Vet Dermatol 2021

DOI: 10.1111/vde.12970

The usefulness of a hydrolysed fish and rice starchelimination diet for the diagnosis of adverse foodreactions in cats: an open clinical trial
Chiara Noli*and Giorgia Beltrando†*Servizi Dermatologici Veterinari, Strada Bedale della Ressia 2, Peveragno (CN), 12016, Italy†Student Veterinary Faculty, University of Turin, Largo P. Braccini 2, Grugliasco (TO), 10095, Italy
Correspondence: Chiara Noli, Strada Bedale della Ressia 2, 12016 Peveragno (CN), Italy.
E-mail: info@dermatologiaveterinaria.it

Background – Diagnosis of adverse food reaction (AFR) is based on an eight week elimination diet (ED) and isconfirmed by relapse upon re-challenge with the previously fed diet. Hydrolysed EDs are commonly used for thispurpose.
Objective – To evaluate the commercially available hydrolysed fish protein and rice starch ED Farmina UltraHypo(FUH) for the diagnosis of feline AFR.
Animals – Thirty-two nonseasonally pruritic cats.
Methods and materials – Pruritus was assessed with a new dual Visual Analog Scale, lesions with the Scoring
Feline Allergic Dermatitis scale and Quality of Life with a validated questionnaire on days 0 and 56. Short-acting
corticosteroids or oclacitinib were permitted during the first six weeks. Cats showing 50% pruritus and/or lesional improvement were separately challenged with their prior diet, fish and rice. Cats not responding to the study
diet were fed another hydrolysed diet for two months.
Results – Twenty-five cats completed the ED: four dropped out due to vomiting and/or diarrhoea, one owing to
low palatability and two were lost to follow-up. In 17 cats, pruritus improved by >50% and these underwent dietary challenges. Of these, nine reacted to their prior diet and/or fish and/or rice and were diagnosed with AFR,
while eight did not relapse (and a diagnosis of AFR was considered to be doubtful). Of the eight cats in which pruritus did not improve, four underwent a second ED with no improvement.
Conclusion and clinical importance – FUH may be a useful ED for the diagnosis of feline AFR, even in catsreacting to fish or rice.

Introduction
Adverse food reaction (AFR) is defined as any unexpectedreaction to food due to immunological and nonimmunological mechanisms, and thus encompasses both foodallergy and food intolerance.1 Prevalence of feline AFR isestimated to be approximately 5% of all skin diseases,and ≤21% of all feline pruritic skin conditions.2
The most common dermatological signs of feline AFR
are nonseasonal pruritus, leading to self-induced alopecia
and excoriations, miliary dermatitis and eosinophilic
lesions, affecting the face/head, the ears, the ventrum
and the feet.3 Cats with AFR also may show gastrointestinal signs – mainly vomiting and diarrhoea, while salivating
and flatulence are less frequently reported.4 The diagnosis of feline AFR relies on the administration of an elimination diet (ED) for at least eight weeks, as in vitro testing isreported to be unreliable for this purpose.5,6 An

Accepted 13 February 2021
Source of Funding: This study was funded by Farmina Pet
Food, Nola, NA, Italy
Conflicts of Interest: Chiara Noli received consulting and speakers fees from Farmina Pet Food.

improvement of the skin and/or gastrointestinal condition
followed by relapse of clinical signs after re-feeding theusual diet, followed by renewed improvement when
feeding the ED, is required to confirm AFR. For this purpose, the selection of a proper ED, containing ingredients
unknown to the cat and/or that do not elicit an adverse
response, is a key factor for the diagnosis of AFR. Limited
antigen diets are not always reliable, as a consequence of
frequent label discrepancies and potential crossreactions, albeit not yet determined in cats.7–9
Hydrolysed EDs are currently considered a valuable
tool for the diagnosis of AFR, able to overcome theabove-mentioned drawbacks of limited antigen diets.
However, only a few investigations on undeclared protein
content in these diets have been conducted.10 Hydrolysis
is an enzymatic proteolytic process that cleaves large proteins into small peptides, thereby reducing the allergenicity of food components. Extensive protein hydrolysation(<10 kD) is important to prevent allergen recognition.11
Proteins present in vegetables also can be recognised by
the immune system, and starch rather than flour preferably should be contained in these foods.12 Interestingly,
one small in vitro study suggests that even hydrolysed
diets could elicit an adverse response in cats comparable© 2021 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the European Society of Veterinary
Dermatology and the American College of Veterinary Dermatology
1This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License,
which permits use, distribution and reproduction in any medium, provided the original work is properly cited andis not used for commercial purposes.

Noli and Beltrando

to that of their basal diet containing the same intact proteins.13
Two studies report the use of hydrolysed diets forchronic vomiting and diarrhoea, inflammatory bowel disease and AFR with gastrointestinal signs, yet, to theauthors’ knowledge, there are no studies reporting theuse of hydrolysed diets for the diagnosis of AFR in catswith dermatological signs.14,15 Recently, a hydrolysedfish protein (herring) and rice starch diet (Vet Life Canine
UltraHypo, Farmina Pet Food; Nola, NA, Italy) claiming theabsence of peptides >6 kDa in size, was considered suitable for the diagnosis of AFR in dogs.16 A feline formulation of the same diet is commercially available. The aim of
this study was to evaluate the performance of Vet Life
Feline UltraHypo (FUH) diet for the diagnosis of AFR incats with nonseasonal pruritic dermatitis. We hypothesised that this hydrolysed fish and rice starch diet would
be well-tolerated by cats, including those sensitised tofish and/or rice.

Methods and materials

weeks before the end of the ED trial and final assessment. If for any
reason the adjunct treatments were not stopped or skin infections
were still present at the end of the ED trial, the diet was prolonged
until two weeks after discontinuation of therapies and resolution of
infections.
After at least eight weeks of ED (V2), cats were re-evaluated by
the same veterinarian. After assessing the absence of concurrent
infections through a dermatological examination, clinicians reevaluated skin lesions by means of SCORFAD, and owners completed the dual pVAS and the feline QoL questionnaire.
Whenever the owner-assessed pVAS had decreased by ≥50%
compared to V1 and/or lesions had resolved at V2, owners were
instructed to perform a diet provocation test to confirm the diagnosis
of AFR. Owners were instructed to add home-cooked rice, fish (usually either canned tuna or boiled cod) and the prior diet, individuallyand one after the other, for a maximum of 14 days each. If a relapse
was observed during the provocation phase, owners were instructedto stop the provocative food and feed the ED exclusively until clinicalimprovement was achieved again, and then to proceed to the next
provocation test. In case of relapse with the prior diet, fish and/or
rice, followed by a new improvement with the elimination diet, thecats were diagnosed with AFR.
Cats in which pruritus and lesions did not improve were fed
another ED (Anallergenic, Royal Canin; Milan, Italy) for two further
months and re-evaluated at the end of the diet.

Animals

Informed consent and animal use

Inclusion criteria

In order for their cats to be included in the study, owners needed togive oral informed consent. The food was marketed and labelled forthe purpose of AFR diagnosis at the time the study was conducted.
Additionally, the procedure of feeding a hypoallergenic diet for eightweeks, followed by challenge periods with the original diet or withsingle ingredients, was deemed to be the standard of care for the
diagnosis of AFR.

Nonseasonally pruritic cats were recruited by four veterinarians ineight referral clinics and included whenever they showed clinicalsigns compatible with feline allergic dermatitis such as self-induced
alopecia, self-inflicted excoriations, miliary dermatitis and lesions of
the eosinophilic granuloma complex. Owing to the fact that some of
the included cats could have suffered flea bite allergy, whenever no
preventive measures effective against fleas or other parasites had
been adopted previously, a fluralaner-moxidectin topical solution(Bravecto Plus, MSD; Milan, Italy) was administered one month
before inclusion, in order to exclude flea bite allergy as a confounderof the study results.

Exclusion criteria
Cats were not enrolled whenever they showed seasonal pruritic
flares or concurrent systemic diseases at the time of inclusion, or ifthey had been treated with short-acting glucocorticoids or oclacitinib(off-label) in the previous two weeks or with long-lasting glucocorticoids or ciclosporin within the previous two months. Presence of askin or ear canal infection was not an exclusion criterion.

Evaluation of cats
At the time of inclusion (Visit 1, V1) all cats underwent a dermatological examination, including (when necessary) a cytological evaluation
for bacterial and/or yeast infections. The investigators then recorded
the historical information and assessed the skin lesions by means of
the Scoring Feline Allergic Dermatitis system (SCORFAD; range 0–16).17 Owners were requested to assess their cats’ pruritus using a
not yet validated double (licking and scratching) 10 cm Visual Analog
Scale (pVAS) with descriptors.18 In addition, they were asked to complete a validated feline quality of life (QoL) questionnaire (range 0–45;
the higher the score, the worse the QoL).19 After inclusion, owners
were instructed to feed FUH exclusively for at least eight weeks. In
case of bacterial or yeast infection, systemic antibiotic or antifungal
drugs and/or topical antiseptic treatments were prescribed for the
first three to four weeks together with the diet, starting from theinclusion day onwards. Whenever necessary, oral prednisolone 0.5–
2 mg/kg daily or every other day (Prednicortone, Dechra; Northwich,UK) or off-label oclacitinib 1 mg/kg twice daily (Apoquel, Zoetis;
Rome, Italy) were permitted during the first six weeks to control pruritus. Long-lasting glucocorticoids, ciclosporin or supplements of any
kind were not permitted during the study. Any concomitant drug,with the exception of ectoparasiticides, had to be stopped two

2

Statistical analysis
With the aim of identifying possible clinical parameters that could
predict response to ED and/or to provocation tests, several pre-study
variables were compared between cats with confirmed AFR, thosewith doubtful diagnosis and those not responding to the diet. ANOVA
was used for age, SCORFAD, pVAS and QoL scores, while Fisher’s
test was used for sex and reproductive state. Changes in SCORFAD,
pVAS and QoL between V1 and V2 in each group, were expressed asmeans. All statistical analyses were performed using SAS 9.2 (SASInstitute Inc.; Cary, NC, USA). Significance was set at P < 0.05.

Results
Thirty-two cats were included in the study: 24 European
shorthair, two Devon rex, two British shorthair, and one
each of European longhair, Persian, Chartreux and Mainecoon. The mean age was 5.2 years (range five months–
14 years). Ten were male (all castrated) and 22 werefemale (of which four were intact). Further historical data
are given in Supporting information Tables S1 and S2.
Twenty-five cats completed the eight week trial with
FUH (Figure 1 and Table S3). Of these, eight did not
improve, while 17 (70.8%) were considered to have
improved. All 17 cats which improved underwent the
provocation test. Upon provocation, nine demonstrated a
relapse of clinical signs and a relief of pruritus after reintroduction of the ED and were thus diagnosed with AFR.
Among the nine cats with confirmed AFR, four reacted torice and two to fish. Eight of the 17 cats that improved
with the ED relapsed neither with the old diet, nor withfish or with rice, and a diagnosis of AFR was considered
to be doubtful.

© 2021 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the European Society of Veterinary
Dermatology and the American College of Veterinary Dermatology

Hydrolysed fish and rice starch diet for the diagnosis of adverse food reaction

scores by a mean of 87.5% and QoL by a mean of 48.6%
at V2 (Table 2). The percentage improvements in otherstudy animals are reported in Table 2. Improvements ofall parameters in cats with confirmed or doubtful AFR
were statistically significant (Table 1).

Discussion
There are only two studies evaluating the efficacy of aparticular diet in cats with food allergy. One study evaluated the efficacy of two commercial limited antigen dietsin maintaining the remission obtained with a homecooked diet in cats with dermatological manifestations of
AFR.20 The other study investigated the efficacy of ahydrolysed diet in cats with gastroenteric signs of AFR.14
To the best of the authors’ knowledge, this is the firststudy to evaluate a hydrolysed ED for the diagnosis of
AFR in cats with dermatological signs. Similar to thecanine study with the same product, this study suggeststhat FUH is suitable for use as an ED for the diagnosis offeline AFR.16
A decrease of pruritus and clinical signs was observedin 17 of 25 (68%) cats that completed the ED, in line withwhat was observed in dogs.16 However, only nine of 17(53%) cats that improved on the ED and completed
provocative challenges reacted to other foods. This
resulted in an AFR prevalence of approximately 36% incats with signs of cutaneous allergy (nine of 25 cats thatcompleted the ED trial), similar to the percentage
described in dogs, and higher than that reported previously in cats.2 This discrepancy could depend on the low
number of studies and of cats analysed, as well as on different diagnostic procedures, including diets used for
obtaining the diagnosis.
Two cats improving on the ED did not relapse on theirold food, and recurred when fed whole rice. The reason
for this is not completely understood: they may havebeen exposed to more than one diet in the past and nothave been fed the culprit diet during the provocation test.
This also could be a reason for improving during the ED
and not deteriorating during the provocation phase in“doubtful” cases. In fact, similar to the canine study, several cats improved on the diet and did not relapse upon
provocation, maybe as a result of a wrong choice of
provocation diet, or administration of concomitant treatments (see discussion below) during the first month ofED, or thanks to the good-quality balanced formula of the
ED. Those cats with a doubtful diagnosis of AFR were
nearly as numerous as those with confirmed AFR, andthis finding underpins the importance of performing several provocation tests at the end of the ED trial, for the

Figure 1. Summary of results of feeding a hydrolysed fish and ricestarch diet to 32 cats suspected of having adverse food reactions.

Eight cats did not improve with the ED (Figure 1 andTable S3). Of these, four underwent the second eightweek hydrolysed ED period, and none of these improved.
Seven cats did not complete the elimination trial period(Figure 1 and Table S3). One refused to eat the diet owing
to low palatability, one was euthanised as a consequenceof a malignant tumour, one was lost to follow-up, and four
had signs of vomiting and/or diarrhoea. Of these fourcats, one improved on another hydrolysed ED (Royal
Canin Anallergenic), while the others went back to their
original diet and were treated symptomatically.
For humane reasons, concurrent antipruritic and or
antibiotic treatments were administered to 15 of the 25
cats that completed the diet (Table S4). Of these, fivewere diagnosed with AFR, in three AFR was excluded
and seven had a doubtful diagnosis. Administered molecules comprised methylprednisolone 1 mg/kg once daily),betamethasone (0.1 mg/kg once daily), topical hydroxycortisone aceponate, maropitant (2 mg/kg once daily),oclacitinib (1 mg/kg twice daily), cephalexin (20 mg/kg
twice daily) and amoxicillin/clavulanic acid (15 mg/kg
twice daily). In every case, with exception of one cat(Case 26 with a doubful AFR diagnosis), all treatments
were withdrawn ≥14 days before the final visit. Details on
concomitant treatments in cats which completed the dietare reported in Table S4.
No statistically significant differences in age, sex,
reproductive state or double pVAS scores were observed
at V1 between cats that were ultimately confirmed with
AFR, those that failed to respond to the diet, and thosethat failed to respond to provocative challenges.
Mean pruritus, lesional and quality of life scores are
given in Table 1. In the nine cats with confirmed AFR,
pVAS scores improved by a mean of 68.6%, SCORFAD

Table 1. Mean pruritus score, lesional score and quality of life score before and after a two month hydrolysed fish and rice starch elimination dietin 25 cats with signs of cutaneous allergy

Confirmed AFR
Improved, no relapse
upon provocation
Nonresponders

Numberof cats

pVAS
V1

pVAS
V2

pVAS
P-value

SCORFADV1SCORFADV2SCORFADP-value

QoL
V1

QoL
V2

QoL
P-value

9
8

7.0
6.2

2.2
2.4

0.000
0.003

4.8
4.9

0.6
1.6

0.000
0.032

22.0
20.1

11.3
10.6

0.019
0.063

8

6.1

6.3

0.835

5.6

4.4

0.239

15.3

16.0

0.801

AFR, adverse food reaction; pVAS, double pruritus Visual Analog Scale score (range 0–10); SCORFAD, Scoring Feline Allergic Dermatitis lesion
index (range 0–16); QoL, quality of life score (range 0–45); V1, visit 1; V2, visit 2, at the end of the elimination diet.

© 2021 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the European Society of Veterinary
Dermatology and the American College of Veterinary Dermatology
3Noli and Beltrando

Table 2. Mean percentage improvement of pruritus score, lesional score and quality of life score after a two month hydrolysed fish and rice starchelimination diet in 25 cats with signs of cutaneous allergy
Mean percentage improvement

Number of catspVAS

SCORFAD

QoL

Confirmed AFR
Improved, no relapse upon provocation
Nonresponders

9
8
8

68.6
61.3
–3.3

87.5
67.3
21.4

48.6
47.3
–4.6

AFR, adverse food reaction; pVAS, double pruritus Visual Analog Scale score (range 0–10); SCORFAD, Scoring Feline Allergic Dermatitis lesion
index (range 0–16); QoL, quality of life score (range 0–45).

confirmation of the diagnosis of AFR. A false positive
diagnosis of AFR could possibly imply pointlessly keeping
a cat on an hypoallergenic diet for the rest of its life.
Fifteen of the 25 cats that completed the diet weretreated with concomitant antipruritic and/or antibiotic
therapy in the first period of the ED. Ideally, in order toprecisely evaluate the efficacy of an ED, no treatment
should be allowed during its administration; however, it
would not have been ethical to leave the patients withpruritus and infections for such a long period of time.
Short-acting topical and systemic antipruritic therapies
and antibiotics thus were allowed, as generally prescribedin everyday practice, with a withdrawal of at least two
weeks before the final evaluation visit. A washout periodof two weeks was considered sufficient for the observation of re-occurrence of pruritus and/or lesions in nonresponding cats, similar to what recently has beensuggested in dogs.25 Pruritus was considered to relapse
earlier than skin lesions upon drug withdrawal, and its
improvement at the end of the dietary trial was taken as
major outcome of ED success. In just two AFR confirmed
cases (cases 3 and 17) pruritus scores did not improve by>50%, and lesional improvement was used to define ED
efficacy instead. The first cat (Case 3) had received notreatment during the ED and in the second case (Case 17)
topical aceponate spray was withdrawn >28 d before thefinal visit, so that the lesional improvement observed cannot be considered a consequence of concomitant therapy
in either case. Interestingly, seven of eight doubtful AFR
cases (versus five of nine cats with AFR and three ofeight cats without AFR) had been treated with concomitant therapy in the first month on the ED, which could
have been responsible for their improvement during the
ED trial period.
Four cats of nine (44%) with confirmed AFR relapsed
with rice and two of nine (22%) to fish. These prevalences are much higher than what has been reported previously in food-allergic cats, and the reason for thisdiscrepancy is unknown.26 Differences may depend on
geographical variations in feeding habits, and no study
was yet been performed in the authors’ country to allow
a direct comparison of allergen prevalences.
The fact that cats that did not tolerate rice or fish could
tolerate FUH suggests that the level of hydrolysis is adequate in FUH or that fish fed during the provocation test
was antigenically different to the herring contained in the
ED. The producer declares that FUH contains hydrolysed
proteins with a low molecular weight (<6 kDa) as uniquesource of proteins, a limit considered acceptable for ahydrolysed diet in dogs, while no data are available incats.22 Extensive hydrolysation may impact palatability,
which can, in turn, affect compliance. Surprisingly in this4

study, only one cat refused the diet, a percentage (3%)
much lower than what has been described previously indogs fed FUH and other hydrolysed diets.16,23 Gastrointestinal signs associated with this diet were represented
by vomiting and diarrhoea in three cases and just diarrhoea in a fourth one, for a total of 12.5% of cats, in linewith a previous canine report in which constipation, soft
faeces or diarrhoea were observed in 10% of dogs fedhydrolysed diets.24
Cats not improving on the first ED trial were prescribeda second diet trial with a different hydrolysed protein andstarch food, in order to minimise false negative diagnosesof AFR. Of four nonresponsive cats that underwent a second ED trial, none improved. However, the numbers are
too low to draw a definitive conclusion on the sensitivityof FUH for the diagnosis of AFR in cats. In a previous
canine study, 10% of dogs needed a second ED trial forthe confirmation of AFR, yet no such data are available forthe feline species.21
Similar to the study on dogs fed FUH or other studies
on the efficacy of therapeutical interventions for pruritus
in allergic cats, it is interesting to note that pruritus andlesions decreased by >60% to approximately 90%, while
QoL did not reach 50% improvement in cats with confirmed or doubtful AFR.16,18,19 This observation confirms
the need to measure QoL together with clinical parameters when evaluating therapeutic interventions in animals
with allergic dermatoses: clinical improvement may notreflect a better quality of life, owing to the burden of thetreatment on the pet and/or the owner.
There are several limitations in this study, besides the
low number of included cats and the fact that the study
was not controlled. One of these is that some of the animals were indoor–outdoor cats and may not have
improved owing to uncontrolled access to nonpermitted
food sources. Furthermore, in cats that were not on routine parasite control, a systemic parasiticide (fluralaner)
was chosen, which could not have provided adequate flea
control in flea allergic cats living under high environmental
parasite pressure. In these cases pruritus due to flea biteallergy could have negatively influenced the evaluation of
the efficacy of the diet. Last, and not least, the dual pVAS
(licking and scratching) for the evaluation of feline pruritus
used in this study is not yet validated, and may thus notprovide a precise quantification of pruritus in cats. To thebest of the authors’ knowledge, currently there are no validated feline pruritus scales. Among those used in otherstudies, the dual pVAS was considered the most reliable
one, as it is based on the common observation that catsscratch and/or lick when feeling pruritus, and on theassumption that the two different behaviours should be
evaluated separately. Even though the dual pVAS has not© 2021 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the European Society of Veterinary
Dermatology and the American College of Veterinary Dermatology

Hydrolysed fish and rice starch diet for the diagnosis of adverse food reaction

yet undergone complete validation procedures, its performance was substantiated by correlation analyses in a previous study.18
In conclusion, the low prevalence of gastrointestinal
adverse effects (12.5%) and the excellent palatability(97%) make FUH a useful option for the diagnosis of AFR
in cats, if fed exclusively for at least eight weeks. In thecase of failure, it is advisable to undertake a second diettrial with different protein and carbohydrate sources.
Provocation tests with several diets or ingredients arealways necessary to confirm the diagnosis of AFR.

Acknowledgements
The authors thank Luisa Cornegliani for the statisticalanalysis, Silvia Colombo for critically reviewing the manuscript, and Vera Luciano, Alice Restagno and Antonella
Varina for including some of the cases.

References
1. Verlinden A, Hesta M, Millet S, et al. Food allergy in dogs andcats: a review. Crit Rev Food Sci Nutr 2006; 46: 259–273.
2. Olivry T, Mueller RS. Critically appraised topic on adverse foodreactions of companion animals (3): prevalence of cutaneousadverse food reactions in dogs and cats. BMC Vet Res 2017; 13:51.
3. Olivry T, Mueller RS. Critically appraised topic on adverse foodreactions of companion animals (7): signalment and cutaneous
manifestations of dogs and cats with adverse food reactions.
BMC Vet Res 2019; 15: 140.
4. Mueller RS, Olivry T. Critically appraised topic on adverse foodreactions of companion animals (6): prevalence of noncutaneous
manifestations of adverse food reactions in dogs and cats. BMC
Vet Res 2018; 14: 341.
laud P. Critically appraised topic on
5. Olivry T, Mueller RS, Pre
adverse food reactions of companion animals (1): duration ofelimination diets. BMC Vet Res 2015; 11: 225.
6. Mueller RS, Olivry T. Critically appraised topic on adverse foodreactions of companion animals (4): can we diagnose adverse
food reactions in dogs and cats with in vivo or in vitro tests?
BMC Vet Res 2017; 13: 275.
7. Olivry T, Mueller RS. Critically appraised topic on adverse foodreactions of companion animals (5):discrepancies between ingredients and labeling in commercial pet foods. BMC Vet Res 2018;
14: 24.
8. Bexley J, Nuttal TJ, Mammerberg B, et al. Co-sensitization andcross-reactivity between related and unrelated food allergens indogs – a serological study. Vet Dermatol 2017; 28: 31-e7.
9. Bexley J, Kingswell N, Olivry T. Serum IgE cross-reactivity
between fish and chicken meats in dogs. Vet Dermatol 2018; 30:
25–e8.
10. Lesponne I, Naar J, Planchon S, et al. DNA and protein analyses
to confirm the absence of cross-contamination and support theclinical reliability of extensively hydrolysed diets for adverse foodreaction–pets. Vet Sci 2018; 5: 63.
11. Olivry T, Bexley J, Mougeot I. Extensive protein hydrolyzation isindispensable to prevent IgE-mediated poultry allergen recognition in dogs and cats. BMC Vet Res 2017; 13: 251.
12. Olivry T, Bexley J. Cornstarch is less allergenic than corn flour indogs and cats previously sensitized to corn. BMC Vet Res 2018;
14: 207.
13. Kathrani A, Larsen JA, Cortopassi G, et al. A descriptive pilot
study of cytokine production following stimulation of ex-vivo
whole blood with commercial therapeutic feline hydrolyzed dietsin individual healthy immunotolerant cats. BMC Vet Res 2017;
13: 297.

14. Mandigers PJJ, Biourge V, German AJ. Efficacy of a commercial
hydrolysate diet in eight cats suffering from inflammatory bowel
disease or adverse reaction to food. Tijdschr Diergeneeskd
2010; 135: 668–672.
15. Kathrani A, Church DB, Brodbelt DC, et al. The use of hydrolysed
diets for vomiting and/or diarrhoea in cats in primary veterinary
practice. J Small Anim Prac 2020; 61: 723–731.
16. Matricoti I, Noli C. An open label clinical trial to evaluate the utility of a hydrolysed fish and rice starch elimination diet for the
diagnosis of adverse food reactions in dogs. Vet Dermatol 2018;
29: 408-e134.
17. Steffan J, Olivry T, Forster SL, et al. Responsiveness and validityof the SCORFAD, an extent and severity scale for feline hypersensitivity dermatitis. Vet Dermatol 2012; 23: 410-e77.
18. Noli C, Della Valle MF, Miolo A, et al. Effect of dietary supplementation with ultramicronized palmitoylethanolamide in maintaining remission in cats with nonflea hypersensitivity
dermatitis: a double-blind, multicentre, randomized, placebocontrolled study. Vet Dermatol 2019; 30: 387-e117.
19. Noli C, Borio S, Varina A, et al. Development and validation of aquestionnaire to evaluate the Quality of Life of cats with skin disease and their owners, and its use in 185 cats with skin disease.
Vet Dermatol 2016; 27: 247-e58.
20. Leistra M, Willemse T. Double-blind evaluation of two commercial hypoallergenic diets in cats with adverse food reactions. J
Feline Med Surg 2002; 4: 185–188.
21. Biourge VC, Fontaine J, Vroom MW. Diagnosis of adverse reactions to food in dogs: efficacy of a soy-isolate hydrolyzate-based
diet. J Nutr 2004; 1342: 2,062S–2,064S.
22. Bizikova P, Olivry T. A randomized, double-blinded crossover trial
testing the benefit of two hydrolysed poultry-based commercial
diets for dogs with spontaneous pruritic chicken allergy. Vet Dermatol 2016; 27: 289–e70.
23. Loeffler A, Soares-Magalhaes R, Bond R, et al. A retrospective
analysis of case series using home-prepared and chicken hydrolysate diets in the diagnosis of adverse food reactions in 181 pruritic dogs. Vet Dermatol 2006; 17: 273–279.
24. Loeffler A, Lloyd DH, Bond R, et al. Dietary trials with a commercial chicken hydrolysate diet in 63 pruritic dogs. Vet Rec 2004;
154: 519–522.
25. Favrot C, Bizikova P, Fischer N, et al. The usefulness of shortcourse prednisolone during the initial phase of an elimination diettrial in dogs with food-induced atopic dermatitis. Vet Dermatol
2019; 30: 498-e149.
laud P. Critically appraised topic on
26. Mueller RS, Olivry T, Pre
adverse food reactions of companion animals (2): common
food allergen sources in dogs and cats. BMC Vet Res 2016;
12: 9.

Supporting Information
Additional Supporting Information may be found in the
online version of this article.
Table S1. Onset of pruritus, history of otitis, gastrointestinal signs and anal pruritus in 25 cats with AFR and in cats
where this diagnosis was excluded or was doubtful.
Table S2. Signalment and historical data of 32 cats included in the study.
Table S3. Pruritus scores, lesional scores and quality oflife scores of 32 cats with signs of cutaneous allergy that
underwent a two month elimination diet with a hydrolysed fish and rice starch hypoallergenic diet.
Table S4. Molecules, doses, duration and withdrawal
time of concomitant treatments in 25 cats with signs of
cutaneous allergy undergoing an elimination diet.

© 2021 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the European Society of Veterinary
Dermatology and the American College of Veterinary Dermatology
5Noli and Beltrando



RESUM
E
action alimentaire indesirable (AFR) est basee sur un regime d’e
viction deContexte – Le diagnostic de re par un test de proc-vocation avec l’alimentation pre cedente. Les EDs
huit semaines (ED) et est confirme
es sont frequemment utilise
es a cet effet.
hydrolyse de proteines de poisson hydrolyse
es etObjectif – Evaluer l’aliment FUH (Farmina UltraHypo) composed’amidon de riz en tant que ED pour le diagnostic de AFR chez le chat.
sentant un prurit non saisonnier.
Sujets – Trente deux chats prethodes – Le prurit a e teevalue avec une nouvelle echelle visuelle analogue, les lesions avec le score deMeline et la qualite de vie avec un questionnaire validedermatite allergique fea jours 0 et 56. Les cortico€ıdes te autorises au cours des six premieres semaines. Les chats montrant
courte action ou l’oclacitinib ont e
lioration de 50% de prurit et/ou des lesions ont e
 te provoque
s se
pare
ment avec leur alimentation
une amepondant pas au regime d’e
viction ont e te nourris avec un autre aliinitiale, poisson et riz. Les chats ne re pendant deux mois.
ment hydrolysesultats – Vingt cinq chats ont comple
 te le regime d’e
viction : quatre ont e te exclus en raison de vomisRee, un en raison de manque d’appetence et deux ont e te perdus de vue. Pour 17
sements et/ou diarrheliore de plus de 50% et ont e
 te provoques. Parmi eux, neufs ont reagi 
chats, le prurit s’est ame
a leur ali te diagnostiques AFR, pendant que huit n’ont pas rechute
mentation initiale et/ou poisson et/ou riz et ont e
 te conside re comme douteux). Sur les huit cas pour lesquels le prurit ne s’est(et un diagnostic d’AFR a eliore, quatre ont suivi un nouveau ED sans ame
lioration.
pas ame^tre un ED utile pour le diagnostic d’AFR, me^me chez lesConclusion et importance clinique – FUH peut eagissant au poisson ou au riz.
chats reRESUMEN
 n – el diagno
stico de reaccio
n adversa a los alimentos (AFR) se basa en una dieta de elimiIntroduccio
n (ED) de ocho semanas y se confirma mediante una recaıda al volver a exponer a la dieta previanacio
sito.
nmente para este propo
mente alimentada. Los ED hidrolizados se utilizan comun de arroz EDObjetivo – Evaluar la proteına de pescado hidrolizada disponible comercialmente y el almido
stico de AFR felina.
Farmina UltraHypo (FUH) para el diagno
Animales – treinta y dos gatos con prurito no estacional.
todos – Se evaluo
 el prurito con una nueva Escala Visual An
Me
aloga dual, las lesiones con la escala Scoring
 elFeline Allergic Dermatitis y la Calidad de Vida con un cuestionario validado en los dıas 0 y 56. Se permitio
n corta u oclacitinib durante las primeras seis semanas. Los gatos que mostrauso corticosteroides de accio
ban mejorıa de un 50% de prurito y/o mejorıa de las lesiones fueron expuestos por separado con su dieta
anterior, pescado y arroz. Los gatos que no respondieron a la dieta del estudio fueron alimentados con otra
dieta hidrolizada durante dos meses.
mitos y/o diarrea, uno
Resultados – Veinticinco gatos completaron la ED: cuatro abandonaron debido a vo
 en>debido a baja palatabilidad y dos se perdieron durante el seguimiento. En 17 gatos, el prurito mejoro
ticas. De estos, nueve reaccionaron a su dieta previa y/o
50% y estos se sometieron a exposiciones dietepescado y/o arroz y fueron diagnosticados con AFR, mientras que ocho no recayeron (y se considero
stico de AFR). De los ocho gatos en los que el prurito no mejoro
, cuatro se sometieron adudoso el diagno
una segunda ED sin mejorıa.
 n e importancia clınica – la FUH puede ser una ED ustico de AFR felina, incluso
til para el diagno
Conclusio
en gatos que reaccionan al pescado o al arroz.
Zusammenfassung€chigen ElimiHintergrund – Die Diagnose einer Futtermittelnebenwirkung (AFR) basiert auf einer acht-wo€tterten Futnationsdi€at (ED) und wird durch ein Wiederauftreten nach einer Provokation mit dem zuvor gefu
ter bewiesen. Hydrolysierte EDs werden h€
aufig zu diesem Zweck eingesetzt.
Ziel – Die Evaluierung einer kommerziell erh€
altlichen hydrolysierten Fischprotein und Reisst€
arke ED Farmina UltraHypo (FUH) zur Diagnose einer felinen AFR.
Tiere – Zweiunddreißig nicht saisonal juckende Katzen.
Methoden – Der Juckreiz wurde an den Tagen 0 und 56 mittels neuer dualer Visual Analog Scale erfasst,
die Ver€anderungen mittels Scoring Feline Allergic Dermatitis Scale und die Lebensqualit€at mit einem validierten Fragebogen. Kurzwirksame Kortikosteroide oder Oclacitinib waren w€
ahrend der ersten sechs
Wochen erlaubt. Katzen, die eine 50%ige Verbesserung des Juckreizes und/oder eine Verbesserung der€heren Futter, Fisch und Reis, provoziert. Katzen,
Ver€anderungen zeigten, wurden individuell mit ihrem fru
die sich mit dem Futter der Studie nicht verbesserten, wurde zwei Monate lang eine andere hydrolysierte€ttert.
Di€at gefu
€nfundzwanzig Katzen beendeten die Studie: vier schieden aufgrund von Vomitus und/oder
Ergebnisse – Fu
Durchfall, eine wegen schlechter Akzeptanz des Futters und zwei Katzen, weil es keinen Follow-Up gab,
aus. Bei 17 Katzen verbesserte sich der Juckreiz um > 50% und diese wurden Futterprovokationen ausge€here Di€
setzt. Von diesen reagierten neun auf ihre fru
at und/oder auf Fisch und/oder auf Reis und wurden6© 2021 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the European Society of Veterinary
Dermatology and the American College of Veterinary Dermatology

Hydrolysed fish and rice starch diet for the diagnosis of adverse food reaction€ckfall zeigten (und die Diagnose einer AFR zweifelhaft
mit einer AFR diagnostiziert, w€ahrend acht keinen Ru
erschien). Von den acht Katzen, bei denen sich der Juckreiz nicht verbesserte, wurde bei vier eine zweite€hrt.
ED ohne Verbesserung durchgefu€tzliche ED zur Diagnose der felinen AFR
Schlussfolgerung und klinische Bedeutung – FUH kann eine nu
sein, auch wenn die Katzen auf Fisch oder Reis reagieren.
摘要
背景 – 食物不良反应(AFR)的诊断是基于8周食物排查(ED)，并通过之前喂食的日粮再激发后复发来证实。
水解ED通常用于此目的。
目的 – 评价市售水解鱼蛋白和大米淀粉ED Farmina UltraHypo(FUH)用于猫AFR的诊断。
动物 – 32只非季节性瘙痒猫。
方法 – 在第0天和第56天，使用新的双重直观模拟量表评估瘙痒，使用猫过敏性皮炎量表评估病变，使用经验证的问卷评估生活质量。在前6周内允许使用短效皮质类固醇或奥拉替尼。使用先前的日粮、鱼和大米分别对瘙痒和/或病变改善50%的猫进行激发。对研究日粮无反应的猫喂食另一种水解日粮2个月。
结果 – 25只猫完成了ED：4只因呕吐和/或腹泻退出，1只因适口性低退出，2只失访。17只猫的瘙痒改善 >50%，这些猫接受了食物激发试验。其中，9例对既往饮食和/或鱼类和/或大米有反应，被诊断为AFR，而8
例未复发（AFR的诊断被认为是可疑的）。在瘙痒未改善的8只猫中，4只接受了第二次ED，无改善。
结论和临床重要性 – FUH可能是诊断猫AFR的有用ED，即使对鱼或大米有反应的猫也是如此。
要約
背景 – 食物有害反応(AFR)の診断は、8週間の除去食(ED)に基づいており、以前に与えられた食餌の負荷試験を実施した際に再発することで確認される。この目的のために、加水分解EDが一般的に使用されている。
目的 – 本研究の目的は、猫のAFRの診断のために、市販の加水分解魚蛋白および米澱粉のED Farmina UltraHypo (FUH)を評価することであった。
被験動物 – 32頭の非季節性掻痒症の猫を対象とした。
方法 – 0日目および56日目に、痒みの新しいデュアルビジュアルアナログスケールで、病変をScoring Feline Allergic Dermatitisスケールで、Quality of Lifeを有効な質問票で評価した。最初の6週間は、短時間作用型コルチコステロイドまたはオクラシチニブの投与を許可した。50％の掻痒感および／または病変の改善を示した猫には、以前の食事である魚および米を別途与えた。試験食に反応しなかった猫には、別の加水分解食を2ヶ月間与えた。
結果 – 25頭の猫がEDを完了したが、4頭は嘔吐および/または下痢のために脱落し、1頭は嗜好性が低いために脱落し、2頭は追跡調査できなかった。17頭の猫では、痒みが50%以上改善し、これらの猫は食物負荷試験を実施した。このうち、9頭は以前の食事、魚や米に反応し、AFRと診断されたが、8頭は再発しなかった（AFRの診断は疑わしいとされた）。痒みが改善しなかった8頭の猫のうち、4頭が2回目のEDを受けたが改善しなかった。
結論と臨床上の重要性 – FUHは、魚や米に反応する猫であっても、猫のAFR診断に有用なEDであると考えられる。
Resumostico de reacß~ao adversa a alimentos (AFR) e baseado em uma dieta de eliminacß~Contexto – O diagnoao confirmado por recidiva apo
s nova provocacß~(DE) de oito semanas e e
ao com a dieta fornecida anteriorsito.
mente. DEs hidrolisados s~ao comumente usados para esse propo
Objetivo – Avaliar a DE a base de proteına hidrolisada de peixe e o amido de arroz disponıvel comercialstico de AFR felina.
mente Farmina UltraHypo (FUH) para o diagno
Animais – Trinta e dois gatos pruriginosos n~
ao sazonais.
todos – O prurido foi avaliado com uma nova escala visual analogica dupla, as leso
~es com a escala ScoMering Feline Allergic Dermatitis e Quality of Life com question
ario validado nos dias 0 e 56. Corticosteroides
de curta duracß~ao ou oclacitinib foram permitidos durante as primeiras seis semanas. Gatos com melhora~es foram desafiados separadamente com sua dieta anterior, peixede prurido de 50% e/ou melhora das lesoe arroz. Os gatos que n~ao responderam a dieta do estudo foram alimentados com outra dieta hidrolisada
por dois meses.
^mito e/ou diarreia, um por
Resultados – Vinte e cinco gatos completaram a DE: quatro desistiram por vo
palatabilidade e dois n~ao retornaram e perdeu-se o contato com os proprietarios. Em 17 gatos, o prurido
ticos. Destes, nove reagiram 
melhorou em > 50% e estes foram submetidos a desafios dietea dieta anterior e/ou peixe e/ou arroz e foram diagnosticados com AFR, enquanto oito n~
ao tiveram recidiva (e o diagstico de AFR foi considerado duvidoso). Dos oito gatos em que o prurido n~noao melhorou, quatro foram
submetidos a uma segunda DE sem melhora.
~o e importa^ncia clınica – FUH pode ser uma DE ustico de AFR felina, mesmo
til para o diagno
Conclusa
em gatos que reagem a peixe ou arroz.

© 2021 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the European Society of Veterinary
Dermatology and the American College of Veterinary Dermatology
7