QUARTERLY BEAT / JULY 2024
ROCKSTAR DIET TRIAL TIPS:
1. Choose the right patient a. Nonseasonal pruritus starting at 6 years of age, up to date on excellent flea, tick, and mite prevention, no clinical or cytologic evidence of neoplasia or secondary infections? Excellent diet trial candidate! b. Nonseasonal pruritus in a 14-year-old Yorkie that has severe exfoliative erythroderma and depigmenting skin on the face? NOT a good diet trial candidate – biopsy for cutaneous epitheliotropic lymphoma! 2. Choose the right client a. Owner has been thoroughly educated on the VERY strict diet trial rules and is on board with the process 3. Choose the most appropriate diet a. Over-the-counter diets should NEVER be considered a diet trial
i. Cross-contamination with undisclosed proteins invalidates the diet 4,5 b. No diet is perfect - it is important to have options for picky eaters c. May need to choose diets with treat or pill-hiding options 4. Use an effective antipruritic therapy for the first 3-6 weeks of the diet trial a. Apoquel® or glucocorticoids are recommended b. Cytopoint® should only be used if the duration of action is known in the patient 5. Feed the diet for the right length of time a. 8 weeks will diagnose >90% of food allergic patients 6-8 b. A full 3 months is typically not necessary – should see response earlier
6. Prove food allergy by challenging with the old diet and increasing itch
7. Follow up with ALL diet trials and discuss long-term options a. Some patients require life-long prescription diets, some may tolerate over-the-counter diets that don’t “contain” the allergen 5
DITCH THE ITCH These patients are being presented because they are itchy - it is imperative that they leave with an effective antipruritic therapy. In most cases, antihistamines are not effective at controlling even mild pruritus and are therefore not recommended. 9 Glucocorticoids offer significant itch relief and may be appropriate in cases of severe inflammation and pruritus, but have frequent, and sometimes severe, side effects. Apoquel (tablets or chewable) and Cytopoint are safe and effective options to manage pruritus that are appropriate to use as a first- line treatments.
If there is significant inflammation in the skin, Apoquel is recommended due to its larger anti-inflammatory profile. If pruritus with minimal inflammation is present, Cytopoint is an excellent option. It is important to remember that response to antipruritics varies from dog to dog and there will always be some trial and error in the process of finding the most effective antipruritic protocol for each patient. In chronic, severe, or refractory cases cyclosporine is often an excellent option, but this medication is not appropriate for rapid relief of pruritic flares as it will take 4-6 weeks to reach full effect.
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