Page 741 - Cote clinical veterinary advisor dogs and cats 4th

348 Food Allergy, Gastrointestinal

• Serum biochemistry profile: nonspecific lymphocytes, plasma cells, or eosinophils a long-term positive response to diet as the
changes; low serum albumin concentration in the lamina propria; confirmation of • Over-the-counter novel or limited-ingredient
first-line treatment for chronic enteropathy.
VetBooks.ir • Serum cobalamin, folate, and trypsin-like • Intradermal skin or serum allergen testing diets are not suitable for a diagnostic
food allergy requires favorable response
associated with poorer outcome
to dietary modification.
elimination trial due to the possibility of
immunoreactivity (TLI): results variable but
TLI expected to be normal
hypersensitivity.
• Urinalysis: nonspecific; proteinuria possible are not reliable for diagnosis of food cross-contamination with food antigens
during manufacturing.
with chronic inflammatory disease • Many owners cannot provide a complete diet
• Fecal flotation and smear: rule out parasitism TREATMENT history if they have used multiple foods; in
• Feline immunodeficiency virus/feline these situations, hydrolyzed diets may offer
leukemia virus testing Treatment Overview an advantage over novel allergen diets.
• T 4 /thyroid profile (cats > 5 years) The goal of treatment is to control or abolish • It can be difficult for owners to complete a
clinical signs. strict food trial, but this should be encour-
Advanced or Confirmatory Testing aged because pets with food sensitivity have
Elimination food trial is diagnostic and Acute and Chronic Treatment a good prognosis and can be successfully
therapeutic. • Elimination of the provocative dietary managed with an appropriate diet.
• Diet containing a limited number of novel, component(s) as determined by elimination • Using a food diary during the elimination
highly digestible ingredients (hydrolyzed diet trial and subsequent provocation testing trial helps the owner monitor clinical
or novel protein and novel carbohydrate as • Most owners prefer a commercial diet. Must response and compliance.
based on diet history). Avoid ingredients be sustainable for months to years.
that may cause a nonimmunologic reaction Technician Tips
(e.g., vasoactive amines, lactose). Select a Nutrition/Diet • Recommend gradual transition to a new
commercial or complete and balanced • See Advanced or Confirmatory Testing above food. Mix more of the new elimination diet
home-cooked diet (consult with veterinary for proper selection of elimination diet and food with less of the old food over a period
nutritionist). testing protocol. of at least 7 days.
• Feed diet exclusively for at least 4 weeks. GI • Long-term control of clinical signs may be • An alternative method for transitioning
signs due exclusively to food allergy often possible by feeding a complete and balanced involves offering a small amount of the
improve within a few days to 2 weeks. Partial diet that avoids ingredients that elicit an new food side by side with the old food in
response after 4 weeks warrants continuing allergic response in that patient. identical dishes and increasing the amount
the trial longer. • Be sure all treats, flavorings, and supplements of new food while decreasing the amount
• Must have strict adherence to prescribed also avoid the offending antigens. of the old food over the transition period.
diet and protocol (recommend owner keep a
diary to record all ingested foods and clinical Possible Complications Client Education
signs). • Inappetence, weight loss • Strict adherence to the elimination diet trial
• Partial resolution of clinical signs with • Nutritional-related problems if an incomplete protocol is critical.
recrudescence on provocation testing sug- or imbalanced diet is fed ○ Human food sources, treats, flavored
gests food allergy as one component of the • Patient may develop a hypersensitivity to the medications, supplements, and food from
underlying disease process. previously tolerated intact novel protein in other sources (e.g., multi-pet households,
• No improvement in GI signs despite the future. pet with unsupervised outdoor access)
appropriate diet selection and strict adher- must be eliminated.
ence to protocol makes food allergy unlikely. Recommended Monitoring ○ Stress that a single violation with a small
However, a second diet trial using a different • If clinical improvement occurs during the amount of food during the trial can
novel protein/carbohydrate, a different elimination diet trial, a diagnosis of food reactivate hypersensitivity.
hydrolyzed diet, or a different home-cooked sensitivity is confirmed by recurrence of • Provide a handout listing all items the animal
recipe may be considered. clinical signs after reintroduction of the cannot ingest during the food trial to be read
After a positive response to elimination diet, offending allergen (provocative challenge). by all household members.
provocation (challenge) testing confirms the • If the patient develops a hypersensitivity to • Contact the owner during the first week of
diagnosis and determines the inciting antigen(s): a previously tolerated intact novel protein, the food trial to check that the elimination
• One food or individual ingredient is intro- repeat the elimination diet trial with a new diet has been started, provide support, and
duced at a time while feeding the elimination novel or hydrolyzed diet. address any questions.
diet.
• Adverse GI reaction typically occurs within PROGNOSIS & OUTCOME SUGGESTED READING
days, and the patient may react to more than Dandrieux JRS: Inflammatory bowel disease versus
one food ingredient. Good long-term prognosis if offending foods chronic enteropathy in dogs: are they one and the
If no improvement to an appropriately con- or ingredients are identified and eliminated same? J Small Anim Pract 57:589-599, 2016.
ducted elimination diet trial, consider additional from the diet. AUTHOR: Laura Eirmann, DVM, DACVN
diagnostic testing to rule out other causes of EDITOR: Rance K. Sellon, DVM, PhD, DACVIM
chronic enteropathy: PEARLS & CONSIDERATIONS
• Abdominal imaging, endoscopic or surgical
biopsies, serum bile acids Comments
○ GI biopsies from patients with food • Food hypersensitivity should be a differential
allergy or inflammatory bowel disease diagnosis for all animals presenting with
(IBD) may reveal nonspecific increases in chronic GI signs. Many patients can have

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