Canine Atopic Dermatitis (CAD) or environmental allergy affects 10-15% of dogs and is one of the most common diseases of dogs. Though generally not fatal, it is frustrating and results in a poorer quality of life for the dog and owner.
Common allergy therapies over the years
For decades the main therapy for CAD was systemic glucocorticoids. Almost 20 years ago, cyclosporin (Atopica) came onto the market, but the cost always remained a major limiting factor in medium or larger dogs.
Oclacitinib (Apoquel) is another huge breakthrough that is generally less expensive to use than cyclosporin, well-tolerated, and also rapid in action.
Then the first biologic therapy, lokivetmab (Cytopoint), that is not a drug but is an antibody, then became available. Though a little more costly than oclacitinib for most dogs, it has again revolutionized the treatment of CAD and now offers practitioners multiple nonsteroidal choices for treating CAD, especially long-term.
What we have not seen with these therapies are cures or apparent alterations in the natural course of the disease.
Allergen-specific immunotherapy (ASIT) is the optimal and only way to treat atopic dermatitis in dogs. Around 60-70% of dogs can be expected to have at least 50% improvement following ASIT, which can be significant.
ASIT can be started after diagnosis of CAD (based on history, clinical signs, and elimination of other causes of pruritus and inflammation) and allergy testing (to select allergens for avoidance and ASIT).
ASIT is the practice of administering gradually increased quantities of an allergen extract to an allergic subject to ameliorate the signs associated with subsequent exposure to the allergen (WHO definition). Allergen extracts are generally solutions containing proteins from pollens, molds, epithelia, and insects that cause allergies. It is not a typical drug and is essentially an extract of the things that the dog is being exposed to in its environment.
ASIT can take a year to become effective and, most of the time, is a lifelong therapy. Once the dog is on maintenance therapy, it is generally receiving one subcutaneous injection (or sublingual) at home by the owner between every 7–28 days. When one considers the long-term cost, then ASIT is often considerably less expensive than the other options. The first year is more expensive as the dog has to be allergy tested as well as treated with another treatment, generally for a few months while on ASIT. Once the treatment is just ASIT, then for most dogs, the client cost is $40–$60 per month.
by: Dr. Mohammad Hasiri