Efficacy and safety of rush immunotherapy with alumprecipitated allergens in canine atopic dermatitis

Abstract

Summary Objectives: Canine atopic dermatitis is a very common disease in small animal practice. Its only specific treatment is allergen immunotherapy. In rush-immunotherapy (RIT) increasing doses of allergen extract are injected subcutaneously in short intervals. Maintenance doses are achieved within one day compared to weeks or months with conventional immunotherapy. The aim of this study was to evaluate the safety and efficacy of RIT with alum-precipitated allergens. Materials and methods: A series of 20 dogs with atopic dermatitis underwent RIT with alum-precipitated allergens. Pruritus and medications at the start of the immunotherapy and 12 months afterwards were compared and adverse effects were recorded. Results: Significant improvement in pruritus (p = 0.0001) and medication scores (p = 0.0004) was noted after approximately 12 months of treatment. The observed clinical response was good to excellent in 70% of the dogs, consistent with other published reports. One dog vomited once during the induction day, with no other clinical problems and completion of the normal protocol. The other 19 dogs showed no adverse effects at all during or after RIT. Conclusion and clinical relevance: RIT with alum-precipitated allergens seems to be a safe and efficacious method to treat dogs with atopic dermatitis.

A randomised, double‐blinded comparison between subcutaneous rush and intralympathic allergen immunotherapy induction in atopic dogs

“…There was no difference between ILIT and RIT at any time point with regard to pruritus scores or lesion severity. In other published studies evaluating solely ILIT 21,24 or solely RIT, 16,19 results approximately correspond to our findings. One recently published study comparing ILIT with conventional subcutaneous and sublingual immunotherapy in atopic dogs 22 found improvement with both subcutaneous and intralymphatic administration of allergens in contrast to sublingual application.…”

“…In human medicine, RIT provides earlier clinical improvement and improved convenience, although it is associated with a higher risk of systemic adverse events, 13 which is why RIT in humans is conducted in a hospital setting. RIT has been studied in the dog and its long‐term efficacy has been comparable to published data for classic immunotherapy 15,16,19 . In one double‐blinded, randomised comparison, RIT in the dog also was associated with a faster induction of tolerance compared to conventional immunotherapy, although the difference was not significant, possibly owing to the fact that were only 10 dogs in each study group 16 .…”

“…As dogs with AD frequently develop allergic flares with deterioration in clinical signs, it was deemed unethical as well as simply difficult to achieve good owner compliance over the duration of 1 year without permitting treatment of such flares as appropriate. Consequently, a medication score used in previous studies 19,30 was modified as new drugs used in atopic dogs such as lokivetmab and oclacitinib had to be incorporated. To reflect the actual disease state at the time of the visit, medications used in the month before presentation were included in the score.…”

“…At the beginning of the study, they were asked to estimate the pruritus of their animals using a validated pruritus Visual Analog Scale (PVAS) 27,28 and clinicians determined the lesion severity using CADLI, a validated lesion score 29 . In addition, medication scores were determined using a scoring system published previously 19,30 and adapted to our study as shown in Table S3. Owners were asked to keep a log book of their dogs' daily pruritus scores and to contact the clinic for further advice if there were any changes before and after the subsequent injections of allergen extract.…”

“…RIT also is described in two feline case studies, although a long‐term therapeutic outcome has not been reported in that species 17,18 . Long‐term, a good‐to‐excellent response to RIT was seen in 70% of the dogs in a retrospective study, 19 and total scores (reflecting the severity of cAD) decreased by >50% in 45% of the dogs in a prospective, double‐blinded study 16 . Although the time to efficacy was shorter with RIT compared to conventional immunotherapy in one double‐blinded, randomised trial, the difference between the two groups was not statistically significant, possibly due to the low number (10) of patients included in each group 16 …”