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.
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
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