CAD & Itch Drugs Flashcards
canine atopic dermatitis is
an inflammatory and itchy disease with clinical signs associated with IgE production directed most commonly against enviromental allergens
some risk factors for canine atopic dermatitis include
urban environment, male, neutered, allowed on furnature, receving flea control, exposure to smoke, regular bathing, being raised in a shed, others but im too lazy
the most commone allergen for CAD is
dust mites–>shown to worsen the skin barrier in atopic dogs
can also be: dust, mould, grass, dander
where are lesions of CAD usually?
periocular, muzzle, paws, ventral metacarpal and metatarsal regions, perianal, inguinal, axillary, cubital fold
3 components to diagnosing canine atopic dermatitis?
rule out other diseases that look similar (pyoderma, yeast, ringworm, rule out parasites, and do diet trial)
detailed analysis of history and C/S
demonstration of IgE/identify allergens
what are some favrots criteria
Age at onset <3 years
Mostly indoor
Corticosteroid-responsive pruritus
Chronic or recurrent yeast infections
Affected front feet
Affected ear pinnae
Non-affected ear margins
Non-affected dorso-lumbar area
true or false There is no test to definitively diagnose atopic dermatitis
true
what allergy testing is available for CAD?
intradermal allergy testing (IDAT) : This test requires specific drug withdrawals, the preferred test
serum IgE testing: major advantage is its convenience and widespread availability
allergy tests do not diagnose a patient as
having AD!!!!!!! and not useful for identifying food
allergens !!!!
why do we allergy test
- to identify any allergens that can be avoided. Examples include wool, house dust mites (highest in
beds and bedrooms), and grass. Avoidance is rarely sufficient for a satisfactory reduction in signs, so: - more often allergy testing allows the formulation of a prescription for allergen-specific
immunotherapy (ASIT)
Intradermal skin test showing many strong positive reactions
________is the only way to diagnose food allergy (or
rule out food allergy in dogs with non-seasonal allergic signs)
A well-executed diet trial and challenge
there are 4 main medical therapies for the treatment
of itch which are
glucocorticoids, Modified Cyclosporine (Atopica), Oclacitinib (Apoquel), and Lokivetmab (Cytopoint)
describe how Oclacitinib (Apoquel) works
Janus kinase (JAK) inhibitor, rapid onset of action, has targeted activity against JAK1-dependent cytokines (including the one that causes itch IL-31)
describe how Lokivetmab (Cytopoint) works
caninized anti-IL-31 monoclonal antibody , gets rid of the itch! rapid onset of action, not the same as apoquel!
describe how Cyclosporine (Atopica) works
calcineurin inhibitor , SLOW ONSET (not for acute flareups), can take 4 weeks or longer to see effects, given to both dogs and cats, dont use it in dogs with cancer
describe how Corticosteroids work for allergic conditions
they are anti inflammatory and reduce itching, useful for flare ups and short term treatment
what are soft steroids
potent steroids that are metabolized to much
weaker steroids in the skin before entering systemic circulation. Soft steroids are less
likely to cause cutaneous and systemic side effects and may be appropriate for long-term use at 2-3
times weekly dosing with careful monitoring for adverse cutaneous effects
in my words: a topical steroid that is very potent on the skin but then metabolized to a very weak steroid once it is absorbed
2 examples: hydrocortisone aceponate (Cortavance) and mometasone
_____ is the only treatment that can modify or reverse this disease, rather than just alleviating
clinical signs
ASIT: allergen specific immunotherapy
describe how allergen specific immunotherapy works
ASIT: administering gradually increasing quantities of an allergen extract to an allergic
subject to ameliorate the signs associated with subsequent exposure to the causative allergen.
can take 3-9 months and it can take 12 months or even longer to see the full benefit. If ASIT is
effective, it should be given for life because permanent remissions are uncommon.
There are 4 goals of topical therapy in allergic dogs which are
-
Remove allergens from the skin: the physical act of bathing removes substances, including
allergens from the skin - Treat and prevent secondary infections
- Restore skin barrier
- Deliver anti-itch ingredients
remember DRRT (dirt)
what are the 2 kinds of allergen specific immunotherapy? compare and contrast them
subcutaneous immunotherapy
sublingual immunotherapy
what causes CAD flares?
food allergens, ectoparasites, seasonal exposure, change in medication, infections like staph or yeast
proper way to do a food trial?
use itch meds beforehand to control clinical signs
stop these 1-2 weeks before beginning food trial
over 8 weeks
if no improve: no food allergy
if improvement: rechallenge
what are some reasons why a pet could improve during a feed trial that are NOT food allergy related?
seasonal change, placebo, nutracuticals, infections have resolved, strict flea control is now in place
flea allergy
pediculosois (lice)
scabies
demodex
malassizia
