182 DISEASES/DISORDERS
COMMENTS
AD is a chronic, progressive, often relapsing and lifelong disease; it can be a frustrating
disease for the client as well as for the clinician.
Treatment should be aimed at management rather than “crisis management.”
Many factors may summate to cause intermittent flares (allergic threshold principle).
AD rarely goes into remission and cannot be cured: some form of therapy may be
necessary for life.
Regular evaluations are necessary to achieve adequate control of symptoms and to
manage flares.
Treatment monitoring is based on medications prescribed (e.g., CBC, serum chem-
istry profile, and urinalysis with culture recommended every 6–12 months for patients
on chronic immunomodulatory therapy).Although some allergens identified through testing can be avoided, immunotherapy
is the only treatment that may resolve the allergic response (versus symptom control).
Minimizing other sources of pruritus (e.g., fleas, food hypersensitivity, secondary skin
infections) is crucial to reduce pruritus to acceptable levels.
Secondary pyoderma,Malasseziadermatitis, and concurrent flea allergy dermatitis
are common.
This is not life-threatening unless intractable pruritus results in euthanasia.
Inadequately managed, pruritus worsens and becomes less responsive to treatment;
appropriate diagnosis and intervention should be initiated early.
Fig. 11.1.Erythematous papules and urticaria on the ventrum of a 1-year-old MC French bulldog with AD.