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Efficacy of Allergen-Specific Immunotherapy in Dogs with Atopic Dermatitis

Andrew Simpson, DVM, MS, DACVD, VCA Aurora Animal Hospital, Aurora, Illinois

Dermatology

|October 2022

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In the literature

Fennis EEM, van Damme CMM, Schlotter YM, et al. Efficacy of subcutaneous allergen immunotherapy in atopic dogs: a retrospective study of 664 cases. Vet Dermatol. 2022;33(4):321-e75. doi:10.1111/vde.13075


FROM THE PAGE...

Canine atopic dermatitis requires lifelong management including monotherapy or multimodal treatment options, which can include allergen-specific immunotherapy (ASIT). ASIT is currently the only allergy therapy that can alter the course of atopic dermatitis.1 

This retrospective study evaluated the efficacy of ASIT in 664 dogs diagnosed with atopic dermatitis at 1 of 2 referral centers. No dogs had additional diagnosis of cutaneous adverse food reaction, and all dogs underwent intradermal allergy testing and/or allergen-specific immunoglobulin E serologic testing prior to ASIT. Allergens in the ASIT formula were selected based on individual patient testing and included mites and pollen. After an induction phase, dogs were given a subcutaneous maintenance dose every 3 to 4 weeks for at least 9 months. 

Patient age at the start of ASIT ranged from 6 months to 12 years (mean, 4.08 years). Small-, medium-, and large-size breeds were included, with Labrador retrievers predominating (19.6%). Concurrent treatment with oclacitinib, cyclosporine, or systemic glucocorticoids was permitted. 

Response to immunotherapy was based on owner-assessed pruritus, clinician impression, and concurrent use of systemic antipruritic medications and was scored as excellent (ie, atopic dermatitis controlled by ASIT monotherapy), good (ie, ≥50% improvement in clinical signs and ≥50% reduction of systemic antipruritic drug dosage [if applicable]), or poor (ie, unchanged pruritus or <50% improvement in clinical signs and reduction of concurrent systemic medications). A good to excellent response was noted in 59.9% of atopic dogs after 9 months; this is within previously reported ranges (ie, 51%-64%).2-4 

Repeat examination by a referral clinician at least once every 3 months was associated with a significantly better response to ASIT. Significantly poorer clinical responses were noted in dogs coadministered systemic glucocorticoids with ASIT. Breed, sex, age at the start of ASIT, and types of allergens in ASIT did not have a significant influence on efficacy of immunotherapy.


...TO YOUR PATIENTS

Key pearls to put into practice:

1

ASIT should be recommended as a primary treatment option for canine atopic dermatitis and may allow reduction of coadministered antipruritic medications.

 

2

Regular follow-up examinations and guidance from a board-certified dermatologist can help ensure success of ASIT in dogs through routine monitoring for secondary bacterial and/or yeast dermatitis and regular adjustment of ASIT doses based on clinical response.

3

Chronic systemic glucocorticoids cause adverse effects in dogs. Results of this study suggest decreased efficacy of ASIT with concurrent glucocorticoid administration, prompting consideration of nonsteroidal allergy treatment options (eg, oclacitinib, cyclosporine) during the buildup phase of immunotherapy.

References

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