CLINICAL PRACTICE

Diagnosis and management of

Jon Hardy
qualified from
the University

adverse food reactions in dogs

of Cambridge
in 2007. He
completed
an internship at the Royal

Veterinary College (RVC) in
2009, followed by a three-
year residency in veterinary
dermatology. He gained
the European Diploma in
veterinary dermatology
in 2014, and now works
at Lumbry Park Veterinary
Specialists in Alton,
Hampshire.
Isuru
Gajanayake
qualified from
the University
of Sydney
in 1998.
After working in general
practice in Australia and
the UK, he completed a
combined residency in small
animal internal medicine
and nutrition at the RVC.
He now works as a dual
specialist in small animal
internal medicine and
clinical nutrition at Willows
Veterinary Centre and
Referral Service in Solihull.
and cats
Background: Food allergies are not as common as clients believe, although they are commonly
self diagnosed by pet owners. This phenomenon is also seen in human medicine, where self
and parenteral diagnoses of food allergies far outnumber actual diagnoses by trained medical
professionals. Adverse food reactions (AFRs) in dogs and cats can manifest with a diverse array of
clinical signs; therefore, the diagnosis requires a careful and systematic approach, including the
exclusion of many other conditions that can mimic AFRs.
Aim of the article: This article outlines the approach to diagnosing AFR in cats and dogs and the diet
options available for diet trials and management of food allergies and intolerances.
Terminology and pathogenesis In people, eight food groups are thought to cause
Adverse food reactions (AFRs) can be broadly 90 per cent of these food allergies; that is, peanuts,
categorised into genuine food allergies with an soybeans, fish, crustacea, milk, eggs, tree nuts and
underlying immunological mechanism, and food wheat. The amount of allergen exposure needed
intolerances for which there is no underlying to trigger a reaction is very small; for example,
immunological basis. in people with peanut allergies, as little as 12 mg
will elicit a reaction in 10 per cent of susceptible
Food allergies in people people. Food allergies are more common in
Immunological food allergies in people can be children than they are in adults, and there are
further subcategorised into antibody-mediated strong genetic predispositions (ie, 65 per cent of
and cell-mediated forms. The former are driven by sufferers have a first degree relative with allergic
immunoglobulin E (IgE), which causes immediate disease).
hypersensitivity reactions (ie, within minutes of The other major form of immunological
ingestion) in presensitised patients due to mast food allergy in people is due to a cell-
cell degranulation and release of histamine and mediated mechanism leading to delayed type
other such mediators. The clinical manifestations hypersensitivity reactions (ie, 48 to 72 hours after
include gastrointestinal, cutaneous and respiratory ingestion). The most well-known disease in this
signs; in severe cases, systemic anaphylactic category is coeliac disease, caused by gluten
reactions and death are possible. sensitivity.

KEY LEARNING OUTCOMES Food allergies in dogs and cats

After reading this article, you should understand that:
 Adverse food reaction (AFR) is an important disease that should
be considered in many dogs and cats presenting with cutaneous
and/or gastrointestinal clinical signs;
 AFRs are often indistinguishable from canine atopic dermatitis
based on clinical signs alone;
 A dietary trial is the only way of diagnosing AFR in dogs and cats;
 If the offending food can be identified and avoided, the long-
term prognosis should be very good;
 Other tests, including intradermal, saliva, hair and serological
testing, are not helpful and cannot be recommended.
True food allergies due to IgE antibody responses
are also suspected to occur in dogs. Unlike in
people where allergies to meat proteins are rare,
the most commonly reported food allergens in dogs
are beef, dairy, chicken and fish, and in cats are
beef, fish and chicken. Dietary antigens are also
thought to play a key role in the pathogenesis of
chronic enteropathies, such as inflammatory bowel
disease, whereby an aberrant immunological
response to a dietary allergen is thought to be at
least partly responsible for this condition.
As a correlate to coeliac disease in people,
gluten sensitivity has been suspected in dogs.
This has been reported to cause gastrointestinal
signs in certain breeds (eg, Irish setters, soft-

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Table 1: Non-immunological food intolerances
Type Mechanism
Anaphylactoid reaction Release of histamine from sources other than
mast cells
Metabolic food disorder Enzyme deficiency
Idiosyncratic reaction Allergy-like signs caused by unknown
mechanism
Pharmacological reactions Biochemical effect of an ingredient
Food intoxication Microbial toxins
coated wheaten terriers), and non-gastrointestinal
diseases (eg, movement disorders and gall bladder
mucocoele) have been linked to gluten sensitivity
in border terriers.
Food intolerances in people and animals
Food intolerances caused by non-immunological
mechanisms are uncommon, but these have been
reported in both people and dogs (Table 1).
Unlike in human medicine, the underlying
cause of the food reaction is rarely determined
in veterinary medicine. For this reason, the
descriptive term AFR is deemed most appropriate
in dogs and cats and will be used in this article.
Epidemiology
Prevalence
The prevalence of AFR in dogs and cats is not
precisely known. Confirming the diagnosis can be
challenging; a systematic investigation is needed,
and owner compliance can hinder this. The
prevalence of AFR may also vary between different
geographical populations being studied.
However, based on a published review, AFR
may account for less than 1 per cent of dogs and
cats presenting to a veterinary surgeon with any
diagnosis. This percentage may rise when looking
at animals presenting with pruritus (15 to 20 per
cent) and allergic skin disease (10 to 25 per cent)
(Olivry and Mueller 2017). Approximately 50 to 60
per cent of dogs presenting with chronic enteritis
may respond to dietary changes (Allenspach
and others 2016, Volkmann and others 2017)
and food-responsive enteropathy is a common
cause of chronic diarrhoea. AFR is reported to
account for 17 to 22 per cent of cats presenting
with gastrointestinal signs (Hobi and others 2011).
Concurrent gastrointestinal signs and pruritic skin
disease can also be seen in dogs and cats.
Therefore, consideration of a possible
AFR is an important part of the diagnostic
investigation of many dogs and cats presenting
with signs of allergic skin disease and/or chronic
gastrointestinal signs.
Age of onset and breeds
AFR can affect any age of dog and both sexes,
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Companion animals
Examples
Scombroid fish poisoning
Lactose intolerance, favism
Sulfite-induced asthma
Chocolate toxicity
Botulism, aflatoxicosis
with young dogs (<one year old) and older dogs
(>six years old) being over-represented. An age
of onset by six months and 12 months has been
noted in 22 per cent and 38 per cent of dogs with
cutaneous clinical signs, respectively (Olivry and
Mueller 2019); these signs tend to develop earlier
than those seen with atopic dermatitis. AFR can
develop in any dog, but German shepherd dogs,
West Highland white terries, boxers, Rhodesian
ridgebacks, Labradors, golden retrievers and pugs
are over-represented in some studies.
There are no apparent breed or sex
predispositions in cats, although cats seem to
develop clinical signs later than dogs; only about
20 per cent of cases develop cutaneous clinical
signs by one year of age (Olivry and Mueller 2019).
The mean age of onset is between four and five
years of age.
Clinical signs
Cutaneous
Many dogs present with clinical signs compatible
with canine atopic dermatitis (cAD) and cAD
and AFR often cannot be differentiated based
on the clinical signs alone. In the early stages,
dogs are pruritic and the skin is erythematous
(Fig 1); erythematous macules and papules,
which are not due to self trauma, may be visible.
Over time, secondary skin lesions develop due
to the self trauma from scratching, including
alopecia, lichenification, hyperpigmentation and
excoriations (Fig 2). Saliva staining may be seen
on areas, including the feet, limbs and ventrum.
Common sites of pruritus include the interdigital
areas of the paws, carpi, tarsi, axillae, ventrum,
face and groin. The perineal area is now thought
to be affected less commonly (Olivry and Mueller
2019). Pruritus can be generalised in some cases.
Otitis externa is seen in 50 per cent of dogs with
AFR and can be the only presenting sign (Fig 3).
Secondary microbial infections due to bacteria and
yeast are common and exacerbate the pruritus.
AFR can also be associated with rare cutaneous
clinical signs, including urticaria (Fig 4),
vasculitis, erythema multiforme and erythroderma;
AFR has also been linked to perianal fistulae and
symmetric lupoid onychitis (Fig 5).
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Companion animals
Fig 1: Erythema on the palmar surface of a Fig 2: Chronic pruritus has led to hyperpigmentation and
dog’s paw. This dog had pedal pruritus and lichenification in the groin and perivulvar area of this dog
inflammation associated with an adverse with an adverse food reaction
food reaction
Cats with AFR tend to present with the well-
described cutaneous reaction patterns of the
skin. These include self-induced alopecia, miliary
dermatitis, head and neck pruritus (Fig 6) and
eosinophilic lesions, such as eosinophilic plaques,
granulomas (Figs 7, 8) and indolent ulcers (Fig
9). These reaction patterns are non-specific for
AFR and can be caused by numerous pruritic and
inflammatory skin disorders. Rarely, cats can
develop urticaria, angioedema and plasmacytic
pododermatitis associated with AFR.
Non-cutaneous
Diarrhoea is the most common gastrointestinal
manifestation of AFR in dogs. Other signs include
vomiting, increased frequency of defecation,
tenesmus, abdominal discomfort, flatulence and
borborygmi. A failure to grow may also be seen in
young animals.
Less commonly, non-cutaneous clinical signs,
such as conjunctivitis, sneezing and anaphylaxis,
Fig 4: A six-month-
old boxer dog
with transient
fluid-filled
lesions indicative
of recurrent
urticaria. This
was completely
responsive to
dietary change
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Fig 3: Otitis externa in a dog affected by an
adverse food reaction
have been associated with AFR in dogs.
There have also been several breed-specific
presentations of AFR described. An inherited
hypersensitivity to gliadin and glutenin, two
peptides found in gluten, has been reported in
Irish setters (Hall and others 1992). These dogs
developed clinical signs of inappetence, poor
growth and diarrhoea at a young age, which
were reversible with a gluten-free diet. Canine
epileptoid cramping syndrome has been reported
in six border terriers and this may be a gluten
sensitivity/intolerance as these dogs responded
to a gluten-free diet (Lowrie and others 2015). AFR
has also been diagnosed in soft-coated wheaten
terriers with protein-losing enteropathy (Vaden
and others 2000).
In cats, vomiting and diarrhoea are the most
common gastrointestinal signs, and AFR-
associated vomiting seems to be more common
than it is in dogs. Cats can also develop anorexia,
weight loss, flatulence and abdominal bloating.
Non-cutaneous clinical signs such as
conjunctivitis, hypersalivation, hyperactive
behaviour and respiratory signs have been
reported.
(a) (b)
Fig 5: (a) The pelvic limb paw of a Labrador affected by symmetric lupoid onychitis. Note the
short and dystrophic claws, with some signs of splitting and separation on digits 3 and 4.
(b) The left fore paw also shows dystrophic claws. The claw on digit 3 had previously
sloughed
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Companion animals
Fig 6: Cat affected by the ‘head and neck Fig 7: Eosinophilic (linear) granulomas on the
pruritus’ reaction pattern of cats. The pruritus caudal aspect of a cat’s hindlimbs
associated with this reaction pattern can
result in a considerable amount of self trauma
Diagnosis
It is important to initially rule out reasonable
differential diagnoses for the clinical signs and
treat concurrent diseases that may worsen some
of them. For example, microbial infection and
ectoparasite infestation may mimic or worsen skin
disease and endoparasitic disease may have the
same effect with intestinal disease.
In people, suspected food allergies are confirmed
by an oral food challenge. This is most accurately
and reliably performed using a double blind and
placebo-controlled protocol. Additional methods
can then be used to verify a diagnosis using the
skin prick test or serological testing.
Given that there are no reliable diagnostic tests
to confirm AFRs in dogs and cats, the only way to
establish a diagnosis is to perform a strict diet trial.
In one study, it was reported that only 40 per cent
of 192 pet owners followed an elimination diet trial
with 100 per cent adherence (Painter and others
2019). For this reason, it is vital that pet owners
are well informed and motivated to perform these
Fig 9: Severe indolent ulcers on the upper lips of a cat
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Fig 8: Eosinophilic granulomas at the back of a cat’s mouth
trials. There are several steps involved in an
elimination diet trial, which are detailed below.
Step 1: diet history
In suspected cases of food allergies, a careful and
detailed diet history is essential (Box 1). This is to
obtain a list of previously fed diets and foods, with
a particular focus on any that may have resulted in
clinical signs of an adverse reaction. It is advisable
to use a freely available resource (eg, http://acvn.
org/wp-content/uploads/2020/04/ACVN-Diet-
History-Form-2020-FINAL_fillable.pdf) to complete
the step-by-step process of taking a thorough diet
history so that no omissions are made.
Step 2: selection of a diet and implementation of
a trial
Based on the information from the diet history,
as well as the food preferences of the pet (eg,
BOX 1: KEY CONSIDERATIONS WHEN TAKING
A COMPLETE DIET HISTORY
■ The main foods/diets fed, including form (ie,
dry, canned, home-made), flavours, ingredients,
amounts, likes/dislikes and adverse reactions
■ Treats,including type (eg, commercial, home-
made, table scraps), number and frequency
■ Foods/treats used to administer medications
■ Dental hygiene products
■ Dietary supplements
■ Flavoured medications
■ Access to the food of other pets in the house
■ Accessto food outside the house (eg,
neighbours, hunting)
■ Detailsof who feeds the pet, including adults,
children, dog-walkers, dog-sitters, etc
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Companion animals

dry versus canned versus home-cooked), an Table 2: Canine Inflammatory Bowel Disease Activity Index*
appropriate diet is then selected for the trial. The
Normal Mild change Moderate Severe
possible diet types for this include commercial
(score 0) (score 1) (score 2) (score 3)
hydrolysed protein, commercial single (novel)
protein and home-cooked single (novel) protein. Attitude/activity
The selected diet is then fed to the exclusion of Appetite
all other foods (including treats and foods used to
help administer medication). Vomiting
For cats and dogs with gut disease, a relatively
Stool consistency
short trial of three to four weeks is usually
sufficient. Whereas with skin disease, a much Stool frequency
longer period of up to eight weeks is sufficient in Weight loss
most cases, with a few requiring up to 10 weeks.
Monitoring for an improvement in the clinical Total score Score 0–3 Score 4–5 Score 6–8 Score >9
signs requires assessment and scoring of these Insignificant Mild disease Moderate Severe
signs. For gut disease, this scoring can be *Adapted from Jergens and others (2003)
performed using a system such as the canine
inflammatory bowel disease activity index (Jergens
and others 2003) (Table 2). A scoring system for Hydrolysed protein diets
pruritus has also been reported and may be helpful Hydrolysed protein diets are generally the most
(Rybnícek and others 2009) (Table 3). The owners effective option for conducting diet trials. Many
can use these scoring systems every four weeks different hydrolysed protein diets are formulated
at home and report to the veterinarian. However, for dogs and cats, available as canned and dry
regular re-examinations (eg, every four to eight varieties. It is important to note that these diets
weeks) are advisable, particularly for skin disease may vary in the degree of protein hydrolysation
where veterinary examination is important to and some diets may contain more than one
assess the clinical response and to check for hydrolysed protein source.
concurrent conditions (eg, infections) that could Children with milk allergies fed extensively
hamper interpretation of the trial. hydrolysed casein containing infant formula
can still trigger a reaction. Similar reactions to
Step 3: challenge with former food the intact protein in hydrolysed diets are also
If the clinical signs improve or resolve after the diet suspected in veterinary medicine. For this reason,
trial, the previous diet should be re-introduced to careful selection of the hydrolysed diet to avoid
see if the signs recur. If the signs worsen with the using a protein source that the animal has reacted
challenge, a food allergy is likely to be confirmed. In to in the past when fed intact (ie, not hydrolysed)
one study of dogs with cutaneous clinical signs, 23.9 is important.
per cent developed pruritus within three to six hours
and 60.9 per cent within 12 hours of food challenge
(Shimakura and Kawano 2021). The elimination diet
is then fed again until the signs resolve; in cases with Table 3: Pruritus scale*
cutaneous clinical signs, it is sometimes necessary Severity Description
to provide a short course of anti-inflammatory
medication to induce remission again. Extremely severe itching/almost Itching doesn’t stop no matter what is
continuous happening, even in the consulting room
(needs to be physically restrained from
Step 4: provocation testing itching)
Once the clinical signs improve again with re-
Severe itching/prolonged Itching might occur at night (if observed)
feeding of the elimination diet, provocation testing episodes and also when eating, playing, exercising or
can be performed using one food ingredient at being distracted
a time to determine the particular source of the
Moderate itching/regular episodes Itching might occur at night (if observed), but
AFR. For this, a single ingredient is fed for one not when eating, playing, exercising or being
to two weeks to monitor for recurrence of signs; distracted
it is best to use human food rather than animal
Mild itching/a bit more frequent Doesn’t itch when sleeping, eating, playing,
foods which can sometimes contain undisclosed exercising or being distracted
food ingredients. This is ideally performed using
Very mild itching/only occasional The dog is slightly more itchy than before the
a double-blind method but this is not practical in
episodes skin problem started
veterinary medicine.
Normal dog Itching isn’t a problem
Diet options for diet trials These descriptions are used to measure the severity of itching in dogs. Itching can include scratching, biting,
There are a few diet types available to perform diet licking, chewing, nibbling or rubbing
*Adapted from Rybnícek and others (2009)
trials and also to manage AFRs in the long term.

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Companion animals
Single protein diets
Many single protein commercial diets are also
available for diet trials. However, due to the
extensive diet histories of some dogs and cats,
identifying a novel protein option may not be
easy nor always possible. The use of BEG (ie,
boutique, exotic and grain-free) ingredient diets
have been implicated in the development of dilated
cardiomyopathy in dogs (Freeman and others
2018). In addition to this, some caution should be
exercised when selecting a diet because non-listed
proteins have been found in some commercial
single protein diets (Ricci and others 2013).
Insect protein diets have been investigated as an
ecologically sound alternative to meat-based diets
to manage AFRs (Böhm and others 2018).
Home-cooked diets
Some clinicians prefer using home-cooked diets
for exclusion trials because these do not contain
additives and are cooked at lower temperatures
(thus are less likely to contain de novo antigens
formed in high temperatures). Short-term feeding
(eg, one to three weeks) of an unbalanced home-
cooked diet is unlikely to be detrimental in most
animals; however, for long-term feeding home-
cooked diets should be nutritionally balanced.
In recent years, the feeding of raw diets has
become increasingly popular among pet owners.
The advocates of these diets claim good outcomes
with skin and gut disease; however, there are no
clinical studies to support this. On the contrary,
there are several concerns with regard to raw diets
and the risk of infection (both to the animal eating
the diet and to the people living in the house).
For these reasons, feeding of raw diets to manage
suspected AFRs cannot be recommended.
Diagnostic tests with no proven clinical utility
Serum testing
The International Committee for Allergic Diseases
in Animals advise against using serum tests to
diagnose AFR (Olivry and others 2015).
Serum testing involves submitting a blood
sample for measurement of antibodies to food
allergens. These tests usually measure food-
specific IgE, but some also report IgG. There have
been a number of studies investigating the utility
of these tests in dogs with skin and gastrointestinal
disease and all have concluded that these tests
cannot be used for the diagnosis of AFR.
Recent advances in serological testing
for canine gluten sensitivity have led to the
development of specific blood tests (similar
to those used in people) for this condition
(ie, anti-canine gliadin IgG and anti-canine
transglutaminase-2-IgA). Although a promising
development, the clinical utility of these tests are
yet to be fully elucidated.
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Intradermal testing
This involves injecting small amounts of allergen
into the dermis. In an allergic dog, IgE is present
on the surface of mast cells and binding of allergen
cross-links IgE and triggers degranulation in a
type 1 hypersensitivity reaction. The resulting
wheal and flare is then measured to determine
if the result is ‘positive’. Cell-mediated/delayed
reactions can also be assessed after 24 to 48 hours.
Intradermal testing is more commonly performed
to detect sensitisation to environmental allergens
in atopic dermatitis and there have only been a
few, relatively old, studies looking at this testing
for AFR (Jeffers and others 1991, Kunkle and
Horner 1992). Based on the available evidence,
intradermal testing is not recommended for the
diagnosis of AFR.
Patch testing
This involves placing foods directly in contact with
the skin surface for 48 hours. The areas of skin
are then assessed for the degree of inflammation.
Two studies have looked at patch testing with
food antigens in dogs in an experimental setting
(Bethlehem and others 2012, Johansen and others
2017). Both studies concluded that patch testing
cannot be used for the diagnosis of AFR.
Saliva testing
This measures food-specific IgA and IgM in the
saliva. One study showed no clear difference in
the numbers of positive reactions between healthy
control dogs and allergic dogs (Udraite Vovk and
others 2019). This testing is not recommended for
the diagnosis of AFR.
Hair testing
This is offered by some companies online and
the tests use undefined methodology and are not
validated. One study assessed hair testing offered
by one such company by sending multiple samples
of hair (and saliva) from an allergic dog, a normal
dog and a stuffed toy for analysis (Coyner and
Schick 2019). The test results were similar from all
specimens, including the stuffed toy and the test-
retest reproducibility was poor to slight. This testing
is not recommended for the diagnosis of AFR.
Gastroscopy and colonoscopy
Gastroscopic and colonoscopic testing is where a
food antigen is applied directly onto the gastric
and colonic mucosa, respectively, via endoscopy
to see if a reaction occurs. These tests have been
investigated in a few old studies (Vaden and others
2000, Allenspach and others 2006) but are not
considered useful for the diagnosis of AFR.
Long-term management of AFR
Many dogs and cats that develop AFRs are juvenile.
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This has important nutritional implications
because diets fed to growing puppies and kittens
have specific requirements to support growth. For
this reason, when investigating or managing AFRs
in juvenile animals, a diet suitable for both growth
and the suspected AFR is necessary. Some of the
commercial hydrolysed and single protein diets
are balanced for growth but this should be verified
with the manufacturer.
Once the cause of the AFR has been identified
using a strict and complete diet trial, long-term
feeding of a diet avoiding this ingredient can be
implemented. With multiple allergens this can be
more problematic, particularly with commonly
used ingredients found in pet food. In addition to
this, various types of foods within groups may also
be allergenic (eg, fish from several species).
Sometimes long-term (potentially life-long)
feeding of a hydrolysed protein or novel protein
diet is undertaken due to a concern that deviating
from this could lead to recurrence of the clinical
signs. Although there are no nutritional concerns
about feeding such diets in the long term, the cost
of this approach may become prohibitive. Boredom
with the diet may also lead to deviation from this
diet. In young animals, recovery from AFRs is
possible (nearly 90 per cent of children with food
allergies are able to tolerate the allergen by three
years of age), so monitoring for the persistence of
AFR is advisable.
Summary
AFRs are an important consideration in the
diagnostic investigation of dogs and cats
presenting with skin and gut disease. In addition,
AFRs can present with a number of other rarer
clinical signs which clinicians should be aware of.
Diagnosis relies on a carefully performed dietary
trial which can be time consuming and difficult for
owners. However, if the diagnosis can be made,
and an appropriate diet identified, the long-term
prognosis should be very good.
References
ALLENSPACH, K., CULVERWELL, C. & CHAN, D. (2016) Long-term
outcome in dogs with chronic enteropathies: 203 cases. Veterinary
Record 178, doi: 10.1136/vr.103557
ALLENSPACH, K., VADEN, S. L., HARRIS, T. S., GRONE, A., DOHERR, M.
G., GRIOT-WENK, M. E. & OTHERS (2006) Evaluation of colonoscopic
allergen provocation as a diagnostic tool in dogs with proven food
hypersensitivity reactions. Journal of Small Animal Practice 47,
21–26
BETHLEHEM, S., BEXLEY, J. & MUELLER, R. S. (2012) Patch testing
and allergen-specific serum IgE and IgG antibodies in the diagnosis
of canine adverse food reactions. Veterinary Immunology and
Immunopathology 145, 582–589
BÖHM, T. M. S. A., KLINGER, C. J., GEDON, N., UDRAITE, L.,
HILTENKAMP, A. & MUELLER, R. S. (2018) Effect of an insect
protein-based diet on clinical signs with dogs with cutaneous
IN PRACTICE | May 2022
Hardy.indd 203
20427689, 2022, 4, Downloaded from https://bvajournals.onlinelibrary.wiley.com/doi/10.1002/inpr.197 by Univ of California Lawrence Berkeley National Lab, Wiley Online Library on [01/04/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Companion animals
adverse food reactions. Tierarztliche Praxis Ausgabe K: Kleintiere
Heimtiere 46, 297–302
COYNER, K. & SCHICK, A. (2019) Hair and saliva test fails to identify
allergies in dogs. Journal of Small Animal Practice 60, 121–125
FREEMAN, L. M., STERN, J. A., FRIES, R., ADIN, D. B. & RUSH, J. E.
(2018) Diet-associated dilated cardiomyopathy in dogs: what do
we know? Journal of the American Veterinary Medical Association
253, 1390–1394
HALL, E. J., CARTER, S. D., BARNES, A. & BATT, R. M. (1992) Immune
responses to dietary antigens in gluten-sensitive enteropathy of
Irish Setters. Research in Veterinary Science 53, 293–299
HOBI, S., LINEK, M., MARIGNAC, G., OLIVRY, T., BECO, L., NETT, C.
& OTHERS (2011) Clinical characteristics and causes of pruritus
in cats: a multicentre study on feline hypersensitivity-associated
dermatoses. Veterinary Dermatology 22, 406–413
JEFFERS, J. G., SHANLEY, K. J. & MEYER, E. K. (1991) Diagnostic
testing of dogs for food hypersensitivity. Journal of the American
Veterinary Medical Association 198, 245–250
JERGENS, A. E., SCHREINER, C. A., FRANK, D. E., NIYO, Y., AHRENS, F.
E., ECKERSALL, P. D. & OTHERS (2003) A scoring index for disease
activity in canine inflammatory bowel disease. Journal of Veterinary
Internal Medicine 17, 291–297
JOHANSEN, C., MARIANI, C., MUELLER, R. S. (2017) Evaluation
of canine adverse food reactions by patch testing with single
proteins, single carbohydrates and commercial foods. Veterinary
Dermatology 28, 473–e109
KUNKLE, G. & HORNER, S. (1992) Validity of skin testing for
diagnosis of food allergy in dogs. Journal of the American Veterinary
Medical Association 200, 677–680
LOWRIE, M., GARDEN, O. A., HADJIVASSILIOU, M., HARVEY, R. J.,
SANDERS, D. S., POWELL, R. & GAROSI, L. (2015) The clinical
and serological effect of a gluten-free diet in border terriers with
epileptoid cramping syndrome. Journal of Veterinary Internal
Medicine 29, 1564–1568
OLIVRY, T., DEBOER, D. J., FAVROT, C., JACKSON, H. A., MUELLER, R.
S., NUTTALL, T. & PRELAUD, P. (2015) Treatment of canine atopic
dermatitis: 2015 updated guidelines from the International
Committee on Allergic Diseases of Animals (ICADA). BMC Veterinary
Research 11, 210
OLIVRY, T. & MUELLER, R. S. (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
OLIVRY, T. & MUELLER, R. S. (2019) Critically appraised topic
on adverse food reactions (7): signalment and cutaneous
manifestations of dogs and cats with adverse food reactions. BMC
Veterinary Research 15, 140
PAINTER, M. R., TAPP, T. & PAINTER, J. (2019) Use of the Health
Belief Model to identify factors associated with owner adherence
to elimination diet trial recommendations in dogs. Journal of the
American Veterinary Medical Association 255, 446–453
RICCI, R., GRANATO, A., VASCELLARI, M., BOSCARATO, M.,
PALAGIANO, C., ANDRIGHETTO, I. & OTHERS (2013) Identification
of undeclared sources of animal origin in canine dry foods used in
dietary elimination trials. Journal of Animal Nutrition and Animal
Physiology 97, 32–38
RYBNÍCEK, J., LAU-GILLARD, P. J., HARVEY, R. & HILL, P. B. (2009)
Further validation of a pruritus severity scale for use in dogs.
Veterinary Dermatology 20, 115–122
SHIMAKURA, H. & KAWANO, K. (2021) Results of food challenge
in dogs with cutaneous adverse food reactions. Veterinary
Dermatology 32, doi: 10.1111/vde.12953
UDRAITE VOVK, L., WATSON, A., DODDS, W. J., KLINGER, C. J.,
CLASSEN, J. & MUELLER, R. S. (2019) Testing for food-specific
antibodies in saliva and blood of food allergic and healthy dogs.
Veterinary Journal 245, 1–6
VADEN, S. L., HAMMERBERG, B., DAVENPORT, D. J., ORTON,
S. M., TROGDON, M. M., MELGAREJO, L. T. & OTHERS (2000) Food
hypersensitivity reactions in soft-coated wheaten terriers with
protein-losing enteropathy or protein-losing nephropathy or both:
gastroscopic food sensitivity testing, dietary provocation, and fecal
immunoglobulin E. Journal of Veterinary Internal Medicine 14,
60–67
VOLKMANN, M., STEINER, J. M., FOSGATE, G. T., ZENTEC, J.,
HARTMANN, S. & KOHN, B. (2017) Chronic diarrhoea in dogs – a
retrospective study of 136 cases. Journal of Veterinary Internal
Medicine 31, 1043–1055
203
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