CHAPTER 11 ATOPIC DISEASE 181
Cats: cyclosporine blood level should be measured when on maintenance dosage to
prevent immunosuppression; patients must be FeLV/FIV negative; initial exposure to
toxoplasmosis during treatment may be fatal.Caution: inhibitors of cytochrome p450 activity will decrease drug clearance, requir-
ing dose adjustment.
Janus Kinase Inhibitor (JAK)
Oclacitinib: JAK1 inhibitor (major effect); blocks neuronal itch by inhibiting IL-31
cytokine function; additional immunomodulatory effects.
Advantages: rapid onset; alternative to glucocorticoids during flare-ups.
Adverse reactions associated with chronic use: demodicosis, pneumonia, dermal nod-
ules; rare cutaneous neoplasia; nonspecific immunosuppressive effects; nonspecific
bone marrow suppression; possible increase in urinary tract infection.May not decrease recurrences of AD-associated otitis externa or pyoderma.
Should not be combined with immunosuppressive therapies.
0.4–0.6 mg/kg BID for 14 days; then once daily.
Dogs only; not approved for use in patients under 1 year of age.
Biological Therapy
Caninized anti-cIL31 monoclonal antibody (Loviktinab).
Advantages: rapid onset; alternative to glucocorticoids during flare-ups; effective
4–6 weeks; no gastrointestinal side effects.
Long-term (repeated administration) efficacy and safety information lacking; inacti-
vation or allergic reaction theoretically possible with repeated usage; adverse effects
from continuous inactivation of IL-31 unknown.2 mg/kg by subcutaneous injection; repeated monthly or as needed to control symp-
toms.
Dogs only.
Antihistamines
Variable response; less effective than corticosteroids.
May act synergistically with essential fatty acid supplements.
Advantages: safe; inexpensive; minimal adverse effects.
Diphenhydramine 2.2 mg/kg BID.
Hydroxyzine 2.2 mg/kg BID.
Chlorpheniramine 0.4 mg/kg BID.
Cetirizine 1 mg/kg q24h.
Alternative Drugs
Pentoxifylline (phosphodiesterase inhibitor) 10 mg/kg BID to TID.
Tricyclic antidepressants: doxepin 0.5–3 mg/kg BID; amitriptyline 0.5–2.0 mg/kg BID;
effectiveness variable.