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Anhidrosis in horses is a condition characterized by a persistent reduction or lack of sweat output.1–5 Onset

of anhidrosis can be sudden, usually following a period of profuse sweating,6 or gradual with a sweat response slowly decreasing over time.3 Clinical signs include par-tial or complete loss of sweating ability, hyperthermia, tachypnea, reduced appetite, decreased water intake, alopecia, dull hair coat, and depression.3–6 A quantitative intradermal sweat test (with terbutaline) has been evalu-ated for identification of freely sweating horses.7

Anhidrosis has been described as a physiologic phe-nomenon that results as a consequence of prolonged stimulation of the sweat glands by epinephrine secreted as a response to conditions of hot and humid climate.6 The sweat glands accommodate to the high epinephrine con-tent of the blood, thus becoming insensitive to it.6 This phenomenon can be reversed by rest in a cooler and less humid climate.6 More recently, it was found that the water channel aquaporin-5 may play a role in the pathogenesis of anhidrosis in horses.8 An immunohistochemistry analy-sis revealed a strong aquaporin-5–like activity reaction at the apical membrane of the glandular secretory cells in freely sweating horses.8 In horses with long-term anhidro-sis, however, little aquaporin-5–like activity was detected, hence implicating water channel impairment as a pos-

An epidemiologic study of anhidrosis in horses in Florida

Eric B. Johnson, ms; Robert J. MacKay, bvsc, phd, davcim; Jorge A. Hernandez, dvm, mpvm, phd

Objective—To estimate prevalence of and identify factors associated with anhidrosis in horses in Florida.Design—Cross-sectional study and case-control study.Animals—4,620 horses on 500 farms.Procedures—A questionnaire was structured and mailed to farm owners or managers to obtain information related to diagnosis of anhidrosis in horses and exposure factors associated with this condition. The frequency of investigated farm- and animal-level fac-tors was compared between farms and horses affected and not affected with anhidrosis, respectively.Results—The prevalence of anhidrosis was 11% at the farm level and 2% at the animal level. The odds of anhidrosis were 2.13 and 4.40 times as high in farms located in central and southern Florida, respectively, compared with odds for farms in northern Florida. The odds of anhidrosis were 5.26 and 15.40 times as high in show and riding instruction operations, respectively, compared with odds for ranch operations. At the animal level, breed (Thorough-breds and warmblood horses), foaling place (western or midwestern region of the United States), and family history of anhidrosis were significantly associated with anhidrosis.Conclusions and Clinical Relevance—This study provides new information on the preva-lence of and factors for anhidrosis in horses in Florida. Horses with a family history of anhi-drosis should be examined by a veterinarian for diagnosis of this condition before they are exposed to exercise in a hot and humid climate. (J Am Vet Med Assoc 2010;236:1091–1097)

sible factor in the development of this condition.8 Horses with anhidrosis require medical management and reduced workload (or removal from physical activity). Anhidrotic horses forced to perform can suffer severe consequences, including multiple organ failure in response to hyperther-mia and, in some instances, death.9

Epidemiological aspects of anhidrosis in horses are not well understood. Previous studies have been limited to a low number of horse farms or have not used objective research methods. In a 1982 survey10 of 24 horses affected with anhi-drosis in Florida, the frequency of anhidrosis was higher in native horses and Thoroughbreds, compared with imported horses and other breeds, respectively. In that study,10 healthy horses were not included. Thus, it was not possible to assess the origin and breed as risk factors for anhidrosis in horses. In another study11 conducted in Florida 5 years later, the prevalence of anhidrosis in horses was 6% (52/834); the frequency of this condition was higher in training horses, compared with yearlings, lactating mares, barren or maiden mares, and stallions. Anhidrosis was more common in the summer, and it was typically associated with recent trans-port of horses from geographic regions with a more tem-perate climate. That study11 was limited to 4 Thoroughbred farms with a history of anhidrosis; farms without a history of this condition were not included. Thus, it was not pos-sible to examine factors associated with anhidrosis at the

From the Department of Large Animal Clinical Sciences, College of Veteri-nary Medicine, University of Florida, Gainesville, FL 32610.

Supported in part by the University of Florida College of Veterinary Medicine Research Development Program.

The authors thank Benjamin Klugh, Christy Meyer, Jorge Garcia-Pratts, and Katherine Henry for technical assistance.

Address correspondence to Dr. Hernandez (Hernandezj@vetmed.ufl.edu).

Abbreviations

CI Confidence intervalNASS National Agricultural Statistics ServiceOR Odds ratio

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farm level. The objectives of the study reported here were to estimate the prevalence of anhidrosis in horses in Florida and identify farm- and animal-level factors associated with this condition.

Materials and Methods

Study population—A total of 12,750 horse farms with approximately 400,000 horses in Florida were con-sidered for inclusion in this study. Census data from the 2002 USDA NASS Florida Field Office12,13 were used for identification of the study farms. Racetracks and farms with > 50 horses were excluded because a low survey re-sponse was expected.

Anhidrosis—In this study, horses were classified as af-fected with anhidrosis by the farm owner or manager in the year 2005. In some instances, the diagnosis of anhidrosis was made by the attending veterinarian. Horses affected with anhidrosis were horses that sweated poorly or not at all under conditions in which a clinically normal horse would sweat freely; horses were treated for anhidrosis and had ≥ 1 of the following signs: rapid shallow breathing (usually ≥ 30 breaths/min) in hot conditions, a rectal temperature > 38.9°C (102°F) when resting, loss of hair over the face or chest, or dull coat, dry flaky skin, or both. Horse farms classified as affected with anhidrosis were farms with ≥ 1 horse classified as affected with this condition in the year 2005. This case definition of anhidrosis is acceptable and justified because in most situations, the diagnosis of anhi-drosis in horses is based on clinical findings, which are well recognized by horse owners, farm owners or managers, or veterinarians. Horses that are suspected to have anhidrosis are observed by a farm owner or manager or the attending veterinarian after exercise (observation of either a complete or partial inability to sweat, increased respiratory rate and body temperature for a prolonged period after exercise, and, in some instances, tachypnea).8,10,11 In this observational study, the case definition did not require results of an intradermal sweat test (with terbutaline sulfate, epinephrine bitartrate, or salbutamol sulfate) because, in clini-cal practice, most veterinarians do not use intradermal sweat tests for diagnosis of an-hidrosis in horses. Intradermal sweat test protocols for diagnosis of anhidrosis in horses are not standardized7,14,15 or have not been validated in anhidrotic horses.7,15

Epidemiological questionnaire—A structured questionnaire was devel-oped for collection of epidemiological data. Information requested pertained to farm- and animal-level factors. Farm-level information included the follow-ing: geographic location of the premises (northern, central, and southern Flori-da; Figure 1), type of operation (ranch, boarding, racing, pleasure, instruction, show, or other), whether the horse had access to grass on the premises (yes or no), type of feeding concentrate most commonly used (sweet feed, complete pelleted, alfalfa pellets, corn, oats, or other), type of roughage most com-

monly used (timothy and alfalfa, alfalfa, timothy, coastal, peanut, orchard grass, or other), source of water (pond, lake, river, well-pumped, well-artesian, city or county sup-ply, or other), access to salt and minerals (none, salt-min-eral block, loose salts added to grain, commercial mineral supplements,a or other), number of horses on the premis-es, and horses diagnosed with anhidrosis (yes or no) and, if yes, number of horses affected with this condition. For each horse on the premises, the following information was requested: horse affected with anhidrosis (yes or no), age, sex, breed, color, foaling place (southern, northeastern, western, or midwestern United States; foreign country; or unknown), diet (free-salt minerals [yes or no]), use (hal-ter, pleasure, trail riding, or working ranch horse; racing or race training; breeding; nonracing athletic performance; retired; or other), and family history of anhidrosis (sire or dam with history of anhidrosis [yes, no, or unknown]). In addition, for horses affected with anhidrosis in the year 2005, the following information was requested: age (years) when first affected with this condition, month of onset, clinical signs, treatment type considered as the most successful, and duration of treatment. Finally, among farms with horses affected with anhidrosis, the questionnaire was structured to gather information on every anhidrotic horse (maximum of 5 horses) and up to 10 nonaffected horses/farm. Similarly, among farms with horses not affected with anhidrosis, a maximum 10 horses/farm were selected. A list of random numbers for selection of horses not affected with anhidrosis was sent to each farm along with the survey. The farm own-er or manager was asked to identify each nonaffected horse with a consecutive number (1 to n), then to select the first 10 horses (number identification) shown on the list of random numbers that matched her or his list. The questionnaire was mailed to each study farm from the USDA NASS during November and December of 2006. All questions pertained to events of anhidrosis and condi-

Figure 1—Map of Florida showing the northern, central, and southern regions in the state.

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tions in the horse farm during 2005. Four to 8 weeks after the questionnaires were mailed, farm owners or managers who failed to return the questionnaire were identified by USDA NASS personnel, and an attempt was made to con-tact them via phone call for an interview to complete the questionnaire. Data collection was recorded electronically by USDA NASS personnel.

Study design—This study was designed as a cross-sectional study. To accomplish the first objective, the epi-demiological questionnaire was mailed to 1,207 horse farm owners or managers in Florida. A sample size of 649 horse farms was calculated by use of the following assumptions: population size of 12,750 farms, 20% prevalence of anhi-drosis at the farm level, 95% confidence, and accepted error of 3%. On the basis of a projected 33% response propor-tion, an initial sample of 1,947 farms was selected. How-ever, because of funding limitations to conduct follow-up phone interviews, the number of farms was reduced to 1,207 farms, which were randomly selected from a total of 12,750 horse farms. A computer programb was used to gen-erate random numbers (ie, select farms) needed in this por-tion of the study. The projected response proportion of 33% was based on results from a previous prevalence study16 that used a similar survey method. Prevalence of anhidrosis was estimated by dividing the number of affected premises and horses by the number of premises and horses included in this study, respectively.

The approach to the second objective was to compare the frequency of investigated factors between 56 and 444 farms classified as affected and not affected with anhidro-sis, respectively, as well as between 79 and 2,365 horses classified as affected and not affected with this condition, respectively.

In addition, among 56 farms with horses affected with anhidrosis, the frequency of investigated animal-level fac-tors was compared between 79 horses affected and 327 horses not affected with anhidrosis, matched by farm. The rationale was to control for possible confounding effects that farm conditions might have had on anhidrosis.

Statistical analysis—Under objective 1, a study popu-lation of 500 farms and 4,620 horses was used to estimate the prevalence of anhidrosis. Prevalence of anhidrosis at the farm level was estimated by dividing the number of farms with ≥ 1 affected horses by the total number of study farms. Prevalence of anhidrosis in horses was estimated by divid-ing the number of affected horses by the total number of study horses. For each prevalence estimate, a 95% CI was calculated. Prevalence of anhidrosis was compared among regions (northern, central, and southern Florida) by use of a χ2 test. Differences in response proportions were com-pared among regions by use of a χ2 test. Values of P ≤ 0.05 were considered significant.

Under objective 2, a study population of 500 farms and 2,444 horses (79 affected horses and 2,365 nonaffected horses) with complete data was used in the epidemiological analysis. Unconditional logistic regression was used to model the odds of being a farm or a horse affected with anhidrosis. Initial screening of factors for anhidrosis was performed by use of univariable logistic regression. Initially, variables asso-ciated (P ≤ 0.20) with the outcome of interest (anhidrosis) were entered into a multivariable model. A forward stepwise approach was used to identify which variables were associated

with anhidrosis by use of 2-sided P values (0.05 to enter and 0.10 to remove variables). Two-way interaction terms were included in the final model and tested for significance (P ≤ 0.05). The goodness of fit of the multivariable models was explored by use of the Hosmer-Lemeshow goodness-of-fit χ2 statistic. In the final model, adjusted OR and 95% CI were reported. In this study, an OR was used as an epidemiological measure of association between the investigated factor and anhidrosis. Thus, if a factor was not associated with diagnosis of anhidrosis, the OR was 1. The greater the departure from 1 (either larger or smaller), the stronger the association was between the factor and the odds of diagnosis of anhidrosis. Upper and lower limits of the 95% CI were used to indicate that there was 95% confidence in the assertion that the true OR fell within this interval.

Finally, among farms with horses affected with anhi-drosis, the frequency of investigated animal-level factors was compared between horses affected and horses not af-fected with anhidrosis (matched by farm) by use of con-ditional logistic regression analysis. In the final model, adjusted OR and 95% CI were reported. Values of P ≤ 0.05 were considered significant.

ResultsA total of 500 of 1,207 horse farms participated in the

study; the response proportion was 41%. The frequency with which questionnaires were returned via regular mail or completed via phone call was not recorded. Response pro-portions in northern (45%), central (39%), and southern Florida (41%) were not significantly (P = 0.60) different.

Prevalence of anhidrosis—At the farm level, the preva-lence of anhidrosis was 11.2% (56/500 farms) with a 95% CI of 8.4% to 13.9%. The prevalence of the condition was sig-nificantly different among regions (northern Florida, 5.2%; central Florida, 13.4%; and southern Florida, 26.5%).

At the animal level, the prevalence of anhidrosis was 1.8% (83/4,620 horses) with a 95% CI of 1.4% to 2.2%. The prevalence of this condition was significantly different among regions (northern Florida, 0.08%; cen-tral Florida, 1.7%; and southern Florida, 4.3%). Among 56 farms with ≥ 1 horses affected with anhidrosis, 83 of 1,213 (7%) horses had clinical signs of anhidrosis. The median age when horses were first affected with anhi-drosis was at 10 years old (first and third quartiles of 5 and 18 years old, respectively). Most horses were first di-agnosed as affected with anhidrosis during the warmest months of the year (May through September; Figure 2).

Figure 2—Month of the year in 2005 when horses (n = 75) were first determined to be affected by anhidrosis during the study pe-riod: January to December 2005. Month of diagnosis known for 75 of the 83 affected horses. Letters on the x-axis indicate the months of January through December in sequential order.

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Epidemiological analysis at the farm level—In the univariable analysis, the following variables were associ-ated with anhidrosis: region, number of horses per op-eration, type of operation, type of feeding concentrate, type of roughage fed, and source of water. In the multi-variable analysis, after controlling for number of horses on the farm, the odds of anhidrosis were 2.13 times as high in farms located in central Florida (95% CI, 0.99 to 4.59) and 4.40 times as high in farms located in southern Florida (95% CI, 1.58 to 12.23), compared with farms in northern Florida (Table 1). In addition, the odds of anhidrosis were 5.26 times as high in show operations and 15.40 times as high in riding instruction operations, compared with ranch operations. The odds of anhidrosis

were 3.69 times as high in racing operations, compared with ranch operations (95% CI, 0.94 to 14.53), but this association was not significant (P = 0.06). The P value of the Hosmer-Lemeshow statistic was 0.43, which sup-ported the overall goodness of fit of the model.

Epidemiological analysis at the animal level—In the univariable analysis, the following variables were associ-ated with anhidrosis: sex, breed, foaling place, use, and family history of anhidrosis. In the multivariable analysis, breed, foaling place, use, and family history of anhidrosis were associated with diagnosis of anhidrosis (Table 2). The P value of the Hosmer-Lemeshow statistic was 0.89, which supported the overall goodness of fit of the model.

Farmswith Farmswithout affectedhorses affectedhorses (n=56) (n=444)Variable No. % No. % AdjustedOR 95%CI Pvalue

Region in Florida Northern 11 20 202 46 1.00 Reference NA Central 32 57 206 46 2.13 0.99–4.59 0.05 Southern 13 23 36 8 4.40 1.58–12.23 0.01Operation Ranch 4 7 94 21 1.00 Reference NA Boarding 8 14 24 6 2.71 0.69–10.60 0.15 Racing 7 13 26 6 3.69 0.94–14.53 0.06 Pleasure 13 23 211 50 1.80 0.55–5.91 0.33 Riding instruction 3 5 1 1 15.40 1.20–197.37 0.03 Show 12 22 30 7 5.26 1.49–18.59 0.01 Other 9 16 45 10 2.90 0.79–10.59 0.10

*Adjusted for number of horses on the farm.NA = Not applicable.Hosmer-Lemeshow statistic = 7.96. P = 0.43. df = 8.

Table 1—Final logistic regression model for investigated farm-level exposure factors associated with anhidrosis in horses.*

Horseswith Horseswithout anhidrosis anhidrosis (n=79) (n=2,365)

Variable No. % No. % AdjustedOR 95%CI Pvalue

Breed Quarter Horse 13 16 908 38 1.00 Reference NA Arabian 0 0 190 8 ND ND NA Thoroughbred 32 41 356 15 4.87 2.37–10.04 0.01 Warmblood 12 15 62 3 7.26 2.89–18.21 0.01 Other 22 28 849 36 1.66 0.81–3.38 0.16

Foaling place in the United States Southern 57 72 1,950 82 1.00 Reference NA Northeastern 3 4 32 1 2.08 0.56–7.70 0.27 Midwestern and western 7 9 105 5 2.57 1.07–6.15 0.03 Unknown 4 5 176 8 0.64 0.22–1.85 0.40 Foreign 8 10 102 4 1.24 0.52–2.95 0.62 Use Halter, pleasure, trail riding, 15 19 1,132 48 1.00 Reference NA or working ranch horse * Racing, race training 10 13 172 7 1.46 0.57–3.76 0.43 Breeding 10 13 371 16 1.45 0.61–3.49 0.40 Nonracing athletic performance 13 16 195 8 2.57 1.13–5.87 0.02 Retired 19 24 221 9 4.73 2.28–9.83 0.01 Other 12 15 273 12 2.21 0.96–5.10 0.06

Family history of anhidrosis No 11 14 1,303 55 1.00 Reference NA Yes 6 8 24 1 21.67 6.96–67.51 0.01 Unknown 62 78 1,038 44 6.18 3.18–12.00 0.01

*Includes 303 working ranch horses (all classified as not affected with anhidrosis).NA = Not applicable. ND = Not determined.Hosmer-Lemeshow statistic = 2.87. P = 0.89. df = 7.

Table 2—Final logistic regression model for investigated animal-level exposure factors associated with anhidrosis in horses.

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Among horses from farms affected with anhidrosis, the fol-lowing variables were associated with this condition in the uni-variable analysis: breed, use, and family history of anhidrosis. In the multivariable analysis, breed and family history of anhidrosis were confirmed as factors associated with this condition. The odds of anhidrosis were 4.37 times as high in Thoroughbreds (95% CI, 1.23 to 15.45) and 13.88 times as high in warmblood horses (95% CI, 2.48 to 77.47), compared with Quarter Horses. The odds of anhidrosis were 6.87 times as high in horses with a family history of anhidrosis (95% CI, 1.82 to 25.92), compared with the odds in horses without a history.

Of the 83 horses with anhidrosis, complete data on clinical signs were available for 79 horses. Of these 79 hors-es, 70 had tachypnea (as the most common clinical sign), 33 had a history of profuse sweating followed by no sweat-ing, 31 had a dull coat or skin scaling, 23 appeared fatigued, 22 had alopecia, 9 had hyperthermia, 9 had a decreased ap-petite, and 6 had a decrease in water intake.

Discussion

This study provides new information on the prevalence of anhidrosis and factors associated with this condition in horses in the state of Florida. Compared with previous studies,10,11 the main strength of this study is the random sampling approach used to estimate the prevalence of anhi-drosis. At the farm level, study results revealed that the odds of anhidrosis were higher in farms located in central and southern Florida, compared with farms in northern Florida. Furthermore, the odds of anhidrosis were higher in show and riding instruction operations, compared with ranch operations. At the animal level, diagnosis of anhidrosis was associated with breed (Thoroughbreds and warmblood horses), use (retired horses and nonracing performance horses), and foaling place (western or midwestern regions of the United States) as well as family history of anhidrosis.

This study has several limitations. First, in the epidemio-logical analysis, the cross-sectional nature of the study limited our ability to examine a temporal relationship between time of diagnosis of anhidrosis and exposure factors such as diet or current use of the horse in the year 2005 (eg, retired). Second, the examination of age as a factor associated with anhidrosis was not possible because the age of anhidrotic horses was that when horses were first affected with this condition in their lifetime, whereas the age of nonaffected horses was the same as in the year 2005. In the final version of the questionnaire, the variable for age of affected horses in the year 2005 was not (in-error) recorded. Because the estimated mean age of horses when they were first diagnosed with anhidrosis was 10 years, it is possible that the median age of anhidrotic horses at the time of the survey was > 10 years. Another limitation is external validity, as this study was limited to horse premises in Florida. Thus, prevalence estimates of anhidrosis reported here cannot be extrapolated to other states in the United States. Further-more, racetracks were not included in this study; prevalence of anhidrosis in racetrack horses has been reported to be as high as 20%.10 Finally, in this study, diagnosis of anhidrosis was made by farm owners or managers, and in some instances, the diagnosis was confirmed by the attending veterinarian. Thus, it is possible that some horses may have been misclassified as not affected or affected with anhidrosis by farm owners and man-agers. For example, it is possible that horses with partial signs of anhidrosis may not have been detected as anhidrotic (false-negative results). If this scenario were real, then the prevalence of anhidrosis was underestimated. Furthermore, in the epide-

miological analysis, if this scenario were an important bias, then the factors for anhidrosis identified in this study would apply only to horses with severe signs of anhidrosis. A scenario where horses with complete loss of sweat function were not detected by farm managers is less likely. A different scenario of misclassifica-tion (false-positive results) could be horses with respiratory tract disease classified (in-error) as anhidrotic; the magnitude of this potential type of misclassification in this study is not known.

Our study results revealed that the prevalence of anhidro-sis was 11% at the farm level and 2% at the animal level. To our knowledge, there are no other reports on the prevalence of this condition at the farm level in the United States for those states bordering the Gulf of Mexico, where the condition is commonly diagnosed. In a previous study11 conducted on 4 farms with a history of anhidrosis in Florida, 52 of 834 (6%) horses had clinical signs of anhidrosis. In that study,11 the main objective was not to estimate the prevalence of anhidrosis, but rather to compare clinical findings and results from a clinico-pathologic analysis between affected and nonaffected horses in a selected number of farms with affected horses. Furthermore, in that study,11 Thoroughbreds were the only breed represented in the study population. In our study, among 56 farms with ≥ 1 horses affected with anhidrosis, 83 of 1,213 (7%) horses had clinical signs of anhidrosis. It is difficult to compare these 2 prevalence estimates, as the study objectives, sampling meth-ods, and diagnostic procedures all differed.

In this study, most horses were first diagnosed as affected with anhidrosis during the warmer months of May through September. This finding was expected, and it is in line with those of a previous study,17 where a group of 8 horses with a history of anhidrosis was exposed to riding school train-ing during the summer, autumn, and winter seasons in Hong Kong. Results of that study,17 and a previous study18 with sim-ilar results, suggested that the atrophy of sweat glands and the blockage of sweat gland ducts is the consequence, rather than the cause, of anhidrosis.

At the farm level, the odds of anhidrosis were 2.13 and 4.40 times as high in horse farms located in central and south-ern Florida, respectively, compared with the odds in farms in northern Florida. One explanation for this observed association is exposure to increasingly hot and humid conditions in central and southern Florida, compared with the northern region in Florida. For example, in the year 2005, the number of weeks when the weekly average maximum temperature was ≥ 25°C (≥ 77°F) was 6, 7, and 9 weeks in northern, central, and southern Florida, respectively.c Anhidrosis results from prolonged stimu-lation of the sweat glands by epinephrine secreted as a response to conditions of hot, humid climate.6 It is hypothesized that the sweat glands accommodate to the high epinephrine content of the blood, thus becoming insensitive to it.6 The clinical signs can be reversed by rest in a cooler and less humid climate.6

The odds of anhidrosis were 5.26 and 15.40 times as high in show and riding instruction operations, respectively, com-pared with the odds in ranch operations. Diet and exercise have been identified as aggravating factors, rather than risk factors for anhidrosis.4 The condition of anhidrosis in horses can be aggra-vated by factors that tend to increase the basal metabolism of affected horses (high-protein feed, disease, and exercise), exacer-bate water loss (polyuria), or influence heat loss and help to dis-locate body heat control.4,19,20 In this study, the number of riding instruction operations was small (3 farms with affected horses and 1 farm with nonaffected horses), and this result affected the precision of the point estimate (OR, 15.40), as reflected by the wide 95% CI (1.20 to 197.20). Finally, the association between racing operations and diagnosis of anhidrosis (OR, 3.69) was

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not significant (P = 0.06); however, it is possible that the odds of diagnosis were higher in racing operations, compared with the odds in ranch operations, but the relatively small number of racing operations (n = 7) with affected horses in this study prevented the detection of a significant association.

At the animal level, the odds of being diagnosed with anhidrosis were higher in Thoroughbreds and warmblood horses than in Quarter Horses. Thoroughbreds, in particular, have consistently been the focus of several studies1,10,21 on an-hidrosis. Warmblood horses typically have a larger body size than other breeds of horses included in this study. A larger body size results in a decreased skin surface area-to-body mass ratio, which can effectively limit the thermoregulatory capacity of the sweat mechanism.22 The decreased thermo-regulatory efficiency of the sweat mechanism can lead to in-creased body heat storage, placing horses at a higher risk of anhidrosis.22 In the present study, a definition for warmblood horses was not provided in the survey; the final designation of a horse as a warmblood was made by the owner. In Flor-ida, warmblood horses (eg, Hanoverian, Trakenhner, West-phalian, Holsteneiner, Dutch Warmblood) are often used as sport horses in dressage, jumping, or eventing disciplines. By comparison, Quarter Horses are often used for trail riding or the less strenuous disciplines of western performance (eg, western pleasure, halter). A high-energy diet and strenuous exercise are 2 aggravating factors4 that can increase the fre-quency of anhidrosis observed in Thoroughbreds and warm-blood horses, compared with Quarter Horses.

None of the 190 Arabian horses included in this study were classified as anhidrotic. One possible explanation for this observation could be the differences in breeding regimes be-tween Arabian horses and other breeds. The Arabian horse was first domesticated in what was known as the Fertile Crescent, a crescent-shaped area of land extending from present-day Iraq to Egypt.23 The breed has been evolving in this area for several centuries.23 The Arabian horse has adapted to survive in much higher temperatures than have other breeds, especially Thor-oughbreds and warmblood horses.23,24 Over many generations of selection in moderate climates, breeds partially derived from Arabian bloodlines (eg, Thoroughbreds and Quarter Horses) may have lost, to varying degrees, resistance to anhidrosis. Pos-sibly, these differences in evolution may have affected the sweat gland epithelia of these breeds and allowed for polymorphisms among the genes controlling sweating (eg, β

2-adrenergic recep-

tors or aquaporin-5 channel).5

Our study results support current knowledge from the lit-erature10 that horses originating from more temperate climates can be at risk of anhidrosis when transported to hot, humid climates for racing or exercise. In this study, the odds of anhi-drosis were higher in horses that originated from the western or midwestern regions of the United States, compared with the odds in horses that originated from the southern region. In a previous study10 in Florida, 15 of 24 horses affected with an-hidrosis were native horses and the remaining 9 horses were imported horses. Because that study10 did not include healthy horses, it was not possible to estimate and compare the preva-lence of anhidrosis between these 2 subpopulations of horses. Thus, although other studies1,2 show that native horses are sus-ceptible to develop anhidrosis, our study results provide epide-miological evidence that horses from temperate climates are more likely to be diagnosed with this condition when moved into Florida, compared with native horses.

In this study, the odds of anhidrosis were higher in re-tired horses and horses used for nonracing performance than in horses used for halter, pleasure, or trail riding or working

ranch horses. Among 240 horses classified as retired, most were Quarter Horses (30%) and Thoroughbreds (20%). Age-associated conditions such as hirsutism likely affect thermo-regulatory efficiency in geriatric horses and thereby increase the risk of anhidrosis. It is likely that horses diagnosed with anhidrosis were retired after the diagnosis, more so if they remained in a hot and humid environment. Anhidrosis is a severe condition that can affect performance, possibly ending a horse’s performance career. In addition, it is a welfare issue of concern because of the considerable distress experienced by affected horses.25 The fact that nonracing performance horses were more likely to be diagnosed with anhidrosis can be attributed to diet and exercise, 2 factors that have been identified as aggravating factors, rather than risk factors for anhidrosis.4 Finally, in the present study, the reference group of horses identified at the lowest risk of anhidrosis (OR, 1.00) included 303 working ranch horses, all of which were classi-fied as not affected with anhidrosis; ranch horses are seldom worked hard enough to sweat.

Our study results support a previous hypothesis that there is a hereditary predisposition associated with anhi-drosis in horses. A hereditary predisposition to anhidrosis was first suggested in a review paper4 published in 1976. In our study, results of the epidemiological analysis revealed a strong association between family history of anhidrosis and risk of this condition. In 2 separate analyses, the odds of an-hidrosis were 21.67 and 6.87 times as high in horses with a family history of anhidrosis than in horses without a history. We examined the foaling place data of the 30 horses with a family history of this condition, and almost all horses (n = 29) were foaled in the southern region of the United States. Thus, we could expect that horses in other states (ie, south-eastern United States) with a family history of anhidrosis may be at high risk of anhidrosis when exposed to exercise in a hot and humid climate. Future studies comparing the degree of aquaporin-5 expression and lack of sweat produc-tion from sweat glands between horses with and without a family history of anhidrosis may further advance our lim-ited, current knowledge on the genetic susceptibility as a causative factor for anhidrosis in horses.

Tachypnea was the most common clinical sign ob-served in horses affected with anhidrosis. In anhidrotic horses, tachypnea is recognized as a sign of persisting ther-mal distress even at rest.5 In horses, cutaneous evaporation of sweat is the primary heat loss mechanism; a minor por-tion of heat load is lost via respiratory evaporation and con-vection, mechanisms that are enhanced by increased respi-ration and air movement in hot and humid conditions.25

In summary, our study results revealed that anhidrosis is a condition that is commonly diagnosed in horses during the warmer months in Florida. This condition is more frequently diagnosed in farms in central and southern Florida as well as in show and riding instruction operations. Thoroughbreds and warmblood horses, horses that originated in the western or midwestern regions of the United States and later moved to Florida, and horses with a family history of anhidrosis were more likely to be diagnosed with anhidrosis.

a. SmartPak Supplements Simplified. Available at: www.smartpak-equine.com. Accessed Mar 5, 2010.

b. Research Randomizer, Social Psychology Network, Middletown, Conn. Available at www.randomizer.org. Accessed Mar 5, 2010.

c. AgroClimate. A Service of the Southeast Climate Consortium. Available at: www.agroclimate.org/tools/climateRisk/index.php. Accessed Mar 5, 2010.

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References1. Correa JE, Calderin GG. Anhidrosis, dry-coat condition in the

Thoroughbred. J Am Vet Med Assoc 1966;149:1556–1560.2. Currie AK, Seager SWJ. Anhidrosis. Proc Am Assoc Equine Pract

1976;22:249–251.3. Geor RJ, McCutcheon LJ. Thermoregulation and clinical disor-

ders associated with exercise and heat stress. Compend Contin Educ Pract Vet 1996;18:436–444.

4. Hubert JD, Beadle RE, Norwood G. Equine anhidrosis. Vet Clin North Am Equine Pract 2002;18:355–369.

5. Jenkinson DM, Elder HY, Bovell DL. Equine sweating and anhi-drosis. Part 2: anhidrosis. Vet Dermatol 2007;18:2–11.

6. Evans SCL, Smith D, Ross K, et al. Physiological factors in the condition of “dry coat” in horses. Vet Rec 1957;69:1–9.

7. MacKay RJ. Quantitative intradermal terbutaline sweat test in horses. Equine Vet J 2008;40:518–520.

8. Bovell DL, Lindsay SL, Corbett AD, et al. Immunolocalization of aquaporin-5 expression in sweat gland cells from normal and anhidrotic horses. Vet Dermatol 2006;17:17–23.

9. Evans CL. Physiological mechanisms that underlie sweating in the horse. Br Vet J 1966;122:117–123.

10. Warner AE, Mayhew IG. Equine anhidrosis: a survey of affected horses in Florida. J Am Vet Med Assoc 1982;180:627–629.

11. Mayhew IG, Ferguson HO II. Clinical, clinicopathologic, and epidemiologic features of anhidrosis in central Florida Thor-oughbred horses. J Vet Intern Med 1987;1:136–141.

12. Florida State Agricultural Response Team. Livestock and horses: introducing florida’s livestock and horse industries. Available at: www.flsart.org/pPDF/LS-Horse%20Lesson%20Plan.pdf. Ac-cessed Mar 5, 2010.

13. USDA. National Agricultural Statistics Service, Florida Field Of-

fice. 2002 Census of Agriculture. Available at: www.nass.usda.gov/Census/Pull_Data. Accessed Mar 5, 2010.

14. Guthrie AJ, Van den Berg JS, Killen VM, et al. Use of a semi-quantitive sweat test in Thoroughbred horses. J S Afr Vet Assoc 1992;63:162–165.

15. Scott CM, Marlin DJ, Schroter RC. Quantification of the re-sponse of equine apocrine sweat glands to β

2-adrenergic stimu-

lation. Equine Vet J 2001;33:605–612.16. Rodriguez-Lainz A, Hird DW, Walker RL, et al. Papillomatous digital

dermititis in 458 dairies. J Am Vet Med Assoc 1996;209:1464–1467.17. Jenkinson DM, Loney C, Elder HY, et al. Effects of season and

lower ambient temperature on the structure of the sweat glands in anhidrotic horses. Equine Vet J 1989;21:59–65.

18. Evans CL, Nisbet AM, Ross KA. A histological study of the sweat glands of normal and dry-coated horses. J Comp Pathol 1957;67:397–405.

19. Arnold TF. Panting in cattle and nonsweating horses. Vet Rec 1950;62:463.

20. Wright TWW, Tull TC. A preliminary report of an investigation of a condition known as dry coat in horses. Vet J 1925;81:235–240.

21. Peter JE, Bage P, Morris PG. Anhidrosis in a Thoroughbred. Vet Med Small Anim Clin 1981;76:730–732.

22. Lindinger MI. Exercise in the heat: thermoregulatory limita-tions to performance in humans and horses. Can J Appl Physiol 1999;24:152–163.

23. Arabian Horse Association. Arabian horses history & heritage: origin of the Arabian horse. Available at: www.arabianhorses.org/education/education_history_origin.asp. Accessed Mar 5, 2010.

24. The Ultimate Horse Site. Thoroughbred breed information. Available at: www.ultimatehorsesite.com/breedsofhorses/thor-oughbredhorsebreed.html. Accessed Mar 5, 2010.

25. McEwan Jenkinson D, Elder HY, Bovell DL. Equine sweating and anhidrosis part 1—equine sweating. Vet Dermatol 2006;17:361–392.

From this month’s AJVR

EvaluationofnasolacrimalfluoresceintransittimeinophthalmicallynormaldogsandnonbrachycephaliccatsDaniel R. Binder and Ian P. Herring

Objective—To evaluate fluorescein nasolacrimal transit (NLT) times in ophthalmically normal dogs and non-brachycephalic cats by use of 2 methods of the Jones test.Animals—73 dogs and 36 cats.Procedures—Fluorescein dye was applied to the ocular surface of both eyes by means of a wetted fluorescein strip and, in a subsequent test, by a drop of 0.2% fluorescein solution. During each test, the nares were moni-tored for the appearance of fluorescein for up to 30 minutes after application. Time of fluorescein appearance at the nares was recorded as NLT time. Recorded variables for all study animals included age, reproductive status, body weight, and Schirmer tear test values. For dogs, skull index, snout length, and cephalic conformation were also recorded. Data were grouped for statistical comparisons according to test results.Results—In both dogs and cats, NLT time was faster when the fluorescein solution versus fluorescein strip was used. In cats, none of the recorded variables had a significant effect on NLT time, irrespective of the testing method used. In dogs, several variables had a significant effect on NLT time, including cephalic conformation, snout length, age, and reproductive status, but these findings varied with testing method and testing group.ConclusionsandClinicalRelevance—NLT time was highly variable in dogs and cats, regardless of testing method used. Assessment of nasolacrimal patency in brachycephalic dogs by use of either method evaluated here is not likely to be clinically useful. In cats, assessment of nasolacrimal patency with the fluorescein drop method was faster and more conclusive than the fluorescein strip method. (Am J Vet Res 2010;71:570–574)

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May 2010