Stress in new graduates: can the profession do more to help?

Richard Halliwell and colleagues believe that it can, on the basis of a survey they conducted to assess the incidence of poor mental health and wellbeing in recent veterinary graduates, and workplace factors that might be associated with this.

The responsibilities of veterinary educators in responding to emerging needs in veterinary medicine.

It is an unfortunate fact that not only has veterinary education failed to adapt in the face of likely future needs, but it has also failed to respond to societal changes that have already taken place and that have affected the requirements for veterinary services and veterinary capability. The responsibility is primarily that of educators, although vision and foresight require a co-ordinated approach involving national and international veterinary organisations. Once it is accepted by all parties that change is essential, the implementation will fail unless there is a unified programme involving the schools and colleges, the accrediting agencies, the licensing authorities, governments, the professional organisations and corporate veterinary medicine. All have a role to play, and any one can readily block progress. A unified approach is an absolute requirement. The developed countries must take a leading role, but the issues are global, and ways must be found to facilitate change in all parts of the world. Disease knows no boundaries, and any strategy is only as strong as its weakest link.

Is our divided profession a profession in decline?

Richard Halliwell is concerned by criticisms of the veterinary profession in the recent select committee report on a new Veterinary Surgeons Act. He fears that a lack of leadership and division within the veterinary profession may have contributed to loss of influence, and makes some suggestions for putting that right.

Reducing the suicide rate among veterinary surgeons: how the profession can help.

A short communication on page 415 of this issue of The Veterinary Record draws attention to the high suicide rate among members of the veterinary profession. In this article, Professor Richard Halliwell, who has recently chaired a series of meetings on this matter at the Royal College of Veterinary Surgeons, and Mr Brian Hoskin, chairman of the Veterinary Benevolent Fund, describe some of the support mechanisms available to veterinary surgeons and discuss what more might be done.

The effects of endoparasitism on the immune response to orally administered antigen in cats.

The aim of the study was to assess whether infection with Toxocara cati (T. cati) facilitates the induction of immunoglobulin (Ig) E or other antibody responses to a specific antigen administered with food in kittens. Two groups of 10 cats each, either experimentally infected with T. cati or parasite-free, were dosed with human serum albumin (HSA) added daily to their food from day 7 to 28 inclusive. Levels of HSA-specific IgE, IgG, IgA and IgM were assessed in the serum by enzyme-linked immunosorbent assay (ELISA) in both groups of cats at weeks 0, 2, 4 and 8. Although weak, an IgE response was detected in most of the cats 1 week after exposure to HSA. However, HSA-specific IgG and IgA could only be detected from the third week after exposure to HSA. The group of parasitized cats had significantly higher levels of HSA-specific antibodies of the IgG and IgA at weeks 4 and 8 (p<0.05 by Mann-Whitney) and IgE isotypes at weeks 2 and 4 (p<0.05 by analysis of variance (ANOVA)) than did the group of parasite-free cats. Specific IgM antibody was not detected in the sera of any of the 20 cats. These findings are supportive of a role of T. cati infection in enhancing the IgE response to orally administered antigens, and hence possibly, in genetically susceptible individuals, in the development of food hypersensitivity.

Cutaneous hypersensitivity reactions to Psoroptes ovis and Der p 1 in sheep previously infested with P. ovis--the sheep scab mite.

We have previously shown that infestation with Psoroptes ovis induces an IgE response and intense tissue eosinophilia, typical of a Type I hypersensitivity response [Parasite Immunol. 22 (2000) 407]. Intradermal tests (IDSTs) suggest that there are also delayed and Arthus-type responses to this parasite. In order to study the nature of ovine cutaneous reactions to P. ovis, naïve controls and experimentally infested sheep (n = 5) were challenged intradermally with mite antigen. Challenge elicited immediate (P < 0.001) and delayed (P < 0.005) wheal reactions in sensitised sheep. At 6 (P < 0.02) and 30 h (P < 0.001) the predominant infiltrating cells were eosinophils. To explore the role of circulating antibodies, naïve sheep (n = 5) were subjected to Prausnitz-Kustner (PK) tests. These elicited immediate (P < 0.02) but not delayed wheal reactions. At 6 h eosinophils (P < 0.001) dominated the infiltrate. These results suggest that P. ovis allergens provoke an IgE-dependent immediate and late phase response and a cell-mediated eosinophil-rich delayed-type hypersensitivity response (ER-DTH).

The ACVD task force on canine atopic dermatitis (III): the role of antibodies in canine atopic dermatitis.

Although an important pathogenic role for IgE is established in the case of allergic asthma and rhinitis in man, its role in atopic dermatitis is less clear. There are many studies where allergists and immunologists have provided evidence in favour of such a role, whereas dermatologists are less than convinced. In dogs, however, there is an abundance of clinical evidence implying that atopic dermatitis is antigen driven, and recent studies suggest that there may be a role for IgE, not only in the effector pathway, but also in antigen capture. Although an IgG response often accompanies an IgE response in dogs with atopic dermatitis, there is little evidence in support of a pathogenic role in respect of the former isotype.

The ACVD task force on canine atopic dermatitis (XI): the relationship between arthropod hypersensitivity and atopic dermatitis in the dog.

The relationship between arthropod allergen hypersensitivity and the development of canine atopic dermatitis (AD) is unclear. It has been shown that dogs with AD are more likely to exhibit positive intradermal reactivity to flea allergens than non-pruritic dogs from the same flea-endemic geographic region. Also, dogs in a flea endemic region are four times more likely to suffer from flea allergy dermatitis (FAD) and AD than from FAD alone. These results provide indirect evidence to support the hypothesis that, in the canine species, atopy predisposes to the development of hypersensitivity to flea allergens and eventually to FAD. A causal relationship between insects other than fleas and canine AD has not been identified with certainty.

Serum antibodies to Malassezia yeasts in canine atopic dermatitis.

Significant numbers of humans with atopic dermatitis develop Malassezia-specific IgE. Immediate skin-test reactivity to Malassezia has been demonstrated in atopic dogs. The aim of this study was to compare the serum IgG and IgE response to Malassezia in atopic dogs with and without clinical evidence of Malassezia dermatitis and/or otitis, nonatopic dogs with clinical evidence of Malassezia dermatitis and/or otitis and healthy dogs. Cytology was used to diagnose clinically significant Malassezia dermatitis and otitis. Contact plate cultures confirmed the validity of this technique. Reproducible enzyme-linked immunosorbent assays for Malassezia-specific IgG and IgE in canine serum were established. Atopic dogs had significantly higher serum IgG and IgE levels than either healthy dogs or nonatopic dogs with clinical evidence of Malassezia dermatitis and/or otitis. There was no significant difference in IgG and IgE levels between atopic dogs with and without clinical evidence of Malassezia dermatitis and/or otitis. The implications of these findings in the pathogenesis and management of canine atopic dermatitis are discussed.

Retrospective survey of allergen immunotherapy in canine atopy.

The clinical records of 277 cases of canine atopy treated with specific allergen immunotherapy were reviewed. A good response was defined as control with immunotherapy either alone or with topical agents, a partial response as control with immunotherapy and other systemic agents, and a poor response as no perceived benefit and the immunotherapy discontinued. The mean follow-up period was 29.2 months (range 10 to 85 months). Ninety-one cases (33 per cent) were lost to follow-up or failed to comply with the therapeutic protocol. Of the remaining 186 cases, 40 (21.5 per cent) had a good response to immunotherapy, 74 (39.8 per cent) had a partial response, and 72 (38.7 per cent) had a poor response. Immunotherapy was therefore of long-term benefit in 114 dogs (61.3 per cent). No significant differences in response rates were associated with the breed or sex of the dog, or the age of onset of the disease, or with the type or number of allergens included in a vaccine. Dogs which had clinical signs for more than 61 months before immunotherapy had a significantly poorer response rate (23.5 per cent, P < 0.05). In-house cases had a significantly better response rate (95.2 per cent, P < 0.05) than externally managed cases.

Feline immunoglobulin E: induction of antigen-specific antibody in normal cats and levels in spontaneously allergic cats.

Sera from 10 cats with symptoms consistent with atopy, from 15 normal household cats and from 11 laboratory maintained cats were assessed for allergen-specific IgE and IgG to Dermatophagoides farinae (DF) by enzyme-linked immunosorbent assay (ELISA). In addition, 10 normal cats were immunised with DF and intradermal skin tests (IDST) were performed weekly. Sera from the latter were also assessed for DF-specific IgE by ELISA and using Prausnitz-Küstner (PK) tests. Although DF-specific IgE was detectable in all the atopic cats, there was no significant difference between the levels in this group and in the clinically normal household cats. However levels in both these groups were significantly higher than those in the laboratory maintained cats. Detectable DF-specific IgE was induced in all of the 10 cats, but the levels were not correlated with the development of positive IDSTs, nor with the level of IgE as assessed by PK tests. These findings are consistent with a possible heterogeneity of IgE antibody in cats.

Production and characterisation of polyclonal antisera against feline IgE.

Cats, naturally or experimentally infected with Toxocara cati were immunised with dinitrophenylated ascaris antigen (DNP-Asc). All cats developed immediate skin reactivity to DNP coupled to bovine serum albumin (DNP-BSA) and the sera of the nine cats had a heat labile homocytotropic antibody detectable by homologous Prausnitz-Küstner (PK) tests. Reagin-rich fractions were prepared from these sera and used for the preparation of polyclonal antisera in rabbits. Resultant antisera were passed through a immunoabsorbent column of Sepharose 4B coupled to heated normal cat serum. An immunoabsorbent column prepared with the resultant antisera removed the PK reactivity from the cat sera, and the activity was recovered following acid elution. The antiserum failed to detect any recognised immunoglobulin in cat sera, but precipitated with a heat labile protein with gamma-1 electrophoretic mobility in the sera of parasited cats. These findings support the contention that the antisera are specific for feline IgE.

Allergen-specific IgE and IgGd antibodies in atopic and normal dogs.

Intradermal skin tests (IDSTs) were performed on 65 atopic and 24 normal dogs. The levels of allergen-specific IgE and IgGd antibodies were determined in serum samples by enzyme-linked immunosorbent assay (ELISA) using the same 12 allergens that were used in the IDST on normal dogs. The correlation between the levels of IgE and IgGd to Dermatophagoides farinae (DF) and Dermatophagoides pteronyssinus (DP) was examined. The sensitivity, specificity and positive and negative predictive values of allergen-specific IgE and IgGd levels in the total dog population were also compared. Results were consistent and reproducible for 9/12 allergens, but in the case of house dust, flea and Alternaria tenuis, a less discriminating standard curve and the fact that the negative control gave positive results, suggests non-specific binding and that these allergens are complex and should not be employed without further purification. A high percentage of atopic dogs had positive IDSTs and detectable IgE and IgGd antibodies to DF, DP and house dust. Similar results were obtained in the normal dog population. There were significant correlations between allergen-specific IgE and IgGd levels to DF and DP. However, in contrast to IgE, allergen-specific IgGd in normal dogs was higher than in atopic dogs. Furthermore, a high percentage of the atopic population had detectable IgGd to unrelated allergens, despite negative IDSTs. Overall, the negative predictive values were similar for both IgE and IgGd. Sensitivities were higher in the allergen-specific IgGd assays, but the specificities and positive predictive values were higher in the allergen-specific IgE assays. In conclusion, the concordance of IDSTs with ELISA results to DF and DP in normal dogs without clinical signs implied the possible heterogeneity of IgE in dogs. The presence of IgGd directed against apparently irrelevant allergens in atopic patients and the high levels of IgGd in normal dogs to the most common allergens, DF and DP, implied an uncertain role of IgGd in canine atopic disease. Therefore, the detection of allergen-specific IgE is a more useful adjunct to the diagnosis of atopic disease in the dog than IgGd.