Simplify allergy treatment by addressing flare-ups
Ian Brett Spiegel, VMD, MHS, DACVD
A multimodal approach is often required when initially treating atopic dermatitis in dogs. Secondary bacterial and yeast (Malassezia species) infections must be identified and managed in order to successfully treat these patients. Preventing flea infestations,
ruling out mite infestations, and addressing potential adverse food reactions are important components as well.
Corticosteroids are often indicated at some point in allergy management, but ideally they are used infrequently and administered
orally and only when necessary. If injectable corticosteroids are used, consider short-acting options such as dexamethasone
sodium phosphate. In my opinion, injectable corticosteroids are rarely indicated. The modified formulation of cyclosporine
(ATOPICAź) is an excellent option for managing canine atopic dermatitis. This drug lacks the adverse effects frequently associated
with corticosteroids. A corticosteroid may be needed in conjunction with ATOPICA when therapy is initiated, and even in a
well-managed atopic patient, the therapeutic plan will need to be adapted to address occasional flare-ups of clinical signs.
Intermittent application of topical treatments may also be effective in helping manage flare-ups of atopic dermatitis. Topical
antimicrobials may target the secondary infections, and some topicals may help maintain barrier function. Many topical anti-inflammatory
and antipruritic preparations (e.g., corticosteroid sprays or analgesic sprays containing pramoxine) are also available.
Keep in mind that every patient is different, and every client's situation is unique. It is important to remember that, even
in the most well-managed cases, flare-ups are inevitable. Flare-ups can be caused by anything from a flea infestation or a
change in season to the development of a concurrent disease, such as a food allergy. The art of managing the allergic patient
requires good communication with the client as well as patience and perseverance on the part of both the clinician and the
Dr. Spiegel is affiliated with the following clinics: Veterinary Specialty and Emergency Center, Levittown, Pa.; Animerge
24/7 Animal Emergency and Specialty Care, Raritan, N.J.; and Garden State Veterinary Specialists, Tinton Falls, N.J.
For more information about the Treatment Simplified protocol, visit us.atopica.com/treatmentsimplified.