Effectiveness of regionally-specific immunotherapy for the management of canine atopic dermatitis

BMC Veterinary Research, Jan 2017

Background Canine atopic dermatitis is a common pruritic skin disease often treated with allergen immunotherapy (AIT). AIT in dogs traditionally begins with attempting to identify clinically relevant environmental allergens. Current allergen testing methodologies and immunotherapy techniques in dogs are not standardized. Immunotherapy with a mixture of allergenic extracts selected based on regional aerobiology rather than intradermal tests or serum IgE assays has been described. The objective of this study was to evaluate the effectiveness of regionally-specific immunotherapy in dogs with atopic dermatitis. The medical records of a veterinary dermatology referral clinic were searched for dogs with atopic dermatitis that began regionally-specific subcutaneous immunotherapy from June, 2010 to May, 2013. An overall assessment of treatment effectiveness (excellent, good, fair, or poor) was assigned based upon changes in pruritus severity, lesion severity, and the reduction in concurrent medication(s) during a follow-up period of at least 270 days. Baseline characteristics that might predict treatment success were analyzed with the Spearman’s correlation and the Kruskal-Wallis tests. Results Of the 286 dogs that began regionally-specific immunotherapy (RESPIT) during a 3 year period, 103 met the inclusion criteria. The overall response to RESPIT was classified as excellent in 19%, good in 38%, fair in 25%, and poor in 18% of dogs. The response classification correlated significantly with a reduction in pruritus severity (r = 0.72, p < 0.001) and lesion severity (r = 0.54, p < 0.001), but not with the dogs’ baseline characteristics. Adverse reactions were reported in 7/286 (2.4%) of treated dogs. Conclusions Under the conditions of this study, RESPIT was safe and effective for the treatment of atopic dermatitis in dogs.

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Effectiveness of regionally-specific immunotherapy for the management of canine atopic dermatitis

Plant and Neradilek BMC Veterinary Research Effectiveness of regionally-specific immunotherapy for the management of canine atopic dermatitis Jon D. Plant 0 Moni B. Neradilek 0 SkinVet Clinic , 15800 Upper Boones Ferry Road, Suite 120, Lake Oswego 97035, OR , USA Background: Canine atopic dermatitis is a common pruritic skin disease often treated with allergen immunotherapy (AIT). AIT in dogs traditionally begins with attempting to identify clinically relevant environmental allergens. Current allergen testing methodologies and immunotherapy techniques in dogs are not standardized. Immunotherapy with a mixture of allergenic extracts selected based on regional aerobiology rather than intradermal tests or serum IgE assays has been described. The objective of this study was to evaluate the effectiveness of regionally-specific immunotherapy in dogs with atopic dermatitis. The medical records of a veterinary dermatology referral clinic were searched for dogs with atopic dermatitis that began regionally-specific subcutaneous immunotherapy from June, 2010 to May, 2013. An overall assessment of treatment effectiveness (excellent, good, fair, or poor) was assigned based upon changes in pruritus severity, lesion severity, and the reduction in concurrent medication(s) during a follow-up period of at least 270 days. Baseline characteristics that might predict treatment success were analyzed with the Spearman's correlation and the Kruskal-Wallis tests. Results: Of the 286 dogs that began regionally-specific immunotherapy (RESPIT) during a 3 year period, 103 met the inclusion criteria. The overall response to RESPIT was classified as excellent in 19%, good in 38%, fair in 25%, and poor in 18% of dogs. The response classification correlated significantly with a reduction in pruritus severity (r = 0.72, p < 0.001) and lesion severity (r = 0.54, p < 0.001), but not with the dogs' baseline characteristics. Adverse reactions were reported in 7/286 (2.4%) of treated dogs. Conclusions: Under the conditions of this study, RESPIT was safe and effective for the treatment of atopic dermatitis in dogs. Dog; Atopic dermatitis; Regionally-specific immunotherapy; RESPIT; Allergen; Immunotherapy; Pruritus - Background Canine atopic dermatitis (AD) is a common inflammatory and pruritic skin disease that is frequently associated with sensitization to environmental allergens [1]. Affected dogs often exhibit pruritus of the face, pinnae, feet, axillae, and inguinal region [2]. Secondary otitis externa, staphylococcal pyoderma and Malassezia dermatitis frequently develop in atopic dogs. Canine AD often requires long-term management and therapy [1]. There is substantial evidence to support the use of glucocorticoids, cyclosporine, oclacitinib, and allergen immunotherapy (AIT) for canine AD [3]. With AIT, dogs are given allergenic extracts in order to minimize flares upon subsequent natural exposure [4]. The mechanism of action of AIT is not well defined in dogs, but may include the production of blocking IgG antibodies, a shift in the cytokine balance from a predominantly T-helper (Th) 2 to a Th1 cell profile, and a regulatory T-cell response [5, 6]. Therapeutic allergens are identified through a combination of aerobiology, intradermal test (IDT) findings, serum allergen-specific IgE assays (SIA), and clinical history [2]. Allergenic extracts are administered either by subcutaneous injection or via application to the oral mucosa [3]. Allergen immunotherapy prescriptions are customized for each dog. An optimal allergenic extract mixture would © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. contain only allergens that elicit clinical signs upon natural exposure. However, customizing an allergenic extract involves multiple subjective variables. Veterinarians choose which allergens to test for, whether to test with IDT or SIA, which laboratory’s SIA to use, how to interpret borderline reactions, which positive reactions are deemed clinically relevant, what dose of each allergen to include in the ASIT prescription, and by what schedule and route it will be administered. These variables are not trivial. Within a geographic region, the allergens veterinary dermatologists evaluate with IDT vary substantially [7], as do the allergens assayed by different laboratories offering SIA [8]. The agreement between IDT and SIA findings is often poor [2]. False positive and false negative results occur (...truncated)


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Jon Plant, Moni Neradilek. Effectiveness of regionally-specific immunotherapy for the management of canine atopic dermatitis, BMC Veterinary Research, 2017, pp. 4, 13, DOI: 10.1186/s12917-016-0917-z