Allergy basics 2014
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Transcript of Allergy basics 2014
Allergy BasicsAllergy Basics
Body’s Misidentification:
− Pollens
− Molds
− Food Proteins
WHAT IS AN ALLERGY?
Th
resho
ldT
hresh
old
Itchy!! Not itchy…
WHAT IS THRESHOLD?
5 different types of Allergic Reactions, 1 – 4.
TYPES OF ALLERGIC REACTIONS
Serum/Blood
Intradermal/Skin
TYPES OF DIAGNOSTIC TESTING
INTRADERMAL TESTING
SERUM BASED TESTING
Benefits:
– No steroid/antihistamine withdrawal for testing
– Simple blood draw
– Non-invasive
– Numeric values rather than visual confirmation
Workup to Rule out Other Issues
Allergy Testing Methodology & Preparation
Change Diet based on Allergy Results
Hyposensitization
Reasons for Poor Response
MANAGEMENT OF ALLERGY CASES
WORK UP TO RULE OUT OTHER ISSUES
Complete dermatological work-up such as:
– Scabies / Parasite Infections.
– Malassezia / Yeast Infections.
– Bacterial Infections.
– Endocrinology disease (Cortisol test).
– Thyroid disease (T4/T5 test).
DIAGNOSTIC CRITERIA FOR TESTING
by T. Willemse Primary Features:
− Pruritus
− Facial and/or digital involvement
− Hardening/crusting of sores
− Chronically-relapsing dermatitis
− Individual or family history
− Breed predisposition
DIAGNOSTIC CRITERIA FOR TESTING
by T. Willemse Secondary Features:
− Onset of signs before 3 years of age.
− Generalized dry skin.
− Superficial staphylococcal infection.
− Cutaneous Malassezia infection.
− Bilateral external otitis.
− Facial erythema.
Workup to Rule out Other Issues
Allergy Testing Methodology & Prep
Change Diet based on Allergy Results
Hyposensitization
Reasons for Poor Response
MANAGEMENT OF ALLERGY CASES
SERUM BASED TESTING
REGION SPECIFIC PANELS
− Alaska− California− Great Plains− Hawaii− Mid Atlantic− Midwest− North East− North West− Rocky Mountain− South East− South Florida− South West
CALIFORNIA PANEL SPECIFICS
SUBMITTING A SAMPLE
3 – 5 ml of serum
Absolute minimum - 1.5 ml.
Order & History Form
Pre-paid FedEx mailers provided
Within 48 hours of the samples receipt, the results are e-mailed/faxed to the ordering Veterinarian
INTERPRETING RESULTS
INTERPRETING RESULTS
SERUMSERUM - measures the strength of the reaction between the - measures the strength of the reaction between the specific IgE antibody and the allergen.specific IgE antibody and the allergen.
SKINSKIN - measures the immediate reaction caused by the - measures the immediate reaction caused by the degranulation of the Mast Cells.degranulation of the Mast Cells.
SERUM VS SKIN TESTING
Update on Atopic Dermatitis & Secondary Infections - 2006
Stephen D. White, DVM Professor, University of California at Davis:
“There is a great deal of controversy over which is more accurate, intradermal skin testing or serological tests. In 3 studies, at University of California at Davis,
Colorado State University and Gifu University (Japan), involving a combination of over 250 dogs, the number of positive responses to
hyposensitization were similar regardless of whether the hyposensitization solutions were based on Intradermal Skin Testing results or ELISA tests”.
TYPES OF ALLERGY TREATMENT
AVOIDANCEAVOIDANCE – ideal but not always possible. – ideal but not always possible.
HYPOSENSITIZATIONHYPOSENSITIZATION – increases tolerance to antigens, – increases tolerance to antigens,
Workup to Rule out Other Issues
Allergy Testing Methodology & Preparation
Change Diet based on Allergy Results
Hyposensitization
Reasons for Poor Response
MANAGEMENT OF ALLERGY CASES
WHY FOOD ALLERGY TESTING?
IDENTIFYING ADVERSE FOOD REACTIONS
ELIMINATION DIETSELIMINATION DIETS – 6-8 weeks, results vary, difficult to – 6-8 weeks, results vary, difficult to correlate clinical symptoms & diet. correlate clinical symptoms & diet.
BLOOD TESTINGBLOOD TESTING – identifies presence of protein specific IgE, – identifies presence of protein specific IgE, use as a basis to start diet modification. Over 200 different use as a basis to start diet modification. Over 200 different food and treat manufacturers included.food and treat manufacturers included.
HOW PREVALENT ARE FOOD ALLERGIES?
Up to 10% of allergic disease is food protein based (Scott, 1978).
Up to 23% in non-seasonal allergic skin disease is food protein based (Reedy and Miller, 1989).
True prevalence is not known (Hall, 1994) but it is much greater than dermatological signs.
Clinical signs of an allergic response may only become apparent when some arbitrary threshold of immunological activity is exceed (Brostoff and Hall, 1996).
PROBLEMATIC FOODS
Most protein based foods are potentially allergenic
Base molecule must be:– 18,000 – 30,000 Daltons– Heat resistant– Stable to hydrolysis
PROBLEMATIC FOODS
Workup to Rule out Other Issues
Allergy Testing Methodology & Preparation
Change Diet based on Allergy Results
Hyposensitization
Reasons for Poor Response
MANAGEMENT OF ALLERGY CASES
HYPOSENSITIZATION TREATMENT
Time/Dosage
Concentration
IgG
IgEThreshold
TREATMENT SETS
Patient Specific – No Stock Formulas
Treat all Positive reactions – Except foods/Staph
3 vials – increasing concentration Green – Vial A Blue – Vial B Red – Vial C
Up to 20 allergens in a single set*
HYPOSENSITIZATION PROTCOL
EFFECTIVENESS OF TREATMENT
What is Success?
Volume of Testing to Date
Results - 2,463 patients
Diet change alone: 48% improvement. Hyposensitization only: 67% improvement. Diet change & Hyposensitization: 85% improvement
WHY A 91 ANTIGEN PANEL?
30 Allergens 45%
50 Allergens 55%
70 Allergens 70%
91 Allergens 85%
TECHNICAL SUPPORT DURING TREATMENT
Worsening of symptoms returns.
Why? Hyposensitization too aggressive for the particular animal’s immune system.
Successfully handled by an adjustment to the hyposensitization schedule.
Workup to Rule out Other Issues
Allergy Testing Methodology & Preparation
Change Diet based on Allergy Results
Hyposensitization
Reasons for Poor Response
MANAGEMENT OF ALLERGY CASES
REASONS FOR POOR RESPONSE
1. Poor owner compliance
2. Age of animal
3. Failure to treat other illnesses prior to testing
4. Suppressed immune system
HOW TO ORDER TREATMENTS/REFILLS
• Contact Spectrum– Order online– Fax back reminder card – Call toll-free number
• Delivery within 7-10 days
• Statement at E.O.M.
THE SPECTRUM ADVANTAGE
1. Increased services/care to existing client base.
2. Test for more-including foods; lower price.
3. No need to wean of steroids.
4. No need to sedate/shave animal.
5. Blood draw isn’t painful.
6. List of approved foods provided.
7. More comforting to the pet and owner.
8. Same technology used by Veterinary Dermatologist.
9. Competitor Retest provided at no charge.
Questions?
