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Home / Equine Research Bank / Vet Dermatol / Equine allergic skin diseases: Clinical consensus guidelines...
Veterinary dermatology2023; 34(3); 175-208; doi: 10.1111/vde.13168

Equine allergic skin diseases: Clinical consensus guidelines of the World Association for Veterinary Dermatology.

Abstract: Allergic skin diseases are common in horses worldwide. The most common causes are insect bites and environmental allergens. Objective: To review the current literature and provide consensus on pathogenesis, diagnosis, treatment and prevention. Methods: The authors reviewed the literature up to November 2022. Results were presented at North America Veterinary Dermatology Forum (2021) and European Veterinary Dermatology Congress (2021). The report was available to member organisations of the World Association for Veterinary Dermatology for feedback. Conclusions: Insect bite hypersensitivity (IBH) is the best characterised allergic skin disease. An immunoglobulin (Ig)E response against Culicoides salivary antigens is widely documented. Genetics and environmental factors play important roles. Tests with high sensitivity and specificity are lacking, and diagnosis of IBH is based on clinical signs, seasonality and response to insect control. Eosinophils, interleukin (IL)-5 and IL-31 are explored as therapeutic targets. Presently, the most effective treatment is insect avoidance. Existing evidence does not support allergen-specific immunotherapy (ASIT) using commercially available extracts of Culicoides. Hypersensitivity to environmental allergens (atopic dermatitis) is the next most common allergy. A role for IgE is supported by serological investigation, skin test studies and positive response to ASIT. Prospective, controlled, randomised studies are limited, and treatment relies largely on glucocorticoids, antihistamines and ASIT based on retrospective studies. Foods are known triggers for urticaria, yet their role in pruritic dermatitis is unknown. Recurrent urticaria is common in horses, yet our understanding is limited and focussed on IgE and T-helper 2 cell response. Prospective, controlled studies on treatments for urticaria are lacking. Glucocorticoids and antihistamines are primary reported treatments. Background: Les dermatoses allergiques sont courantes chez les chevaux dans le monde entier. Les causes les plus fréquentes sont les piqûres d'insectes et les allergènes environnementaux. Objective: Examiner la littérature actuelle et établir un consensus sur la pathogénie, le diagnostic, le traitement et la prévention. MATÉRIELS ET MÉTHODES: Les auteurs ont passé en revue la littérature jusqu'en novembre 2022. Les résultats ont été présentés au « North America Veterinary Dermatology Forum » (2021) et à l’« European Veterinary Dermatology Congress » (2021). Le rapport a été soumis organisations membres de l'Association mondiale de dermatologie vétérinaire afin de recueillir leurs commentaires. Unassigned: L'hypersensibilité aux piqûres d'insectes (IBH) est l’affection cutanée allergique la mieux caractérisée. Une réponse médiée par les immunoglobulines (Ig)E contre les antigènes salivaires des Culicoides est largement documentée. Des facteurs génétique et les environnementaux jouent un rôle important. Des tests suffisamment sensible et spécifique font défaut, et le diagnostic de l'IBH est fondé sur les signes cliniques, la saisonnalité et la réponse au contrôle des insectes. Les éosinophiles, l'interleukine (IL)-5 et l'IL-31 sont explorés comme cibles thérapeutiques. Actuellement, le traitement le plus efficace consiste en l’éviction parasitaire. Les données actuelles ne permettent pas de recommander l'immunothérapie spécifique (ASIT) avec des extraits de culicoïdes disponibles dans le commerce. L'hypersensibilité aux allergènes environnementaux (dermatite atopique) est le second type d’allergie le plus fréquent. Une implication des IgE est étayée par les tests sérologiques et cutanés et la réponse favorable à l'ASIT. Les études prospectives, contrôlées et randomisées sont limitées et le traitement repose en grande partie sur les glucocorticoïdes, les antihistaminiques et l'ASIT selon les données des études rétrospectives. Les aliments sont des déclencheurs connus de l'urticaire, mais leur rôle dans les dermatites prurigineuses est inconnu. L'urticaire récurrente est courante chez les chevaux, mais notre compréhension est limitée et axée sur la réponse des cellules IgE et T-helper 2. Des études prospectives contrôlées sur les traitements de l'urticaire font défaut. Les glucocorticoïdes et les antihistaminiques sont les principaux traitements rapportés. INTRODUCCIÓN: Las enfermedades alérgicas de la piel son comunes en los caballos en todo el mundo. Las causas más comunes son las picaduras de insectos y los alérgenos ambientales. OBJETIVOS: Revisar la literatura actual y brindar consenso sobre patogenia, diagnóstico, tratamiento y prevención. MATERIALES Y MÉTODOS: los autores revisaron la literatura hasta noviembre de 2022. Los resultados se presentaron en el Foro de Dermatología Veterinaria de América del Norte (2021) y el Congreso Europeo de Dermatología Veterinaria (2021). El informe estuvo disponible para las organizaciones miembros de la Asociación Mundial de Dermatología Veterinaria para recibir comentarios. CONCLUSIONES Y RELEVANCIA CLÍNICA: clínica- La hipersensibilidad a las picaduras de insectos (IBH) es la enfermedad alérgica de la piel mejor caracterizada. Una respuesta de inmunoglobulina (Ig)E contra antígenos salivales de Culicoides está ampliamente documentada. La genética y los factores ambientales juegan un papel importante. Faltan pruebas con alta sensibilidad y especificidad, y el diagnóstico de IBH se basa en los signos clínicos, la estacionalidad y la respuesta al control de insectos. Los eosinófilos, la interleucina (IL)-5 y la IL-31 se exploran como dianas terapéuticas. Actualmente, el tratamiento más efectivo es evitar los insectos. La evidencia existente no respalda la inmunoterapia específica de alérgenos (ASIT) con extractos de Culicoides disponibles comercialmente. La hipersensibilidad a los alérgenos ambientales (dermatitis atópica) es la siguiente alergia más común. El papel de la IgE está respaldado por la investigación serológica, los estudios de pruebas cutáneas y la respuesta positiva a ASIT. Los estudios prospectivos, controlados y al azarson limitados y el tratamiento se basa en gran medida en glucocorticoides, antihistamínicos y ASIT según estudios retrospectivos. Los alimentos son desencadenantes conocidos de la urticaria, pero se desconoce su papel en la dermatitis pruriginosa. La urticaria recurrente es común en los caballos, sin embargo, nuestra comprensión es limitada y se centra en la respuesta de las células IgE y T-helper 2. Faltan estudios prospectivos y controlados sobre tratamientos para la urticaria. Los glucocorticoides y los antihistamínicos son los principales tratamientos reportados. Actualmente, el tratamiento más efectivo es evitar los insectos. La evidencia existente no respalda la inmunoterapia específica de alérgenos (ASIT) con extractos de Culicoides disponibles comercialmente. La hipersensibilidad a los alérgenos ambientales (dermatitis atópica) es la siguiente alergia más común. El papel de la IgE está respaldado por la investigación serológica, los estudios de pruebas cutáneas y la respuesta positiva a ASIT. Los estudios prospectivos, controlados y al azar son limitados y el tratamiento se basa en gran medida en glucocorticoides, antihistamínicos y ASIT según estudios retrospectivos. Los alimentos son desencadenantes conocidos de la urticaria, pero se desconoce su papel en la dermatitis pruriginosa. La urticaria recurrente es común en los caballos, sin embargo, nuestra comprensión es limitada y se centra en la respuesta de las células IgE y T-helper 2. Faltan estudios prospectivos y controlados sobre tratamientos para la urticaria. Los glucocorticoides y los antihistamínicos son los principales tratamientos reportados. Unassigned: Allergische Hauterkrankungen kommen bei Pferden auf der ganzen Welt häufig vor. Die häufigsten Ursachen sind Insektenstiche und Umweltallergene. Unassigned: Das Ziel dieser Studie war die Durchführung einer Review der momentanen Literatur und Darstellung eines Konsenses in Bezug auf die Pathogenese, die Diagnose, die Therapie und die Vorbeugung. Unassigned: Die Autoren überprüften die Literatur bis in den November 2022. Die Ergebnisse wurden beim North American Veterinary Dermatology Forum (2021) und beim Europäischen Veterinärdermatologie Kongress (2021) präsentiert. Der Bericht wurde Mitgliedsorganisationen der World Association for Veterinary Dermatology für ein Feedback zur Verfügung gestellt. Unassigned: Die Insektenstich Hypersensibilität (IBH) ist die am besten beschriebene allergische Hauterkrankung. Eine Immunglobulin (Ig) E Antwort auf Culicoides Speichelallergene ist häufig beschrieben. Die Genetik und Umweltfaktoren spielen dabei eine wichtige Rolle. Es fehlen Tests mit hoher Sensibilität und Spezifität und die Diagnose von IBH basiert auf klinischen Zeichen, Saisonalität und Reaktion auf Insektenkontrolle. Eosinophile, Interleukin (IL)-5 und IL-31 werden als therapeutische Angriffspunkte untersucht. Zurzeit ist die Insektenvermeidung die am besten wirksame Therapie. Die bestehende Evidenz spricht nicht für eine Allergen-spezifische Immuntherapie (ASIT) mit kommerziell verfügbaren Culicoides Extrakten. Die Hypersensibilität auf Umweltallergene (Atopische Dermatitis) ist die zweithäufigste Allergie. Eine Rolle für IgE wird durch serologische Untersuchungen, Hautteststudien und positive Reaktionen auf ASIT gestärkt. Prospektive, kontrollierte, randomisierte Studien sind limitiert und die Behandlung stützt sich hauptsächlich auf Glukokortikoide, Antihistamine und ASIT basierend auf retrospektiven Studien. Futter stellen bekannte Auslöser für Urticaria dar, allerdings ist ihre Rolle bei der juckenden Dermatitis unbekannt. Wiederkehrende Urticaria treten bei Pferden häufig auf, unser Verständnis ist diesbezüglich aber limitiert und konzentriert sich auf Reaktionen von IgE und T2-Helferzellen. Prospektive kontrollierte Studien über die Behandlungen von Urticaria fehlen. Glukokortikoide und Antihistamine sind die am häufigsten beschriebenen Behandlungen. 背景: アレルギー性皮膚疾患は世界中の馬でよく見られる。主な原因は虫刺されや環境アレルゲンである。 目的: 本研究の目的は、 現在の文献をレビューし、病態、診断、治療、予防に関するコンセンサスを得ることであった。 材料と方法: 著者らは 2022 年 11 月までの文献をレビューした。結果は、North America Veterinary Dermatology Forum(2021年)およびEuropean Veterinary Dermatology Congress(2021年)で発表した。報告書は世界獣医皮膚科学会の会員団体に提供し、フィードバックを得た。 結論と臨床的関連性: 虫刺され過敏症(IBH)は、最も特徴的なアレルギー性皮膚疾患である。サシバエの唾液抗原に対する免疫グロブリン(Ig)E応答は広く報告されている。遺伝および環境因子が重要な役割を果たす。IBHの診断は、臨床症状、季節性、防虫への反応に基づいて行われる。好酸球、インターロイキン(IL)-5、IL-31が治療標的として探索されている。現在のところ、最も効果的な治療法は昆虫の忌避である。既存のエビデンスは、市販のサシバエ抽出物を用いたアレルゲン特異的免疫療法(ASIT)を支持しない。環境アレルゲンに対する過敏症(アトピー性皮膚炎)は、次に多いアレルギーである。IgEの役割は、血清学的調査、皮膚試験、およびASITに対する陽性反応によって裏付けられている。プロスペクティブな無作為化対照試験は限られており、治療は主にグルココルチコイド、抗ヒスタミン剤、レトロスペクティブな研究に基づくASITに頼っている。食品は蕁麻疹の誘因として知られているが、痒みのある皮膚炎におけるその役割は不明である。蕁麻疹の再発は馬によく見られるが、我々の理解は限られており、IgEとヘルパーT2細胞反応に焦点を当てている。蕁麻疹の治療法に関するプロスペクティブな対照試験は不足している。グルココルチコイドと抗ヒスタミン剤が主な治療法として報告されている. 背景: 过敏性皮肤病在世界各地的马中很常见。最常见的原因是昆虫叮咬和环境过敏原。 目的: 回顾现有达成共识的文献，就发病机制、诊断、治疗和预防。 材料和方法: 作者回顾了截至2022年11月的文献。研究结果在北美兽医皮肤病论坛(2021)和欧洲兽医皮肤病大会(2021)上公布。该报告可供世界兽医皮肤病学协会的成员组织反馈。 结论和临床相关性: 虫咬超敏反应(IBH)是最具特征的过敏性皮肤病。针对库蚊唾液抗原的免疫球蛋白(Ig)E反应已被广泛记录。遗传和环境因素起着重要作用。缺乏高灵敏度和特异性的测试，IBH的诊断是基于临床症状、季节性和对昆虫控制的反应。嗜酸性粒细胞、白细胞介素(IL)-5和IL-31被探索作为治疗靶点。目前，最有效的治疗方法是避开昆虫。现有证据不支持使用市售库蚊提取物的过敏原特异性免疫疗法(ASIT)。对环境过敏原过敏(特应性皮炎)是第二常见的过敏。血清学调查、皮肤试验研究和ASIT阳性反应支持了IgE的作用。前瞻性、对照、随机研究有限，治疗主要依赖于基于回顾性研究的糖皮质激素、抗组胺药和ASIT。食物是已知的荨麻疹诱因，但它们在瘙痒性皮炎中的作用尚不清楚。复发性荨麻疹在马中很常见，但我们的理解有限，主要集中在IgE和辅助T细胞2的反应上。缺乏关于荨麻疹治疗的前瞻性对照研究。糖皮质激素和抗组胺药是主要的治疗方法. Unassigned: Dermatopatias alérgicas são comuns em equinos em todo o mundo. As principais causas são picadas de insetos e alérgenos ambientais. Objective: Revisar a literatura atual e produzir um consenso sobre patogênese, diagnóstico, tratamento e prevenção. MATERIAIS E MÉTODOS: Os autores revisaram a literatura até novembro de 2022. Os resultados foram apresentados no North America Veterinary Dermatology Forum (2021) e no European Veterinary Dermatology Congress (2021). O relatório estava disponível para as organizações membro da World Association for Veterinary Dermatology para que dessem seu feedback. CONCLUSÕES E RELEVÂNCIA CLÍNICA: Hipersensibilidade a picada de insentos (IBH) é a dermatopatia alérgica melhor caracterizada. Resposta mediada por imunoglobulina (Ig)E contra antígenos salivares de Culicoides é amplamente documentada. Genética e fatores ambientais possuem participação importante. São poucos os testes com alta sensibilidade e especificidade, e o diagnóstico de IBH é baseado em sinais clínicos, sazonalidade e resposta ao controle de insetos. Eosinófilos, interleucina (IL)-5 e IL-31 estão sendo exploradas como alvos terapêuticos. Atualmente, o tratamento mais eficaz é evitar o contato com os insetos. As evidências existentes não corroboram com a utilização de imunoterapia alérgeno-específica (ASIT) utilizando extratos comerciais de Culicoides. Hipersensibilidade a alérgenos ambientais (dermatite atópica) é a segunda alergopatia mais comum. Investigação sorológica, testes cutâneos e resposta positiva à ASIT confirmam a participação de IgE. Estudos prospectivos placebo-controle randomisados são limitados e o tratamento é feito com glicocorticoides, antihistamínicos e ASIT baseado em estudos retrospectivos. Alimentos são gatilhos conhecidos para urticária, mas a sua participação em dermatopatias pruriginosas é desconhecida. Urticária recorrente é comum em equinos, apesar de o nosso conhecimento ser ainda limitado e focado em IgE e respostas de células T-helper 2. Faltam estudos prospectivos e controlados sobre tratamentos para urticária. Glicocorticoides e antihistamínicos são os principais tratamentos relatados.
© 2023 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of ESVD and ACVD.
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Publication Date: 2023-05-08 PubMed ID: 37154488DOI: 10.1111/vde.13168Google Scholar: Lookup
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Summary

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This research addresses allergic skin diseases in horses, examining causes, diagnosis, and possible treatments. It identifies insect bites and environmental allergens as the most common sources of these afflictions and highlights a need for more precise diagnostic tools and more systematic, controlled studies for more effective treatment options.

Research Methodology

  • The authors conducted an extensive literature review surveying data up until November 2022.
  • The research findings were presented at the North America Veterinary Dermatology Forum and European Veterinary Dermatology Congress in 2021.
  • Further, these results were shared with member organizations of the World Association for Veterinary Dermatology for additional feedback and insights.

Findings on Insect Bite Hypersensitivity (IBH)

  • IBH, an allergic reaction to insect bites, particularly those from the Culicoides species, has been identified as the most characterized allergic skin disease in horses.
  • This reaction is principally mediated by Immunoglobulin E (IgE) responses to Culicoides salivary antigens, implying that the substances present in the insect saliva trigger the allergic response.
  • Genetics and environmental factors are integral to the occurrence of IBH; however, the research indicates a lack of highly sensitive and specific tests for diagnosing this allergy. Present methods rely on the identification of clinical signs, seasonality, and the horse’s response to insect control initiatives.

Investigations and Recommendations

  • Researchers have been exploring eosinophils (a type of disease-fighting white blood cell), and certain proteins like interleukin-5 (IL-5) and interleukin-31 (IL-31), as potential therapeutic targets for this condition.
  • Currently, the most definitive solution to prevent IBH is to keep the horses away from carrier insects.
  • Immunotherapy using commercially available extracts of Culicoides is not supported by current evidence.

Cases of Atopic Dermatitis (Environmental Allergens)

  • The second most common allergy observed in horses is hypersensitivity to environmental allergens, also known as Atopic Dermatitis.
  • The role of IgE is corroborated in this type of allergic reaction as well, evidenced through serological investigation, skin test studies, and observed positive response to allergen-specific immunotherapy (ASIT).
  • Therapeutic measures for this condition currently include glucocorticoids, antihistamines and ASIT, largely based on retrospective studies, given the limited number of prospective, controlled, randomized studies.

Understanding Urticaria in Horses

  • Food is recognized as a trigger for urticaria (hives), but its role in causing pruritic (itchy) dermatitis is still under investigation.
  • Recurrent urticaria is a common occurrence in horses; however, the knowledge about this condition is limited and mainly focuses on IgE and T-helper 2 cell response.
  • Existing effective treatments are primarily glucocorticoids and antihistamines, due to a lack of controlled studies on urticaria treatments.

Cite This Article

APA
Marsella R, White S, Fadok VA, Wilson D, Mueller R, Outerbridge C, Rosenkrantz W. (2023). Equine allergic skin diseases: Clinical consensus guidelines of the World Association for Veterinary Dermatology. Vet Dermatol, 34(3), 175-208. https://doi.org/10.1111/vde.13168

Publication

Veterinary dermatology
ISSN: 1365-3164
NlmUniqueID: 9426187
Country: England
Language: English
Volume: 34
Issue: 3
Pages: 175-208

Researcher Affiliations

Marsella, R
  • Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
White, S
  • Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA.
Fadok, V A
  • Zoetis, US PET CARE, Bellaire, Texas, USA.
Wilson, D
  • School of Clinical Veterinary Sciences, University of Bristol, Bristol, UK.
Mueller, R
  • Medizinische Keleintierklinik, Zentrum für klinische Tiermedizin, LMU, Munich, Germany.
Outerbridge, C
  • Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA.
Rosenkrantz, W
  • Animal Dermatology Clinics, Tustin, California, USA.

MeSH Terms

  • Animals
  • Horses
  • Dermatitis, Atopic / diagnosis
  • Dermatitis, Atopic / therapy
  • Dermatitis, Atopic / veterinary
  • Retrospective Studies
  • Prospective Studies
  • Dermatology
  • Immunoglobulin E
  • Hypersensitivity / veterinary
  • Allergens
  • Urticaria / veterinary
  • Horse Diseases / diagnosis
  • Horse Diseases / therapy
  • Insect Bites and Stings / complications
  • Insect Bites and Stings / veterinary
  • Ceratopogonidae

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Citations

This article has been cited 6 times.
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