Dermatologic Food Reactions in Cats
While the pathogenesis of dermatologic food reactions is not fully understood, immediate reactions and delayed reactions to food are thought to be due to a hypersensitive immune response. Dermatologic food reactions are non-seasonal reactions which occur following ingestion of one or more allergy causing substances in an animal’s food. The physical reaction is frequently excessive itchiness, with resultant excessive scratching at the skin.
On the other hand, food intolerance is a non-immunologic idiosyncratic reaction due to the metabolic, toxic or pharmacologic effects of the offending ingredients. Since it is not easy to distinguish between immunologic and idiosyncratic reactions, any negative response to food is generally referred to as an adverse food reaction.
Symptoms and Types
- Non-seasonal itchiness of any body location
- Poor response to anti-inflammatory doses of glucocorticoids suggests food hypersensitivity
- Excessive gut sounds, passing of gas, and frequent bowel movements
- Malassezia dermatitis (fungal skin infections), pyoderma (bacterial skin infections), and otitis externa (inflammation of the outer ear)
- Plaque – broad, raised flat areas on the skin
- Pustule – pus-containing raised skin inflammation
- Erythema – redness of the skin
- Crust – dried serum or pus on the surface of a ruptured blister or pustule
- Scale – flakes or plates of dead skin
- Self-induced baldness due to scratching
- Abrasion/sores on the skin due to scratching
- Leathery, thick, bark-like skin
- Hyperpigmentation – darkening of the skin
- Hives – swollen or inflamed bumps on the skin
- Giant wheals (elongated marks) on the skin
- Pyotraumatic dermatitis – bacterial infection of skin wounds due to scratching excessively
- Immune-mediated reactions – result of the ingestion and subsequent presentation of one or more glycoproteins (allergens) either before or after digestion; sensitization may occur as the food passes into the intestine, after the substance is absorbed, or both
- Non-immune (food intolerance) reactions – resulting from ingestion of foods with high levels of histamine (an antigen known to cause immune hypersensitivity) or substances that induce histamine either directly or through histamine-releasing factors
- It is speculated that in juvenile animals intestinal parasites or intestinal infections may cause damage to the intestinal mucosa, resulting in the abnormal absorption of allergens and subsequent sensitization to some ingredients
Your veterinarian will perform a complete physical exam on your cat, including a dermatological exam. Non-food causes of dermatologic disease should be ruled out. Your veterinarian will order a blood chemical profile, a complete blood count, a urinalysis and an electrolyte panel to rule out other causes of disease. You will need to give a thorough history of your cat's health, onset of symptoms, and possible incidents that might have preceded this condition, especially regarding any changes in diet, and any new foods added to your cat's diet, even if temporary.
Food elimination diets are advised for cats thought to be suffering from adverse food reactions. These diets typically include one protein source and one carbohydrate source to which the cat has had limited or no previous exposure to. A clinical improvement may be seen as soon as four weeks into the new diet, and maximum alleviation of clinical signs may be seen as late as thirteen weeks into the food elimination diet.
There are two things to keep in mind when undertaking the elimination diet with your cat: cats require a source for taurine in their diets or they will become quickly and extremely ill and die. Your cat will ingest sufficient quantities of taurine as long as it is being fed meat; and, cats do not naturally have the digestive capabilities to handle a large amount of carbohydrates, so the protein in their diet should outweigh the carbohydrate by about 90 percent. Choose a protein source that is high in taurine, such as meat, chicken, or fish. Avoid raw meats, as they can be a source of other bacteria, such as salmonella. Some suggested animal meats that may be fed to your cat are organ meats such as the liver, heart, etc.
If your cat improves on the elimination diet, a challenge should be performed to confirm that the original diet was the cause of disease and to determine what ingredient in the original diet triggered the adverse reaction.
Challenge: feed your cat with the original diet. A return of the signs confirms that something in the diet is causing the signs. The challenge period should last until the signs return but no longer than ten days.
If the challenge confirms the presence of an adverse food reaction, the next step is to perform a provocation diet trial: going back to the elimination diet, begin by adding a single ingredient at a time to the diet. After waiting a sufficient amount of time for the ingredient to prove either agreeable or adverse, if there is no physical reaction, move on to adding the next ingredient to your cat's diet, again, keeping in mind that your cat need always have a source of taurine in its diet. The provocation period for each new ingredient should last up to ten days, less if signs develop sooner. Should symptoms of an adverse reaction develop, discontinue the last added ingredient and wait for the symptoms to subside before moving forward to the next ingredient.
The test ingredients for the provocation trials should include a full range of meats (beef, chicken, fish, pork, and lamb), a minimal but full range of grains (corn, wheat, soybean, and rice), eggs, and dairy products. The results of these trials will guide your selection of commercial foods, based on those prepared foods that do not contain the offending substance(s).
Avoid any food substances that caused the clinical signs to return during the provocation phase of the diagnosis. Antibiotics or antifungal medications may be prescribed by your veterinarian if secondary pyodermas or Malassezia infections occur.
Living and Management
Treats, chewable toys, vitamins, and other chewable medications (e.g., heartworm preventive) that may contain ingredients from your cat's previous diet must be eliminated. Make sure to read all ingredient labels carefully. If your cat spends time outdoors you will need to create a confined area to prevent foraging and hunting, or you may need to consider keeping your cat indoors, at least during the trial period. All family members will need to be made aware of the test protocol and must help keep the test diet clean and free of any other food sources. Cooperation is essential to the successful treatment of this disorder.