DERMATOLOGY
FELINE MEDICINE
Modifications of the standard SCIT protocol are
emerging and include rush immunotherapy and intra-
lymphatic immunotherapy.
Rush immunotherapy has the advantage of
limiting the number of injections that an owner
must apply during the initiation phase of ASIT as
maintenance levels are achieved rapidly. Dogs
must be hospitalised and increasing doses of
allergen extract or injected subcutaneously every
30 minutes for 7 hours. Animals are then discharged
and continue on maintenance therapy. Therefore,
with rush immunotherapy maintenance doses are
achieved within one day compared with weeks or
months with conventional immunotherapy.
Intra-lymphatic immunotherapy is a recent
modification of ASIT vaccine application, is
reported to be associated with fewer and less
severe adverse reactions then encountered with
SCIT and to be effective for several years after only
3 intra-lymphatic injections. Alum precipitated
ASIT vaccines are administered monthly into
1 of the popliteal nodes (alternating sides with
each subsequent injection), under ultrasound
guidance over 3 to 5 months. The number of
intra-lymphatic injections (4 to 6) is based on the
clinical improvement of the individual dog. In
most instances, no sedation is required. In various
studies complete remission was documented in
13% to 24% of dogs.
Trouble shooting allergen specific
immunotherapy (ASIT).
Subcutaneous immunotherapy (SCIT)
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Be alert to anaphylactic reactions, most likely
during the initial loading phase.
Monitor for increase in pruritis and flare ups of
otitis or pyoderma.
If pruritis initially decreases after each injection
but then slowly increases prior to the next
injection, the interval between injections should
be decreased.
If pruritis initially increases after each injection,
followed by improvement prior to the next
injection, the allergen dose is too high. Decrease
the dose by 25%. If pruritis still spikes after
injection, reduce dose by a further 25%.
Sublingual immunotherapy (SLIT)
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A few dogs rub or scratch at their mouth
following application and individual dogs will
vomit. However, these effects are short lived and
usually disappear after a few applications.
If signs persist or worsen, lowering of the allergen
dose may be required.
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Monitor for increase in pruritis and flare ups of
otitis or pyoderma.
Some highly effective drugs such as cyclosporin
(Atopico®, Elanco) and oclacitinib (Apoquel®, Zoetis)
and biologicals (anti-IL-31 therapeutic monoclonal
antibody), control clinical signs over a long period of
time and may obviate some of the “need” for ASIT.
However, these drugs and biologicals still require
lifelong treatment and they only reduce clinical
signs rather than reversing the pathogenesis of the
condition as observed with ASIT. Long-term safety
of these agents is not always known, and they carry
no hope of permanent cure that can sometimes be
achieved with ASIT. Use of these drugs and biologicals
in conjunction with ASIT provides a template effective
disease control in many instances.
Historically, allergen specific immunotherapy has
been viewed in general clinical practice as a last resort
treatment option. With the growing knowledge of
how and when to use ASIT, it has taken its place as a
foundation treatment for the long-term management
of canine atopic dermatitis.
REFERENCES
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efficacy of sublingual immunotherapy in canine atopic
dermatitis World Congress of Veterinary Dermatology 2012
Vancouver, Canada.
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atopic dermatitis: detailed guidelines for diagnosis and
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and Developmental Immunology 2012
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