Drug allergy in veterinary medicine awareness, incidence, and clinical characteristics

Fosset, Fabrice T.J.

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Description

Title

Drug allergy in veterinary medicine awareness, incidence, and clinical characteristics

Author(s)

Fosset, Fabrice T.J.

Issue Date

2015-07-20

Director of Research (if dissertation) or Advisor (if thesis)

Lavergne, Sidonie N

Department of Study

Veterinary Clinical Medicine

Discipline

VMS-Veterinary Clinical Medcne

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

M.S.

Degree Level

Thesis

Keyword(s)

• canine
• immunotoxicology

Abstract

The World Health Organization defines adverse drug reactions (ADRs) as “a noxious, unintended, and undesired effect of a drug that occurs at doses used for prevention, diagnosis, or treatment”. These ADRs can be classified into: type A reactions (60-80%, dose-dependent, predictable, and directly related to pharmacology/chemical properties), and type B reactions (20-40%, usually not dose-dependent, non-predictable). Drug allergic/hypersensitivity reactions are antigen-specific immune-mediated type B ADRs. They can be immediate (IgE-mediated; “anaphylaxis”) or delayed (IgG- or T cell-mediated). In human medicine, drug allergies are estimated to affect 0.1-3% of the general population and up to 15-20% of hospitalized patients. Drug hypersensitivity reactions appear similar clinically in dogs and humans, but their exact incidence in dogs remains unknown. Little is known about the pathogenesis of drug allergy in humans, and even less in veterinary patients. In addition, the literature about drug hypersensitivity in animals is very limited and most veterinary curricula spend little time covering this clinical issue. For the first time in veterinary medicine, this thesis aimed to investigate the awareness of veterinarians about drug allergy and its incidence in dogs. To address these goals, we first conducted a survey to evaluate the awareness of UIUC graduate veterinarians on the topic. We also conducted a retrospective study to determine the incidence and the clinical characteristics of drug allergic reactions in dogs seen at a US veterinary teaching hospital over an 11 year-period. We designed a survey through SurveyMonkey that targeted UIUC alumni veterinarians (n=2164) to evaluate their opinion on drug allergy in veterinary medicine. The results of this survey suggest a lack of awareness and/or knowledge about drug allergic reactions amongst veterinarians. Our data further suggests a lack of training in veterinary medical school and a lack of information in the literature about veterinary drug allergy. Importantly, the survey also highlights the interest of the participants to learn more on the subject. We conducted a tiered keyword search of the two clinical medical databases of the UIUC veterinary teaching hospital for the past 11 years, and thoroughly reviewed identified cases of potential drug HS. The retrospective study is the first to estimate an incidence for drug allergic reaction in dogs (0.15%), to report cases of DRESS in dogs (19 cases), and to establish an incidence for drug allergic contact dermatitis in dogs (7.7% of all drug allergic reactions). The incidence, the clinical pattern, and the drugs involved, matched what has been described in human medicine. This study also demonstrated a link between early drug discontinuation and prognosis as previously shown in human drug allergy. Importantly, the quality and completeness of the medical record were important limiting factors. Overall, this thesis identified a lack of awareness about drug allergy in veterinary medicine, leading to a lack of or delayed recognition of these reactions, often leading to inadequate management. This work also confirmed that drug allergic reactions are potentially as frequent in dogs as they are in humans, with similar clinical patterns that can be life threatening, and therefore represents a significant issue in dogs as well. We therefore believe that improving education of veterinarians on the subject could have a significant impact. In the meanwhile, more research will be needed to better understand the impact of the drug allergic reactions in veterinary medicine, and eventually create guidelines to improve diagnosis and management of these reactions.

Graduation Semester

2015-8

Type of Resource

text

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Copyright and License Information

Copyright 2015 Fabrice Fosset

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