180 DISEASES/DISORDERS
Administration of gradually increasing doses of the allergens identified by test-
ing (serum and/or intradermal) as potentially contributing to symptoms to reduce
sensitivity.Allergens selected based on allergy test results, patient history, and knowledge of local
flora; immunotherapy with standard, regional-specific allergens not selected by test-
ing of the individual patient not as effective.Indicated when symptoms last longer than 4–6 months per year, when nonsteroidal
forms of therapy are ineffective, and/or to avoid or reduce the use of corticosteroids.
Successfully reduces pruritus in 60–80% of dogs and cats.
Response is gradual and may take months to induce a beneficial competitive inhibi-
tion; treatment should be continued at least 1 year to fully evaluate effect.
ASIT may be administered by subcutaneous injection or by sublingual (oral) route.
Both modalities are safe and effective.
Patients that fail to respond to one modality of immunotherapy may respond to the
alternative formulation.
Client/patient compliance in treatment should be considered when choosing the
modality.
Corticosteroids
Most effective for management of acute “flare-ups” to break the itch–scratch cycle.
Should be tapered to the lowest dosage that adequately controls pruritus.
Prednisolone or methylprednisolone tablets: 0.2–0.5 mg/kg PO at a tapering dosage
with targeted maintenance of twice-weekly administration if needed.
Repository injectable corticosteroids should be avoided due to persistent adrenal
access suppression and increased incidence of long-term adverse effects.
Cyclosporine
Inhibits cytokine-induced activation of immune cells (specifically lymphocytes,
Langerhans cells, mast cells, and eosinophils).
Poor bioavailability; microemulsion formulation increases absorption; name-brand
(Atopica®) more effective.
Advantages: long-term experience indicates safety; steroid sparing; effective as single-
therapy management of AD.
Adverse reactions: gastrointestinal upset (vomiting, diarrhea); psoriasiform
lichenoid-like dermatitis; papillomatosis; gingival hyperplasia; opportunistic
infections (rare); possible increase in urinary tract infection.Slow onset: 4–8 weeks treatment required for control of symptoms prior to tapering
of dosage.
Dogs 5 mg/kg q24h; cats 7.3 mg/kg q24h: administered daily until control of symp-
toms; most patients maintained on every other day schedule.
Reduce initial dosage if gastrointestinal upset occurs.