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

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


Dr. Felsted: So what kinds of things do you look for in those diets? The fatty acids?

Dr. Liska: That is probably a big part of it.

Dr. Strauss: I think the essential fatty acids are the ones that have the most clinical evidence behind them. Some of the newer things ... they have shown some effect in trials, you know, barrier function type things. As Dr. Liska said, in tough cases you are always looking for that additional thing that you can do to kind of get that last 10 percent or 15 percent.

Dr. Garfield: I would agree. The high levels of fatty acids are the dietary ingredients that have been through numerous clinical trials and have the most evidence based support. B vitamins, trace minerals, and pre- and probiotics certainly have shown some evidence to improve barrier function.

Dr. Fadok: I prefer diets with elevated fatty acid levels, as well as Vitamin E and other antioxidants. Coat quality is improved and general owner satisfaction seems to be high. Quality food is one tool in our toolbox to manage the allergic patient.

Dr. Felsted: What is the issue of the skin barrier . .. that is not something I am familiar with.


Skin Barrier Function
Dr. Strauss: That's the newest thing - improving barrier function. They have shown now that atopic patients have impaired barrier function of their skin

Dr. Felsted: And that means exactly what?

Dr. Strauss: Well basically that the skin barrier is more permeable to water. So the thought is that this may allow transepidermal absorption of an environmental allergen.

Dr. Garfield: Besides the allergen absorption, if barrier function is abnormal the skin surface is more likely to colonize with staphylococcal bacteria and with malassezia yeast adding to the patients symptoms. So improving barrier function may decrease allergen absorption and help prevent secondary infections. That can be done from the inside out with dietary supplementation or from the outside in with emollients and ceramides applied topically to the skin through shampoos, sprays, topical spot on products, etc.

Dr. Felsted: But, it would be easier to do with food, wouldn't it, then have to do from the outside in?

Dr. Garfield: Absolutely.

Dr. Strauss: Now there are a lot of supplements and ingredients that they put in foods that have been shown to have some affect on barrier function.