5 KEYS TO TREATMENT SUCCESS: YOU CAN HAVE SUCCESS WITH YOUR ALLERGIC PATIENTS BY PAYING ATTENTION TO THESE 5 STEPS FIONA BATEMAN, BVSc, MANZCVS, DACVD (continued)
4 FIND AN ANCHOR TREATMENT AS THE FOUNDATION FOR LONG TERM CONTROL Anchor therapies are the long term, single (preferably), sustainable treatments for allergic skin disease. In the case of flea allergy or food allergy, this may be as simple as isoxazoline flea control or the appropriate diet. In the case of atopic dermatitis, many treatment options are available for long term control of the disease. Steroids have been used to reduce and inflammation. 3,4 Antihistamines have historically been used for allergy control in pets. However, simply blocking histamine is often inadequate because it doesn’t control the key cytokine mediators that cause the pet’s itch and inflammation. According to the International Committee on Allergic Diseases of Animals, antihistamines offer little or no benefit in treating flares of canine atopic dermatitis. 5 Newer targeted therapies work by inhibiting specific steps in the pathway that produces itching and inflammation in dogs with atopic and/or allergic dermatitis. Cytokines are chemical signaling molecules that act as inflammatory mediators. Cytokines with a pivotal role in canine allergic dermatitis include interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-13 (IL- 13) and interleukin-31 (IL-31). 6 These cytokines contribute significantly to itching and inflammation in allergic dogs, especially IL-31, a key cytokine in the neuronal pathway of itch. One targeted therapy, CYTOPOINT® (Zoetis), is an injectable, caninized monoclonal antibody that targets IL-31 specifically, stopping itching by
inhibiting the binding of this cytokine to its receptors in dogs with allergic dermatitis and atopic dermatitis. 7,8 APOQUEL® (oclacitinib tablet), by Zoetis, is a targeted therapy that works fast and provides good efficacy in dogs with atopic dermatitis and allergic dermatitis. APOQUEL is a JAK enzyme inhibitor that selectively targets JAK-1– dependent pruritogenic, proallergic and pro-inflammatory cytokines. 6 APOQUEL stops itching and inflammation at the source by suppressing transmission of chemical signals that lead to clinical signs in dogs with atopic and allergic dermatitis. Other therapies such as Atopica® (cyclosporine) are also used to control atopic dermatitis. Cyclosporine is a potent inhibitor of cell-mediated immunity and a less potent inhibitor of humoral immunity. 9 This occurs primarily by blocking the gene transcription of cytokines such as IL-2, IL-4, IL-5, and IL-13. As such, cyclosporine has been shown to have both anti-pruritic and anti-inflammatory effects on the skin. 9 Finally, allergen specific immunotherapy is another option for many pets. Allergen specific immunotherapy relies on intradermal or serological testing to identify the offending allergens responsible for the pets’ clinical signs. Then, immunotherapy is administered (generally subcutaneous injections or oral sublingual drops) at frequent intervals to induce immunological tolerance to the allergens and desensitize the patient. Generally, immunotherapy is considered a life- long treatment.
It is important to also recognize the importance of supportive therapies such as parasite control, skin barrier repair such as essential fatty acids and ceramides, topical antimicrobials and dietary support. 5 THE IMPORTANCE OF COMMUNICATION TO PARTNER WITH OWNERS AND SET REALISTIC EXPECTATIONS Communication is of critical importance in managing the allergic patient – from your initial patient visit, through the diagnostic steps and finally managing the patient long term. Without great communication, positive outcomes can be hard to achieve. It is important to understand the perspective of itchy dog owners, and that they in turn understand the need for the systematic workup of the patient and the likely lifelong treatment needed. (continued)
15
vetgirlontherun.com
Made with FlippingBook - Online Brochure Maker