Page 1474 - Clinical Small Animal Internal Medicine

1412 Section 12 Skin and Ear Diseases

concurrent antipruritic pharmacotherapy during the Conclusion
VetBooks.ir induction of immunotherapy. Atopic dermatitis can be extremely frustrating to man-
Two formulations currently exist for immunotherapy:
subcutaneous injections and sublingual/oral drops.
Injections have been available much longer than the oral age for the practitioner and owner alike. That being said,
thorough client education efforts can markedly enhance
formulation and so we have much more information compliance and, therefore, results long term. It is impor-
regarding their use. Although they are very safe, side‐ tant to let clients know from the beginning that this
effects may include injection site pruritus, angioedema, or is a disease which can be managed but never cured.
anaphylaxis in a small percentage of patients. Anecdotally, Additionally, even with excellent control overall, flares
these effects may be more common in toy‐breed and very may periodically occur and the animal may still be con-
small patients. They are generally well tolerated by cats. sidered more pruritic than a normal patient. Although
Sublingual immunotherapy is a newer option; it is a nee- we strive for perfection, it is rarely achieved in a dog or
dle‐free way to administer the formulated allergen “cock- cat with atopic dermatitis. Goals for the patient should
tail” which may improve client compliance. Although a set be to improve their comfort (e.g., reduction of pruritus,
protocol has yet to be developed, sublingual immunother- decreased frequency of secondary infections) by approx-
apy is typically administered more frequently (e.g., 1–3 imately 80–90% for approximately 80–90% of the time.
times daily) compared to its injectable counterpart (e.g., This may require a combination of therapeutic interven-
q1–3 weeks long term). Although less information is tions including bathing/topical therapy along with
available for the sublingual formulation, trends appear to immunotherapy or various medications. Every patient
follow what is seen for immunotherapy injections with with atopic dermatitis is different; specific therapy needs
regard to time to improvement and percentage of animals to be tailored to the individual based on both patient and
experiencing clinical benefit. client feasibility. Having a client “onboard” with a multi-
There are alternative options for immunotherapy modal approach to atopic dermatitis is imperative for
which have been developed more recently. Regional successful management.
immunotherapy and more generalized formulations Additionally, it is important to remember that rarely
eliminate the need for allergen testing prior to formula- does a therapy “stop working” for managing the disease.
tion. How these less specific options compare to inject- For example, a dog has been doing fairly well on aller-
able or sublingual allergen‐specific immunotherapy has gen‐specific immunotherapy injections for several
yet to be determined. months/years and all of a sudden develops moderate to
severe pruritus. Prior to jumping to repeating allergen
testing/reformulating immunotherapy or abandoning
Prognosis immunotherapy altogether for alternative medications,
secondary flare factors such as infections and parasites
Although there is no cure for atopic dermatitis in the dog (particularly fleas and Sarcoptes) should be investigated
or cat, the long‐term prognosis is considered to be good. and addressed appropriately. In endemic areas, all
Most patients, however, require life‐long therapy for the patients should be treated year‐round with adulticide
disease and, even with generally good control, flares may flea prevention at least every 30 days to minimize the
periodically occur, necessitating additional therapeutic chance of flea infestation leading to an increase in pruri-
intervention. tus, thereby exacerbating atopic dermatitis.

Further Reading

Favrot C, Steffan J, Seewald W, et al. A prospective study on Olivry T, Bizikova P. A systemic review of randomized
the clinical features of chronic canine atopic dermatitis and controlled trials for prevention or treatment of atopic
its diagnosis. Vet Dermatol 2010; 21(1): 23–31. dermatitis in dogs: 2008–2011 update. Vet Dermatol
Hobi S, Linek M, Marignac G, et al. Clinical characteristics 2013; 24(1): 97–117.
and causes of pruritus in cats: a multicenter study on Olivry T, DeBoer DJ, Favrot C, et al. for the International
feline hypersensitivity‐associated dermatoses. Vet Task Force on Canine Atopic Dermatitis. Treatment of
Dermatol 2011; 22(5): 406–13. canine atopic dermatitis: 2010 clinical practice
Olivry T. Is the skin barrier abnormal in dogs with atopic guidelines from the International Task Force on Canine
dermatitis? Vet Immunol Immunopathol 2011; 144: 11–16. Atopic Dermatitis. Vet Dermatol 2010; 21(3): 233–48.