DOG WITH PRURITUS

Dog with Pruritus

Rebecca England
VETE 4323 Nutrition and Care
Tarleton State University

DOG WITH PRURITUS

Roman is a 2-year-old male-neutered Labrador Retriever. He was brought into the clinic
today by his owner. He feels that Roman is itchy, as he has been chewing on his feet and rubbing
his face on the carpet every day for the last 5 months. The owner has attempted to fix this issue at
home before bringing Roman to the clinic. He has tried multiple coat shampoos and conditioners
and has also treated for fleas. None of these things have given Roman any relief; although, the
itchiness has not become any worse over this period of time. His physical exam is detailed below.
Physical exam findings:
General appearance: Abnormal, see skin/coat
Skin/coat: Mild alopecia and erythema on face and front paws
Ears: Reddened
All other body systems were found to be within normal limits.
After Romans physical exam is finished, he is diagnosed with food allergies. There are
several technician evaluations that could be associated with food allergies. Examples include
impaired tissue integrity, risk of infection, and self-inflicted injury (Rockett, 2009).
Another common name for an allergic reaction is a hypersensitivity reaction. Food
allergies are generally considered to be Type-I hypersensitivity reactions. These types of reactions
occur within a very short time-period (minutes) after exposure to an antigen (Sirois, 2004).
Antigens may cause reactions by direct contact, inhalation, ingestion, insect bites or stings, or
injection. For example, proteins in food can be considered antigens. The immunoglobulin
(antibody) IgE is what mediates Type-I hypersensitivity reactions. This reaction occurs on mast
cells that are located in connective tissues, and on mucosal surfaces such as the intestines (Sirois,
2014). When the antigen meets the IgE immunoglobulins, the mast cells release histamine,
serotonin, and leukotrienes. All of these factors cause inflammatory changes in the body (Sirois,
2004). Type-I hypersensitivity reactions can be mild to severe. Severity can depend on multiple
components including the location and number of mast cells stimulated, the route of exposure,
and the type of antigen present (Sirois, 2004). A common mild reaction may include urticaria
(hives) or diarrhea. A severe reaction may be acute anaphylaxis, in which hypotension,

DOG WITH PRURITUS

pulmonary edema, and collapse may occur. If a severe reaction occurs, it may be due to major
exposure to a particular antigen (Sirois, 2004).
There are several common clinical signs that are associated with food allergies in dogs.
These include (Case, 2011):
1.
2.
3.
4.
5.
6.
7.
8.

Intense pruritis on feet, axillae, and inguinal area

Self-induced skin trauma (i.e. licking or chewing)
Chronic skin inflammation
Papular eruptions
Hair loss
Hyperpigmentation and scaling of the skin
Otitis externa (inflammation of the ear canals)
Vomiting and diarrhea

Some dogs that have these clinical signs may need to be prescribed antibiotics because a
secondary bacterial infection is present or very likely to occur. With the exception of vomiting
and diarrhea, the other clinical signs listed above can lead to infection if not resolved quickly.
Oftentimes, food hypersensitivity reactions are chronic, which is why infection can be difficult to
resolve or keep from recurring; and as long as the offending antigen is there, it may not resolve.
Patients with intense pruritis also cant help but lick, chew, and rub their skin (as in Romans
case). Self-trauma that cant be controlled can cause such damage to the skin in which infection
can be easily established. In addition to antibiotics to clear infection and heal the skin, it may be
necessary to use other medications such as steroids or relieving topicals to assist in the
management of the itch-scratch cycle until the pet can get relief with a new food. Also, it may be
beneficial to the pet to use an Elizabethan collar and socks or boots on the feet so the ability to
self-traumatize the skin is minimal or further prevented.
The most common food allergens in dogs and cats are beef, soy, and dairy products;
however, they can develop adverse reactions to other sources such as wheat, pork, chicken, corn,
egg, fish, and others (Case, 2011).
There are 2 major types of diets that can be fed to dogs with food allergies: a novel
nutrient based diet or a hydrolyzed protein based diet. Commercial dog food companies such as

DOG WITH PRURITUS

Royal Canin and Hills have several diets available that may be appropriate for a dog with food
allergies. A novel nutrient based diet is one that contains a single protein and a single
carbohydrate that a pet has not been previously exposed to (fed). The idea is that the body will
not recognize those particular ingredients, and in doing this, it is hopeful that any food-related
hypersensitivity reactions will be reduced or eliminated altogether. Common novel proteins and
carbohydrates used in homemade elimination diets include lamb, rabbit, venison, tofu, rice, and
potatoes (Case, 2011). These, among others, can be used as long as the pet has not been
previously exposed, as mentioned prior. In contrast, a hydrolyzed protein based diet does not
necessarily change the types of proteins present in the food. This diet includes proteins which
have been reduced in size by a process called enzymatic hydrolysis. Doing this reduces or
eliminates the ability of a protein to cause a reaction (Case, 2011). However, if a patient is
known to be sensitive to a particular protein or carbohydrate, those ingredients should be avoided
if at all possible (Case, 2011). Common nutrient sources in hydrolyzed diets include soy, chicken,
casein, and liver (Case, 2011).
The Royal Canin food sensitivity product line offers numerous choices. The hydrolyzed
protein formulas state that they support dogs with food sensitivities through (Royal Canin, 2015):
1.
2.
3.
4.
5.

Hydrolyzed soy protein

High digestibility
Vitamin B and amino acids for the skins natural barrier
Long-chain fatty acids, EPA and DHA to promote healthy skin and coat
High quality ingredients

The selected protein diets state that they support dogs with food sensitivities through (Royal
Canin, 2015):
1.
2.
3.
4.

Protein sources that are rarely associated with food sensitivity

B vitamins and amino acids for the skins natural barrier
Long-chain fatty acids, EPA and DHA to promote healthy skin and coat
High quality ingredients

The Hills food sensitivity product line offers choices as well. The hydrolyzed protein formula
states that the key benefits are (Hills, 2015):

DOG WITH PRURITUS

1.
2.
3.
4.
5.
6.
7.

Improves digestion and stool quality

Helps eliminate food related causes of skin irritation
Visible improvement in skin and coat
Helps maintain a healthy skin barrier
Contains highly hydrolyzed protein
Contains a single carbohydrate source
Enriched with essential fatty acids and clinically proven antioxidants

The selected protein diets state that the key benefits are (Hills, 2015):
1.
2.
3.
4.
5.
6.
7.
8.

Improves digestion and stool quality

Visible improvement in skin and coat
Helps maintain a healthy skin barrier
Supports a healthy immune system
Limited ingredient nutrition with a single intact animal protein
Free from soy protein
Gluten-free
High levels of fatty acids and clinically proven antioxidants
The Royal Canin foods that are novel protein based include Canine Selected Protein

Adult PD, PV, PW, and PR. The Royal Canin foods that are hydrolyzed protein based are Canine
Ultamino, Hydrolyzed Protein Adult PS, and Adult HP. There is also a formula for weight control
(moderate calorie) and a formula for small dogs.
The Hills diet that is novel protein based is called d/d. It comes formulated with different
novel protein options. This way there are choices available for a patients needs. The Hills diet
that is hydrolyzed protein based is called z/d.
The main novel proteins and carbohydrates used by these companies include duck,
venison, salmon and other fish, rabbit, and potato. The reason there are so many novel proteins is
because there are so many ingredients used in commercial dog foods today, it is difficult to
formulate an elimination diet that is suitable for every dog (Case, 2011). Due to this wide variety,
some dogs may have had a greater exposure to some proteins than others. This is why a several
novel protein choices need to be available.
There are several things that Romans owner should be educated about in regards to home
care and feeding. If medications are prescribed, they should be given as directed. It is important
to follow the instructions so that Romans condition can improve. If the owner gives more than

DOG WITH PRURITUS

directed, it may cause harmful side effects. On the flip side, if the owner gives less than directed,
it may not be effective at all. It is also important to prevent self-trauma. As discussed previously,
Roman may need to wear an Elizabethan collar so that he doesnt lick and chew on his feet or rub
his face on the carpet. He may also need to apply boots or socks to his feet to limit the effects of
scratching. If these are not tolerated well, a t-shirt may be applied to the trunk of the body. This
may also reduce the effects of scratching. Direct interaction with the dog and the prevention of
boredom may also help lessen the need to scratch. If the mind is focused on something else,
something stimulating or fun, the dog may be less likely to want to scratch.
In regards to feeding Roman, there are several things that the owner should know.
Diagnosing and treating a pet with food allergies is not easy or quick. It can be a complicated task
that takes time, patience, consistency, and commitment. Once an elimination diet has been started,
the pet needs to be fed this food strictly. This means that the pet is not permitted to have any other
sources of food or protein ingredients. This includes table scraps, treats, rawhides or chews of any
kind, or any flavored chewable medications (i.e. heartworm prevention). Even healthy human
foods such as green beans should not be fed. It is important to stick with the elimination diet for
at least 12 weeks, or as directed by the veterinarian, to see if the pet is responding in a positive
manner. Improvement may occur as soon as 3 weeks into the trial, so it is important to watch for
changes of any kind in the pets condition. Once an appropriate diet is found for Roman that
works well, a feeding challenge will need to be performed. By feeding Roman his original food,
this will determine if he truly has a food hypersensitivity. If pruritus occurs within 4 hours to 14
days, the hypersensitivity is confirmed (Case, 2011). The last goal is to identify the ingredients
that are causing the hypersensitivity reaction. To do this, add one ingredient at a time, and assess
the patient for recurring clinical signs. If signs recur, then it is determined that the particular
ingredient is an offender (Case, 2011). Once one ingredient is determined to be an offender, the
other ingredients should still be tested, as more than one ingredient may be causing the
hypersensitivity reaction. The owner should also be aware that an elimination diet is generally

DOG WITH PRURITUS

used long term, and the same one should be used as long the pet tolerates it well and clinical signs
are occurring. If at some point clinical signs do recur, the entire process may need repeated.
There are several steps that need to be taken to prepare a microscope smear of an ear
swab and stain it. The steps should be performed in the following order:
1. The sample obtained with a cotton-tipped applicator needs to be rolled out thinly onto a
microscope slide.
2. The bottom of the slide needs to be heat fixed for a few seconds to ensure that the
material will stay adhered to the slide during the staining process.
3. Generally, a three-step stain is used (Hendrix, 2007). The slide needs to be dipped into
Stain #1 for about 30 seconds. This is also a fixative. The slide then needs to be dipped
into Stain #2 for about 12 seconds, and then rinsed gently with distilled water. Stain #3 is
then used for about 12 seconds, followed by another rinse with distilled water. The slide
should then be allowed to air dry standing up, or patted down gently with bibulous paper
if it is needed to be looked at immediately.
4. In addition, if one is looking for the presence of bacteria, a gram stain should also be
performed.
These steps are all important in the proper preparation of an ear debris slide.
Common microorganisms found in ear swabs include streptococcus (bacteria) and
malassezia (yeast). Under a microscope, this type of bacteria appears as spheres in chain
formation, much like that of a beaded necklace. They may be stained pink-red or blue-purple
depending on the exact species and their characteristics. Other types of bacteria may also be
present. Without a culture or further testing, exact identification is not possible. The yeast
organism, malassezia appears under the microscope like the impression left by footprints in the
snow (if the yeast is budding). This organism generally appears to be stained blue-purple.
Ectoparasites such as mites may also be found on cytology. There are other cells and materials
that are also commonly seen on ear cytology. These include wax, hair, foreign material (i.e.

DOG WITH PRURITUS

plant), neutrophils (white blood cells that indicate infection), red blood cells, and epithelial cells
(skin cells).
With the proper diet, medications, and home care, Roman can become a healthy dog
again. Food allergies can be complicated, but it is possible to find the right solution for him.
Feeding a strict elimination diet is extremely important in identifying the cause or causes of the
hypersensitivity reactions that are occurring. Once the identifying offenders are known, they can
be avoided. Client education and compliance are major factors in the success of treating a dog
with food allergies, and it is extremely important that veterinary professionals provide owners
with the information and help they need to achieve the goals of the patient.

DOG WITH PRURITUS

9
References

Hendrix, C., Sirois, M. (2007). Laboratory Procedures for Veterinary Technicians, 5th ed.
Mosby-Elsevier.
Hills Science Diet Dog Foods Online (2015). Hills Pet Nutrition, Inc.
Retrieved from: http://www.hillspet.com/products/science-diet.html
Rockett and Christensen (2010). Case Studies in Veterinary Technology: A Scenario Based
Critical Thinking Approach. Heyburn, ID: Rockett House Publishing LLC.
Rockett, J., Lattanzio, C., Anderson, K., (2009). Patient Assessment, Intervention, and
Documentation for the Veterinary Technician. Clifton Park, NY: Delmar Cengage
Learning.
Royal Canin Dog Foods Online (2015). Royal Canin U.S.A., Inc.
Retrieved from: http://www.royalcanin.com
Sirois, M. (2004). Principles and Practice of Veterinary Technology, 3rd ed. St. Louis, MO:
Mosby-Elsevier.