Al­ler­gic Re­sponse

The Lat­est Un­der­stand­ing, Treat­ment and Nu­tri­tional In­ter­ven­tion For Horses Ex­pe­ri­enc­ing Skin & Res­pi­ra­tory Al­ler­gies

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Much like the im­pact that al­ler­gies have on hu­mans and their daily qual­ity of life, horses are af­fected by both skin and res­pi­ra­tory al­ler­gies that go be­yond sim­ple dis­com­fort to limit per­for­mance ca­pac­ity, cause in­fec­tion, al­ter be­hav­ior and, in se­vere cases, cause per­ma­nent dam­age to the skin and lungs.

Al­ler­gies are a con­stant frus­tra­tion shared by horse own­ers and vet­eri­nar­i­ans. Their spe­cific cause is of­ten shrouded in mystery, and the breadth and ef­fec­tive­ness of avail­able treat­ments are lim­ited. There are, how­ever, sev­eral in­sights gleaned from ex­ist­ing data, evolv­ing re­search and anec­do­tal suc­cess seen by vet­eri­nar­i­ans that are of­fer­ing re­lief to af­fected horses.

What is an “Al­lergy?”

“Al­ler­gies are im­mune disor­ders char­ac­ter­ized by hy­per­sen­si­tiv­ity to spe­cific sub­stances that re­sult in an ex­ces­sive in­flam­ma­tory re­sponse,” ex­plains Tara Hem­brooke, PhD, MS, Re­search Sci­en­tist with Plat­inum Per­for­mance, Inc. “Most com­monly,” she con­tin­ues, “al­ler­gic re­ac­tions af­fect the skin and res­pi­ra­tory air­ways in horses and gen­er­ally de­velop in re­sponse to ex­po­sure to in­sect bites, molds, spores and cer­tain pro­teins present in pas­ture grasses.” Al­ler­gies are ubiq­ui­tous, mean­ing that po­ten­tial causes are ev­ery­where in the typ­i­cal horse’s en­vi­ron­ment, mak­ing al­ler­gens dif­fi­cult to avoid and pin­point di­ag­nos­ti­cally.

“The num­ber one thing I try to do is first iden­tify the prob­lem and be as spe­cific as I can,” says Roland Thaler, VMD, owner of Me­ta­mora Equine in Me­ta­mora, Michi­gan. “When I get a horse with a cough, runny eyes or in­creased res­pi­ra­tory ef­fort, then I try to say ‘is this an al­lergy, a bac­te­rial is­sue or a virus?’ ” A vet­eri­nar­ian’s pri­mary ap­proach is very of­ten an elim­i­na­tion strat­egy; slowly elim­i­nat­ing el­e­ments from a horse’s en­vi­ron­ment un­til symptoms im­prove and the cause of the al­ler­gic re­sponse can be de­ter­mined, or at least nar­rowed.

The Im­mune Sys­tem Com­po­nent

With an al­ler­gic re­sponse be­ing at­trib­uted to an im­mune sys­tem hy­per­sen­si­tiv­ity, main­tain­ing a healthy im­mune sys­tem be­comes greatly im­por­tant. “In ad­di­tion to a bal­anced diet, sup­ple­men­ta­tion with spe­cific nu­tri­ents can help sup­port the im­mune sys­tem and, thereby, re­duce the oc­cur­rence of al­ler­gic re­sponse and other im­mune-re­lated re­ac­tions,” says Dr. Hem­brooke. The health of the equine im­mune sys­tem plays a role in vir­tu­ally every other as­pect of a horse’s over­all health and, ar­guably, their per­for­mance as well. One of the most ef­fec­tive ways to main­tain an op­ti­mally-func­tion­ing im­mune sys­tem is to pro­vide the foun­da­tional sup­port needed for optimal well­ness; it’s one of the pri­mary rea­sons Plat­inum Per­for­mance® was devel­oped in clin­i­cal prac­tice over 20 years ago. Pay­ing close at­ten­tion to a horse’s diet, then sup­ple­ment­ing them with the miss­ing pieces and more ther­a­peu­tic nu­tri­ents lays the ground­work for horses to thrive long-term as health­ier an­i­mals and more durable ath­letes.

Skin Al­ler­gies & In­sect Bite Hy­per­sen­si­tiv­ity

Skin al­ler­gies are by far the most com­mon type of al­ler­gies in horses, de­vel­op­ing as a re­sult of ex­po­sure to vir­tu­ally any­thing the horse may come into con­tact with, from pollen, dust and mold to sham­poos, fly spray and sad­dle pads. Al­though rare, skin al­ler­gies can also present as a re­ac­tion to cer­tain grasses, grains, feed ad­di­tives and sup­ple­ments, and take on sev­eral forms. “Skin al­ler­gies may present as itch­i­ness and pos­si­bly dam­age to skin like bald spots or scabs,” says Dr. Hem­brooke. The in­ter­sec­tion of the im­mune and ner­vous sys­tems re­sults in an itch­ing sen­sa­tion for af­fected horses, of­ten­times re­sult­ing in loss of use un­til the al­ler­gic re­sponse can be mit­i­gated. “Raised bumps that may or may not be itchy may be an­other sign,” con­tin­ues Dr. Hem­brooke, “and while skin al­ler­gies are mostly seen as a nui­sance, they can re­sult in in­fec­tion if not con­trolled prop­erly.” Kim Gill-Favier, DVM, shares the frus­tra­tion of chronic skin al­ler­gies, “The most com­mon thing I see is ur­ticaria, or hives. It al­ways seems to come up in Fe­bru­ary and March when we’ve had a lot of rain, things are start­ing to bloom and there may be molds. Horses will start to have ur­ticaria, which you treat once and it al­ways seems to come back.”

Horse own­ers don’t nec­es­sar­ily equate a horse’s in­sect bites and the sub­se­quent re­ac­tion to an al­ler­gic re­sponse, but in re­al­ity, horses can be pre­dis­posed to re­act more se­verely de­pend­ing on the state of their im­mune sys­tem. In­sect bite hy­per­sen­si­tiv­ity (IBH) is the most pro­lific equine al­lergy, and sub­se­quently, among the most ex­ten­sively stud­ied. Char­ac­ter­ized by a skin re­ac­tion to bites from in­sects such as Culi­coides, flies, mos­qui­tos and other in­sects, IBH af­fects an in­cred­i­bly large num­ber of horses re­gard­less of breed, age or dis­ci­pline. “IBH is re­ally a big prob­lem,” says Dr. Thaler. “I don’t think we ap­proach it strongly enough and fly spray just isn’t cutting it. We should be treat­ing these horses proac­tively.” Aside from re­mov­ing horses from an out­side en­vi­ron­ment dur­ing times of prime in­sect ac­tiv­ity, such as dawn and dusk, fans can be added to barns and stalls to help curb in­sect ac­tiv­ity. Work­ing from within the horse, their diet should be fo­cused on re­duc­ing in­flam­ma­tion and main­tain­ing a bal­anced im­mune sys­tem. High-qual­ity for­age with lim­ited grains and

con­cen­trates plus a fo­cus on omega-3 oils and sup­ple­mented omega-3 fatty acids and an­tiox­i­dants can lay the ground­work for a horse that’s more equipped to han­dle the in­sult of in­sect bites.

Res­pi­ra­tory Al­ler­gies

The study of res­pi­ra­tory al­ler­gies in horses is ad­vanc­ing well be­yond the lim­ited un­der­stand­ing of decades past. A greater link be­tween the horse’s en­vi­ron­ment and vary­ing lev­els of res­pi­ra­tory dis­tress has been made, lead­ing to a change in nomen­cla­ture and stronger ties be­tween the study of res­pi­ra­tory al­ler­gies in horses and hu­mans. “We study what is now called equine asthma,” ex­plains Cypri­anna Swider­ski, DVM, PhD, DACVIM, As­so­ciate Pro­fes­sor, Equine Medicine De­part­ment of Clin­i­cal Sci­ences at Mis­sis­sippi State Univer­sity. “And the first thing is to rec­og­nize that equine asthma is a syn­drome that typ­i­cally houses what was for­merly known as in­flam­ma­tory air­way dis­ease and also RAO, or re­cur­rent air­way ob­struc­tion.” There are two lev­els of sever­ity when it comes to equine asthma, with the first be­ing for­merly known as equine in­flam­ma­tory air­way dis­ease, and now re­ferred to as mild to mod­er­ate asthma. The sec­ond was for­merly re­garded as RAO, and now deemed se­vere asthma. “With se­vere asthma, there are horses who go in the barn, they’re ex­posed to moldy hay, and that’s how they trig­ger that dis­ease,” says Dr. Swider­ski. Grow­ing up in Mary­land, Dr. Swider­ski was shocked by the preva­lence of se­vere asthma in the horses she saw when she moved to the south­east­ern United States. “These horses dif­fered from the barn-as­so­ci­ated dis­ease I had grown up with, in that they ex­pe­ri­enced signs on pas­ture dur­ing con­di­tions of high heat and hu­mid­ity. I had never seen horses in so much dis­tress,” she says, with a hint of sad­ness un­der­ly­ing the de­ter­mi­na­tion in her voice. “I’ve be­come pas­sion­ate about equine asthma be­cause my heart goes out to these horses that have no real way to es­cape from the pas­ture as­so­ci­ated anti­gens that are trig­ger­ing this dis­ease that is chronic and pro­gres­sive. Horses ul­ti­mately can die from it.”

Symptoms of the barn as­so­ci­ated form of se­vere equine asthma can in­clude nasal or oc­u­lar dis­charge, cough­ing or la­bored breath­ing and can of­ten be greatly im­pacted by mod­est changes to a horse’s en­vi­ron­ment. “I’ll first try to get this horse away from the dust,” says Dr. Thaler. “I’ll try to get [the barn as­so­ci­ated horses] out­side the barn, have their hay soaked to min­i­mize what they’re in­hal­ing from it, and I’ll have my clients add the right oil to the feed.” Choos­ing an oil, such as omega-3-rich flax oil, can re­duce the sever­ity of the in­flam­ma­tory re­sponse, while more pro-in­flam­ma­tory omega-6-heavy oils, such as corn oil, can fur­ther ex­ac­er­bate the prob­lem. Be­yond oils, short-term treat­ment with cor­ti­cos­teroids is com­mon­place to help get symptoms un­der con­trol, as is the use of cer­tain tar­geted nu­tri­ents for longer-term ben­e­fit. “My rea­son for go­ing to nu­tri­tion is to get these horses off the cor­ti­cos­teroids as quickly as I can while us­ing as lit­tle of them as I can,” says Dr. Thaler. “A lot of my show horses are pretty over­weight, so for sev­eral rea­sons I try to use nu­tri­tion, and specif­i­cally, the Plat­inum Skin & Al­lergy for­mula. I use it as an ad­junct to ther­apy and to sup­port these horses by try­ing to re­duce the in­flam­ma­tory re­sponse.”

The Im­pact of Your Horse’s Diet

In­flam­ma­tion is known to play a sig­nif­i­cant role in al­ler­gic re­sponse. Horses main­tain­ing a low level of chronic in­flam­ma­tion are more equipped to han­dle al­ler­gens while horses above the in­flam­ma­tory dis­ease thresh­old with unchecked chronic in­flam­ma­tion are more apt to ex­pe­ri­ence a se­ri­ous re­ac­tion in re­sponse to an al­ler­gen. Diet is per­haps one of the best ways to in­flu­ence health and help man­age in­flam­ma­tion in a horse’s body.

“A pri­mary goal is to es­tab­lish or re-es­tab­lish a proper bal­ance be­tween the high-in­flam­ma­tory omega-6 fatty acids and the low-in­flam­ma­tory omega-3 fatty acids,” says Dr. Hem­brooke. Oils high in omega-6 fatty acids, like corn and cot­ton­seed, should be elim­i­nated and re­placed with low-in­flam­ma­tory oils high in omega-3 fatty acids like flaxseed. An­tiox­i­dants like vi­ta­mins E and C may help with re­pair of dam­aged tis­sue. Also, these an­tiox­i­dants can help with the in­ter­nal in­flam­ma­tory state. Ox­i­da­tion and in­flam­ma­tion are in­ter­twined. If there is a strong im­mune re­sponse, then there is go­ing to be an in­creased pro­duc­tion of free rad­i­cal species that can be me­di­ated with an­tiox­i­dants. Quercetin is a pow­er­ful polyphe­no­lic antioxidan­t that of­fers fur­ther sup­port for al­ler­gies by nat­u­rally in­hibit­ing the re­lease of his­tamine. Pro- and pre­bi­otics should also be con­sid­ered as they will

“I re­mind my clients how much it costs to have me come out to treat their horse for hives com­pared to how much it costs to prac­tice proac­tive care and use the Plat­inum for­mu­las I rec­om­mend.”

Kim Gill-Favier, DVM

sup­port a healthy gut mi­cro­bial pop­u­la­tion that is go­ing to then sup­port a healthy im­mune state.

Start­ing with the right hay is cru­cial, but re­al­iz­ing ex­actly what nu­tri­ents hay is pro­vid­ing — and what it’s not — is equally as im­por­tant. For in­stance, the level of omega-3 fatty acids and an­tiox­i­dants in fresh, still grow­ing al­falfa can be 38-40 per­cent higher than the same al­falfa just 6 weeks post-har­vest. With nu­tri­ent rates di­min­ish­ing over time in even the high­est-qual­ity hay, baled hay stops short of de­liv­er­ing all of the nec­es­sary nu­tri­ents horses need to func­tion at their best, mak­ing sup­ple­men­ta­tion an ex­cel­lent choice. It’s for this rea­son that foun­da­tional well­ness and per­for­mance for­mu­las like Plat­inum Per­for­mance® Equine, Plat­inum Per­for­mance® CJ and Plat­inum Per­for­mance® GI are rec­om­mended to sup­port im­mune func­tion, al­ler­gic re­sponse and to­tal body health. “Most of my pa­tients are al­ready on Plat­inum Per­for­mance Equine or Plat­inum Per­for­mance CJ,” says Dr. Gill-Favier of her ap­proach. “If they have re­cur­rent ur­ticaria, then I put them on the Plat­inum Skin & Al­lergy. I warn my clients that it may take a few weeks to turn their horses around, but it seems to solve the prob­lem. I re­ally don’t have many al­lergy-re­lated is­sues any­more with this pro­gram, and horses with fly bites re­spond re­ally well to it also.”

When ‘Nat­u­ral’ May Be Bet­ter

Tar­geted nu­tri­tion can be sig­nif­i­cantly ef­fec­tive in sup­port­ing a nor­mal al­ler­gic re­sponse be­cause of its im­pact on in­flam­ma­tion, man­ag­ing ox­ida­tive stress and help­ing to main­tain an optimal equine im­mune sys­tem. Though nat­u­ral, these nu­tri­ents are po­tent and well-re­searched tools for vet­eri­nar­i­ans and horse own­ers to turn to for longterm re­sults in horses with chronic al­ler­gies. “For me, I would rather take a nu­tri­tional ap­proach or an herbal ap­proach,” says Dr. Gill-Favier. “I don’t want to have horses on (dex­am­etha­sone) all the time; I think it’s dan­ger­ous, and es­pe­cially so with a lot of these horses that are bor­der­line meta­bolic.” Ther­a­peu­tic nu­tri­ents can be used as an ad­junct to clin­i­cal ther­a­pies for sus­tained re­sults, help­ing a horse’s body to heal without the side-ef­fects of­ten seen with pro­longed phar­ma­ceu­ti­cal in­ter­ven­tion.

Preven­tion vs. Treat­ment

With the use of en­vi­ron­men­tal in­ter­ven­tion and nu­tri­tion, a large ma­jor­ity of al­lergy is­sues can be avoided be­fore they ever have the op­por­tu­nity to be­come clin­i­cal. “There’s no one thing,” says Dr. Gill-Favier. “You have to man­age the en­vi­ron­ment, nu­tri­tion and take a to­tal holis­tic ap­proach.” From keep­ing dust un­der con­trol to man­ag­ing in­sect ac­tiv­ity and choos­ing a high-qual­ity, anti-in­flam­ma­tory diet to­gether with the right sup­ple­ments, small steps can lead to sig­nif­i­cant re­sults. “I re­mind my clients how much it costs to have me come out to treat their horse for hives com­pared to how much it costs to prac­tice proac­tive care and use the Plat­inum for­mu­las I rec­om­mend,” says Dr. Gill-Favier.

The Fu­ture

“With ad­di­tional re­search into un­der­stand­ing the com­plex im­mune mech­a­nisms as­so­ci­ated with al­ler­gic re­sponses in horses, it will be pos­si­ble to gain a bet­ter un­der­stand­ing of how to man­age the clin­i­cal man­i­fes­ta­tions of al­ler­gies,” says Meri Strat­ton-Phelps, DVM, MPVM, DACVIM, (LAIM), DACVN, Vet­eri­nary Clin­i­cal Nu­tri­tion­ist with Plat­inum Per­for­mance, Inc. “The ef­fect of the gas­troin­testi­nal mi­cro­biome on the health of the im­mune sys­tem and an im­proved un­der­stand­ing about the bar­rier func­tion of equine skin as it re­lates to atopic der­mati­tis are im­por­tant ar­eas of re­search in the fu­ture.” The gut mi­cro­biome to which Dr. Strat­ton-Phelps is re­fer­ring is seen by many in both vet­eri­nary and hu­man medicine to be the so-called ‘next fron­tier.’ With far-reach­ing in­flu­ence on nu­mer­ous sys­tems in the body, the gut mi­cro­biome is thought to af­fect im­mune func­tion, meta­bolic health, al­ler­gic re­sponse and even play a role in pre­de­ter­min­ing a hu­man or horse’s propen­sity for dis­ease.

While other as­pects of vet­eri­nary medicine may be more clearly de­fined and their treat­ments more black and white, equine al­ler­gies are a gray area that take trial and er­ror com­bined with tried and true strate­gies for the most pos­i­tive out­comes. Much is hap­pen­ing and great hope is on the hori­zon for sig­nif­i­cant break­throughs that could fur­ther im­prove the health, longevity and per­for­mance ca­pac­ity for horses af­flicted with skin and res­pi­ra­tory al­ler­gies. “In our horses where this is chronic and pro­gres­sive, if we can de­crease their pro­gres­sion, then they can stay where they are longer, and if we can mod­er­ate them, then they can have a longer and bet­ter qual­ity of life,” says Dr. Swider­ski.

Ul­ti­mately, it comes down to a greater fo­cus on preven­tion and a treat­ment plan with long-term and sus­tained re­sults as the end goal. Dr. Gill-Favier reminds her­self of­ten of why she chooses the ap­proach she does. “The body — whether that’s a hu­man or a horse — has a tremen­dous ca­pac­ity to heal if we give it the right tools and get out of the way.”

For Sup­port­ive Lit­er­a­ture:

• Fadok, Valerie A. Up­date on Equine Al­ler­gies. Vet Clin Equine 29 (2013) 541-550.

• Jensen-Jarolim et al. Out­stand­ing animal stud­ies in al­lergy II. From atopic bar­rier and mi­cro­biome to al­ler­gen-spe­cific im­munother­apy. Curr Opin Al­lergy Clin Im­munol 17 (2017) 180-187.

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