent cross contamination. Even small amounts of proteins from other sources can adulterate the product with other allergens. So one thing with the sort of over-the-counter foods is you don't know if they are making venison next to a beef-based diet resulting in cross contamination. You don't know that.
Dr. Felsted: What about things like fatty acids, preservatives, pre- or probiotics. How important do you think those ingredients are and how does this impact your selection of a diet?
Dr. Strauss: In an academic setting, of course, they do not want high levels of essential fatty acids. They do not want probiotics. They do not want things that affect the skin barrier because they only want to change one thing and that is the proteins that are in the diet and see if the patient gets better. I understand that argument. To me if I change the dog's diet and the dog gets better it doesn't necessarily matter to me whether that was due to the change of proteins that the dog was eating or due to the other ingredients that are in the diets. Again, from a practical standpoint if the patient gets better that is what we are all aiming for. A dietary challenge if the patient improves can help to determine if there is a food allergy or if other ingredients are helping, but often clients are reluctant to perform a food challenge.
Dr. Garfield: I agree with Dr. Strauss. I know that some of the manufacturers' marketing and production has gone in that direction and the manufacturers have shown data that with diets containing high levels of fatty acids, probiotics, etc., thirty percent or forty percent of the pruritic patients may experience an overall improvement. That is not necessarily picking out truly food allergic patients. I think from a purist standpoint, we are trying to find a direction to manage this patient, we are trying to differentiate between food allergy versus are we helping relieve symptoms with a diet that is supplemented highly in fatty acids. That does make a difference. We can get through that by doing a food challenge with the original diet and monitoring for exacerbation of symptoms within 1-7 days.
Dr. Strauss: Again, ideally they would not have those ingredients for a diet trial but all of them now have high levels of essential fatty acids
Dr. Fadok: I prefer to use diets that incorporate high levels of fatty acids because I know that the animal is actually getting them in the appropriate balance and ratio, at least to our knowledge.