Physical Findings
Physical examination findings in dogs may vary from normal (alesional) to the presence of primary and secondary lesions, including papules, pustules, plaques, wheals, angioedema, erythema, ulcers, excoriations, urticaria (associated with eosinophilic vasculitis), Iichenification, hyperpigmentation, posttraumatic alopecia, scale, crusts, and erosions.
Otic findings may include discharge ranging from mild to copious; it may be black, tan, yellow, or cream colored. There may be hyperplasia of the ceruminous glands resulting in a “cobblestone” appearance of the vertical and/or horizontal ear canal. The external ear canals may also have erosions, ulcerations, hemorrhage or sanguineous discharge; fibrosis or calcification of the cartilage of the external ear canals; or proliferation of the epithelium of the vertical or horizontal canals, manifested as otic “masses.” If there is involvement of the middle ear, the tympanum may be absent (ruptured), bulging, or necrotic in appearance. However, it has been reported that dogs may also have concurrent otitis media even in the presence of an intact and normal-appearing tympanic membrane.3a Pinnal marginal vasculopathy has also been associated with cutaneous adverse food reaction. As previously mentioned, the distribution of lesions may be focal or generalized, but the ears and rump are commonly affected. Due to the disruption of the normal barrier function of the epithelium that occurs with cutaneous adverse food reactions, secondary bacterial pyoderma, Malassezia dermatitis, bacterial or Malassezia otitis externa, and seborrheic skin disease are common.4,7Cats, like dogs, vary in their physical examination findings. They too may be normal (alesional); more commonly, they have excoriations, papulocrusts, alopecia, crusts, erosions, ulcers, or exfoliative erythroderma. Miliary dermatitis, eosinophilic plaques, eosinophilic granulomas, and indolent ulcers have all been associated with cutaneous food reactions. Pruritus typically affects the face and neck (especially the pinnae and pre- aural region) but can affect any location.4,5,7 Cats may have the same otic signs as dogs.
Adult humans may be affected by the oral allergy syndrome.3 This occurs in patients with pollen allergies in which certain raw fruits and vegetables are crossreactive with pollens. An immediate hypersensitivity response causes pruritus, tingling, and angioedema of the lips, tongue, palate, and throat. Occasionally there is otic pruritus.3 Whether this may occur in dogs and cats is currently unknown.
The differential diagnosis of cutaneous adverse food reaction may include (depending on the presenting clinical signs) environmental allergen-induced atopic dermatitis (atopy), cutaneous drug reaction, flea-bite hypersensitivity, pediculosis, intestinal parasite hypersensitivity, scabies, and primary seborrhea.
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