Allergen-specific immunotherapy for canine atopic dermatitis: Making it work - Veterinary Medicine
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Allergen-specific immunotherapy for canine atopic dermatitis: Making it work
You don't hesitate to recommend home-administered insulin injections in diabetic patients, so why not do the same for immunotherapy in atopic dogs? Here's how to help yourself and your clients feel more comfortable with this effective and economical therapeutic option.


VETERINARY MEDICINE


CONCURRENT THERAPIES

Generally, atopic dogs receiving immunotherapy also should be bathed every one to two weeks and, in flea endemic areas, should receive proper flea control. In a patient that is doing well, fleas will often cause or exacerbate atopic disease as well as induce secondary infections. This may even occur in atopic dogs that are not flea-allergic. Essential fatty acid supplementation or diets high in omega-3 fatty acids may also be beneficial.

Even in cases in which immunotherapy is considered beneficial, an occasional secondary infection may occur and exacerbate pruritus. Clients need to learn about early signs of secondary infections and appropriate intervention with bathing or a recheck examination. You can then prescribe antimicrobial therapy based on cytologic examination or possible culture and sensitivity results if empiric therapy is not effective. This will prevent the secondary problem from aggravating the atopic disease and making the client think the immunotherapy is ineffective or losing efficacy.

In dogs that do not respond to immunotherapy in the first month and in dogs with pruritus that the client cannot tolerate or that the veterinarian feels is excessive based on the severity of skin lesions, concurrent therapies such as antihistamines, glucocorticoids, or cyclosporine may be used. There is no evidence that these concurrent therapies decrease immunotherapy's efficacy. But these adjunctive treatments need to be discontinued every four to six weeks to assess the response to immunotherapy and to determine whether adjustments need to be made.

CONCLUSION

Allergen-specific immunotherapy is a useful tool in treating atopic dermatitis in dogs. Its use is facilitated by client education and training. Although serious adverse reactions are rare, life-threatening reactions may occur and owners need to be educated about them. Minor reactions and poor response are the basis often used for altering protocols and adjusting the therapy. Using adjunctive therapies judiciously and monitoring responses as well as teaching owners to observe their dogs' actions and skin are necessary for optimal management.

The recommendations in this paper are purely mine and are based on more than 25 years of experience managing many thousands of dogs using allergen-specific immunotherapy.

Editors' note: Dr. Griffin is a consultant for Veterinary Allergy Reference Laboratories (VARL). The recommendations in this article are not representative of or endorsed by VARL or any other business or company.

Craig E. Griffin, DVM, DACVD
Animal Dermatology Clinic and Animal Allergy Specialists
5610 Kearny Mesa Road
San Diego, CA 92111

REFERENCES

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2. Nuttall TJ, Thoday KL, van den Broek AH, et al. Retrospective survey of allergen immunotherapy in canine atopy. Vet Rec 1998;143:139-142.

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8. Power HT. Why do owners discontinue immunotherapy? Vet Dermatol 2000;11(suppl 1):14.

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10. Rosenkrantz WS, Animal Dermatology Clinic, Tustin, Calif: Personal communication, 2004.

11. Zur G, White SD, Ihrke PJ, et al. Canine atopic dermatitis: a retrospective study of 169 cases examined at the University of California, Davis, 1992-1998. Part II. Response to hyposensitization. Vet Dermatol 2002;13:103-111.

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