Allergen specific immunotherapy for itchy dogs

RE: Allergen specific immunotherapy for itchy dogs

Rob Davis — Fri, 14 Jul 2017 19:58:25 GMT

[quote user="Stephanie Fursland"]

I am very anti immunotherapy!

I find it is very hard for the owners to comply with the schedule (we have lots missing injections and having to alter the schedule).

I haven't seen any patients improve to the extent that no other treatments are needed - they still end up on multimodal management (which probably would work just as well without immunotherapy...)

Also we have had a fair few possible adverse reactions - vomiting and diarrhoea, increase in itching, and one death (although not proven).

[/quote]

I'm really surprised by this. My experiences are similar to others. I have seen it used in many dogs over the years and have never seen any adverse effects

RE: Allergen specific immunotherapy for itchy dogs

Thomas Johnson — Fri, 14 Jul 2017 16:43:37 GMT

[quote user="robloxley"]

For a review of the science surrounding ASIT, look at https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/26276051/

Our experience seems to be in line with reported studies and we simplify when explaining to clients that a third will be completely controlled, a third improved but still needing adjunctive treatment and a third no improvement. If clients aren't going to be happy trialling an expensive, slow treatment in case it might still not help, then it (and the preceding allergy identification) is probably best avoided...

We had one client switch to sublingual, but found it such a faff they moved back to injections.

Haven't seen anaphylaxis, but we still monitor the animals after injection during induction.

[/quote]

My experience is very similar, we have about 8 dogs on immunotherapy at the moment, I would say that 5 of them are well controlled and don't need any other treatment, the other 3 are much improved but still need occasional treatment with Apoquel, prednisolone or topical ear treatment. There have been 2 or 3 dogs over the past few years that I have tried on immunotherapy but they haven't really improved.

Our clients are generally very good at coming in for injections, and in the past once they have got on to the full dose monthly injections I have dispensed the injections for owners to give at home.

I also have never seen an anaphylactic response, though we always get he client to stay at the surgery after the first few injections just in case.

RE: Allergen specific immunotherapy for itchy dogs

Anthony Todd — Fri, 14 Jul 2017 00:02:35 GMT

[quote user="Eilidh Corr"]That's pretty much what I said [/quote]

Er, yes, sorry

RE: Allergen specific immunotherapy for itchy dogs

Eilidh Corr — Thu, 13 Jul 2017 21:08:10 GMT

[quote user="Anthony Todd"]Or the malassezia hasn't overgrown because the over production of "sebum" has reduced because of the immunotherapy's reducing the cause??[/quote]

That's pretty much what I said

RE: Allergen specific immunotherapy for itchy dogs

Anthony Todd — Thu, 13 Jul 2017 20:02:37 GMT

[quote user="Eilidh Corr"]I don't bath her any more, because she hasn't needed treatment for malassezia overgrowth since starting the immunotherapy.[/quote]

Or the malassezia hasn't overgrown because the over production of "sebum" has reduced because of the immunotherapy's reducing the cause??

RE: Allergen specific immunotherapy for itchy dogs

Eilidh Corr — Thu, 13 Jul 2017 18:23:25 GMT

[quote user="Anthony Todd"]Might be able to use pred as necessary and spare the pain and aggro of bathing etc.?[/quote]

I don't bath her any more, because she hasn't needed treatment for malassezia overgrowth since starting the immunotherapy.

RE: Allergen specific immunotherapy for itchy dogs

Stephanie Wellings — Thu, 13 Jul 2017 18:13:40 GMT

I am very anti immunotherapy!

I find it is very hard for the owners to comply with the schedule (we have lots missing injections and having to alter the schedule).

I haven't seen any patients improve to the extent that no other treatments are needed - they still end up on multimodal management (which probably would work just as well without immunotherapy...)

Also we have had a fair few possible adverse reactions - vomiting and diarrhoea, increase in itching, and one death (although not proven).

RE: Allergen specific immunotherapy for itchy dogs

Anthony Todd — Thu, 13 Jul 2017 16:10:25 GMT

[quote user="Eilidh Corr"]

Malaseb didn't clear it, although it did control it. As long as her skin was inflamed it would come back. I needed to control the underlying hypersensitivity reaction. I should probably mention that her diagnostics and treatment were not carried out by me but by a Specialist.

I suppose the correct term is malassezia overgrowth. Whatever you want to call it, it stinks and it itches

[/quote]

Fair enough. It might explain the good response I always got with the dreaded steroids in waxy brown otitis, sort of like marmite, which was probably just an allergic otitis and the excess exudate encouraged malazzezia overgrowth, as you say.

Might be able to use pred as necessary and spare the pain and aggro of bathing etc.?

RE: Allergen specific immunotherapy for itchy dogs

Rob Loxley — Thu, 13 Jul 2017 15:31:36 GMT

[quote user="Beats"]I have zero personal experience, and only limited anecdotes, but am always reading about this and still not quite sure if should be taking it seriously or not[/quote]

For a review of the science surrounding ASIT, look at https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/26276051/

We had one client switch to sublingual, but found it such a faff they moved back to injections.

Haven't seen anaphylaxis, but we still monitor the animals after injection during induction.

RE: Allergen specific immunotherapy for itchy dogs

Eilidh Corr — Thu, 13 Jul 2017 14:48:14 GMT

I suppose the correct term is malassezia overgrowth. Whatever you want to call it, it stinks and it itches

RE: Allergen specific immunotherapy for itchy dogs

Anthony Todd — Thu, 13 Jul 2017 13:44:11 GMT

[quote user="Eilidh Corr"]malassezia infection[/quote]

Isn't this a misnomer, as it only becomes obvious with increased cutaneous secretions, particularly in ears?

Does it ever satisfy Koch ie can you actually "infect" anything with it?

Isn't it there anyway in and on all dogs?

RE: Allergen specific immunotherapy for itchy dogs

Martin Atkinson — Thu, 13 Jul 2017 10:08:19 GMT

[quote user="Eilidh Corr"] her concurrent malassezia infection has not been back since it started.[/quote]Regular washing with Malaseb/Adaxio would have sorted that out.

RE: Allergen specific immunotherapy for itchy dogs

janine redman — Wed, 12 Jul 2017 21:58:45 GMT

Has anyone used the SLIT sublingual immunotherapy? Had a very itchy spaniel with multiple positive responses on IgE levels to different allergens. Was about to order it in but the pruritis significantly resolved with bravect! Probably sarcoptes in hindsite though negative on skin scrape.

RE: Allergen specific immunotherapy for itchy dogs

Eilidh Corr — Wed, 12 Jul 2017 21:45:49 GMT

My own dog is atopic and has been receiving immunotherapy for about a year and a half. It does seem to be helpful, and while she isn't completely controlled in terms of pruritus, her concurrent malassezia infection has not been back since it started.

I've had numerous clients on immunotherapy over the years and most report a reasonable degree of improvement. These have all been based on intradermal testing rather than blood sampling though.

RE: Allergen specific immunotherapy for itchy dogs

Charlie Lyon — Tue, 11 Jul 2017 15:59:58 GMT

Have used it in a couple of cases, have had good responses with both and one has been controlled since September 2014 - Weimaraner with mite allergies. The other case a Boxer who finished his course in April who had 9 allergens including grasses and mites who is controlled at the moment. Both clients were insured so were happy to go down the testing route as always advise that the reponse varies from dog to dog

RE: Allergen specific immunotherapy for itchy dogs

Julie Innes — Tue, 11 Jul 2017 15:19:45 GMT

Sorry, Martin, I was talking about immunotherapy. (don't think I've even heard of cytopoint )

And I usually do full flea/ parasite treatment in any of these guys before even starting down the road of immunotherapy!! (of course ) It's never my first line treatment, but it has its place, I guess. I have seen some really impressive results at times.

RE: Allergen specific immunotherapy for itchy dogs

Joyce Whitehead — Tue, 11 Jul 2017 14:21:59 GMT

Sorry my re was on immunotherapy, no experience of cytopoint.

RE: Allergen specific immunotherapy for itchy dogs

Anthony Todd — Tue, 11 Jul 2017 09:53:13 GMT

[quote user="Julie Innes"]We have quite a few on it. I usually tell clients that as a rough guide 1 in 3 do really well, 1 in 3 improve a little and 1 in 3 it doesn't help at all.[/quote]

Trouble is this "success" may discount the introduced concurrent decent flea control and probably a diet change.

RE: Allergen specific immunotherapy for itchy dogs

Martin Atkinson — Tue, 11 Jul 2017 09:25:27 GMT

[quote user="Emily Rainbow"]

Bit of a tangent but does anyone have any experience using Cytopoint?

[/quote]I wan't aware Cytopoint had been released in the UK yet. Perhaps Julie and Joyce could tell us if their subsequent posts relate to this or the OP as its not clear. If its as good as the promotional blurb sounds it will be well worth trying but haven't seen a price yet and I suspect it won't be cheap. But good on Zoetis for bringing out two innovative products in a relatively short time.

Back to the OP. I've never use allergen specific immuno-therapy, I've managed every single case of allergic dermatitis successfully with multi-modal treatment: shampoos (esp Malaseb), EFA supplements, good parasite control, diet trials and judicious use of prednisolone more recently of course with Apoquel. It would be the treatment of last resort as I am far from convinced of its value when weighing up cost, efficacy, side effects, convenience in fact all the issues that concern the other posters.

RE: Allergen specific immunotherapy for itchy dogs

Julie Innes — Tue, 11 Jul 2017 08:34:25 GMT

We have quite a few on it. I usually tell clients that as a rough guide 1 in 3 do really well, 1 in 3 improve a little and 1 in 3 it doesn't help at all.

Never had any issues with anaphylaxis or side effects.

I always discuss the success rate with owners before starting treatment, so they have realistic expectations when they are going to be spending a couple of hundred quid, or more.

RE: Allergen specific immunotherapy for itchy dogs

Joyce Whitehead — Tue, 11 Jul 2017 08:31:08 GMT

We have quite a number of dogs on it (maybe 20 ish?). In all cases they have improved, and mostly don't need long term meds, just occasional treatment of a flare up. Included in this are some who mainly presented as recurrent allergic otitis, and they particularly seem to be helped.

I haven't noticed a deterioration after a few years in our cases, but is it possible this is just a worsening of the allergy anyway as most atopics seem to get worse year on year? I would agree that some must have allergens not tested for, they can't check for everything.

RE: Allergen specific immunotherapy for itchy dogs

Emily Rainbow — Mon, 10 Jul 2017 22:13:46 GMT

Bit of a tangent but does anyone have any experience using Cytopoint?

RE: Allergen specific immunotherapy for itchy dogs

Neil Wheadon — Mon, 10 Jul 2017 21:17:32 GMT

I ask hundreds of owners and I'm not exaggerating here, having seen this in loads of places. I always ask clients

I think about 2 have gone into remission, a handful are a lot better, about 1/3 seem a little better and in about 2/5 it makes no difference at all.

Regardless of the science, I'm increasingly thinking the reasons are that the companies don't test for everything out there and if? desensitisation does work, it's limited to the allergens used in the blood test.

However, it's safe but in my opinion overrated

Neil

RE: Allergen specific immunotherapy for itchy dogs

Busybee — Mon, 10 Jul 2017 21:16:31 GMT

Seems to work well initially then in two cases I've seen, the effects have worn off - one after about 10 months, one after a few years. Agree with Anthony that most cases still have occasional flare ups.

RE: Allergen specific immunotherapy for itchy dogs

Anthony Dennison — Mon, 10 Jul 2017 19:54:04 GMT

I've seen a mixed bag of results. Usually takes a few months to properly work, some dogs still require anti-pruritic therapy for small periods of the year, but the skin isn't as bad as it might have been without it. Some dogs have responded really well, but they've been on it for 2 or 3 years.

Never seen a reaction to it as of yet.