J Vet Intern Med 2001;15:7–13

Food Sensitivity in Cats with Chronic Idiopathic

Gastrointestinal Problems
W. Grant Guilford, Boyd R. Jones, Peter J. Markwell, Donald G. Arthur, Mark G. Collett, and John G. Harte

The objectives of this study were to investigate the prevalence of food sensitivity in cats with chronic idiopathic gastrointestinal
problems, to identify the food ingredients responsible, and to characterize the clinical features. Seventy cats that presented for
chronic gastrointestinal signs underwent diagnostic investigation. Fifty-five cats had idiopathic problems and were entered into the
study. Diagnosis of food sensitivity was made by dietary elimination-challenge studies by using commercial selected-protein diets
as the elimination diet. Sixteen (29%) of the 55 cats with chronic idiopathic gastrointestinal problems were diagnosed as food
sensitive. The clinical signs of another 11 cats (20%) resolved on the elimination diet but did not recur after challenge with their
previous diet. The foods or food ingredients responsible for the clinical signs were dietary staples. Fifty percent of affected cats
were sensitive to more than 1 food ingredient. The clinical feature most suggestive of food sensitivity was concurrent occurrence
of gastrointestinal and dermatological signs. Weight loss occurred in 11 of the affected cats, and large-bowel diarrhea was more
common than small-bowel diarrhea. Assay of serum antigen-specific immunoglobulin E (IgE) had limited value as a screening
test, and gastroscopic food sensitivity testing was not helpful. In conclusion, adverse reactions to dietary staples were common in
this population of cats, and they responded well to selected-protein diets. Diagnosis requires dietary elimination-challenge trials
and cannot be made on the basis of clinical signs, routine clinicopathological data, serum antigen-specific IgE assay, gastroscopic
food sensitivity testing, or gastrointestinal biopsy.
Key words: Diagnosis; Diarrhea; Food allergy; Vomiting.

A dverse reactions to food (food sensitivities) include

those mediated by the immune system (food aller-
gies) and those without an immunological basis (food in-
tolerances).1 Clinical signs attributed to food sensitivity by
veterinarians usually are dermatological or gastrointestinal.
The prevalence of chronic dermatological abnormalities re-
sulting from food sensitivity in cats has been estimated to
be 5.8% in a university practice.2 Food sensitivity is thought
to be the second most common cause of allergic dermatitis
in cats and is considered responsible for up to 11% of cats
with miliary dermatitis.3 In contrast, the frequency with
which chronic gastrointestinal complaints in cats are caused
by food sensitivity is unknown.4 A number of observations
suggest that the prevalence of food sensitivity in cats with
gastrointestinal problems may be higher than in cats with
skin problems. For example, evidence from other species
suggests that not only can food sensitivity produce gastro-
intestinal problems, but conversely that gastrointestinal dis-
eases can lead to food sensitivity by compromising oral
tolerance.5 Furthermore, food intolerances from such dis-
orders as brush border enzyme abnormalities and ingested
toxins would more commonly affect the bowel and result
in gastrointestinal clinical signs rather than dermatological
signs.
From the Institute of Veterinary, Animal, and Biomedical Sciences,
Massey University, Palmerston North, New Zealand (Guilford, Jones,
Collett); Waltham Centre for Pet Nutrition, Waltham-on-the-Wolds,
UK (Markwell, Harte); and the Ministry of Agriculture and Forestry,
Quality Management, P.O. Box 24, Lincoln, New Zealand (Arthur).
Presented in part at the 14th American College of Veterinary Internal
Medicine Forum, 1996.
Reprint requests: Professor W. Grant Guilford, BVSc, PhD, Dipl
ACVIM, Institute of Veterinary, Animal, and Biomedical Sciences,
Massey University, Private Bag 11-222, Palmerston North, New Zea-
land; e-mail: W.G.Guilford@massey.ac.nz.
Submitted December 2, 1999; Revised May 17, 2000; Accepted Au-
gust 2, 2000.
Copyright q 2001 by the American College of Veterinary Internal
Medicine
0891-6640/01/1501-0001/$3.00/0
It is uncertain to which food ingredients cats with gas-
trointestinal problems are most frequently sensitive. Lim-
ited information from studies of cats and more compelling
evidence from other species suggest that the most prevalent
food allergens are proteins commonly included in the diet.1,5
In contrast, the food ingredients most likely to be respon-
sible for food intolerances are more varied and do not re-
quire prior exposure. These include disaccharides (such as
lactose), food additives (such as coloring agents), pharma-
cologically active products (such as histamine), and food
toxins.1,5,6
The gastrointestinal signs of food sensitivity in cats are
poorly described. Vomiting and diarrhea usually are re-
ported,3,5,7,8 but the specific characteristics of the pattern of
vomiting and type of diarrhea are rarely mentioned. Fur-
thermore, the presence or absence of particular clinical fea-
tures suggestive of gastrointestinal food sensitivity have not
been methodically investigated.
Adverse reactions to food usually are suspected when an
association is made between the ingestion of a certain food
and the appearance of a clinical sign. The diagnosis is con-
firmed by dietary elimination-challenge studies. Alternative
methods of diagnosis have been proposed in other species,
including assay of serum antigen-specific immunoglobulin
E (IgE) and gastroscopic food sensitivity testing (GFST).5,9–11
A commercial assay of cat antigen-specific IgE in serum
now is available.a A technique to perform GFST recently
has been developed for use in dogs11 and awaits application
in cats. The primary advantage of serum antigen-specific
IgE assay over elimination-challenge trials is convenience.
The principal advantage of GFST testing is that the re-
sponse of the gastrointestinal mucosa to several food aller-
gens can be directly and simultaneously observed. An im-
portant disadvantage of serum antigen-specific IgE assay
(and most likely GFST) is that these tests focus on the
diagnosis of just 1 type of food sensitivity—immediate
(type 1) hypersensitivity. Therefore, the effectiveness of
these tests as screening tests for the entire range of adverse
reactions to foods requires investigation.
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8 Guilford et al

The principal objective of this study was to investigate Table 1. Food additive and histamine solutions used in
the prevalence of adverse reactions to foods in cats with GFST.
chronic idiopathic gastrointestinal problems and to identify
Solu-
the foods or food ingredients to which the cats were sen-
tion Percent-
sitive. In addition, we aimed to characterize the clinical No. Additive age Mixture
features of gastrointestinal food sensitivity in cats and to
evaluate the concordance of serum antigen-specific IgE as- 1 Sodium nitrite 0.01 10 mg in 100 mL basea
2 Red oxide 0.1 100 mg in 100 mL base
say and GFST with the elimination-challenge tests by
Titanium oxide 0.2 200 mg in 100 mL base
which the diagnosis was made.
3 Guar gum 0.1 100 mg in 100 mL base
‘‘Petset’’b 0.6 600 mg in 100 mL base
Materials and Methods 4 Liquid caramel 0.2 200 mg in 100 mL base
5 Histamine 0.01 27.5 mg histamine phosphate
Cats
in 100 mL base
Seventy cats that were presented to the Massey University Veteri-
nary Teaching Hospital (MUVTH) with chronic gastrointestinal signs GFST, gastroscopic food sensitivity testing.
underwent thorough diagnostic investigation (see below) to determine
a
Base 5 sterile saline with 0.2% phenol.
their suitability for entry into the study. Thirty-seven cats were female,
b
Petset 5 carageenan : locus beangum : potassium chloride 40 : 40 :
and 33 cats were male. All of the cats had diarrhea or vomiting for 20 (also called carob gum).
more than 2 weeks (36 cats with vomiting, 22 cats with diarrhea, and
12 cats with both vomiting and diarrhea). The cats showed a variety
gist was unaware of whether the cats had been diagnosed as food
of other clinical signs, including weight loss (40 cats), anorexia (22
sensitive.
cats), flatulence (18 cats), and abdominal bloating (8 cats). Of the 70
cats, 15 were diagnosed with renal disease, liver disease, hyperthy-
roidism, parasitism, infection with feline leukemia virus (FeLV) or Serum IgE Assay
feline immunodeficiency virus (FIV), obstruction of the gastrointesti- Serum samples were taken at admission from all cats and stored at
nal tract, neoplasia, or infectious gastroenteritis and were eliminated 2208C for a maximum of 6 months before analysis by antigen-specific
from the study at various stages of the diagnostic workup. Fifty-five enzyme-linked immunoadsorbent assay by a commercial laboratory.a
cats completed workups without identification of a specific diagnosis Cats with food-specific IgE concentrations greater than 200% of con-
to explain their clinical signs. These cats were diagnosed as having trol sera were considered positive.
‘‘chronic idiopathic gastrointestinal problems’’ and were entered into
the study. The gastrointestinal biopsy specimens of the majority of Gastroscopic Food Sensitivity Tests
these 55 cats were subjectively assessed to have mild to moderate
increases in the number of lymphocytes, plasma cells, or eosinophils All cats underwent GFST according to a previously described tech-
in the lamina propria (ie, inflammatory bowel disease), but other cats nique.11 The staple diets of the cats were withheld for at least 3 days
had no evidence of increased numbers of mucosal inflammatory cells. before the GFST in the hope of increasing the sensitivity of the test.11
The procedure was performed after induction of anesthesia with tile-
Gastrointestinal Workup tamine-zolazepamc and maintenance with halothane. All cats were test-
ed with 0.5-mL volumes of 5 diluted food protein extracts,d a dilute
Standardized patient history forms were completed to determine the histamine solution, and 4 solutions of food additives (Table 1). Four
clinical signs, the staple diet, the temporal relationship of the clinical of the food proteins (milk, beef, lamb, and chicken) were tested in all
signs to food intake (if any), and the time between bouts (if the clinical cats. Milk, beef, and lamb proteins are dietary staples for most New
signs were episodic). A complete physical examination was performed Zealand cats. Chicken was used as the negative control protein because
and the results recorded on standardized physical examination forms it is infrequently fed as a dietary staple in New Zealand. The 5th food
to ensure consistency in examination. A database was collected con- protein was varied according to the dietary history of the individual
sisting of complete blood count, serum chemistry profile, FeLV and cat under study. Most commonly, this protein was wheat, corn, or a
FIV test, urinalysis, and at least 2 zinc and sugar fecal flotations for mixed-fish extract.d The food extracts were applied at a final concen-
Giardia and nematode parasites, respectively. A radiopaque markerb tration of 15,000 protein nitrogen units (PNUs) per milliliter with the
study was performed on all vomiting cats to rule out partial obstruc- exception of wheat and corn extracts, which were applied at concen-
tions of the bowel and to evaluate gastrointestinal motility. Total serum trations of 5,000 PNU/mL. The additives tested were those included
thyroxine concentration was measured in all cats older than 6 years. frequently in commercial cat foods in New Zealand. The additives
Cats with diarrhea additionally underwent rectal scraping for cytology were donated by a local pet food manufacturer and were diluted in
and acid-fast stain of the feces to detect Cryptosporidium spp. All cats saline to obtain the concentrations used by this manufacturer in their
underwent gastroduodenoscopy, during which biopsy samples were products. All cats were tested with the same additives. Some of the
obtained from the stomach and duodenum for histopathology and du- additives were tested in combination to minimize the anesthesia time
odenal fluid was aspirated for quantitative aerobic and anaerobic cul- required to test the additives.
ture. In addition, incisional biopsy was obtained from the rectal mu-
cosa of all cats, and a colonoscopy and biopsy were performed on Dietary Elimination-Challenge Trial to Diagnose
those cats with a history of blood or mucus in their feces. All endo-
Food Sensitivity
scopic biopsy samples were pinch biopsy specimens, and 8 to 12 bi-
opsy samples were collected from each region of the gastrointestinal After the diagnostic procedures were completed, the cats were fed
tract examined. The biopsy specimens were viewed by the pathologist sufficient food to satisfy their appetites with a commercially available
on duty at the time of the diagnostic workup. All biopsy samples chicken- or venison-based selected-protein diet e,f for a minimum of 4
subsequently were pooled and reviewed by a pathologist (D.G.A.) with weeks. The choice between these diets was based on the dietary his-
a subjective grading system based on the number and type of inflam- tory of the individual cat. Most cats were placed on the chicken-based
matory cells in the lamina propria. The degree of mucosal inflamma- diet, but any cats that had eaten chicken within the previous 6 months
tion was classified as absent, mild, moderate, or severe. The patholo- were fed the venison-based diet. The owners were given the option of

Food Sensitivity in Cats
taking the cat home or leaving it in the hospital for this phase of the
study. The majority of owners (90%) took their cats home. Owners
were warned of the importance of feeding the elimination diet exclu-
sively. If the owner had more than 1 cat, the owner was instructed to
feed all of the cats the elimination diet. If the cat had access to the
outdoors, the owners were asked to visit their neighbors to ask them
not to feed the cat. During the elimination trial, the owner was asked
to record on a daily basis the cat’s food intake and clinical signs on
standardized logs. The clinical signs recorded by the owners included
the number of times the cat vomited and the grade of the feces as
compared with a photographic fecal grading chart. The 5-point chart
graded the fecal consistency from firm stools (grade 5) to liquid di-
arrhea (grade 1). Those cats with clinical signs that did not become
reduced in frequency or severity after 4 weeks were considered not to
be suffering from food sensitivity.
Cats with clinical signs that completely resolved on the elimination
diet were returned to their staple diet for 4 to 7 days. If more than 1
food had formed part of a cat’s staple diet, the cat was challenged
with each of these foods for a 4-day period followed by a 3-day wash-
out period, during which the cat was fed the elimination diet before
the next diet challenge. The 4-day challenge period was considered
the minimum desirable but was chosen to allow a new food to be
tested on a weekly basis. The washout period minimized the chance
of misdiagnosis caused by a delayed food sensitivity reaction appear-
ing during the subsequent week of testing. These challenge tests were
performed either at home or in the hospital, depending on the owner’s
preference. A cat was considered to have recrudescence of its clinical
signs if fecal consistency deteriorated to the grade assigned before the
elimination trial or if the vomiting increased to a frequency similar to
that recorded before the elimination trial. Cats were again fed the
elimination diet for 2 to 4 weeks until signs resolved. Cats were di-
agnosed as food-sensitive if their clinical signs resolved when they
were fed the elimination diet, recrudesced when they were challenged
with their staple diet, and then resolved for a 2nd time when they were
returned to the elimination diet.
Dietary Elimination-Challenge Trials to Identify the
Responsible Food Ingredient
The owners of 12 of the cats diagnosed as food-sensitive agreed to
admit their cats to the MUVTH for more detailed dietary challenge
studies, with the aim of identifying the specific food ingredient to
which the cat was sensitive. Dietary challenge studies were undertaken
by adding a small quantity of food protein (minimum 0.6 grams of
protein per kilogram body weight) or food additives to the elimination
diet on a weekly basis. The food proteins chosen were those that
formed the majority of the cat’s diet in the previous 3 months. Most
cats were tested with lamb and beef (50 g diced fresh meat per day),
wheat (25 g cooked cereal per day), canned viscera (50 g of sheep
and beef lung, testicles, kidney, and liver minced on an equal weight
basis), and milk (15 g of whole milk powder in a slurry). Up to 2
other protein sources were tested, depending on the owner’s willing-
ness to accept a prolongation of the hospitalization period. The other
protein sources (dependent on diet history) included tuna (50 g),
whitefish (50 g), pork (50 g), corn gluten (15 g), oats or barley (25
g), or egg (1 whole egg cooked and diced into diet). The food additives
chosen were the same as those used in the GFST. The additives were
mixed in combination into the elimination diet at concentrations com-
monly found in New Zealand commercial pet foods (Table 2). If an
adverse reaction to the combination of additives was observed, cats
then underwent a series of challenges with the individual additives
added to the elimination diet. For all challenge trials with food ingre-
dients, a 4-day challenge period and 3-day washout period were used.
Both the food proteins and the food additives were tested in a random
order. Clinical signs evaluated during in-hospital challenge trials were
the same as those evaluated by the owners (vomiting frequency and
19391676, 2001, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2001.tb02291.x by Cochrane Philippines, Wiley Online Library on [01/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
9
Table 2. Food additive and histamine doses used in die-
tary challenge studies.
Additive Dose
Sodium nitrite 12 mg
Red oxide 300 mg
Titanium oxide 600 mg
Guar gum 300 mg
‘‘Petset’’a 1,800 mg
Liquid caramel 600 mg
Histamine 20 mg
a
Petset Carageenan : locus beangum : potassium chloride 40 : 40 : 20
(also called carob gum).
fecal grade) but with the addition of defecation frequency (which could
not be assessed reliably in nonhospitalized indoor-outdoor cats).
Results
Sixteen (29%) of the 55 cats with chronic idiopathic gas-
trointestinal problems were diagnosed as food sensitive. In
addition to the 16 food-sensitive cats, the clinical signs of
another 11 cats (20%) entered into the study resolved on
the selected-protein diet but did not recrudesce on challenge
with their old diet. The clinical signs of the food-sensitive
cats resolved quickly on the elimination diet. Vomiting
stopped immediately in almost all affected cats, and diar-
rhea resolved in most affected cats within 2 or 3 days. Re-
crudescence of clinical signs in the food-sensitive cats was
rapid also, occurring within 3 to 4 days of challenge with
their previous diet.
Commercial canned food comprised some or all of the
diet of 93% of the food-sensitive cats and 94% of the non–
food-sensitive cats. Commercial dry diets were fed to 60%
of the food-sensitive cats and 54% of the non–food-sensi-
tive cats. Six percent of the food-sensitive cats and none of
the non–food-sensitive cats were fed exclusively dry diets.
Table foods occasionally were fed to 73% of food-sensitive
cats and 67% of non–food-sensitive cats.
The foods or food ingredients to which the affected cats
were sensitive are listed in Table 3. The most common al-
lergens were beef, wheat, and corn gluten. One of the cats
with wheat sensitivity was determined to have a transient
sensitivity to wheat gluten, which resolved after approxi-
mately 6 weeks of dietary management with a selected-
protein diet. One cat vomited immediately after ingestion
of the mixture of food additives but demonstrated no ad-
verse reactions to any of the food additives when they were
fed separately. The cat was rechallenged with the mixture
of additives and immediately vomited a 2nd time. Of the 8
food-sensitive cats that underwent elimination-challenge
testing with multiple food ingredients, 4 (50%) were found
to be sensitive to more than 1 food ingredient.
Nine of the food-sensitive cats were female, and 7 were
male. Their ages ranged from 6 months to 14 years (me-
dian, 5 years), with only 3 cats being less than 1 year. The
majority of cats were domestic short hairs. Their gender,
age, and breed distributions were similar to the non–food-
sensitive cats in the study.
Nine of the food-sensitive cats had a history of vomiting
(56%), 4 had a history of diarrhea (25%), and 3 had a
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10 Guilford et al

Table 3. Foods or food ingredients responsible for food a combination of dermatological and gastrointestinal dis-
sensitivity.a ease, 4 of these cats (40%) were diagnosed as food sensi-
tive.
Food or Ingredient No. Cats
The duration of clinical signs in the food-sensitive cats
Commercial dry diet 5b ranged from 1 to 70 months (median, 7.5 months). The
Commercial canned diet 1b clinical signs were episodic in 4 (25%) of the cats, with an
Beef 3 interval free of clinical signs for up to 3 months. A similar
Corn gluten 3
percentage of non–food-sensitive cats had episodic clinical
Wheat 3
signs, but in these cats longer intervals free of clinical signs
Wheat gluten 1
Barley 1 were reported (as long as 1 year).
Chicken 1 No consistent abnormalities were detected in the CBC
Lamb 1 and serum chemistry profiles of the food-sensitive cats.
Sardines 1 However, 29% of the food-sensitive cats had eosinophilia.
Viscera 1 The eosinophil counts ranged from 0.07 to 6.1 3 109 per
Lactose 1 liter (median, 0.55 3 109 per liter). A smaller percentage
Food additives 1 (10%) of non–food-sensitive cats had eosinophilia. In these
a
Fifty percent of the cats were multiply allergic. cats, the eosinophil counts ranged from 0.13 to 5.4 3 109
b
The allergen in the dry or canned foods fed to these cats was not per liter (median, 0.76 3 109 per liter). Fourteen percent of
identified either because the owners refused further testing or because the food-sensitive cats had lymphopenia. The lymphocyte
further elimination-challenge testing failed to identify the allergen. counts ranged from 1.16 to 7.0 3 109 per liter (median,
3.12 3 109 per liter). Twenty-four percent of the non–food-
sensitive cats had lymphopenia. In these cats, the lympho-
history of both vomiting and diarrhea (19%). The vomiting cyte counts ranged from 0.57 to 10.68 3 109 per liter (me-
was relatively infrequent, occurring less than once per day dian, 2.59 3 109 per liter).
in most cats and up to a maximum of 3 times per day in Serum antigen-specific IgE test results were available for
the most severely affected cat. The nature of the vomitus 12 of the food-sensitive cats. Of these 12 cats, 7 cats (58%)
and its timing after eating was variable. Some cats vomited had one or more positive test results. Two cats with adverse
food within minutes of eating, whereas others vomited food reactions to corn gluten and 1 cat with an adverse reaction
2 hours to more than 12 hours after eating. In some cats, to dry food containing corn had positive serum tests for
the timing of the vomiting was seemingly unrelated to eat- corn-specific IgE. Two food-sensitive cats (17%) had pos-
ing, and the vomitus consisted primarily of bile. Four of itive serum IgE tests to antigens to which they showed no
the 7 food-sensitive cats (57%) with diarrhea had evidence adverse reactions. Three food-sensitive cats (25%) had pos-
of large-bowel dysfunction (mucus and fresh blood in the itive serum IgE tests to antigens to which they were not
feces, excessive straining to defecate, or both). tested but to which they were unlikely to be sensitive be-
The frequency of vomiting (63%), diarrhea (34%), and cause the antigens were novel proteins to which these cats
concurrent vomiting and diarrhea (13%) in the non–food- were unlikely to have been exposed. The remaining 5 food-
sensitive cats was similar to that of the food-sensitive cats. sensitive cats had no positive serum antigen-specific IgE
Fifty-six percent of non–food-sensitive cats with diarrhea tests.
had evidence of large-bowel dysfunction. Serum antigen-specific IgE tests were available for 24 of
Weight loss and flatulence were observed in 11 (69%) the non–food-sensitive cats. Of these 24 non–food-sensitive
and 6 (38%) of the food-sensitive cats and 53% and 21%, cats, 6 (25%) had 1 or more positive tests. Eighty-three
respectively, of the non–food-sensitive cats. The weight percent of these positive results were to soy (3 cats), rice
loss was classified as moderate to marked in 50% of the (4 cats), and corn (3 cats) or some combination of these 3
food-sensitive cats. Appetite was variably reported as de- foods. One cat had a positive test to peanut and another to
creased, unchanged, or increased in food-sensitive cats. potato. The labels of the staple diets of the non–food-sen-
Some of the food-sensitive cats with weight loss had mod- sitive cats with positive serum antigen-specific IgE tests did
erate or severe histologic abnormalities (20%) of the small not list rice, soy, peanut, or potato. However, transient ex-
intestinal mucosa, but most had mild histologic abnormal- posure to these food antigens could not be discounted be-
ities (40%) or no histologic abnormalities (40%). cause all of these cats had very varied diets, including table
The demeanor of 6 (38%) of the food-sensitive cats was foods and canned and dry foods purchased from supermar-
reported as irritable. Another 4 cats (25%) were reported kets and veterinary practices.
as lethargic. Collectively, therefore, altered demeanor was Gastroscopic food sensitivity testing was not helpful.
reported in 10 (63%) food-sensitive cats. Altered demeanor Only one suspicious reaction (swelling without erythema)
was noted in 45% of the non–food-sensitive cats. was observed in all of the procedures performed. This re-
Concurrent dermatological disease was observed in 4 action occurred after the application of a gum mixture (so-
cats (25%) with gastrointestinal problems caused by food lution 3; Table 1) and was not confirmed by positive dietary
sensitivity. These cats suffered from miliary dermatitis, pru- challenge to gums.
ritus, and alopecia. The dermatological signs were caused All of the food-sensitive cats had histological changes in
by food sensitivity in 3 of these 4 cats. In contrast, con- at least 1 region of the bowel. However, the region of the
current dermatological signs were reported in 15% of the gastrointestinal tract affected was not consistent, and the
non–food-sensitive cats. Of a total of 10 cats presented with histological changes were nonspecific and were similar in

Food Sensitivity in Cats
frequency and severity in food-sensitive and non–food-sen-
sitive cats. One food-sensitive cat had a subacute diffuse
suppurative glossitis with focal ulceration. Gastric mucosal
biopsy specimens were abnormal in two thirds of the food-
sensitive cats. One cat had severe lymphocytic gastroenter-
opathy characterized by diffuse infiltration of lymphocytes
throughout the gastric lamina propria along with clumps of
plasma cells. In some areas, invasion and obliteration of
glands was observed. Nine other food-sensitive cats had
mild histological changes in their gastric mucosa, including
small numbers of eosinophils migrating through the glan-
dular epithelium, scattered foci of lymphocytes, patchy sub-
epithelial edema or hemorrhage, or mild fibroplasia. Lym-
phoid nodules were observed in the gastric mucosa of 2
food-sensitive cats. The duodenal mucosal biopsy speci-
mens were abnormal in 50% of the food-sensitive cats. On
most occasions, the pathologic diagnosis was mild lympho-
cytic-plasmacytic enteritis. Two food-sensitive cats had
moderately severe lymphocytic-plasmacytic enteritis, and 2
had moderate to severe eosinophilic enteritis. In the most
severely affected cat with eosinophilic enteritis, the villi in
all sections were blunt and often showed fusion. At the tips
of the villi, epithelial cells often were vacuolated. Some of
the duodenal biopsy specimens of the food-sensitive cats
had a variety of other features. These included small num-
bers of neutrophils, occasional globular leukocytes, evi-
dence of edema, and foci of hemorrhage, mild fibrosis, or
hyperplasia of glands in the basal mucosa. The colonic or
rectal mucosal biopsy specimens were abnormal in two
thirds of the food-sensitive cats. The pathological diagnosis
was usually mild colitis or proctitis. On most occasions, the
findings included mild lymphocytic-plasmacytic infiltration.
Attenuation of the epithelium occasionally was reported, as
was the presence of small numbers of neutrophils, eosino-
phils or globular leukocytes, mild fibrosis, or mucus dis-
tension of crypts.
Discussion
The results of this study suggest that almost one third of
cats presented to a referral hospital with chronic idiopathic
gastrointestinal problems have food sensitivity. It is impor-
tant to emphasize that this high prevalence of food sensi-
tivity was observed in a highly selected population of cats
that had undergone extensive diagnostic effort to rule out
other common causes of gastrointestinal dysfunction. The
population studied included many cats that satisfied the cur-
rent definition of inflammatory bowel disease and other cats
that did not satisfy this definition, either because they were
diagnosed as food sensitive or because they were consid-
ered to have normal numbers of mucosal inflammatory
cells.12
In the present study, the diagnosis of food sensitivity was
based on dietary elimination-challenge trials. Of note was
the quick resolution of clinical signs in the food-sensitive
cats during the dietary elimination trials. These results, to-
gether with the high prevalence of food sensitivity detected
in the present study, suggest that the duration of the elim-
ination diet in cats with gastrointestinal disease need not
exceed 4 days. In contrast, veterinary dermatologists often
recommend elimination diets for a minimum duration of 8
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11
weeks to diagnose the dermatological manifestations of
food sensitivity.3,13,14 Rapid recrudescence of signs after re-
challenge of food-sensitive cats with the responsible aller-
gen was seen in the present study. In studies of cats with
dermatological problems, most cats recrudesce within 3 to
5 days, but some took up to 10 days.3,15 This observation
raises the possibility that a longer period of rechallenge in
the present study may have increased the number of diag-
noses of food sensitivity. Countering this possibility, how-
ever, is that all of the food-sensitive cats in the present study
first showed recrudescence within 3 days, and none re-
quired the full 4 to 7–day challenge period allotted. The
reasons for these apparent differences in behavior between
skin and gastrointestinal food sensitivities are unknown.
In addition to the food-sensitive cats, the clinical signs
of another 20% of cats entering the study resolved on the
selected-protein diet but did not recrudesce on challenge
with their staple diets. If the diagnosis of food sensitivity
had not depended on observing recrudescence of signs after
rechallenge with their staple diets, the number of cats di-
agnosed as food sensitive would have almost doubled in
the present study. It is unclear why the clinical signs of so
many cats resolved on the selected-protein diet and then
did not recrudesce after rechallenge. The dietary histories
of some of these cats may have been incomplete, and they
may not have been challenged with the food to which they
were sensitive. Alternatively, some of the cats may have
spontaneously recovered from their gastrointestinal disor-
der, and the recovery of others may have been facilitated
by other therapeutic aspects of the selected-protein diet,
such as high digestibility. Collectively, 50% of the cats fed
the selected-protein diets had resolution of their clinical
signs. This observation suggests that selected-protein diets
should be considered an important part of the management
of cats with idiopathic gastrointestinal problems.
The foods or food ingredients responsible for the clinical
signs usually were dietary staples of the affected cats. Beef,
wheat, and corn were common allergens. Beef also was a
common allergen in another recent study of food-sensitive
cats3 and frequently is incriminated in dogs.14 In other stud-
ies of food-sensitive cats, the foods most often incriminated
were fish and dairy products.8,16 To our knowledge, the ad-
verse reactions to gluten, viscera, and the mixture of ad-
ditives observed in the present study are the first docu-
mented reports of these food sensitivities in cats. The high
percentage of cats in the present study that were sensitive
to more than 1 food ingredient contrasts with reports of
animals with dermatological problems, in which reactions
to multiple allergens are considered unusual.14
No clinical features allowed differentiation of food-sen-
sitive from non–food-sensitive cats without the use of the
elimination-challenge trial. The signalment was diverse, the
vomiting pattern not helpful, and the characteristics of the
diarrhea were variable. Of note was that a history of large-
bowel diarrhea was more common than a history of small-
bowel diarrhea in the food-sensitive cats. Lymphocytic-
plasmacytic colitis in cats previously has been observed to
be food responsive,17 and large-bowel diarrhea also has
been described as an important feature of dogs with food
sensitivity.18 This predilection for large-bowel disease con-
trasts with the typical clinical picture in gluten enteropathy

12 Guilford et al
of humans, in which the upper small intestine is most se-
verely affected and suggests that the concentration of an-
tigen is not the primary determinant of the severity of the
mucosal histological changes in cat food sensitivity. The
high frequency of weight loss in the food-sensitive cats was
unexpected and without clear explanation in some of the
cats. The appetite of some of the cats with weight loss was
reduced, but most ate well. The small-bowel diarrhea and
flatulence observed in some cats indicated malabsorption,
but most cats with weight loss did not have these signs,
and many had few histological abnormalities in their small
intestinal mucosa. Weight loss is also a prominent clinical
feature of mild gluten enteropathy in Irish Setters.19 Enteric
protein loss has been recognized during intestinal anaphy-
laxis to foods in laboratory animals.5 Chronic enteric pro-
tein loss is energetically demanding and may explain the
weight loss observed in the food-sensitive cats and dogs.
The clinical feature most suggestive of food sensitivity
was the concurrent occurrence of gastrointestinal and der-
matological signs. Others also have noted an association
between dermatological and gastroenteric diseases in cats
with food sensitivity. Twenty-nine percent of the food-sen-
sitive cats in a recent study had both pruritus and gastro-
intestinal signs.3 The concomitant appearance of cutaneous
and gastrointestinal signs in food-sensitive patients also was
noted by Walton.16 A high frequency of simultaneous cu-
taneous and gastrointestinal signs has been reported in one
study of dogs with food sensitivity,18 but other studies have
not described this association.14 White13 has pointed out that
this discrepancy may be partially caused by failure of the
owner to detect or report the gastrointestinal signs and also
emphasizes the importance of a thorough medical history
with respect to both gastrointestinal and dermatological
signs. The concurrent appearance of cutaneous and gastro-
intestinal signs is not pathognomic, however, for food sen-
sitivity. In the present study, some non–food-sensitive cats
had gastrointestinal disease in association with flea allergic
or idiopathic pruritus.
The routine laboratory work did not allow differentiation
of food-sensitive and non–food-sensitive cats. Peripheral
eosinophilia was present in fewer than one third of the
food-sensitive cats and also was observed in non–food-sen-
sitive cats.
The diagnostic value of in vitro tests for food-specific
IgE antibodies varies widely in studies of humans10 and has
been disappointing in dogs.14 Several observations in the
present study call into question the value of the serum an-
tigen-specific IgE assay as a screening test for food sensi-
tivity in cats. These include the observations that as many
as 25% of the non–food-sensitive cats had positive tests,
only 58% of the food-sensitive cats had positive tests, and
only 25% of the food-sensitive cats showed concordance
between a positive antigen-specific IgE and a positive oral
challenge test. The lack of value of antigen-specific IgE as
a screening test for gastrointestinal food sensitivity is not
surprising. It is unreasonable to expect measurement of se-
rum antigen-specific IgE concentration to be effective for
this purpose when there is strong evidence that many gas-
trointestinal food sensitivities are food intolerances that are
not mediated by IgE.5,20,21 It is perhaps more appropriate for
clinicians to use serum antigen-specific IgE tests to assist
19391676, 2001, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2001.tb02291.x by Cochrane Philippines, Wiley Online Library on [01/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
them in determining whether animals suffering from ad-
verse reactions to foods are affected by type I hypersensi-
tivity reactions. The results of the present study suggest that
type I hypersensitivities account for only 25% of gastro-
intestinal food sensitivities in cats.
Caution must be exercised, however, in interpreting the
serum IgE results of the present study because, to the au-
thors’ knowledge, validation of this commercial assay has
not been reported. An earlier publication, comparing the
results of intradermal skin tests and serum antigen-specific
IgE in cats showed a poor correlation.22 Other than the ob-
servation that the positive serum antigen-specific IgE tests
were twice as common in the food-sensitive cats than the
non–food-sensitive cats, there was little evidence to support
the diagnostic accuracy of the assay. The observation that
17% of the food-sensitive cats and 25% of the non–food-
sensitive cats had positive serum IgE tests to antigens to
which they showed no clinically evident adverse reactions
indicates the presence of subclinical food sensitivity,
asymptomatic sensitization, or false-positive test results.10
Gastroscopic food sensitivity testing has been success-
fully used to detect food sensitivity in dogs11,23 and humans9
but was not helpful in detecting food sensitivity in cats in
this study. The reason for this apparent species difference
is unclear. Possibilities include a difference in gastric mu-
cosal permeability to macromolecules, differences in the
behavior of mucosal mast cells, or a difference in the path-
ogenesis of food sensitivity among species. The modifica-
tion of GFST proposed by Ermel et al,24 in which the food
allergen is injected into the mucosa rather than dripped onto
it, may provide better results in cats. Unfortunately, how-
ever, in one author’s experience this method in dogs creates
difficulties in separating the acute phase reaction to mucosal
injury from that induced by hypersensitivity (Guilford, per-
sonal communication).
No histological features distinguished food-sensitive
from non–food-sensitive cats in the present study. The
stomach and rectum were the gastrointestinal sites that were
most frequently considered abnormal in the food-sensitive
cats but, as with humans and laboratory animals,20,25–27 all
levels of the gastrointestinal tract can be affected by food
sensitivity. Eosinophilic infiltrates were observed in the mu-
cosa of some food-sensitive cats, but the majority of cats
did not have excessive mucosal eosinophilic inflammation.
The severity of the mucosal changes was also not helpful
in differentiating food-sensitive from non–food-sensitive
cats. Some food-sensitive cats had no detectable mucosal
abnormalities, and others had severe changes. Idiopathic
chronic gastritis, lymphocytic-plasmacytic enteritis, and
chronic colitis currently cannot be differentiated from food
sensitivity on the basis of histological examination of a sin-
gle set of biopsy specimens. At times, the lymphocytic in-
filtrate in the intestinal mucosa of food-sensitive cats can
be so intense as to mimic lymphosarcoma.28
The diverse histological findings in the gastrointestinal
tract of food-sensitive cats observed in the present study
have been described previously. Eosinophils have been
found in rectal scrapings from food-sensitive cats.3 Lym-
phocytic-plasmacytic colitis has been attributed previously
to food sensitivity in cats.17 The small intestine of a cat
allergic to milk showed congestion, edema, villous degen-

Food Sensitivity in Cats
eration, hemorrhage, and an increase in the number of plas-
ma cells after 4 days of milk challenge.29 The acute phase
reactions observed in the stomachs of food-sensitive dogs
are characterized by congestion and edema.24 In food-sen-
sitive humans and laboratory animals, the mucosa can be
microscopically normal or can show mucosal edema, sep-
aration of the epithelium from the lamina propria, fat ac-
cumulation in the epithelium, sloughing of villus tip epi-
thelium, increased mucus secretion, increased intraepithelial
lymphocytes, infiltration of the lamina propria with lym-
phocytes and plasma cells, and villus atrophy.20,25–27,30,31 The
histological features of food protein–induced enteropathies
usually are patchy and the villus atrophy partial rather than
complete.26
In conclusion, adverse reactions to dietary staples are
common in cats with chronic gastrointestinal problems and
can be successfully managed by feeding selected-protein
diets. Diagnosis requires dietary elimination-challenge trials
and cannot be made on the basis of clinical signs, routine
laboratory work, serum antigen-specific IgE assay, gastro-
scopic food sensitivity testing, or histological examination
of a single set of gastrointestinal biopsy specimens.
Footnotes
a
Bio-Medical Services, Austin, TX
b
BIPS, Med ID, Grand Rapids, MI
c
Zoletil, TechVet, Auckland, New Zealand
d
Greer Laboratories, Lenoir, NC
e
WHISKAS Feline Selected Protein Diet (Waltham), Masterfoods,
Bruck, Austria (chicken and rice)
f
WALTHAM Veterinary Diet Feline Selected Protein Diet, Effem
Foods, Bolton, Canada (venison and rice)
Acknowledgments
The authors would like to thank the many veterinarians
who referred cats for the study, in particular Drs Pru Gal-
loway and Stuart Burroughs. We would also like to ac-
knowledge the contribution of Jo Wills of the Waltham
Centre, pathologists Drs Maurice Alley and Michelle
Cooke, and the technical assistance of the clinical staff of
the Massey University Veterinary Teaching Hospital. The
work was performed at Massey University and supported
by a grant from the Waltham Centre for Pet Nutrition, Wal-
tham-on-the-Wolds, UK.
References
1. Anderson JA, Sogu DD, eds. Adverse Reactions to Foods. Na-
tional Institute for Health Publication No. 84-2442, July 1984.
2. Denis S, Paradis M. Food allergies in dogs and cats. Part 2:
Retrospective study. Med Vet Quebec 1994;24:15–20.
3. Guaguere E. Food intolerance in cats with cutaneous manifes-
tations: A review of 17 cases. Eur J Companion Anim Pract 1995;5:
27–35.
4. Hall EJ. Gastrointestinal aspects of food allergy: A review. J
Small Anim Pract 1994;35:145–152.
19391676, 2001, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2001.tb02291.x by Cochrane Philippines, Wiley Online Library on [01/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
13
5. Guilford WG. Adverse reactions to foods. In: Strombeck DR,
Guilford WG, eds. Small Animal Gastroenterology, 3rd ed. Philadel-
phia, PA: WB Saunders; 1996:436–450.
6. Anderson JA. Non-immunologically-mediated food sensitivity.
Nutr Rev 1984;42:109–116.
7. Stogdale L, Bomzon L, van den Berg PB. Food allergy in cats.
J Am Anim Hosp Assoc 1982;18:188–194.
8. White SD, Sequoia D. Food hypersensitivity in cats: 14 cases
(1982–1987). J Am Vet Med Assoc 1989;194:692–695.
9. Reimann HJ, Ring J, Ultsch B, Wendt P. Intragastral provocation
under endoscopic control (IPEC) in food allergy: Mast cell and his-
tamine changes in gastric mucosa. Clin Allergy 1985;15:195–202.
10. Ownby DR. In vitro assays for the evaluation of immunologic
reactions to foods. Immunol Allergy Clin North Am 1991;11:851–862.
11. Guilford WG, Strombeck DR, Rogers Q, et al. Development of
gastroscopic food sensitivity testing in dogs. J Vet Intern Med 1994;
8:414–422.
12. Guilford WG. Idiopathic inflammatory bowel diseases. In:
Strombeck DR, Guilford WG, eds. Small Animal Gastroenterology,
3rd ed. Philadelphia, PA: WB Saunders; 1996:454–455.
13. White SD. Food allergy in dogs. Compend Contin Educ Pract
Vet 1998;20:261–268.
14. Rosser EJ. Diagnosis of food allergy in dogs. J Am Vet Med
Assoc 1993;203:259–262.
15. Sousa CA. Exudative, crusting and scaling dermatoses. Vet Clin
North Am 1995;25:813–831.
16. Walton GS. Skin responses in the dog and cat to ingested al-
lergens: Observations on one hundred confirmed cases. Vet Rec 1967;
81:709–713.
17. Nelson RW, Dimperio ME, Long GG. Lymphocytic-plasmacyt-
ic colitis in the cat. J Am Vet Med Assoc 1984;184:1133–1135.
18. Paterson S. Food sensitivity in 20 dogs with skin and gastro-
intestinal signs. J Small Anim Pract 1995;36:529–534.
19. Batt RM, Hall EJ. Chronic enteropathies in the dog. J Small
Anim Pract 1989;30:3–12.
20. Gryboski JD. Gastrointestinal aspects of cow’s milk protein in-
tolerance and allergy. Immunol Allergy Clin North Am 1991;11:733–
797.
21. Heyman MB. Food sensitivity and eosinophilic gastroenterop-
athies. In: Sleisinger MH, Fordtran JS, eds. Gastrointestinal Disease,
4th ed. Philadelphia, PA: WB Saunders; 1989:1113–1134.
22. Foster AP, O’Dair H. Allergy testing for skin disease in the cat
in vivo versus in vitro tests. Vet Dermatol 1993;4:111–115.
23. Elwood CM, Rutgers HC, Batt RM. Gastroscopic food sensi-
tivity testing in 17 dogs. J Small Anim Pract 1994;35:199–203.
24. Ermel RW, Kock M, Griffey SM, et al. The atopic dog: A model
of food allergy. Lab Anim Sci 1997;47:40–49.
25. Proujansky R, Winter HS, Walker WA. Gastrointestinal syn-
dromes associated with food sensitivity. Adv Pediatr 1988;35:219–
238.
26. Patrick MK, Gall DG. Protein intolerance and immunocyte and
enterocyte interaction. Pediatr Clin North Am 1988;35:17–34.
27. Sampson HA. Immunologic mechanisms in adverse reactions
to foods. Immunol Allergy Clin North Am 1991;11:701–716.
28. Wasmer ML, Willard MD, Helman RG, Edwards JF. Food in-
tolerance mimicking alimentary lymphosarcoma. J Am Anim Hosp
Assoc 1995;31:463–466.
29. Walton GS, Parish WE, Coombs RAA. Spontaneous allergic
dermatitis and enteritis in a cat. Vet Rec 1968;83:35–41.
30. Sampson HA, Buckley RH, Metcalfe DD. Food allergy. J Am
Med Assoc 1987;258:2886–2890.
31. Curtis GH, Patrick MK, Catto-Smith AG, Gall DG. Intestinal
anaphylaxis in the rat. Effect of chronic antigen exposure. Gastroen-
terology 1990;98:1558–1566.