The itchy dog: Short- and long-term approaches to allergy

A recent survey of veterinarians revealed mixed results regarding current trends in diagnosis and treatment of atopic dermatitis (AD) in dogs.

The good news is that newer antipruritics (e.g., oclacitinib, lokivetmab) are improving patient comfort and changing the way more than three-quarters (78.7%) of veterinarians are diagnosing, managing, and treating atopic dogs.1

The survey also revealed bad news, however—when atopy is suspected in a patient, nearly half of veterinarians (46%) are not recommending the gold standard therapy2: allergen-specific immunotherapy (ASIT).1 Many respondents described recommending either antipruritics or ASIT.1

Luckily, veterinarians do not have to choose one or the other. Below is an excerpt from the first ever step-by-step guide that provides both rapid relief of signs and the most appropriate long-term control of this condition (The full article is available via a link below).

Here’s how to get the best of both worlds in 4 steps…

Step 1: Use antipruritics to make patients comfortable in the short-term.

Surveyed practitioners most commonly cited the “quick fix,” noting that newer antipruritics allowed them to change clinical approaches to atopy.1 These medications quickly provide relief and comfort for pets without the concerns for side effects associated with long-term steroid use.1

Step 2: Recommend gold standard therapy, highlighting the long-term health and cost benefits of ASIT.

A chance at a better life. AD is a lifelong disease10 that can worsen over time11,12 ASIT is the only therapy that:

  • Can prevent signs13
  • May change the course of disease11
  • Occasionally leads to remission10,14
  • May decrease the number of new sensitizations15

       Step 3: Perform dermatological testing on patients while they are on antipruritics.

Luckily, practitioners do not have to choose between treating patients’ discomfort and determining a pet’s sensitivities. Patients do not have to be taken off either oclacitinib or lokivetmab before allergy testing.14

Step 4: Use multimodal therapy to improve comfort and decrease costs

A veterinary dermatologist or immunotherapy laboratory can offer consultations and advice on individual cases to help practitioners determine appropriate treatment options. Many clinicians may already be using antipruritics concurrently while they start ASIT.

In conclusion, veterinarians do not have to choose between antipruritics and immunotherapy. Newer antipruritics empower us to make our clients and patients happy, giving us short-term solutions that can pave the way for healthier and less expensive long-term solutions. Ultimately, immuno- therapy is still considered the gold-standard for long-term allergy relief.2

Review the complete and downloadable step-by-step guide here

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References:

  1. Survey: Allergy Testing in the Clinic. Data on file with Brief Media.
  2. Dell D. It’s not magic: the skinny on treating canine atopic dermatitis. Vetted. http://veterinarymedicine.dvm360.com/ it-s-not-magic-skinny-treating-canine- atopic-dermatitis Published July 19, 2016. Accessed June 28, 2018.
  3. Gadeyne C, Little P, King VL, Edwards N, Davis K, Stegemann MR. 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. 2014;25(6):512- 518.
  4. Little PR, King VL, Davis KR, Cosgrove SB, Stegemann MR. A blinded, randomized clinical trial comparing the efficacy and safety of oclacitinib and ciclosporin for the control of atopic dermatitis in client-owned dogs. Vet Dermatol. 2015;26(1):23-30.
  5. Zoetis launches Apoquel®—a novel dermatology solution for canine pruritus [news release]. Paris, France: Zoetis Inc; January 29, 2014. http://news.zoetis. com/press-release/apoquel/zoetis- launches-apoquel-%E2%80%93-novel- dermatology-solution-canine-pruritus. Accessed June 28, 2018.
  6. Zoetis receives USDA license for CytopointTM. Parsippany, NJ: Zoetis Inc; December 21, 2016. http://news.zoetis. com/press-release/companion-animals/ zoetis-receives-usda-license-cytopoint. Accessed June 28, 2018.
  7. Cosgrove SB, Cleaver DM, King VL, et al. Long-term compassionate use of oclacitinib in dogs with atopic and allergic skin disease: safety, efficacy, and quality of life. Vet Dermatol. 2015;26(3):171-179.
  8. Michels GM, Walsh KF, Kryda KA, et al. A blinded, randomized, placebo-controlled trial of the safety of lokivetmab (ZTS-00103289), a caninized anti-canine IL-31 monoclonal antibody in client- owned dogs with atopic dermatitis. Vet Dermatol. 2016;27(6):505-e136.
  9. Olivry T, DeBoer DJ, Favrot C, et al. Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC Vet Res. 2015:11:210.
  10. Moriello K. Canine atopic dermatitis. In: Line S, Moses MA, eds. Merck Veterinary Manual. 11th ed. Kenilworth, NJ: Merck; 2016. https://www.merckvetmanual. com/integumentary-system/atopic- dermatitis/canine-atopic-dermatitis. Accessed June 28, 2018.
  11. Verde M. Canine atopic dermatitis. Clinician’s Brief. 2016;14(3):18-27. https://www.cliniciansbrief.com/article/ canine-atopic-dermatitis. Accessed June 28, 2018.
  12. Rosenkrantz WS, Bourgeois AS. Pros and cons of oclacitinib therapy. In: Torres SMF, Roudebush P, eds. Advances in Veterinary Dermatology. Vol 8. Oxford, UK: Wiley Blackwell; 2017:192-198.
  13. Olivry T, DeBoer DJ, Favrot C, et al. Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis. Vet Dermatol. 2010;21(3):233-248.
  14. Hansen B, Lewis TP, McKay L, Rosychuk R, Stokking L. Canine atopic dermatitis: building a lifelong treatment plan. Clinician’s Brief. 2017;15(1):1-8. https:// www.cliniciansbrief.com/article/ clinicians-forum-canine-atopic- dermatitis-building-lifelong-treatment- plan. Accessed June 28, 2018.
  15. Marsella R, De Benedetto A. Atopic dermatitis in animals and people: an update and comparative review. Vet Sci. 2017;4(3):E27. doi:10.3390/vetsci4030037
  16. Apoquel [product label]. Kalamazoo, MI: Zoetis Inc; 2013. https://www.zoetisus. com/products/dogs/apoquel/downloads/ final_apoquel_pi_030116.pdf. Accessed June 28, 2018.
  17. Cytopoint [package insert]. Kalamazoo, MI: Zoetis Inc; 2016. https://www. zoetisus.com/products/dogs/cytopoint/ assets/resources/cytopoint-approved- package-insert.pdf. Accessed June 28, 2018.
  18. Stone AES, Landau G, Wuerz J, Mandese W. University of Florida study finds multiple benefits in offering wellness plans. AAHA NewSTAT. Published October 2014. Accessed June 28, 2018.
  19. Insurers say pet care spending, visits increase with pet insurance. JAVMANews. https://www.avma.org/News/ JAVMANews/Pages/161015k.aspx. Published September 28, 2016. Accessed June 28, 2018.
  20. Plumb DC. Oclacitinib maleate. Plumb’s Veterinary Drugs. https://www. plumbsveterinarydrugs.com/#!/ monograph/ooIQfS2sVC. Updated August 2017. Accessed June 28, 2018.
  21. Falk E, Ferrer L. Oclacitinib. Clinician’s Brief. 2015;13(12):30-32. https://www. cliniciansbrief.com/article/oclacitinib. Accessed June 28, 2018.