Clinical signs and diagnosis of feline atopic syndrome: detailed guidelines for a correct diagnosis

Abstract

Background-Feline atopic syndrome (FAS) describes a spectrum of hypersensitivity disorders characterised by highly diverse clinical presentations including skin, gastrointestinal and respiratory systems. Among these disorders is feline atopic skin syndrome (FASS), in which hypersensitivity is typically associated with environmental allergens, although food allergy may coexist. Involvement of other organ systems (e.g. asthma) also may occur. Because of its highly heterogeneous clinical presentation, diagnosis of FASS can be challenging. Objectives-A subgroup of the International Committee on Allergic Diseases of Animals was tasked to summarise the most current information on the clinical presentations of FASS and to develop diagnostic guidelines. Methods and materials-Online citation databases and abstracts from international meetings were searched for publications related to feline allergic conditions. These were combined with expert opinion where necessary. Results-A total of 107 publications relevant to this review were identified. Compilation of these data enabled development of a detailed description of the clinical features of FASS and development of guidelines focusing on systematic elimination of other skin conditions with similar clinical characteristics. As allergen tests are frequently used by dermatologists to support a clinical diagnosis of FASS, a brief review of these methodologies was also performed. Conclusions and clinical importance-In a similar way to atopic dermatitis in dogs, FASS is a clinical diagnosis based on the presence of compatible clinical signs and exclusion of other diseases with similar clinical features. Elimination or exclusion of fleas/flea allergy, other parasites, infections and food allergy is mandatory before reaching a diagnosis of FASS.

Characterisation of the serum cytokine profile in feline atopic skin syndrome

“…Cats were diagnosed with FASS based on history, the clinical examination findings, exclusion of other pruritic dermatoses and fulfillment of published diagnostic criteria for FASS 3,4 . All allergic cats were deemed systemically healthy except for the clinical signs of FASS.…”

“…The presence of bacterial pyoderma and/or Malassezia spp. yeast overgrowth in contributing to pruritus was ruled out with skin cytological evaluation 3 . Clinical lesions and pruritus were assessed in all enrolled cats by SCORFAD 24 and pVAS 6,25 .…”

“…Feline atopic skin syndrome (FASS) refers specifically to allergic skin disease incited by environmental allergens, and in one large multicentre study represented 20% of the study cats 1,2 . Pruritus is a major component of FAS (excluding asthma), FASS and flea allergy dermatitis (FAD) in addition to clinical lesion patterns consisting of head neck pruritus with excoriations and erosions, self‐induced symmetrical alopecia, miliary dermatitis and eosinophilic granuloma complex 2–4 . FASS frequently requires medical therapy, which can pose challenges to both treatment and owner compliance.…”

Atopic Dermatitis in Domestic Animals: What Our Current Understanding Is and How This Applies to Clinical Practice

“…Allergy testing (either by use of serology testing or intradermal skin test) can be used to select environmental allergens to include for allergen-specific immunotherapy but not for the purpose of making a diagnosis of feline atopic skin syndrome [ 106 , 107 , 108 ]. Intradermal skin testing can be technically challenging in cats [ 109 ], and serology is frequently used in its place.…”

Interobserver reliability of Feline Dermatitis Extent and Severity Index (FEDESI) and Scoring Feline Allergic Dermatitis (SCORFAD) and the relationship between lesion scores and pruritus

“…Feline allergic skin disease is commonly encountered in small animal practice and can be challenging to diagnose and treat 1–4 . To develop new therapies for allergic cats, researchers need to be able to evaluate clinical outcomes.…”