• Allergy Testing & Immunotherapy

    7 April at 08:13 from atlas

    Allergy testing and Immunotherapy (desensitisation)

    Immunotherapy (desensitisation) is used in atopic dermatitis with the aim of eliminating or minimising the need for corticosteroids "cortisone". These drugs have serious medium term side effects.

    Small doses of allergens identified by skin testing are given at regular intervals to "retrain" the immune system so as not to "over-react" to common allergens such as grasses, weeds, pollen, insects, moulds and dust mites.

    Immunotherapy has a good success rate in dogs, cats and horses. Multiple studies have shown that about 65-70% of patients will improve by at least 50%. This reduces their suffering and dependence on immunosuppressive drugs

    Allergen Testing

    Dr Rob performs intradermal skin testing to identify the allergens needed to make an immunotherapy vaccine. This requires sedation as at least 60+ allergens are tested for.

    Withdrawal periods of drugs prior to Intradermal testing

    Oral prednisolone 1 month (short course 7-14 days) 6-8 weeks (long term courses)

    Depot corticosteroid injections 6-8 weeks minimum (longer the better)

    Potent topical corticosteroids , including ear drops, 10-14 days

    Hydrocortisone topicals and antihistamines 7 days

    Cyclosporine Nil

    Apoquel (oclacitinib) 3 days

    Intradermal skin testing is regarded by Veterinary Dermatologists as the "Gold Standard" for testing. There are various blood tests available but they do not correlate well with the results from skin testing. A recent study in Australian dogs has shown higher numbers of blood test positives in NORMAL non-atopic West Highland White terriers than in the atopic group!

    A recent study (ESVD Congress 2013) comparing four major laboratories in the US with respect to serum allergy testing found little better correlation and agreement between labs on the same samples than would be expected by chance.

    Further reading:

    Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis (see LINKS)

    The ACVD task force on canine atopic dermatitis (XVII): intradermal testing.

    http://www.ncbi.nlm.nih.gov/pubmed/11553391

    The ACVD task force on canine atopic dermatitis (XVI): laboratory evaluation of dogs with atopic dermatitis with serum-based "allergy" tests.

    http://www.ncbi.nlm.nih.gov/pubmed/11553390

    Results of allergen-specific immunotherapy in 117 dogs with atopic dermatitis

    http://www.ncbi.nlm.nih.gov/pubmed/16428661

    High allergen-specific serum immunoglobulin E levels in nonatopic West Highland white terriers.

    http://www.ncbi.nlm.nih.gov/pubmed