Food allergies - Next+ Food Reactivity Test - Nextmune
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Next+
Food Reactivity
Test
__
Food allergies
Diagnosis and management
Introduction
Adverse food reactions (AFR) encompass food intolerances
as well as immunologically mediated hypersensitivities,
that is, food allergies.
Immunologic Food allergy
Adverse Food Reactions
Food intolerance
Non-Immunologic
Dietary indiscretion
Pathogenesis
The specific immunological mechanisms involved in food allergy are not
clearly understood. It is hypothesized that immunological food reactions
(food allergy) develop when a food specific IgE antibody on a mast cell
binds with a food antigen.
This binding initiates mast cell release of potent inflammatory mediators
and cytokines1. Although, it is believed that most food allergies are type I
or IgE mediated, there is also some evidence to suggest Type III and IV
hypersensitivity reactions may be involved2.
Prevalence, age of onset and
genetic predisposition
The true incidence of such reactions is still not entirely clear, but has
been reported to range between 10% and 25%, in dogs with allergic
skin disease3. It is also estimated to be around 1/3 of dogs with atopic
Among animals with
dermatitis3. It is described a stronger incidence in dogs under 1 year of
pruritus and clinical signs age or above 6 years old4.
of allergic dermatitis,
Labrador retrievers, West Highland White Terriers, Boxers, Rhodesian
the prevalence of AFR is ridgebacks and Pug breeds are predisposed to developing AFR. The
high enough to justify this most common allergens responsible for AFR in dogs seemed to be beef,
chicken, egg, milk, wheat, soy and corn, which are also common ingredients
syndrome to be ruled-out
in many commercial foods5.
Clinical Signs
Dogs suffering from AFR generally present with dermatological
or gastrointestinal signs, or combination of both.
Dermatological signs are varied, and often indistin-
guishable from those associated with atopic derma-
titis, although the presence of an unusual distributi- • Non-seasonal pruritus
on or concomitant gastrointestinal signs may raise
suspicion for an adverse food reaction.
• Signs of allergic dermatitis
• Gastrointestinal signs
When pruritus is not corticosteroid-responsive, a
• Corticosteroid non-responsive
food allergy should be considered (if pruritus res-
ponds to corticosteroids that does not rule out the
possibility that a food allergy is present). pruritus with the addition of environmental allergens
during high pollen season. Otitis externa and recur-
Generalized or localized non-seasonal pruritus (face, rent pyoderma with or without pruritus has also
ears, paws, axillae, inguinal and perineal regions) is been associated with AFR in dogs.
the most frequently described dermatological sign. It
is also possible for the effects of a food allergy to be Gastrointestinal signs may include vomiting,
below the ‘itch threshold’ and only observe flares of diarrhea, weight loss, and abdominal discomfort.
Ears Face
Appearance: Appearance:
Waxy discharge; redness; odor Inflammation; redness; conjunctivitis; swelling
Behaviour: Behaviour:
Scratching or rubbing ears Scratching or rubbing face
with paws or against furniture with paws or against furniture
Skin
+ Otitis externa
Recurrent pyoderma
Appearance: Vomiting
Reddened; possibly with crusts or scales; Diarrhea
odor with secondary infections Weight loss
Behaviour:
Abdominal discomfort
Scratching and licking sides/belly,
Flatulence
elbows, groin
Feet Haircoat
Appearance: Appearance:
Inflammation, redness, odor, brown Bald spots; brown discoloration where
discoloration where licking has occured licking has occured
Behaviour: Behaviour:
Licking and chewing of feet/pads Scratching sides/belly, rubbing face
against furniture or carpet, licking
Diagnosis
Currently, the definitive diagnosis of food allergy in dogs is only
possible through a food elimination trial followed by a food challenge
test. The recommended length of this trial is, at least, 6 weeks.
Complete or partial improvement of pruritus during There are conflicting studies on the effectiveness of
the trial is the main criterion for suspected food allergy. hydrolyzed diets for allergic patients, with 10% to 40%
The diagnosis is confirmed by the recurrence of clinical of patients allergic to the basic protein continuing to
signs when the food given previously is reintroduced. show clinical signs on a hydrolyzed version7.
As animals may be multi sensitive, it may be necessary
to attempt dietary restriction more than once. Home cooked diet is thus regarded as the most reliable
diagnostic option, however less practical.
The elimination trial can be done with a homemade
diet, a commercial diet with hydrolyzed protein, or a During the elimination diet, the dog must not receive
commercial diet with proteins unusual for the dog. any other food, treats, medications, vitamins, or sup-
plements with any protein other than the one chosen
Commercial diets often contain larger protein mole- for the diet.
cules capable of inducing clinical deterioration in some
dogs6,7 or protein sources not declared on the label8,9.
Food elimination Trial - Food Challenge
Original food
source removed + Elimination Diet
introduced
Allergy symptoms: Allergy symptoms:
Disappear or reduced Little or no change
significantly over time is observed
Original food source Start new trial using a
reintroduced different Elimination Diet
Allergy symptoms: Allergy symptoms:
Reappear Little or no change
is observed
Food Allergy Food Allergy unlikely
Next+ Food Reactivity Test
Although not diagnostic, combined assays of food specific
IgE and IgG, represent a useful tool to identify a suitable
composition for an elimination diet, when attempting to
diagnose and manage a suspected adverse food reaction10.
The testing of IgE on its own, represents a half-reliable tool. Evidence
shows significant improvements when choosing an elimination diet based
Which Elimination Diet on combination of IgE and IgG results, when compared with IgE alone10,11.
should be used? Generally, serum testing for food-specific IgE and IgG shown an average
accuracy of 75%12.High predictive negative values (Ø75% IgE and 84% IgG)
represent a more accurate interpretation when compared with positive
predictability (15-100% IgE and 35% IgG)12.
Next+ Food Reactivity Test includes the results for food-specific IgE and
IgG levels for 20 different allergens, together with clear advice on potential
suitable ingredients and commercial diets for a food elimination trial.
Owner name: Example
Example
23 allergens x2 (lgE + lgG)
Animal Name:
Species: Dog
• Beef • Horse • Egg • Pea
Veterinarian:
Veterinary practice: Artuvet Animal Health
NL
Practice details: Vijzelweg 11, 8243 PM Lelystad,
• Chicken
Phone / Fax:
Email:
• Duck • Soya bean • Wheat
Serum Test results Test type:
Date tested:
Complete food
20/12/2019
Test number:
Customer number:
22
10006607
• Lamb • Rabbit • Corn • Rice
• Pork • White fish • Potato • Oat
• Turkey • Blue fish • Sugar beet • Yeast
EA Units* 200 250
Allergen
IgE 512
• Venison • Milk • Carrot
Beef
IgG 400
IgE 394
Chicken 354
IgG
IgE 15
Lamb 7
IgG
IgE 422
Pork 371
IgG
IgE 356
Turkey 314
IgG
IgE 30
Venison 24
IgG
IgE 547
White fish 569
IgG
IgE 216
Oily fish 287
IgG
IgE 250
Milk 237
IgG
IgE 148
Egg 60
IgG
IgE 15
Soyabean 20
IgG
IgE 671
Corn 524
IgG
IgE 256
Potato 232
IgG
IgE 143
Sugar beet 108
IgG
IgE 75
Carrot 6
IgG
IgE 61
Pea 47
IgG
IgE 174
Wheat 128
IgG
IgE 394
Rice 305
IgG
IgE 273
Oat 209
IgG
IgE 164
Yeast 115
IgG
> 250
200-250 high.
< 200 Can be considered Scores of 250 or above are unusually
Scores in this range are dubious. potential suitable
Scores of less than 200 can be
considered as
for an elimination Should not be considered as a
as a potential suitable ingredient Low Positive
a potential suitable ingredient for
an elimination history and ingredient for an elimination diet.
diet if no scores below 200. Clinical Ø 35% (IgG).
diet. High Negative Predictabili
ty: Ø 75%
extensively evaluated. Predictability: 15-100% (IgE),
previous diets should be
(IgE), Ø 84% (IgG).
the severity of the disease,
not necessarily correlate with
and IgG detected. The magnitude of the signal does
the level of allergen-specific IgE
* Elisa Absorbance Units. EA indicate
but does reflect the pet’s immune
response to ingredients. 1
Management
Once food allergy is established, strict avoidance of allergen is
the gold standard. Taxonomic relationship between protein sources
should be considered to avoid the risk of cross-reactivity13.
If the trial appears to have been performed correctly, environmental allergens that your patient is reacting
but the patient did not improve or slightly improved, to and help you putting together an appropriate
then it is likely suffering from atopic dermatitis and immunotherapy to treat the cause of the allergy –
reacting to environmental allergens. Next+ Serum Artuvetrin® Therapy.
Test and/or Artuvetrin® Skin Test can identify these
Suitable Ingedients Elimination
Next+ Food Reactivity Test Suitable Commercial Diets Diet
Original food
source removed + Elimination Diet
introduced
Allergy symptoms: Allergy symptoms:
Disappear or reduced Little or no change
significantly over time is observed
Original food source Start new trial using a
reintroduced different Elimination Diet
Allergy symptoms: Allergy symptoms:
Reappear Little or no change
is observed
Food Allergy Food Allergy unlikely
Atopic Dermatitis likely
Next+ Serum Test Artuvetrin®
and/or Artuvetrin® Skin Test Therapy
References
1 Sampson, H. A., 2004: Update on food allergy. Journal of Allergy Clinical Immunology.
113:805-819
2 Verlinden, A. et al, 2006: Food allergy in dogs and cats: a review. Clinical Reviews in food
Science and Nutrition. 46:259-273
3 Olivry, T., Mueller, R., 2017: Critically appraised topic on adverse food reactions of companion
animals (3): prevalence of cutaneous adverse food reactions in dogs and cats. BMC Veterinary
Research. 13:51
4 Pali-Schöll, I. et al, 2017: Comparing immediate-type food allergy in humans and companion
animals. EAACI. 72:1643-1656
5 Jeffers J. G. et al, 1996: Responses of dogs with food allergies to single-ingredient dietary
provocation. J Am Vet Med Assoc. 209:608-611
6 Ricci, R., et al, 2010: A comparison of the clinical manifestations of feeding whole and
hydrolyzed chicken to dogs with hypersensitivity to the native protein. Vet Dermatol.
21:358-366
7 Olivry, T. et al, 2010: A systematic review of the evidence of reduced allergenicity and clinical
benefit of food hydrolysates in dogs with cutaneous adverse food reactions. Vet Dermatol.
21:32-41
8 Ricci, R. et al, 2013: Identification of undeclared sources of animal origin in canica dry foods
used in dietary elimination trial. J Anim Physiol Anim Nutr (Berl). 97(Suppl 1):32-38
9 Raditic, D. et al, 2011: ELISA testing for common food antigens in four dry foods used in
dietary elimination trial. J Anim Physiol Anim Nutr (Berl).95:90-97
10 Haliwell, R. et al, 2004: IgE and IgG antibodies to food antigens in sera from normal dogs,
atopic dogs and dogs with adverse food reactions. Vet Dermatol. 15: 2-3
11 Arribas, J. et al: Assessment of an “in-vitro” diagnosis of IgG/IgE in dogs suspected to
suffer food allergy and/or food intolerance. School of Veterinary Science Madrid.
12 Olivry, T., Mueller, R., 2017: Critically appraised topic on adverse food reactions of companion
animals (4): can we diagnose adverse food reactions in dogs and cats with in vivo or in vitro
tests? BMC Veterinary Research. 13:275
13 Bexley, J. et al, 2016: Serological cross reactivity between beef, lamb and cow’s milk allergen
extracts in dogs. Vet Dermatol. 27:9
FA1220EN3
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