Select Therapeutic Agents for Atopic Dermatitis in Dogs

Allergen-Specific Immunotherapy (ASIT)

Injectable ASIT: subcutaneous allergen-specific immunotherapy (SCIT)

Various protocols exist; patient-specific recommendations are typically provided by the serum manufacturer on the basis of testing results, patient history, allergen cross-reactivity, and geographical location.

Very specific targeted effect

Slow onset of action (up to 12 mo)

Not useful for acute flares

Most common adverse reaction: worsening of pruritus

Oral ASIT: sublingual allergen-specific immunotherapy (SLIT)

Pump dispenser directly onto oral mucosa, between lip and gum, q 12 h

Most common adverse reactions: face rubbing, transient worsening of pruritus, GI signs

Topical Glucocorticoids

Triamcinolone acetonide 0.015%

Topically q 12–24 h^b

Indicated for acute flares and localized lesions

Apply to the affected area

Best suited for short-term use (7–14 d)

Potential adverse effects of note: cutaneous atrophy, calcinosis cutis

Hydrocortisone aceponate 0.0584%

Topically q 12–24 h^c

Betamethasone valerate (various concentrations)

Topically q 12–24 h^d

Mometasone furoate (various concentrations)

Topically q 12–24 h^d

Oral Glucocorticoids

Prednisone or prednisolone

Induction or initial dose: 0.5–1.1 mg/kg, PO, q 24 h^e

Target dose after tapering: 0.25–0.5 mg/kg, PO, q 48 h^e

Indicated for acute flares

Fast acting

Broad, nonspecific anti-inflammatory response

Many potential adverse effects

Calcineurin Inhibitors

Cyclosporine

Initial dose: 5 mg/kg, PO, q 24 h; tapered to the lowest dose that controls the disease^e

Indicated for long-term management

Can take 4–6 wk to achieve clinical improvement

Not suitable for treatment of acute flares

Most common adverse effects: GI signs

Indicated for localized lesions

Appears safe for short-term use

Tacrolimus 0.1% ointment

Topically q 12–24 h^b

Phosphodiesterase Inhibitors

Pentoxifylline

20 mg/kg, PO, q 8 h^f

May be best suited as adjunctive therapy for chronic conditions

Slow onset of action (4–6 wk)

Not suited for acute flares

Good safety profile

Antihistamines

Fexofenadine

18 mg/kg, PO, q 24 h^g

Helpful for mild pruritus

Best as part of combination therapy

Preventive role

Sparing agents for glucocorticoids

Not suitable for acute flares

Hydroxyzine

2 mg/kg, PO, q 12 h^h

Hydroxyzine + chlorpheniramine

(20.9 mg + 0.7 mg)/10 kg (divided), PO, q 12 hⁱ

Cetirizine

0.5–1 mg/kg, PO, q 12 h^h

Essential Fatty Acids

High-quality fish oil (with EPA and DHA)

65–90 mg/kg, PO, q 24 h ^j,^k,l

No evidence of superior efficacy of any particular combination, dosage, ratio, or formulation to improve skin and coat quality and decrease pruritus

Janus Kinase Inhibitors

Oclacitinib maleate (tablet or chewable tablet)

0.4–0.6 mg/kg, PO, q 12 h for 2 wk, then q 24 h^e

Indicated for acute flares and long-term management of pruritus in dogs 12 mo or older

Fast onset of action (within 24 h) for pruritus control

Most common adverse effects: GI signs

Contraindicated in dogs with serious infections or neoplasia

May increase susceptibility to infections, demodicosis, and neoplastic conditions

Acute kidney injury possible with toxic doses (eg, 27.3 mg/kg)^m

Ilunocitinib 

0.6–0.8 mg/kg, PO, q 24 hⁿ

Indicated for control of pruritus associated with allergic and atopic dermatitis in dogs 12 mo or older

1. Contraindicated in dogs with serious infection

   1. Dogs should be current on vaccinations before starting this medication. Ilunocitinib should be discontinued for at least 28 d to 3 mo before vaccination and for at least 28 d after vaccination.

      1. Concurrent use with glucocorticoids, cyclosporine, or other immunosuppressive agents have not been tested.

Monoclonal Antibodies

Lokivetmab

2 mg/kg, SC, q 4–8 wk^o

Indicated for acute flares and long-term management

Fast onset of action (1–3 d) for pruritus control

Most common adverse effects: lethargy, vomiting