Anaphylaxis in Dogs: An Exploration of Clinical Characteristics and Diagnostic Biomarkers

Kate Turner

Anaphylaxis is a life-threatening condition affecting dogs. It is difficult to accurately diagnose due to the variable clinical presentation and the absence of a test to accurately differentiate it from other critical illness. To address these problems, we conducted a combined retrospective and prospective observational study to better classify the clinical presentations of dogs with suspected anaphylaxis, and a prospective observational study to identify potential blood biomarkers to differentiate anaphylaxis from other critical illness. The retrospective component of the first study identified that the predominant clinical signs include dermatological (140/186), gastrointestinal (141/186) and cardiovascular signs (129/186). Cardiovascular signs represented several shock categories. Most dogs showed vasoconstrictive shock (92/129), with fewer showing vasodilatory shock (24/129). Atypical forms of shock were also observed. This study also identified a lower-than-expected prevalence of gallbladder wall oedema (42/71). Results of the prospective component were similar. The second study investigated potential discriminatory biomarkers, comparing dogs with clinically-diagnosed anaphylaxis, dogs with other critical illness, and healthy dogs. Histamine concentration was significantly (P<0.001) higher in the anaphylaxis group compared to healthy and critical illness. CRP was significantly (P<0.001) higher in other critical illness compared to anaphylaxis and healthy. No differences in mast cell tryptase were detected amongst groups. Differences between groups (P<0.05 for all) were also detected for alanine transferase, alkaline phosphatase, antithrombin, aspartate aminotransferase, chemokine (C-C motif) ligand 2, fibrinogen, hyaluronan, interleukins 6 and 10, keratinocyte chemokine and protein C. Both serum C-reactive protein (CRP) and histamine concentration showed good to excellent ability to discriminate between anaphylaxis and other critical illness, with an area under receiver operator characteristic curve (AUROC) of 0.96 (95% CI 0.91-1) and 0.81 (95% CI 0.69-0.93), respectively. These studies highlight the difficulty in differentiating anaphylaxis from other critical illness based on clinical presentation, however CRP and histamine may help differentiate these conditions.

Anaphylaxis in Dogs: An Exploration of Clinical Characteristics and Diagnostic Biomarkers

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