Two primary forms of treatment for atopy are available: drug treatment and immunotherapy. The ideal treatment for most moderately and severely affected animals is some combination of both types of treatment. Drug therapy relieves the symptoms of atopy but does nothing to treat the underlying allergy itself. Most dogs with atopy are young and may require years of therapy. Treatments for atopy may include one or more of the following: Antihistamines are much less helpful in atopic dogs than they are in humans. Antihistamines help only 25 to 30% of atopic dogs, but often are tried first because they have fewer adverse effects than do the cortisone-like drugs. Some animals respond better to one antihistamine than to others, and your veterinarian may try 2 or 3 different types of antihistamines before concluding that they are not helpful in a given dog.
Fatty acid supplements may relieve itchiness by modulating the immune response. Certain fatty acids such as eicosapentanoic acid (found in fish oil) help change the chemical composition of cell membranes and ultimately the types of chemical mediators produced during the allergic response, resulting in a milder response. Like antihistamines, these products are not helpful in all affected animals, but they are very safe. Some dogs that do not respond well to antihistamines may respond to a combination of antihistamines and fatty acids.
Secondary bacterial infections are common in dogs with allergic skin disease. Therefore, dogs with atopy occasionally need antibiotics to treat complicating pyoderma. Yeast infections of the skin and ear also have to be treated occasionally.
Shampoo therapy may be very helpful in managing itchiness caused by atopy. Shampoos that contain colloidal oatmeal are soothing and moisturizing, and can be used frequently without drying the skin. Some oatmeal-based shampoos contain topical anesthetics or topical corticosteroids that are very safe and further help reduce itchiness.
When the above treatments are no longer effective, corticosteroids such as prednisone may be used. This class of drugs is very effective in atopic animals. Unfortunately, however, these drugs have many potential adverse effects that restrict their long-term use. Examples of the adverse effects of corticosteroids include increased water consumption and urinations, increased appetite and food intake leading to obesity, suppression of the immune system leading potentially to secondary infections, irritation of the stomach, alterations in liver function tests, and suppression of normal adrenal gland activity. Short-acting, orally-administered corticosteroids are safer than long-acting injectable corticosteroids because the former can be cleared rapidly from the animal's body in the event of adverse effects. Any dog that can be helped by long-acting injectable corticosteroids can be relieved just as effectively and with less risk by use of short-acting orally-administered corticosteroids.
Immunotherapy (hyposensitization, desensitization, allergy shots) theoretically is the ideal form of treatment for atopy, and is recommended for dogs that cannot be managed safely and effectively with symptomatic therapy. The exact mechanism by which immunotherapy works is not well understood, but the goal is to induce tolerance by the immune system to allergens to which the animal is sensitive. This technique is effective in 60 to 80% of atopic dogs. An extract of the allergens selected by allergy testing is prepared. Initially, a small amount is injected frequently (every 1 to 2 days) and the dosage gradually increased. Due to the frequency of injections, your veterinarian usually will show you how to administer the injections at home. Once the cumulative dose reaches a certain level, the injection interval is slowly increased until injections are given every 2 to 3 weeks. The interval then may be maintained for a relatively long period of time. Improvement is gradual and your dog may not benefit markedly for the first 3 to 6 months of immunotherapy. Antihistamines, fatty acid supplements and soothing shampoos may be used while immunologic tolerance develops.
Another therapy includes use of an immunomodulator drug called cyclosporine A (Atopica®, Novartis). Cyclosporine has properties that fight against inflammation and itching. It is generally started daily and often decreased to every other day or every third or forth day as clinical signs improve. It may take four to eight weeks to see improvement.
A newer therapy called Oclacitinib (Apoquel) has been very effective in control of itching in dogs with allergies. This drug uniquely targets cytokines that are involved in the itch process. Onset of relief can be as early as 4 hours and controls the itch within 24 hours. Many veterinarians like this drug because it controls itching without the side effects of steroids.