Allergic itch—getting it right the first time (and every time thereafter)
Consider this common everyday scenario: a dog presents with pruritus associated with early onset allergic dermatitis or a flare of allergic disease. How you manage this situation is important not only for this episode but also has important consequences for what follows. Provide an outstanding experience for the dog and the owner, and they will be back at your practice if the problem recurs, confident that you will provide solutions that work for them and ready to accept your future recommendations for the care and health of their pet.
If you are not sure that is true, consider how the owner’s experience may differ dramatically based on your treatment recommendation. The goal, and owner expectation, is that there will be rapid (within hours), effective and safe relief from allergic itch. What are the choices to meet these expectations: topical therapy, antihistamines, corticosteroids, and oclacitinib? Let’s consider the experience with each:
Topical therapy: Topical corticosteroid sprays may be helpful for localized areas but may be difficult to apply and maintain. The only products in clinical studies to show a benefit are a 0.015% triamcinolone spray and a 0.584 mg/ml hydrocortisone aceponate spray. Both products are currently unavailable in the U.S. The safety and efficacy of other topical corticosteroids are unknown.
Antihistamines: As indicated by the guidelines from the International Committee of Allergic Disease of Animals published in 20151, “antihistamines are likely to be of little or no benefit to treat acute flares of canine atopic dermatitis.” Studies reflect that approximately 25% of dogs may respond to antihistamines—no more than a placebo effect. For the 75% who fail to respond, there is progression of disease and possible development of secondary infections, as well as frustration and despair for the owner, who will also likely question the value of the veterinarian’s recommendation for drugs that are ineffective, not labeled for use in canine allergies, and available over the counter.
Corticosteroids: While oral and injectable corticosteroids provide rapid itch relief for most allergic dogs, their use may come with consequences. Because they affect every organ system, side effects are common. Over 60% of owners report increased thirst, appetite, and urinations, as well as lethargy and disinterest in regular activities2; over 30% of dogs on short-term corticosteroids will have behavior changes that can include anxiety, stress, and aggression3. Replacing itch with multiple new problems is a burden and a negative experience.
Oclacitinib: This drug for allergic dermatitis is as rapidly effective as corticosteroids4 but with an excellent safety profile and none of the consequences of steroids4,5. This is a most attractive solution that owners appreciate—market research demonstrates the overwhelming satisfaction of dog owners and veterinarians of treating allergic itch with oclacitinib6. In addition, oclacitinib can be continued safely for the long term, if necessary, in the individual patient.
Getting it right the first time is best medicine and also provides a positive experience that will build practice loyalty and confidence in the veterinarian.
IMPORTANT SAFETY INFORMATION: Do not use APOQUEL in dogs less than 12 months of age or those with serious infections. APOQUEL may increase the chances of developing serious infections and may cause existing parasitic skin infestations or pre-existing cancers to get worse. APOQUEL has not been tested in dogs receiving some medications including some commonly used to treat skin conditions such as corticosteroids and cyclosporines. Do not use in breeding, pregnant, or lactating dogs. Most common side effects are vomiting and diarrhea. APOQUEL has been used safely with many common medications including parasiticides, antibiotics, and vaccines.
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References:
1. Olivry T., et al. "Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA)." BMC Veterinary Research 11.1 (2015): 210.
2. Data on file. Pet owner quantitative research, Zoetis LLC
3. Notari L., Mills D. Possible behavioral effects of exogenous corticosteroids on dog behavior: a preliminary investigation. J Vet Behav 6.6 (2011): 321
4. Gadeyne C., et al. "Efficacy of oclacitinib (Apoquel®) compared with prednisolone for the control of pruritus and clinical signs associated with allergic dermatitis in client‐owned dogs in Australia." Vet Dermatol 25.6 (2014): 512-e86.
5. Cosgrove S.B., et al. "Efficacy and safety of oclacitinib for the control of pruritus and associated skin lesions in dogs with canine allergic dermatitis." Vet Dermatol 24.5 (2013): 479.
6. Data on file. Apoquel EEP Veterinarian Aggregate Data, Zoetis LLC
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