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  Discussion on Horse moved to rice bran diet needs supplement recommendation
Author Message
Member:
mcashman

Posted on Wednesday, Feb 23, 2011 - 3:49 pm:

Hi, Dr. O and all...

My horse is allergic to wheat, oats and barley and breaks out in huge hives when exposed. I have transitioned him to MannaPro's rice bran feed to escape this but I need now to find a mineral supplement appropriately overloaded with calcium to offset the phosphorus imbalance. Ideally the supplement would be pelleted as he seems to be avoiding the powder I was using (Grostrong from ADM). He is a reining horse in heavy work.

Any thoughts or recommendations?
Member:
mrose

Posted on Wednesday, Feb 23, 2011 - 5:08 pm:

What kind of hay is he being fed? And, just out of curiosity, how did you find out what he is allergic too? What a pain!
Moderator:
DrO

Posted on Wednesday, Feb 23, 2011 - 6:08 pm:

Hello Mark,
Most prepared bran feeds balance the calcium and phosphorus for you what does the guaranteed analysis say on the bag about this?
DrO
Member:
mcashman

Posted on Thursday, Feb 24, 2011 - 12:52 am:

It does say they added calcium carbonate to balance the Ca/P ratio, but the ratio on the label is 1.3-1.7 / 1.5. On a good day I guess that means it's 1.7 to 1.5 but on a bad day it's 1.3 to 1.5 (thus inverted). Also, the carbonate isn't as bioavailable as citrate, right?
Member:
mcashman

Posted on Thursday, Feb 24, 2011 - 1:22 am:

Hi, Sara!

He eats grass hay.

As you suspect, it was hard to find his allergy. Last year it was especially bad and it continued into winter, so I had a blood allergy panel done and found he was allergic to 23 things (many of which were not in his environment). Top of the list besides horse and deer flies (not applicable in winter) were oats, wheat and barley. He had no exposure to any of the other top allergens except timothy (which may be in his hay) and aspergillis (which may be in his stall).

So now I've eliminated the wheat and oats and after a month I'm tapering off the dexamethasone I had to use to suppress the urticaria. Down to a quarter dose a day now and so far so good.

I don't think the grain alone triggered the terrible urticaria (some were the size of my hand) but we were at a stable with very bad flies as well. The combination of allergens probably triggered it. So I'm just getting rid of everything I can before summer. And we're at a new stable where I expect much lower flies. If this works, maybe he'll have a good summer.
Moderator:
DrO

Posted on Friday, Feb 25, 2011 - 7:27 am:

I would not sweat the tiny tenths of a difference in the calcium in an adult horse Mark nor the differences in the carbonate or citrate salts. Basically the product has balanced the Ca/Phos at a acceptable if less than ideal level. You can look at the whole diet and if you find you would feel better with a little more calcium in the diet, consider alfalfa hay or beet pulp.

Reconsider the findings of the blood test for allergens as positive proof and consider the findings tentative. They are unreliable as they ID things as allergens that are not and surprisingly have missed known allergens in some horses.
DrO
Member:
mcashman

Posted on Friday, Feb 25, 2011 - 11:37 am:

Hi Dr. O.,

Thanks for the reassurance about the Ca levels. I probably worry more about his health than I do my own... :-)

I've used the SPOT test as a guide and tried to focus on things I knew were in his environment, and eliminate what I could in hopes that even if I didn't get everything that I would get enough to go below the threshold.

I know he's allergic to the insects as some of his hives would start near an insect bite welt and develop over a period of hours into something more obvious. But when the insects were all dead for the winter and I still had hives showing up, I was left with food and bedding items. He's allergic to fescue, but he stopped eating pasture, so even if there was fescue in the pasture, he wasn't getting any. I plotted the SPOT test results and found the wheat, oats and barley positives at the same level as the insect bites, so I figured eliminating those ingredients of his diet would be a good next target.

One of the things I was advised was that it would take at least a month to flush allergens from the system. A person I know who has lupus also suggested tapering but not just cutting off the dex, because her experience was that a sharp cutoff exacerbated her inflammatory symptoms. Following both these guidelines, at this point, I'm a little over a month in and the dex level is down to a quarter dose. There's a bit of a pattern each time I reduce the dex of there being a slight symptom visibility one day, and then if I continue the same level of dose, it decreases and disappears. In a week or so I'll go down to an eighth and then after a week or two of that, cut him off and see if he's OK before the bugs start to come back with spring.

Any thoughts on the above?
Moderator:
DrO

Posted on Saturday, Feb 26, 2011 - 8:30 pm:

To be frank, I think working around the blood test results a waste of time but if that is all you have to work on and the way you feel it is best to approach the problem I will not argue it will move us forward and who knows maybe I am wrong? I agree the steroids need to be tapered off rather than quit cold turkey.
DrO
Member:
mcashman

Posted on Tuesday, Apr 5, 2011 - 12:05 am:

Hi, Dr. O!

Wanted to let you know the rice bran seems to have eliminated my horse's allergies and he has been off dex for over a week with no hives. I did find that it was critical to be very slow about tapering off the dex as the suppression of his natural corticosteroids would take about 12-24 hours on each decrease to recover, and the hives would recur during that period. I was tempted several times to not continue the lowered dose because I was afraid I hadn't really found the allergy, but I "stayed the course" and his symptoms typically disappeared by next evening - and then I held level for a week before the next decrease. Each time it was hard not to think that I had failed to find his allergy, but finally it's clear I did.

It was really important to do this when the environmental and food causes were all that might be in play and I'm really glad to have found this before the insects are back out.

Thank goodness it wasn't something like hay or shavings... and the rice bran makes his coat beautifully shiny!
Member:
ajudson1

Posted on Tuesday, Apr 5, 2011 - 7:54 am:

Great news Mark! And a shiny coat to boot.
Member:
vickiann

Posted on Tuesday, Apr 5, 2011 - 12:17 pm:

Wonderful, Mark!
Moderator:
DrO

Posted on Friday, Apr 8, 2011 - 7:39 am:

Delighted to hear your horse is better Mark but I would note that it is not at all clear that removing the former feed stuffs and including the rice bran is the cause of your horses improvement. There is a temporal relationship here (one event followed another event) but there may not be a causal one (one event caused another event).

Food allergies that cause itching and hives is referred to as atopy. In my experience this appears to be a rare or nonexistent event in horses despite the almost universal reporting of reactions to common foodstuffs in these allergy tests. My personal experience with undiagnosed hives is to have the same history and results you outline above without the change in foodstuffs. Treatment with dex is usually followed by a period of remission.
DrO
Member:
mcashman

Posted on Saturday, Apr 9, 2011 - 1:50 am:

Thanks, Dr. O. I will keep an eye on things and repost here if I get a recurrence. We are about two weeks after the final does of dex, and there is no sign of recurrence. Nothing other than the switch to the rice bran feed has changed since we started this quest. I do get correlation is not causation, but it's hard to see anything else having done the job.

Remember, the pattern I saw when I reduced the dex. There was a lag period during which he would get a mild hiving (12-24 hrs), presumably a period during which his natural cortisol production was ramping back up.

What the heck was he reacting to during that period? And why does the slow decrease in the dose end with no hives if there are still things he's allergic to in the environment at a concentration that he's reacting to in the lag period? And if it's not the wheat and oats but something else, why don't the lag period symptoms blossom into the full urticaria, but just simply die away?

It seems like the natural cortisols are always fighting off some sort of environmental allergen(s) and then in the lag period, he gets inflammation from whatever that is.

Could this be the allergens from the wheat and oats being slowly flushed out (my reading says 3ish weeks to flush food allergens out in humans) so that by the time the dex dose is to zero it's all gone?

Or it could be that the rice bran has enough additional fatty acids per the above, to reduce the reaction?

Or is it possible that during the untreated urticaria period he was suffering from a brief suppression of his natural cortisol due to unknown causes, and the naturally present allergens it normally suppresses are free to wreak havoc? And then somehow it turns back on in time...?

Now in humans, I find a reference that says... "Reduction of cortisol production. During and after steroid treatment, the adrenal gland produces less of its own cortisol, resulting from hypopituitary-pituitary-adrenal (HPA) axis suppression. For up to twelve months after the steroids are stopped, the lack of steroid response to stress such as infection or trauma could result in severe illness." So why is the lag for my horse so short?

Cortisol insuffiency should cause Addison's disease, whose symptoms aren't anything like Lensman's "Addison’s disease has been reported in horses but is extremely rare. It can be secondary to worm damage of the adrenal glands and is known to follow very stressful events such as colic surgery. The signs are vague and include depression (no), anorexia (Lensman has a BCS of 5 and works 5 days a week quite hard), weight loss (stable weight since I've owned him), colic signs (none), poor coat condition (no) and sometimes renal problems (none observed)." so I don't think that I can blame his urticaria on that...

It's a big mystery to me, but I'm hoping I've found something that will help him. In the warm months, he will be exposed to flies again and we'll see if he's still allergic to them, or if reducing the food allergens might help his reactions stay in bounds...

Well, like I said, I'll keep you posted for what it's worth.

Thanks again!
Moderator:
DrO

Posted on Saturday, Apr 9, 2011 - 12:52 pm:

It appears to be much harder to induce iatrogenic adrenal insufficiency in the horse (and cat) than in other species we deal with for more see HorseAdvice.com » Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » Steroids, Overview of Antiinflammatory Use.

As to explaining the onset of hives and the eventual disappearance leaving of the hives, I agree this is a mystery but one you will see several times a year in practice.
DrO
Member:
mcashman

Posted on Sunday, Aug 14, 2011 - 10:10 pm:

A final update on Lensman's hives. Since his diet change he has had no recurrence, despite horseflies, mosquitoes and deer flies.

It looks like the overload of the food allergens was able to push his immune system over the edge, and taking those out has returned his sensitivity to normal.
Moderator:
DrO

Posted on Monday, Aug 15, 2011 - 7:31 pm:

Delighted things are doing well Mark.
DrO
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