Small Animal Dermatology, 3rd edition

290 DISEASES/DISORDERS

 Provocation:
If the challenge confirms the presence of a food reaction, return to the previous

elimination diet until symptoms resolve

Add single ingredients to the elimination diet: ingredients include meats (beef,

chicken, fish, pork, lamb), grains (corn, wheat, soybean, rice), eggs, and dairy

products

Choice of ingredients may be guided by ingredients present in the previous

(offending) diet

Provocation period for each ingredient should last up to 10 days (less if signs

develop sooner; may develop within 1–2 days)

Results guide the selection of commercial foods that do not contain the offending

substance(s) and may be tolerated.

 Some patients with CAFR must remain on prescription diets to prevent reactions.

Inaccurate or Ineffective Methods for the Diagnosis of CAFR

 Serum testing: multiple studies have confirmed a no better than random chance for

the identification of CAFR; these tests cannot be used to identify either offending or

tolerated diet ingredients.

 Gastroscopic testing.

 Intradermal testing with food antigens.

 Prick testing with food antigens.

 Hair analysis.

 Saliva analysis.

THERAPEUTICS

 Avoid any food substances that caused the clinical signs to return.

 Review carefully the principles of allergen avoidance with the client (and family).

 Inform client to eliminate treats, chewable toys, vitamins, and other flavored medica-

tions (e.g., heartworm preventative) that may contain ingredients from the patient’s

previous diet (and/or the patient has been exposed to consistently).

 Outdoor pets must be confined to prevent foraging and hunting.

 Provide handouts/instructions for clients to take home.

 Systemic antipruritic drugs may be useful during the first 2–3 weeks of diet trial to

control self-mutilation.

 Antibiotics or antifungal medication may be required to relieve secondary infections;

avoid those that are known to have antiinflammatory effects (e.g., tetracycline, ery-

thromycin, and trimethoprim-potentiated sulfas) during the later phase of the elimi-

nation diet trial.

 Encourage routine bathing with a shampoo that can control/eliminate bacterial and

yeast organisms as well as promote a healthy epidermal barrier function.

 Glucocorticoids and antihistamines should be discontinued during the last month of

the diet trial to evaluate the animal’s response.