Ciclosporin oral solution in cats: a retrospective survey of compliance with treatment and adverse effects.

OBJECTIVES: The aim of the study was to assess long-term ciclosporin oral solution compliance in cats treated for feline atopic skin syndrome (FASS). METHODS: A survey was sent by email to 114 owners who had administered ciclosporin oral solution to their cats for FASS. RESULTS: In total, 42 owners completed the survey. The population was composed of 30 domestic shorthair cats and 12 pure breeds. There were 20 males and 22 females, and the median age was 5.5 years. Ciclosporin oral solution was administered directly into the mouth in 32/42 (76%) and with food/other in 10/42 (24%) cats. The administration was considered easy in 18/42 (43%) cats, difficult in 23/42 (55%) and impossible in 1/42 (2%). Treatment was stopped in 25/42 (60%) cats. The causes were as follows: administration difficulty (nine cats, 21%); complete resolution (four cats, 10%); treatment failure (four cats, 10%); price (two cats, 4%); and other causes (two deaths, two neoplasia, one adverse effect and one lack of compliance). Adverse effects involving clinical signs were reported in 25 (60%) cats: ptyalism (8/42); dysorexia/anorexia (6/42); vomiting (4/42); diarrhoea (4/42); gingival hyperplasia (1/42); and a combination of vomiting, diarrhoea and ptyalism (2/42). In addition, altered behaviour was reported in 27/42 (64%) cats: hiding in seven cats; scared of owner in 10 cats; modification of sleeping or playing activity in six cats; inappropriate urination/defecation in two cats; aggression in one cat; and all of the above in one cat. CONCLUSIONS AND RELEVANCE: In total, 24 (57%) cats had adverse effects involving both clinical signs and altered behaviour, and only six cats had either adverse clinical signs or behavioural changes. This survey showed that behavioural changes appear to be underestimated in the cats treated with ciclosporin oral solution and this could cause treatment failure due to lack of compliance. Larger-scale studies are needed to confirm these preliminary results.

Alopecia X in a cloned Pomeranian dog.

A two-year-old Pomeranian dog with Alopecia X was cloned after accidental death. Despite earlier castration, the cloned animal developed the same lesions of Alopecia X at the same age. This observation suggests that the disease is due to genetically programmed hair cycle arrest without strong environmental influences.

Un chien de Poméranie de 2 ans atteint d'alopécie X a été cloné après un décès accidentel. Malgré une castration antérieure, l'animal cloné a développé les mêmes lésions d'alopécie X au même âge. Cette observation suggère que la maladie est due à un arrêt du cycle pilaire génétiquement programmé sans influence environnementale évidente.

Um cão da raça spitz de dois anos com Alopecia X foi clonado após morte acidental. Apesar da castração precoce, o animal clonado desenvolveu as mesmas lesões da Alopecia X na mesma idade. Esta observação sugere que a doença se deve à interrupção do ciclo capilar geneticamente programada, sem fortes influências ambientais.

Un perro Pomerania de 2 años con Alopecia X fue clonado tras una muerte accidental. A pesar de una castración anterior, el animal clonado desarrolló las mismas lesiones de Alopecia X a la misma edad. Esta observación sugiere que la enfermedad se debe a una detención del ciclo capilar genéticamente programada sin fuertes influencias ambientales.

Open field study on the efficacy of fluralaner topical solution for long-term control of flea bite allergy dermatitis in client owned cats in Ile-de-France region.

BACKGROUND: Flea bite is considered to be the main cause of allergic dermatitis in cats. There is a need for treatments able to control clinical signs of allergic dermatitis associated with flea bite in cats. This was an open pre-treatment versus post-treatment clinical field study. All cats included in the study presented pruritus, skin lesions or other evidence compatible with flea infestation. Skin lesions were assessed (using SCORFAD) at days 0, 28, 56 and 84 whereas pruritus severity was assessed (using PVAS) at days 0, 15, 28, 56 and 84. On day 0, The fluralaner (280 mg/ml) product (Bravecto® spot-on for cats) was supplied in pipettes containing 0.4, 0.89 and 1.79 ml for cats of 1.2-2.8 kg, > 2.8-6.25 kg and > 6.25-12.5 kg body weight, respectively. The other animals living in the same household also received fluralaner. Based on cytological examination at day 0, oral amoxicillin and clavulanic acid was prescribed for 21 days if indicated. For cats presenting intense pruritus and discomfort at day 0, oral prednisolone at 0.5 mg/kg was prescribed for 3 days. RESULTS: During the study all cats, except for one (cat number 10), improved significantly. Post-treatment median SCORFAD scores at all evaluations were significantly different from the pre-treatment score on day 0 (P values < 0.002 for all three post treatment examination days) with a score reduction of 49% on day 28, 79% on day 56 and 87% on day 84. The PVAS score decreased significantly over the study period for all cats but one (cat number 10). Post-treatment median PVAS scores at all evaluations were significantly different from the pre-treatment PVAS score on day 0 (P value < 0.002 for all four post-treatment days) with a reduction of 46% on day 15, 67% on day 28, 82% on day 56 and 92% on day 84. No adverse reaction or other health issue was reported during the study. CONCLUSIONS: A single topical treatment with fluralaner results in a significant reduction of flea bite allergic dermatitis clinical signs in cats over the subsequent 12 weeks without any additional environmental treatment.

The novel high molecular weight Dermatophagoides farinae protein Zen-1 is a major allergen in North American and European mite allergic dogs with atopic dermatitis.

BACKGROUND: Atopic dogs with hypersensitivity to Dermatophagoides farinae (Df) have IgE recognizing high molecular weight (MW) allergens more often than the low MW Der f 1 and 2. A new high MW Df allergen, Zen-1, has been identified recently. OBJECTIVES: To determine the IgE reactivity of American and European Df-hypersensitive dogs to Zen-1, Der f 1 and Der f 2. METHODS: We tested sera from 33 Df-reactive dogs from the USA, 29 from Europe and 15 experimentally sensitized to Df, by ELISA against crude Df, Der f 1, Der f 2 and Zen-1. ELISA inhibition was performed with sera reactive to Zen-1. Intradermal testing (IDT) was also done with the same allergens in 25 other American atopic dogs. RESULTS: Altogether, IgE seropositivity to Zen-1 was more prevalent (86%) than that to Der f 1 (17%) or Der f 2 (19%). The IgE reactivity to Zen-1 was correlated to that against crude Df; this allergen alone inhibited a high percentage (median: 50%; range: 22-84%) of the binding to the crude mite extract. The seropositivity to low MW allergens was highest in experimentally sensitized dogs. Serum IgE recognition of Der f 1 was low in dogs with AD; that to Der f 2 was significantly lower in American dogs (6%) than in European ones (28%). A high prevalence of positive immediate IDT reactions to Zen-1 confirmed the likely relevance of serological results. CONCLUSIONS AND CLINICAL IMPORTANCE: This study establishes Zen-1 as a major allergen in atopic dogs sensitized to Df.

Critically appraised topic on adverse food reactions of companion animals (2): common food allergen sources in dogs and cats.

BACKGROUND: To diagnose cutaneous adverse food reactions (CAFRs) in dogs and cats, dietary restriction-provocation trials are performed. Knowing the most common offending food allergens for these species would help determining the order of food challenges to optimize the time to diagnosis. RESULTS: The search for, and review and analysis of the best evidence available as of January 16, 2015 suggests that the most likely food allergens contributing to canine CAFRs are beef, dairy products, chicken, and wheat. The most common food allergens in cats are beef, fish and chicken. CONCLUSIONS: In dogs and cats, after a period of dietary restriction leading to the complete remission of clinical signs, food challenges to diagnose CAFR should begin with beef and dairy products, the most commonly recognized food allergens in these two species.

Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA).

BACKGROUND: In 2010, the International Task Force on Canine Atopic Dermatitis (now International Committee on Allergic Diseases of Animals, ICADA) published the first consensus guidelines for the treatment of atopic dermatitis (AD) in dogs. This is the first 5-year minor update of this document. RESULTS: The treatment of acute flares of AD should involve the search for, and then elimination of, the cause of the flares, bathing with mild shampoos, and controlling pruritus and skin lesions with interventions that include topical and/or oral glucocorticoids or oclacitinib. For chronic canine AD, the first steps in management are the identification and avoidance of flare factors, as well as ensuring that there is adequate skin and coat hygiene and care; this might include more frequent bathing and possibly increasing essential fatty acid intake. The medications currently most effective in reducing chronic pruritus and skin lesions are topical and oral glucocorticoids, oral ciclosporin, oral oclacitinib, and, where available, injectable recombinant interferons. Allergen-specific immunotherapy and proactive intermittent topical glucocorticoid applications are the only interventions likely to prevent or delay the recurrence of flares of AD. CONCLUSIONS: This first 5-year minor update of the international consensus guidelines for treatment of AD in dogs further establishes that the treatment of this disease is multifaceted, and that interventions should be combined for a proven (or likely) optimal benefit. Importantly, treatment plans are likely to vary between dogs and, for the same dog, between times when the disease is at different stages.

Critically appraised topic on adverse food reactions of companion animals (1): duration of elimination diets.

BACKGROUND: Restrictive (i.e. elimination)-provocation dietary trials remain the standard of care to diagnose cutaneous adverse food reactions (CAFRs) in dogs and cats. There is currently no consensus on the duration of elimination diet trials that would permit the highest sensitivity of diagnosis of CAFR in companion animals. RESULTS: The search for, and review and analysis of the best evidence available as of December 14, 2014 suggests that, by 5 weeks in dogs and 6 weeks in cats after starting an elimination diet, more than 80 % of patients had achieved a remission of clinical signs of CAFR. Increasing the diet trial duration to 8 weeks leads to a complete remission in more than 90 % of dogs and cats with CAFR. CONCLUSIONS: For diagnosing CAFRs in more than 90 % of dogs and cats, elimination diet trials should last at least 8 weeks.

Dose tapering for ciclosporin in cats with nonflea-induced hypersensitivity dermatitis.

BACKGROUND: Little information is available on the ciclosporin dose-tapering regimen and clinical response in the treatment of feline hypersensitivity dermatitis. HYPOTHESIS/OBJECTIVES: To test a dose-tapering regimen and assess efficacy and clinical safety for up to 18 weeks. ANIMALS: Eighty-eight client-owned cats with feline hypersensitivity dermatitis. METHODS: Cats that received either a placebo or ciclosporin at 2.5 mg/kg or 7 mg/kg daily for 6 weeks were given 7 mg/kg ciclosporin daily for 4 weeks. Depending on the clinical response, the dose was tapered from daily to every other day over the next 4 weeks and further to twice a week for an additional 4 weeks. RESULTS: After all cats received 7 mg/kg for 4 weeks, the dose could be tapered to every other day for the next 4 weeks in 70% of cats remaining in the study. During the next 4 weeks, 57, 15 and 22% of cats remaining in the study could be treated at twice a week, every other day or daily, respectively. After the first 4 weeks, the mean lesion score and owner-assessed pruritus improved over baseline by 69 and 61%, respectively, and remained stable during the following 8 weeks. Approximately 65% of the cats in the study were reported to have an adverse event (AE), very often mild and resolving spontaneously. The most frequent AEs were gastrointestinal and included primarily vomiting and diarrhoea. Eighty per cent of AEs occurred when cats were on daily treatment. CONCLUSIONS AND CLINICAL IMPORTANCE: Results suggest that the induction dose of 7 mg/kg ciclosporin can be tapered as soon as 4 weeks without deterioration of the clinical response. Establishment of the lowest effective dosing regimen of ciclosporin reduced the frequency of AEs.

Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis.

Atopic dermatitis (AD) is a common chronic relapsing pruritic skin disease of dogs for which treatment has varied over time and geographical location. Recent high quality randomized controlled trials and systematic reviews have established which drugs are likely to offer consistent benefit. The International Task Force for Canine AD currently recommends a multi-faceted approach to treat dogs with AD. Acute flares should be treated with a combination of nonirritating baths and topical glucocorticoids, once an attempt has been made to identify and remove the suspected causes of the flare. Oral glucocorticoids and antimicrobial therapy must be added when needed. In dogs with chronic AD, a combination of interventions should be considered. Again, factors that trigger flares of AD must be identified and, if possible, avoided. Currently recognized flare factors include food, flea and environmental allergens, Staphylococcus bacteria and Malassezia yeast. Skin and coat hygiene and care must be improved by bathing with nonirritating shampoos and dietary supplementation with essential fatty acids. The severity of pruritus and skin lesions can be reduced with a combination of anti-inflammatory drugs. Currently, medications with good evidence of high efficacy include topical and oral glucocorticoids, and calcineurin inhibitors such as oral ciclosporin and topical tacrolimus. The dose and frequency of administration of these drugs should be tailored to each patient considering each drug's efficacy, adverse effects and cost. Allergen-specific immunotherapy should be offered, whenever feasible, in an attempt to prevent recurrence of clinical signs upon further exposure to environmental allergens to which the patient is hypersensitive.

Determination of CADESI-03 thresholds for increasing severity levels of canine atopic dermatitis.

To evaluate the extent and severity of skin lesions in clinical trials enrolling dogs with atopic dermatitis (AD), the International Task Force on Canine Atopic Dermatitis recently recommended the use of the third version of the CADESI. This version of the CADESI was found to exhibit acceptable content, construct, criterion, inter- and intraobserver reliability and sensitivity to change. The current study was aimed at determining optimal CADESI-03 cut-off points to separate AD severity categories for future clinical trials. One hundred and eight dogs with AD were selected based on current diagnosis standards. At one or more visits, clinicians subjectively rated the severity of AD as 'in remission', 'mild', 'moderate' or 'severe', and a CADESI-03 score was then determined. In all, 158 CADESI-03 values were recorded and divided among the four disease severity categories. Receiver-operating characteristics (ROC) curves were generated at increasing cut-off values to determine the benchmark that would offer optimal sensitivity and specificity between adjacent categories. Cut-offs of 16, 60 and 120 are proposed at the interface of remission, mild, moderate and severe categories, respectively. Proposed intervals therefore are: remission: 0-15; mild AD: 16-59; moderate AD: 60-119; and severe AD: >/= 120. This Task Force recommends that, whenever applicable and relevant, subgroup analyses of outcome measures, based on disease severity as determined with these cut-off CADESI-03 values, be preplanned for clinical trials enrolling dogs with AD. Such subgroup analyses could help determine whether specific interventions might be more effective in a particular subset of atopic dogs.

Cutaneous manifestations of neurological diseases: review of neuro-pathophysiology and diseases causing pruritus.

Pruritus does not always originate from stimulation to the skin associated with primary dermatological disorders. It may be caused by neurological or behavioural disorders. The essential role of the nervous system in the control (enhancement and inhibition) of pruritus and its pathophysiology are presented. In order to allow differentiation between dermatological and neurological disorders, inherited or acquired peripheral neuropathies and central nervous disorders (Arnold-Chiari syndrome, seizure-related disorders, central nervous system tumours) that may induce itch are discussed.

Randomized controlled trial of the efficacy of cyclosporine in the treatment of atopic dermatitis in dogs.

OBJECTIVE: To evaluate efficacy of cyclosporine A, administered at either of 2 dosages, in dogs with atopic dermatitis (AD). DESIGN: Multicenter randomized controlled trial. ANIMALS: 91 dogs with AD. PROCEDURE: Dogs were assigned to receive placebo (30 dogs), cyclosporine at a low dosage (2.5 mg/kg [1.1 mg/lb], PO, q 24 h for 6 weeks; 30 dogs), or cyclosporine at a high dosage (5.0 mg/kg [2.3 mg/lb], PO, q 24 h for 6 weeks; 31 dogs). RESULTS: After 6 weeks, mean percentage reductions, compared with baseline scores, in scores of lesion severity were 34, 41, and 67% for dogs treated with the placebo, cyclosporine at the low dosage, and cyclosporine at the high dosage, respectively. Similarly, mean percentage reductions in pruritus scores were 15, 31, and 45%, respectively. Percentage reductions in skin lesion and pruritus scores were significantly higher for dogs given cyclosporine at the high dosage than for dogs given the placebo. Treatment efficacy was significantly associated with whether dogs had a history of seasonal AD. Percentage reductions in skin lesion and pruritus scores were high for dogs treated with cyclosporine at the highest dosage that had a history of nonseasonal AD. Dogs in all groups with seasonal AD improved during the study period. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that oral administration of cyclosporine at a dosage of 5.0 mg/kg once daily is effective in reducing severity of pruritus and skin lesions in dogs with AD, especially those with nonseasonal disease.

Sensitisation to the House Dust Mite, Dermatophagoides farinae, in Dogs with Sarcoptic Mange.

Abstract- Sensitisation to the house dust mite, Dermatophagoides farinae, was demonstrated by skin testing and allergen-specific IgG determination in 15 out of 20 dogs in which a definitive diagnosis of sarcoptic mange was made following recovery of Sarcoptes scabiei mites on skin scrapings. After therapy, no dogs exhibited clinical signs of atopic dermatitis. Intradermal skin testing and 40 per cent of specific IgG assays for Dermatophagoides farinae were negative 90-180 DAys after the original diagnosis. Résumé- Une sensibilisation a l'acarien de la poussière de maison, Dermatophagoides farinae, est demontrée par tests cutanés et dosage d'immunoglobulines IgG specifiques d'allergenes sur 15/20 chiens atteints de gale sarcoptique prouvée par la presence de nombreux sarcoptes aux raclages cutanés. Après traitement, aucun chien n'a présenté des signes cliniques de dermatite atopique. Les tests cutanés intradermiques et 40 plus des posages IgG pour Dermatophagoides farinae sont negatifs 90 à 180 jours après le diagnostic initial. [Prélaud, P., Guaguère, E. Sensitisation to the house dust mite, Dermatophagoides farinae, in dogs with sarcoptic mange (Une sensitisation à l'acarien de la poussière de maison sur les chiens atteints de gale sarcoptique).