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Dermatology > Skin Therapy - Allergy > Flashcards

Skin Therapy - Allergy Flashcards

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Dermatology Board Prep flashcards
1
Q

4 main ways to manage allergic skin disease?

A
  1. avoidance
  2. medication: pruritis and erythema
  3. immunomodulation
  4. control of 2* flare factors
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2
Q

Which type of allergy is easiest to avoid?

A

food

  • fleas potentially
  • house dust mites very difficult to avoid (hard to eradicate and dead mites still allergenic)
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3
Q

Is shampoo therapy advocated?

A
  • may remove allergens from skin
  • allermyl (lipids, sugars, antiseptic)
    + others (oatmeal episoothe)
  • but not just SHAMPOO
  • rare evidence but not doing harm, may be halpful
  • monitor
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4
Q

What are the main 3 most efficacious options for medical tx of pruritis?

A
  1. Glucocorticoids
  2. Ciclosporin [atopica has flavouring, cyclavance and sporimmune more recent] (+ topical ciclosporin Tacrolimus [protopic])
  3. Oclacitanab [Apoquel] (lic but not available atm)
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5
Q

What additional therapies may be used at medical tx of pruritis?

A 
> antihistamines
- better for seasonal use
- preventative (stops MC degranulation, not useful if already degranulated) 
- 30% effecivity 
- weeks to build up to theraputic doses 
> EFAs 
- do no harm
> chinese herbal medicine, progestagens (cats) side eeffects, pentoxyfylline and misoprostol not very good, but people will know about them/use them)
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6
Q

Advantages of GC use? Most common drug and dose rate?

A
  • effective, readily available, cheap
  • prednisolone (Short acting)
  • anti-inflammaotry dose dog 0.5-1mg/kg/d cat 1-2mg/kg/day (aim long term control LOWEST POSSIBLE DOSE alternate days to prevent adrenal suppression)
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7
Q

Adverse effects of GCs? Alternative form?

A
  • immediate: PUPD, polyphagia, restlessness
  • long-term: hyperadrenocorticism, ^weight, connective tissue problems
    > topical GCs for localised lesions eg. Fusiderm (+fusidic acid ABx) Cortavance (hydrocortisone)
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8
Q

What is ciclopsorin? Efficacy? Side effects?

A
  • Cacineurin-inhibitor
  • more targetting T-cell suppression than GCs
  • efficacy = GCs (~80%)
  • freq side effects = GCs (prednisolone)
    > VD+, gingival hyperplasia, hirsuitism, lameness
    > hepato- or nephrotoxicity not at therapeutic doses
    > ^ risk neoplasia? V immune surveillance
    > expensive
    > slow onset of action
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9
Q

How regularly should chronic cases on long term steroids be checked up?

A

monitor q6months

  • haem/biochem
  • urine
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10
Q

How long ciclosporin onset of action?

A

4 weeks dog or 7 weeks for cat

not for acute itch

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11
Q

Mechanism of action of Apoquel? Licensed?

A

(Oclacitinib) Janus-kinase 1 inhibitor (IL31 cytokines) pruritis but NOT inflam
- lic dogs > 12 months (tx pruritis ssociated with allergic dermatitis and atopic dermatitis) currently unavailable

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12
Q

Adverse effects of Oclacitinib?

A
  • doesnt tx inflammation so 2* bacterial pyoderma still common
  • monitor
  • VD+/anorexia/lumps/lethargy been reported
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13
Q

Egs antihistmaines?

A
  • chlorpheniramine (only one for cats)
  • clemastine
  • hydroxyzine
    > try different types fro 2 weeks each
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14
Q

Which antihistamines are licensed for animal use? Are tehy advocated?

A

NONE!!!

  • human piriton get from pharmacy
  • may be effective
  • steroid sparing
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15
Q

What types of EFA are usually used?

A

fish oils N3 and plant oils N6

- arachidonic acid cascade

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16
Q

When are EFA advocated? When should they not be used?

A
  • steroid sparing
  • safe
    > do not use during food trials (gelatin)
    > take few weeks to kick in so long term
17
Q

What types of EFA are available?

A
  • vet (start with these)

- shop bought

18
Q

Options for cheap tx plan for atopic dermatitis?

A
  • GCs
  • EFAs
  • antihistamines?
  • shampoos
    > compliance necessary for success!
19
Q

How often should GCs dose be reduced?

A

~ 3 months

20
Q

What is ASIT? Effects? Efficacy?

A
  • injections of allergen extract (SC) at increasing quantities
  • in humans v inflammaotry cells, Ig, modulation of Th1/Th2 response [missing out Langerhans cells alleviates some of immune response?]
  • aqueous, alum precipitated or glycerinated available
  • injected at ^ doses, ^ intervals ~ 9 months (ending with ~1ml/month, owners can do at home)
  • dogs 50% horses higher
21
Q

Cost of ASIT?

A
  • £300 per allergy testing

- vax ~ £200

22
Q

How is ID of individual allergens?

A
  • intradermal test for mast cell bound IgE

- IgE serology for FcERIa (more common 1st opinion)

23
Q

What main allergens are tested for?

A
  • house dust mites
  • epithelia
  • pollens
  • NOT FOODS (IgG and IgE to food are physiological not allergic)
24
Q

How should allergy tests be used?

A

Combine with clinical signs (eg. time of year etc.)

25
Q

Long term plan using ASIT?

A
  • 9 months

- review: if working, continue for life; if hasnt helped then stop

26
Q

What alternative ROA for immunotherapy is now available?

A

Sublingual (SLIT)

27
Q

Pros and cons of ASIT and SLIT?

A 
> pros
- safety
- injection monthly only 
- may be cost effective 
- preventative not reactive
- good for large dogs 
> cons
- anaphylaxis (1st time escpecially) rare
- initial cost
- full efficacy ~ months
- compliance may be poor 
- flare factors need control during initial tx to assess efficacy 
- syringes dispensed to owner
28
Q

Most commonly recognised flare factors?

A
  • flea/parasites
  • concurrent allergens (fleas, food, environment)
  • staphylocollal pyoderma
  • malasezzia dermatitis
29
Q

What must owners be made aware of with allergic skin disease?

A
  • waxing and waning disease
  • life long
  • follow up [ruritis levels and adverse effects of therapy
30
Q

What neoplasia may mimic atopic/allergic skin disease? How would you differentiate?

A 
- Epitheliotropic lymphoma
> depigmentation of nasal planum
> exfoliative erythroderma (all skin not just predilection sites) 
> old age of onset 
> foot pads involved (not interdigital) 
> plaques and nodules 
> dx: histo, poor prog -> chemo

Dermatology (25 decks)

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