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160 Allergic Skin Diseases 1417

Therapy increased pruritus after exposure to a flea. For the symp-
VetBooks.ir The most effective treatment for animals with FAD is tomatic therapy of pruritus, antiinflammatory dosages of
oral glucocorticoids (e.g., prednisone/prednisolone at
avoiding exposure to fleas combined with aggressive flea
control. Veterinarians should be aware that none of the 0.5–1 mg/kg PO daily) and/or topical therapy (e.g., hydro-
cortisone aceponate spray [Cortavance®,Virbac], available
current flea preventives have an effective repellent effect. only in Canada and Europe, or triamcinolone acetonide
Since fleas in the pupal stage can survive up to 174 days topical spray [Genesis®, Virbac]) may provide sufficient
in the environment, it is not unusual for the response to relief. In dogs, oclacitinib (Apoquel, Zoetis) can be
effective flea prevention to take a couple of months. For administered at a dose of 0.4-0.6 mg/kg PO BID for up to
this reason, it is strongly recommended to maintain reg- 2 weeks, then once daily thereafter to alleviate pruritus
ular application of flea products in endemic areas. Fast‐ associated with FAD. Lokivetmab (Cytopoint, Zoetis) is
acting systemic adulticides are recommended over now licensed for the treatment of allergic dermatitis in
topically applied flea preventives because they reduce dogs and, thus, could also be considered as an option for
the contact time between the flea and the animal, result- treating pruritus. A minimum dose of 2 mg/kg is admin-
ing in faster reduction of irritation and pruritus. Flea istered SC and can be repeated every 4 to 8 weeks as
preventives with a rapid adulticidal effect act through needed. Other important measures include keeping the
activation of nicotinic acetylcholine receptors or inhibi- affected animal indoors and treating all in‐contact pets.
tion of gamma‐aminobutyric acid (GABA)‐gated chlo-
ride channels. Such products are available as oral tablets
and topical solutions, and contain either nitenpyram, Prognosis
spinosad, or an isoxazoline (e.g., fluralaner, sarolaner,
afoxolaner, lotilaner). Cats are very sensitive to Canine and feline FAD tends to worsen with age but with
permethrin so parasiticidals containing this product strict flea control, control of other underlying hypersen-
should be avoided in this species. sitivities and other measures which may help to reduce
Despite strict flea prevention and depending on the exposure to fleas, the disease can be well controlled.
severity of FAD, dogs and cats may develop episodes of

Further Reading

Bruet V, Bourdeau PJ, Roussel A, Imparato L. Desfontis associated pruritus in dogs. Vet Parasitol 2013; 191(3‐4):
JC. Characterization of pruritus in canine atopic 340–6.
dermatitis, flea bite hypersensitivity and flea infestation Koch SN, Torres SMF, Plumb DC. Canine and Feline
and its role in diagnosis. Vet Dermatol 2012; 23(6): Dermatology Drug Handbook. Ames, IA: Wiley‐
487–93. Blackwell, 2012.
Dryden MW, Ryan WG, Bell M, Rumschlag AJ, Young LM, Miller WH, Griffin CE, Campbell KL. Hypersensitivity
Snyder DE. Assessment of owner‐administered monthly disorders. In: Miller WH, Griffin CE, Campbell KL, eds.
treatments with oral spinosad or topical spot‐on Muller and Kirk’s Small Animal Dermatology, 7th edn.
fipronil/(S)‐methoprene in controlling fleas and St Louis, MO: Elsevier, 2013, pp. 363–41.