Immediate intradermal flea antigen reactivity in clinically normal adult dogs from south Florida, USA

Eighty-six clinically normal adult dogs from southern Florida, USA, with no history of dermatitis, were intradermally skin tested with Greer flea antigen 1:1000 w/v to determine the prevalence of positive immediate intradermal reactivity. This study describes the test group of animals and reports the prevalence of sensitivity to the Greer whole-body flea antigen in normal dogs living in a flea-rich environment. Similar to previous research, the highest prevalence of reactivity to flea antigen occurred at 3–4 years of age. The results indicate that 24% of clinically normal dogs from a flea-rich environment exhibited positive immediate skin test reactivity. These dogs had no clinical signs of flea allergic dermatitis (FAD) in spite of ongoing flea exposure. A 2-year follow-up telephone call to the owners of these flea antigen intradermal skin test (IDST)-positive dogs indicated that only two of 21 dogs had developed clinical signs of FAD.     

Pilot study to assess the effects of early flea exposure on the development of flea hypersensitivity in cats

This pilot study was to determine if early oral flea exposure reduces the incidence of flea allergy dermatitis (FAD) in cats. Eighteen kittens, assigned to three groups, received no flea exposure, oral flea exposure or flea infestation for 12 weeks. Then all the kittens were exposed continually to fleas for 31 weeks. Sensitization was monitored using intradermal testing (IDT), in vitro measurement of anti-flea saliva immunoglobulin E (IgE) and development of FAD. There was no statistically significant difference between groups in IDT reactions, in vitro data or clinical scores. The development of FAD was not associated with the presence of anti-flea saliva IgE. However, the development of a delayed reaction to flea bite was associated with symptoms after flea exposure. Although not statistically significant, the FAD scores in the oral group were lower than in the controls. Further studies are required to determine the role of oral flea exposure in the development of FAD in cats.     

Induction of feline flea allergy dermatitis and the incidence and histopathological characteristics of concurrent indolent lip ulcers

The objectives of this study were to characterize the role of intermittent vs. continual flea exposure in the development of flea allergy dermatitis (FAD) in cats, assess the accuracy of intradermal skin testing (IDST) and in vitro testing, and document the incidence and histopathological features of indolent lip ulcers. Ten flea‐naive cats were divided into two groups. One group received intermittent flea exposure for 120 days. Thereafter, both groups of cats received continuous flea exposure for 120 days. In vitro testing for flea salivary antibody and IDST utilizing both whole flea antigen and flea salivary antigen were performed. Eight of 10 cats developed clinical signs of FAD within 3 months and five of these eight cats developed lip ulcers which where characterized histopathologically by ulceration with predominantly neutrophilic inflammation and surface bacterial colonization. There was no association between the presence or absence of clinical signs and positive IDST or in vitro results, and no difference in the development of clinical signs was noted between the two groups of cats.     

Comparison of intradermal and serum testing for allergen-specific IgE using a Fcepsilon RIalpha-based assay in atopic dogs in the UK

Atopic dermatitis in dogs is a common allergic skin disease that affects substantial numbers of dogs in the UK. The purpose of this study was to compare the results of an intradermal test (IDT) and an in vitro test in a large cohort of dogs. Dogs were intradermal tested with Greer allergens (Greer Labs Inc, Lenoir, NC, USA) using standard techniques. At the same time blood samples were drawn and submitted for evaluation by ELISA using the ALLERCEPT Definitive Allergen Panels for allergen-specific IgE, a commercial assay that uses a biotinylated recombinant extracellular domain of the high affinity Fc-epsilon receptor alpha chain protein (Fcepsilon RIalpha). The allergens used in the two tests included grass, tree and weed pollens, moulds, flea saliva/whole flea extract and house dust mite species. The optical density readings from the ELISA for each allergen were compared with the results of the IDT for 265 dogs. The prevalence of positive reactions in the ELISA was equal to or greater than the results of the IDT in the case of almost all of the allergens, but two notable exceptions were the house dust mites Dermatophagoides farinae and Dermatophagoides pteronyssinus. These two allergens were the most common positive reactions by IDT (prevalence D. farinae 78.9%, D. pteronyssinus 66.4%). The results of the two tests were significantly different (McNemar's test, P<0.05) for 16 of the 22 allergens. The sensitivities of the ELISA compared to the IDT (where there were more than 3 dogs with positive reactions in both tests) varied between 19.3 and 77.1% (D. pteronyssinus 19.3% and D. farinae 67.9%) and the specificities varied between 64.2 and 96.6% (D. pteronyssinus 96.6% and D. farinae 89.3%).     

Comparison of immediate intradermal test reactivity with serum IgE quantitation by use of a radioallergosorbent test and two ELISA in horses with and without atopy

OBJECTIVE: To compare a radioallergosorbent test and 2 ELISA with intradermal testing for the determination of environmental allergen hypersensitivity in horses with and without atopic diseases. DESIGN: Prospective clinical study. ANIMALS: 10 horses with recurrent urticaria, 7 with atopic dermatitis, 16 with chronic obstructive pulmonary disease, and 22 without atopy. PROCEDURE: History, physical examination, hemogram, serum biochemical analyses, bronchoalveolar lavage, and an intradermal test (used as the criterion standard) with a regional panel of 73 allergens were performed in all horses. Serum was analyzed by use of the 3 in vitro assays of allergen-specific IgE. RESULTS: An ELISA based on the alpha chain of the high-affinity IgE receptor, the Fcepsilon receptor immunoglobin epsilon chain (FcepsilonRIalpha) for IgE, had the overall highest kappa statistic (0.238), positive predictive value (49%), and negative predictive value (78%). Overall agreement between the FcepsilonRIalpha-based ELISA and the intradermal test was fair. The highest kappa statistic was obtained by the FcepsilonRIalpha-based ELISA in horses with atopic dermatitis (0.330). Kappa statistics for the radioallergosorbent test and a polyclonal antibody-based ELISA agreed slightly with that of the intradermal test at best. CONCLUSIONS AND CLINICAL RELEVANCE: None of the 3 serum allergy tests reliably detected allergen hypersensitivity, compared with the intradermal test. The FcepsilonRIalpha-based ELISA performed significantly better overall than the other 2 tests. Low sensitivity of all 3 assays indicates the need for continued study to elucidate a more sensitive test for the determination of potentially pathogenic allergens in horses.     

P-6 Double-blinded comparative study of the efficacy of azithromycin and cephalexin in canine pyoderma

Bacterial pyoderma is one of the most frequent skin diseases in dogs. Recurrent pyoderma is often secondary to an underlying skin disease, but no epidemiological study has been published on the subject to the authors' knowledge. This study was designed to prospectively evaluate the causes responsible for recurrent pyoderma in dogs. Dogs presenting with a history of more than three episodes of skin infection in the last year were included in the study. For each case, epidemiological and clinical data were collected. Pyoderma was confirmed by the clinical signs, the demonstration of bacteria on microscopic examination of cytological smears and a positive culture. Each animal was treated with an appropriate course of antibiotics until resolution of signs of pyoderma. Depending upon the presence of pruritus, appropriate diagnostic tests were performed: skin scrapings, acaricidal trial, flea treatment, elimination diet, intradermal testing, biopsies, endocrinological tests, leishmaniasis and ehrlichiosis serology, antinuclear antibody testing. Thirty dogs (14 males and 16 females) of 19 different breeds, aged from 1 to 12 years (mean 4.9 years) were included. Diagnosis was folliculitis (44%), folliculitis and furunculosis (20%), furunculosis (20%), cellulitis (10%). Staphylococcus intermedius was isolated in 97% of cases. The following underlying diseases were identified: atopic dermatitis (60%), food allergy (7%), flea allergy (7%), hypothyroidism (7%), hyperestrogenism (4%), demodicosis (4%), and zinc-responsive dermatosis (4%). In two dogs, no underlying cause could be identified. Atopic dermatitis is the most common disease associated with recurrent pyoderma in dogs.
Funding: Pfizer Animal Health.     

Canine atopic dermatitis: a retrospective study of 169 cases examined at the University of California, Davis, 1992-1998. Part II. Response to hyposensitization

One hundred and sixty-nine dogs were diagnosed with atopic dermatitis, and treated with hyposensitization for at least 1 year based on the results of either intradermal skin tests (IDST) or enzyme-linked immunosorbant serum assays (ELISA). Excellent (i.e. hyposensitization alone controlled clinical signs), good (> 50% improvement), moderate (< 50% improvement) and no (clinical signs were unchanged) responses were seen in 19.5, 32.5, 20.1 and 27.8%, respectively. Age of onset, age when treatment was initiated or the duration of clinical signs had no influence on response to hyposensitization. Dogs having concurrent flea allergy dermatitis were statistically more likely to respond better than dogs with concurrent food allergies. Although not statistically significant, there were trends for Golden Retriever and male dogs to respond better than other breeds and female dogs, respectively. Dogs having more than 21 positive reactions in allergy tests and treated with more than 21 allergens had lower response scores, and a longer time course before achieving beneficial response. Lower response scores were seen in dogs having positive reactions to cultivated plants, grasses, trees or insects. There was no difference in response to hyposensitization whether based on IDST or ELISA results.     

Reactivity to intradermal injection of extracts of Dermatophagoides farinae, Dermatophagoides pteronyssinus, house dust mite mix, and house dust in dogs suspected to have atopic dermatitis: 115 cases (1996-1998)

OBJECTIVE: To compare reactivities to intradermal injection of extracts of Dermatophagoides farinae, Dermatophagoides pteronyssinus, house dust mite mix, and house dust in dogs suspected to have atopic dermatitis. DESIGN: Retrospective study. ANIMALS: 115 dogs. PROCEDURES: Records of all dogs suspected to have atopic dermatitis that underwent intradermal testing between October 1996 and July 1998 were reviewed. Reactivities to intradermal injection of crude mixed house dust mite (1:25,000 wt/vol) and crude house dust (25 PNU/ml) extracts were compared with reactivities to intradermal injection of individual extracts of D farinae and D pteronyssinus (1:50,000 wt/vol). RESULTS: Ninety dogs were confirmed to have atopic dermatitis including 61 of the 69 dogs with positive reactions to either or both of the individual house dust mite extracts. Intradermal testing with the mixed house dust mite extract had sensitivity of 75%, specificity of 96%, and accuracy of 83%. Intradermal testing with the house dust extract had sensitivity of 30%, specificity of 93%, and accuracy of 56%. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that use of crude mixed house dust mite and crude house dust extracts for intradermal testing in dogs is not as accurate a method of determining house dust mite hypersensitivity as is the use of individual D farinae and D pteronyssinus extracts mainly because of the high percentage of false-negative results. Extracts of individual house dust mites are recommended for intradermal testing of dogs suspected to have atopic dermatitis.     

Evaluation of a point-of-care immunodot assay for predicting results of allergen-specific intradermal and immunoglobulin E serological tests

Immunotherapy to prevent recurrence of clinical signs of atopic dermatitis (AD) is based on intradermal or serological tests that assist in identifying allergen-specific immunoglobulin E hypersensitivities. Unfortunately, the results of such tests can be negatively influenced by several factors, which include the age of the patients, the season of testing and the administration of anti-allergic drugs. Screening to predict when these expensive tests will be useful would benefit owners of dogs with AD. The objectives of this study were to determine whether a point-of-care allergen-specific immunodot assay (Allercept E-Screen, Heska Corp., Ft Collins, CO, USA) could predict results of either intradermal or Allercept full panel serological tests in atopic dogs. Thirty dogs living in the south-eastern USA were diagnosed with AD in accordance with current standards. Allergen-specific intradermal, serological and E-Screen tests were performed in all subjects. For flea, house dust mite and pollen allergens altogether, results of the E-Screen assay agreed with those of intradermal and serological tests in 26/30 dogs (87%) and 25/30 dogs (83%), respectively. In this group of dogs, the probabilities of obtaining intradermal or serological tests positive for these allergens were 70 and 67%, respectively. If either skin or serum tests were performed only in dogs with positive E-Screen tests, the probability of obtaining positive results would be increased from 70 to 95% and from 67 to 90%, respectively. In this population of dogs with AD, results of the E-Screen point-of-care immunodot assay was found to often agree with those of allergen-specific intradermal or Allercept tests for selected allergen groups.     

The immunopathogenesis of flea allergy dermatitis in dogs, an experimental study

In this study, we investigated the development of clinical disease and immune responses in the development of an experimental model of flea allergy dermatitis. Dogs were randomly divided into four treatment groups and were infested with fleas on two different feeding schedules (continuous and episodic). Group 1 consisted of four non-exposed dogs (negative controls) and Group 2 consisted of six dogs exposed to fleas continually. Groups 3 and 4 consisted of 14 dogs each that were exposed to fleas on an episodic schedule (two consecutive days every other week for 12 weeks). Group 4 also received intraperitoneal injections of a low dose of lectin (ricin) with immunomodulatory properties. The purpose of Group 4 was to investigate the effects of ricin on enhancing the development of clinical signs, flea antigen-specific IgE levels and altering the number of CD4+ and CD8+ T cell subsets in peripheral blood. Clinical signs developed in all flea exposed dogs, however, the dermatology lesion scores were less and shorter in duration for continuously exposed dogs compared to episodic exposed dogs, independent of ricin treatment. Lesion development was concentrated in the flea triangle and consisted principally of erythema, followed by alopecia, excoriation, papules, and crusts. CD4+ and CD8+ lymphocyte subsets or IgE levels were not altered by ricin treatment. Flea antigen-specific IgE values were highest in dogs exposed to fleas on a continuous basis compared to those episodically exposed. A greater percentage of clinical responder dogs with negative flea-specific IgE titers or negative intradermal test (IDT) were present in the episodic exposure groups than in the continuous exposure group. IgE titers corresponded slightly better with clinical responders than the IDT. The agreement between the IgE titers and IDT was good (weighted K = 0.67). Histopathology of skin samples were consistent with a Type I hypersensitivity. In conclusion, we were able to develop a model of flea allergy dermatitis by experimentally exposing dogs to fleas on an episodic and continuous feeding schedule. In this study, continuously exposed dogs did not develop immunotolerance, and ricin did not enhance the development of FAD.     

Effect of tiletamine/zolazepam sedation on intradermal allergy testing in atopic dogs.

Seven atopic dogs underwent intradermal allergy testing with 46 inhalant antigens before and after administration of a tiletamine/zolazepam solution (4 mg/kg of body weight, IV). This anesthetic protocol had no significant effect on the intradermal response caused by histamine, whole flea extract, or various inhalant allergens. Short-acting chemical restraint induced by the drug combination facilitated the intradermal testing procedure.     

Effect of topical application of fipronil in cats with flea allergic dermatitis

OBJECTIVE: To determine whether topical application of a 10% fipronil solution would control signs of flea allergic dermatitis in cats housed under natural conditions. DESIGN: Multicenter open clinical trial. ANIMALS: 42 client-owned cats with flea allergic dermatitis. PROCEDURES: Study cats along with all other cats and dogs living in the same houses were treated with 10% fipronil solution topically on days 0, 30, and 60. Flea counts and clinical assessments were performed on study cats on days 0, 14, 30, 60, and 90. RESULTS: Percentage reductions in geometric mean flea counts on days 14, 30, 60, and 90, compared with day-0 geometric mean count, were 75, 73, 85, and 94%, respectively. Pruritus score was significantly improved at each examination after day 0, and pruritus was reduced or eliminated in 31 of 40 (78%) cats at the final examination. Similarly, scores for severity of miliary dermatitis and alopecia were significantly improved at each examination, except for alopecia score on day 14. Overall treatment efficacy, assessed on day 90, was excellent for 28 (70%) cats, good for 6 (15%), moderate for 3 (7.5%), and poor for 3 (7.5%). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that monthly topical application of fipronil is effective for treatment of flea allergic dermatitis in cats housed under natural conditions.     

Hypersensitivity of dog skin to fleas-a clinical report

The results of an examination of the clinical signs, epidemiology and histopathology of dogs presented with flea bite dermatitis at two Dublin clinics are given. Whilst the majority of Dublin dogs are infested with fleas only some develop a reaction to flea saliva.
It is concluded that on the evidence available, flea dermatitis is a hypersensitive reaction to flea saliva and elimination of fleas from the environment of affected animals remains the best method of controlling the disease.     

Characterization of pruritus in canine atopic dermatitis,flea bite hypersensitivity and flea infestation and its role in diagnosis

Background – In dogs, flea infestation (FI), flea bite hypersensitivity (FBH) and canine atopic dermatitis (CAD) have been mainly characterized by their lesions but never by their pruritus. In clinical practice, many of these dogs exhibit only pruritus. Hypothesis/Objectives – The purpose of this study was to evaluate the characteristics of pruritus in these dermatoses and their potential usefulness for diagnosis. Animals – Dogs included were selected from the Oniris clinical data. Cases were selected in which the dogs had only one of the three dermatoses diagnosed. The diagnosis of CAD was based on Prélaud’s criteria and positive intradermal tests except flea; for FBH by compatible clinical signs and a response to an intradermal test with flea allergen; and for FI by the presence of fleas. Moreover, in each group, other primary pruritic skin diseases were excluded. Methods – Location, behavioural manifestations, seasonality and quantification of the pruritus were evaluated. The statistical analysis used chi‐squared test with a P‐value <0.05. Results – Three hundred and forty‐six dogs were analysed, 91 with CAD, 110 FI and 145 FBH. The period (season) of onset was not statistically different either for each dermatosis or among the three dermatoses. Some locations were highly specific for one dermatosis as follows: ventral abdomen/medial surface of thigh (chewing) and radius/carpus/tibia/tarsus (chewing) in FI; back/dorsolumbar area (chewing) and tail (chewing) in FBH; and paws (chewing/licking) and face/neck (rubbing) in CAD. Conclusions and clinical importance – Some features of pruritus could be suggestive of the causal disease, with possible diagnostic value in pruritic dogs.     

Canine atopic dermatitis: a retrospective study of 266 cases examined at the University of California, Davis, 1992-1998. Part I. Clinical features and allergy testing results

The medical records of 266 dogs diagnosed as having atopic dermatitis were reviewed. Statistical data were evaluated referable to breed predilections, clinical signs and positive reactions to allergens. Positive reactions were most common to house dust mites (more common with clinical signs in the fall) followed by moulds (more common with clinical signs in the fall and spring). Dogs with positive reactions to moulds, trees or cultivated plants were more likely to have skin and ear yeast infections. Dogs with positive reactions to cultivated plants were more likely to have otitis externa and pedal lesions. Positive reactions to house dust were more common in dogs with early onset of signs and in those tested early in the disease. Dogs had more positive reactions to weeds when allergy tests were performed in the summer and fall. Positive reactions to flea antigen were highly correlated with the clinical diagnosis of flea allergy dermatitis.     

The ACVD task force on canine atopic dermatitis (XI): the relationship between arthropod hypersensitivity and atopic dermatitis in the dog.

The relationship between arthropod allergen hypersensitivity and the development of canine atopic dermatitis (AD) is unclear. It has been shown that dogs with AD are more likely to exhibit positive intradermal reactivity to flea allergens than non-pruritic dogs from the same flea-endemic geographic region. Also, dogs in a flea endemic region are four times more likely to suffer from flea allergy dermatitis (FAD) and AD than from FAD alone. These results provide indirect evidence to support the hypothesis that, in the canine species, atopy predisposes to the development of hypersensitivity to flea allergens and eventually to FAD. A causal relationship between insects other than fleas and canine AD has not been identified with certainty.     

Evaluation of fipronil spot-on in the treatment of flea allergic dermatitis in dogs

The purpose of this study was to evaluate the effectiveness of treatment with 10 per cent fipronil solution for controlling signs of flea allergic dermatitis in dogs under field conditions. Thirty-one client-owned dogs with flea allergic dermatitis were treated with three monthly applications of 10 per cent fipronil solution. Flea counts and pruritus were significantly reduced at all post-treatment visits. At the final visit, on day 90, flea counts were reduced by 98 per cent, and pruritus was reduced or eliminated in 84 per cent of the study dogs. Dermatological lesion scores for erythema, crusts, scales and papules were also significantly improved by the final visit. The overall assessment of efficacy on day 90 was 'excellent' to 'good' for 87 per cent of the study dogs. The results demonstrate that treatment with monthly topical applications of 10 per cent fipronil solution is effective in reducing the prevalence and severity of signs of flea allergic dermatitis in dogs.     

Clinical and histological evaluation of immediate and delayed flea antigen intradermal skin test and flea bite sites in normal and flea-allergic cats

Seven cats diagnosed as flea allergic by specific criteria and seven normal control cats were exposed to flea bites in a controlled manner and were given intradermal injections of 1:1000 w/v flea antigen. Subjective evaluation of gross lesions and documentation of histological changes at flea antigen intradermal skin test (IDST) and flea bite sites were performed at 15 min, 24 h and 48 h after IDST or flea exposure. Control cats did not develop an immediate gross reaction to either flea bites or the intradermal injection of flea antigen. All seven flea-allergic cats had an immediate gross reaction at the site of IDST with flea antigen; five of these cats also developed immediate gross reactions to flea bites. Three of seven flea-allergic cats developed a gross 24 h and/or 48 h delayed reaction at the flea antigen IDST sites. These three and one other cat had both an immediate and delayed gross reaction to flea bites. Histological examination of 15 min skin specimens from IDST and flea bite sites of flea-allergic cats were similar with a mild lymphocytic, histiocytic and mastocytic superficial perivascular dermatitis. Histological examination of 24 h and 48 h skin specimens from IDST and flea bite sites of flea-allergic cats showed that they were often indistinguishable. Histological features of IDST and flea bite sites of flea-allergic cats at 24 h consisted of a perivascular to diffuse predominately eosinophilic dermatitis and mural folliculitis with variable epidermal necrosis and ulceration.     

Efficacy of selamectin in the treatment and control of clinical signs of flea allergy dermatitis in dogs and cats experimentally infested with fleas

OBJECTIVE: To determine whether treatment with selamectin would reduce clinical signs of flea allergy dermatitis (FAD) in dogs and cats housed in flea-infested environments. DESIGN: Randomized controlled trial. ANIMALS: 22 dogs and 17 cats confirmed to have FAD. PROCEDURE: Animals were housed in carpeted pens capable of supporting the flea life cycle and infested with 100 fleas (Ctenocephalides felis) on days -13 and -2 and on alternate weeks with 10 to 20 fleas. On day 0, 11 dogs and 8 cats were treated with selamectin (6 mg/kg [2.7 mg/lb]). Dogs were retreated on day 30; cats were retreated on days 30 and 60. All animals were examined periodically for clinical signs of FAD. Flea counts were conducted at weekly intervals. RESULTS: Throughout the study, geometric mean flea counts exceeded 100 for control animals and were < or = 11 for selamectin-treated animals. Selamectin-treated cats had significant improvements in the severity of miliary lesions and scaling or crusting on days 42 and 84, compared with conditions on day -8, and in severity of excoriation on day 42. In contrast, control cats did not have any significant improvements in any of the clinical signs of FAD. Selamectin-treated dogs had significant improvements in all clinical signs on days 28 and 61, but in control dogs, severity of clinical signs of FAD was not significantly different from baseline severity at any time. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that topical administration of selamectin, even without the use of supplementary environmental control measures and with minimal therapeutic intervention, can reduce the severity of clinical signs of FAD in dogs and cats.     

Immune dysregulation in flea allergy dermatitis--a model for the immunopathogenesis of allergic dermatitis

BACKGROUND: Flea allergy dermatitis (FAD) is a common skin disease in dogs and can be induced experimentally. It often coexists with other allergic conditions. So far no studies have investigated the quantitative production of cytokine mRNA in skin biopsies and peripheral blood mononuclear cells (PBMC) in flea allergic dogs. OBJECTIVE: The aim of our study was to improve the understanding of the immunopathogenesis of allergic dermatitis as a response to fleabites. MATERIAL AND METHODS: Allergic and non-allergic dogs were exposed to fleas. Before and after 4 days of flea exposure mRNA was isolated from biopsies and PBMC. Production of chymase, tryptase, IL-4, IL-5, IL-13, TNF-alpha and IFN-gamma mRNA was measured by real-time RT-PCR. The inflammatory infiltrate in the skin was scored semi-quantitatively. The number of eosinophils, mast cells (MC) and IgE+ cells/mm2 was evaluated to complete the picture. RESULTS: FAD was associated with a higher number of MC before flea exposure and with a significant increase of eosinophils after flea exposure as compared to non-allergic dogs. The number of IgE+ cells was higher in allergic dogs before and after flea exposure. In allergic dogs mRNA for most cytokines and proteases tested was higher before flea exposure than after flea exposure. After exposure to fleas an increased mRNA production was only observed in non-allergic dogs. In vitro stimulation with flea antigen resulted in a decreased expression of most cytokines in allergic dogs before flea exposure. In contrast, in PBMC, only increased levels of IL-4 and IL-5 mRNA were observed in allergic dogs before flea exposure. However, after flea exposure and additional stimulation with flea antigen the production of mRNA for all cytokines tested was significantly increased in allergic dogs. CONCLUSION: We demonstrated that the response in biopsies and PBMC is different and that FAD is associated with a TH2 response.