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)