Allergies- What is the Veterinary Nurse’s Role?

Clients complaining about their pet itching while the family loses sleep?

Skin disorders, including allergic skin disease, are a common reason owners bring their pets to the vet. Allergies in pets affect quality of life for not only the pet, but the pet owners as well – impacting the human-animal bond. Pruritic (itchy) pets are often uncomfortable, leaving owners to determine the reason for the itching and what can be done to stop the itch. Common skin allergies diagnosed in dogs and cats are fleas, atopy (environmental allergies), and food.1

Allergens in the environment

Common allergens that our pets are allergic to our dust mites, mould and pollens and many are ubiquitous in the environment. Atopy is an inherited disorder caused by a dermal barrier defect. Allergens penetrate the skin, which subsequently stimulates the immune system. This immunologic response results in the release of inflammatory mediators and causes an inflammatory cascade which tends to worsen each subsequent season.

Diagnosis for atopy can be complex and involves eliminating other conditions with similar symptoms. It is important to ensure appropriate control for external parasites is used, and potentially food elimination trials may need to be done. The nutritional history is of utmost importance when diagnosing and managing atopy and the veterinary nurse leads this history taking.

Adverse reactions to food (AFR)

Adverse reactions to food are not easy to diagnose as they frequently imitate other, more common  allergic diseases such as atopy. An adverse reaction to food is an abnormal response to an ingested food or food additive. Adverse food reactions typically occur as non-seasonal pruritic dermatitis, occasionally accompanied by gastrointestinal signs. In dogs, adverse reactions to food make up around 10-20% of allergic skin disease in dogs and is conceivably as common as atopic dermatitis in cats. 5

A complete nutritional history by the veterinary nurse should determine the quality and adequacy of the food being fed to the pet, the feeding protocol, and a thorough history of the types of foods fed, including access to treats, supplements, and/or other foods (including another pet’s food). Ask open ended questions to stimulate conversation with the owner. A proper nutritional history for suspected derm cases will result in uncovering the following:

• Specific foods pet ingests
• Commercial snacks or treats
• Supplements
• Chewable medications
• Chew toys
• Human foods
• Access to other sources of food
• Other pets in the home

Nutritional history – The Nurse’s Role

The pet owner should maintain a diary for several weeks prior to the visit and document the types of food and other items the pet ingests daily. The patient’s nutritional history should be reviewed carefully for allergens or ingredients believed to be commonly associated with or at risk of exacerbating skin disorders.

The nutritional status of the animal will affect the health of the skin and veterinary nurses are responsible for educating owners regarding how this happens and what nutrients are involved.

Nutrition plays a primary role in the management and treatment of skin disorders and research has demonstrated that the use of dietary fatty acids, antioxidants, novel proteins, and hydrolysed proteins are beneficial in the management of inflammatory skin diseases and adverse food reactions. 

She has authored many articles, textbooks, and textbook chapters and is an internationally invited speaker, focusing on topics of nutrition, leadership, and technician utilization. Kara and her wife Dr. Ellen Lowery developed the Pet Nutrition Coach Certification course through NAVC. 

Ms. Burns has been featured on the cover of the Veterinary Technician Journal and the NAVTA Journal and most recently has been featured in PetVet Magazine.  She was named the North American Veterinary Conference Technician Speaker of the Year in 2013 and in 2016. She was granted an honorary VTS (Internal Medicine) in 2011. She was also granted an honorary VTS (Dentistry) in 2012.  She is the 2010 NAVTA Veterinary Technician of the Year, as well as the 2011 Dr. Franklin Loew Lecturer.  Kara has also been named the National Association of Professional Women ‘Woman of the Year’ for 2010-2011 and the Cambridge Who’s Who in Professionals V.I.P. for 2010-2011. She was accepted into the International Women’s Leadership Association in 2012.

References

1. Burns, KM. Nutrition and Adverse Reactions to Food. The NAVTA Journal. February/March, 2019. Pp. 25-29
2. Ograin V, Burns KM. Nutritional Considerations in Allergic Skin Disease. The NAVTA Journal, Convention Issue. 2016. Pp. 12 – 16.
3. Olivry T, Deboer D, et al. Treatment of Canine Atopic Dermatitis: 2010 Clinical Practice Guidelines from the International Task Force on Canine Atopic Dermatitis. Vet Dermatol. 2010: 21:233-248. 
4. Inman AO, Olivry T, Dunston, SM, et al.: Electron microscopic observations of stratum corneum intercellular lipids in normal and atopic dogs. Vet Pathol. 38(6), 2001, 720–723.
5. Hillier A, Griffin CE. The ACVD task force on canine atopic dermatitis (I): incidence and prevalence. Vet Immunol Immunopathol. 2001;81(3–4):147–51.
6. Wortinger A, Burns KM. Dermatology. In Nutrition and Disease Management for Veterinary Technicians and Nurses, 2nd ed. 2015. Wiley-Blackwell. Ames, IA.
7. MacLeay JM. Let’s Make Itching Ancient History: Innovation in Nutritional Management of Atopic Dermatitis and Food Allergies in Dogs. Proceedings of the Hill’s Global Symposium, 2021. Pp. 27-30
8. Weemhoff et al, Successful nutritional control of scratching and clinical signs associated with adverse food reaction: A randomized controlled COSCAD’18 adherent clinical trial in dogs in the UK. JVIM 2021 35(4) 1893-1901
9. Hill’s Data on File, 2020. Clinical nutrition for the management of dogs with environmental sensitivities