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Feline Allergic Dermatitis, 18_103705 , flea-allergy-dermatitis1 ,…

- - - - SQ injection of allergens at intervals and increasing concentration until target maintenance dose is reached
      - Success rate: 50-80%
      - Induction: same dose until no further increase in pruritus
        
        Maintenance: decrease dose
        
        If subsides after injection, need more frequent injection
        
        Remission: immunotherapy continued at lowest dose and widest interval
      - Needs 1-8 months to see the improvement
      - Concurrent symptomatic ttx but with mild residual pruritus for judgement
      - Life long teatment
      - Dampening the inflammation
    - - House dust mites
        
        Worsens: prolonged indoor confinement Improves: boarding
        
        Vacuum worsens the situation unless is High-Efficiency Particulate Air (HEPA) vacuum cleaners
        
        Remove suspected items (close proximity to dogs) like carpets, mattresses, pillows
        
        Limiting access
      - Pollen
        
        Seasonal or after walks, Limited to distal limbs
        
        Rinsed with water after walks or short indoor confinement
      - Ectoparasite
        
        Benzyl benzoate spray on bedding, carpets, rugs, etc can kill the mites
        
        Spot-on medication
      - Food
        
        Change to other ingredient base
        
        Food trial
  - - - No AH with proven efficacy in treating FAD feline patients!
    - - Naturally occurring lipid with anti-inflammatory property: reduces mast cell degranulation
        
        Preliminary study:
        10mg/kg SID for 30 days
        
        Improve pruritus, erythema, alopecia and lesions of the eosinophilic granuloma complex
    - - Initially 7mg/kg for 4weeks, then taper down to every other day, then to twice weekly
        
        Same efficacy as prednisolone,
        patients shall be FIV and FeLV free
        
        Side effects:
        Vomiting, diarrhea, gingival hyperplasia, rare weight loss and hepatic lipidosis
    - - Control pruritus and restore defective epidermal protective lipid barrier of skin
        
        Lag period of 4-12 weeks
    - - Use at 2mg/kg in refractory cases together with corticosteroids/ ciclosporin
    - - Published report available for successful treatment of
        feline idiopathic ulcerative dermatosis:
        
        Oclacitinib 1-1.5mg/kg SID
        
        Gabapentin 10mg/kg BID or topiramate 5 mg/kg BID
    - - Predinosolone:
        1-2mg/kg daily for 3-5 days, then taper down to
        0.2-0.5mg/kg every other day
        
        Side effects:
        PU/PD, CHF, increased susceptibility to bladder infections, skin fragility syndrome, diabetes
        
        Alternative for long-term usage
        (in kidney and liver patients):
        
        Spray formulation
        (hydrocortisone aceponate spray)