Select Therapeutic Agents for Feline Atopic Skin Syndrome
Agent | Dosagea | Key Points |
|---|---|---|
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 | ||
Hydrocortisone aceponate 0.0584% | 2 sprays, once q 24 h for 28 d, then q 48 h as toleratedb | Rapidly effective in most cats in one study, with no adverse effectsb Requires monitoring for adverse effects if used long-term |
Oral Glucocorticoids | ||
Methylprednisolone | 1.4–1.5 mg/kg, PO, once q 24 h until remission,c then tapered to lowest effective dose and frequency that maintains remission | Rapid and effective in most catsb Requires monitoring for adverse effects if used long-term |
Calcineurin Inhibitors | ||
Modified cyclosporine | 7 mg/kg, PO, once q 24 h, then tapered to q 48 h or twice weeklyd-l | Most common adverse effects: GI disturbances (eg, vomiting, diarrhea, anorexia) Other adverse effects: gingival hyperplasia, weight loss, sneezing, lethargy, acute bullous keratopathy, changes in blood cell counts or biochemical parameters, fatal toxoplasmosis in naive cats |
Antihistamines | ||
Chlorpheniramine | 2 mg/cat, PO, q 12 hm | |
Endogenous Fatty Acid Amides | ||
Ultramicronized palmitoylethanolamide | 15 mg/kg, q 24 hn,o | Moderate efficacy supported by moderate evidence |
Janus Kinase Inhibitors | ||
Oclacitinib | 1 mg/kg, PO, q 12–24 hp-s | Extralabel use; long-term safety data not available When effective, response is usually within the first month Potential adverse effects: vomiting, diarrhea, changes in blood cell counts, thrombocytopenia, increased BUN and creatinine concentrations, increased ALT activity |
Neurokinine-1 Receptor Antagonist | ||
Maropitant citrate | 2 mg/kg, PO, q 24 h for 4 wkt | Extralabel use Most common adverse effect: hypersalivation |
a For most antipruritic agents used to treat cats with feline atopic skin syndrome, therapy typically continues until clinical signs have resolved. However, in many cases, long-term therapy is required to maintain control of clinical signs. When long-term therapy is required, medications should be tapered to the lowest dose and frequency that maintains remission of clinical signs. b Schmidt V, Buckley LM, McEwan NA, Rème CA, Nuttall TJ. Efficacy of a 0.0584% hydrocortisone aceponate spray in presumed feline allergic dermatitis: an open label pilot study. Vet Dermatol. 2012;23(1):11-16, e3-4. doi:10.1111/j.1365-3164.2011.00993.x c Ganz EC, Griffin CE, Keys DA, Flatgard TA. Evaluation of methylprednisolone and triamcinolone for the induction and maintenance treatment of pruritus in allergic cats: a double-blinded, randomized, prospective study. Vet Dermatol. 2012;23(5):387-e72. doi:10.1111/j.1365-3164.2012.01058.x d Roberts ES, Speranza C, Friberg C, et al. Confirmatory field study for the evaluation of ciclosporin at a target dose of 7.0 mg/kg (3.2 mg/lb) in the control of feline hypersensitivity dermatitis. J Feline Med Surg. 2016;18(11):889-897. doi:10.1177/1098612X16636660 e King S, Favrot C, Messinger L, et al. A randomized double-blinded placebo-controlled study to evaluate an effective ciclosporin dose for the treatment of feline hypersensitivity dermatitis. Vet Dermatol. 2012;23(5):440-e84. doi:10.1111/j.1365-3164.2012.01086.x f Wisselink MA, Willemse T. The efficacy of cyclosporine A in cats with presumed atopic dermatitis: a double blind, randomised prednisolone-controlled study. Vet J. 2009;180(1):55-59. doi:10.1016/j.tvjl.2007.11.018 g Noli C, Scarampella F. Prospective open pilot study on the use of ciclosporin for feline allergic skin disease. J Small Anim Pract. 2006;47(8):434-438. doi:10.1111/j.1748-5827.2006.00110.x h Steffan J, Roberts E, Cannon A, et al. Dose tapering for ciclosporin in cats with nonflea-induced hypersensitivity dermatitis. Vet Dermatol. 2013;24(3):315-322, e70. doi:10.1111/vde.12018 i Roberts ES, Tapp T, Trimmer A, Roycroft L, King S. Clinical efficacy and safety following dose tapering of ciclosporin in cats with hypersensitivity dermatitis. J Feline Med Surg. 2016;18(11):898-905. doi:10.1177/1098612X15602523 j Heinrich NA, McKeever PJ, Eisenschenk MC. Adverse events in 50 cats with allergic dermatitis receiving ciclosporin. Vet Dermatol. 2011;22(6):511-520. doi:10.1111/j.1365-3164.2011.00983.x k Ravens PA, Xu BJ, Vogelnest LJ. Feline atopic dermatitis: a retrospective study of 45 cases (2001-2012). Vet Dermatol. 2014;25(2):95-102, e27-28. doi:10.1111/vde.12109 l Vercelli A, Raviri G, Cornegliani L. The use of oral cyclosporin to treat feline dermatoses: a retrospective analysis of 23 cases. Vet Dermatol. 2006;17(3):201-206. doi:10.1111/j.1365-3164.2006.00514.x m Mueller RS, Nuttall T, Prost C, Schulz B, Bizikova P. Treatment of the feline atopic syndrome—a systematic review. Vet Dermatol. 2021;32(1):43-e8. doi:10.1111/vde.12933 n Scarampella F, Abramo F, Noli C. Clinical and histological evaluation of an analogue of palmitoylethanolamide, PLR 120 (comicronized Palmidrol INN) in cats with eosinophilic granuloma and eosinophilic plaque: a pilot study. Vet Dermatol. 2001;12(1):29-39. doi:10.1046/j.1365-3164.2001.00214.x o Noli C, Della Valle MF, Miolo A, Medori C, Schievano C; Skinalia Clinical Research Group. Effect of dietary supplementation with ultramicronized palmitoylethanolamide in maintaining remission in cats with nonflea hypersensitivity dermatitis: a double-blind, multicentre, randomized, placebo-controlled study. Vet Dermatol. 2019;30(5):387-e117. doi:10.1111/vde.12764 p Fernandes KSBR, Ferreira MB, da Silva AM et al. Eficácia do oclacitinib no manejo da síndrome da atopia felina. Acta Sci Vet. 2019;47:374-379. q Pandolfi P, Beccati M. Head and neck feline pruritus: response to oclacitinib treatment. In: Proceedings of the 8th World Congress of Veterinary Dermatology. World Congress of Veterinary Dermatology; 2016:28. r Ortalda C, Noli C, Colombo S, Borio S. Oclacitinib in feline nonflea-, nonfood-induced hypersensitivity dermatitis: results of a small prospective pilot study of client-owned cats. Vet Dermatol. 2015;26(4):235-e52. doi:10.1111/vde.12218 s Noli C, Matricoti I, Schievano C. A double-blinded, randomized, methylprednisolone-controlled study on the efficacy of oclacitinib in the management of pruritus in cats with nonflea nonfood-induced hypersensitivity dermatitis. Vet Dermatol. 2019;30(2):110-e30. doi:10.1111/vde.12720 t Maina E, Fontaine J. Use of maropitant for the control of pruritus in non-flea, non-food-induced feline hypersensitivity dermatitis: an open-label, uncontrolled pilot study. J Feline Med Surg. 2019;21(10):967-972. doi:10.1177/1098612X18811372 | ||