Plus-Hex CLINICAL
Assessing compliance
Is it important to assess compliance with the diet trial before making a final decision as to whether a patient has a food allergy or not. Making sure that owners have adhered to the diet and have not been feeding treats or allowing their pet access to other food sources, and making sure the topical medications have been appropriately applied, are incredibly important to assess the validity of the trial. Diet trials can always be repeated if there are any doubts.
Conclusions
Elimination-provocation diet trials remain the current best practice for diagnosing CAFR, but their success depends on far more than simply selecting an appropriate diet. Careful patient selection, appropriate timing, thorough owner education, meticulous attention to potential sources of dietary contamination and systematic interpretation of each phase of the trial are all essential to achieving a reliable diagnosis. Regular monitoring by the veterinary team helps to identify secondary infections and other confounding factors that could invalidate the results, while maintaining owner engagement throughout what can be a lengthy process. Although diet trials require considerable commitment from both veterinary professionals and owners, a wellplanned and carefully managed approach can result in a confident diagnosis or exclusion of a food allergy. This can enable long-term dietary management where appropriate and reduces unnecessary medication, treatment costs and the impact of chronic allergic disease on both patients and their owners.
Assessment of learning
1. When should a diet trial be commenced? a) When the patient is having a flare b) When the patient is in remission
2. When should medications be withdrawn during a trial?
a) They should not be withdrawn b) After at least 4 weeks if the patient is doing well
3. Which medications are more useful during a diet trial?
a) Oral steroids and oclacitinib b) Injectable steroids and lokivetmab
4. When is a food allergy diagnosed at the end of the trial?
a) If a patient flares upon provocation
1. b) When the patient is in remission 2. b) After at least 4 weeks if the patient is doing well 3. a) Oral steroids and oclacitinib 4. a) If a patient flares upon provocation
REFERENCES
Answers
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11 Souza CP, Rosychuk RAW, Contreras ET, Schissler JR, Simpson AC. A retrospective analysis of the use of lokivetmab in the management of allergic pruritus in a referral population of 135 dogs in the western USA. Veterinary Dermatology. 2018; 29( 6): 489 – e164. Available from: https:// doi. org / 10.1111 / vde. 12682. b) If a patient flares when their medication is reduced
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