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Flea Bite Allergy 343

• Seasonal in climates with cold winters and amino acids induces development of to oral predniso(lo)ne, or use oclacitinib
• Continuous in indoor infestations or warm, various hypersensitivity reactions (p. 1238). 0.4-0.6 mg/kg PO q 12h for 7-14 days, then
VetBooks.ir ASSOCIATED DISORDERS ○ Cutaneous basophil hypersensitivity (dogs) • Cats: prednisolone 2.2 mg/kg PO q 24h Diseases and Disorders
○ Type I (immediate/anaphylactic) hyper-
humid climates
once daily
sensitivity (dogs, cats)
for 5-7 days, then taper. If daily oral drug
• Infestation with Dipylidium caninum
• Gastric trichobezoars (hairballs) associated ○ Type IV (delayed/cell-mediated) hyper- administration is not possible, may substitute
methylprednisolone injectable 5 mg/kg
sensitivity (dogs, cats)
with excessive grooming ○ Late-phase, IgE-mediated reactions (dogs) or 20 mg/CAT IM or SQ; however, there
• Secondary bacterial pyoderma • Hypersensitivity reactions, particularly are multiple risks with use (e.g., diabetes
intermittent, may become more intense and mellitus, iatrogenic hyperadrenocorticism,
Clinical Presentation be triggered with progressively less antigen congestive heart failure).
DISEASE FORMS/SUBTYPES (flea saliva). Topical flea adulticide: several options (NOTE:
Canine flea bite allergy: product types and names may change):
• Pruritic papular dermatitis DIAGNOSIS • Permethrin sprays/spot applications (e.g.,
• Acute moist dermatitis (hot spot) Active-3, numerous others)
• Fibropruritic nodules in chronic cases Diagnostic Overview • Imidacloprid (e.g., Advantage, Advantage-
Feline flea bite allergy: The diagnosis of flea bite allergy is based almost Multi, Advantix for dogs; Seresto collar)
• Pruritic papulocrustous dermatitis (miliary entirely on history and physical exam findings. • Fipronil (e.g., Frontline, Catego for cats,
dermatitis) Even in the absence of live fleas or flea excreta, others)
• Symmetrical, self-induced alopecia physical signs as described warrant empirical • Selamectin (e.g., Revolution)
• Eosinophilic granuloma complex antiflea treatment before or while pursuing • Indoxacarb (e.g., Activyl)
advanced diagnostic testing for other causes • Spinetoram (e.g., Cheristin for cats)
HISTORY, CHIEF COMPLAINT of pruritus. • Fluralaner (Bravecto for cats)
• Dogs: acute onset of moderate to severe • Dinotefuran, permethrin, pyriproxyfen
pruritus and hair loss and malodor in Differential Diagnosis (e.g., Vectra 3D) for dogs, Vectra without
longer-standing cases. Clients may report Dogs, cats: permethrin for cats
live fleas on their pet or experience flea bites • Other hypersensitivities (atopic dermatitis, Oral flea adulticide:
themselves. foods, intestinal parasites, drugs) • Nitenpyram (Capstar)
• Cats: hair loss, pruritus, excessive grooming, • Ectoparasitic dermatoses • Spinosad (e.g., Comfortis, Trifexis) for dogs
vomiting hairballs, or small, crusted papules • Bacterial folliculitis • Isoxazoline class drugs for dogs: afoxolaner
are noted under the haircoat. Lip ulcers, raised Dogs: (NexGard), fluralaner (Bravecto), sarolaner
plaques, or granulomas may be noted. Fleas • Malassezia dermatitis (Simparica), lotilaner (Credelio)
are less commonly observed than in dogs. Cats: Specific therapy for any secondary infections
• Dermatophytosis (p. 851)
PHYSICAL EXAM FINDINGS • Anal sac disease (excessive grooming of
Dogs: ventral abdomen, lateral flanks, and cau- Chronic Treatment
• Papulocrustous lesions, varying degrees of domedial thighs) Integrated flea management is essential for
alopecia, erythema, and excoriations. Most eradication of the problem:
commonly affected regions are dorsal lum- Initial Database • Ongoing use of flea adulticide
bosacral region, tailhead, and caudomedial History, physical exam findings ± observation • Insect growth regulators: methoprene, pyri-
thighs. Ventral abdomen, especially near the of fleas or flea excreta proxyfen, others. NOTE: some products are
umbilical area, flanks, neck, and feet may formulated for spraying the patient; others
also be affected. Advanced or Confirmatory Testing are for treating the environment.
• Well-demarcated, moist, erythematous, • Intradermal testing with 1 : 1000 w/v aqueous • Insect development inhibitors: lufenuron
exudative skin lesions with alopecia solution of whole flea antigen oral, monthly or semiannual injectable (cats)
• Lichenification, lattice pattern hyperpigmen- • ELISA serologic allergen screening for flea • Environmental control may be required for
tation, scaling saliva antigens: accuracy varies, does not flea infestation.
• Poor body condition, weight loss, worn document delayed hypersensitivity reactions ○ Identify “point sources” of infestation.
incisor teeth • Response to flea eradication: considered by ○ Cleaning or frequent vacuuming
• ± Fleas, flea excreta (flea dirt) many to be the most definitive test ○ Organic debris removal outdoors
Cats: ○ Use of an approved insect growth regulator
• Self-inflicted, symmetrical hair loss on TREATMENT premise spray
the ventral abdomen, lateral flanks, and • Immunotherapy is experimental at this time.
caudomedial thighs Treatment Overview
• Erythematous, crusted papules around the In flea infestation, the goals of treatment are Possible Complications
neck and on the lumbosacral region (miliary focused on eradication of the flea population • Neurotoxicosis with the use of pyrethrins,
dermatitis) from the animal and its environment (i.e., permethrins in cats (p. 858); isoxazoline
• Lesions consistent with eosinophilic granu- integrated flea management). In flea bite compounds
loma complex (indolent ulcer, eosinophilic allergy, the goals of treatment also include • Diabetes mellitus, iatrogenic hyperadre-
plaque, eosinophilic granuloma) providing rapid relief of the clinical signs and nocorticism (glucocorticoids, especially
• Excoriations, crusts discomfort. sustained-release injections)
• Weight loss, poor body condition, peripheral
lymphadenopathy Acute General Treatment Recommended Monitoring
• Uncommonly, fleas, flea excreta (flea dirt) Antiinflammatory therapy: Routine flea combing
• Dogs: prednisone/prednisolone 1 mg/kg PO
Etiology and Pathophysiology q 24h for 5-7 days, then taper; may also PROGNOSIS & OUTCOME
• Repeated exposure to flea salivary polypep- use hydrocortisone aceponate spray topically
tides, histamine-like compounds, enzymes, once daily as monotherapy or in addition Good with long-term management

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