A randomised, double‐blinded comparison between subcutaneous rush and intralympathic allergen immunotherapy induction in atopic dogs

Abstract

Background: Atopic dermatitis (AD) is one of the most common skin diseases in small animal practice. Allergen immunotherapy (AIT) is the only curative treatment for the disease, and oral, subcutaneous and intralymphatic administration of allergens are commonly employed. Objectives: To compare the efficacy of AIT following an induction phase with intralymphatic injections (ILIT) or rush immunotherapy (RIT). Animals: Fifty privately owned dogs with AD. Materials and Methods:In a double-blinded study, dogs were randomly assigned to either four monthly ILIT of allergen extract or RIT with five injections administered subcutaneously at hourly intervals on the first day. They were assessed by validated scores; Canine Atopic Dermatitis Lesion Index (CADLI) and pruritus Visual Analog Scale (PVAS) at the beginning of the study and after 1, 3, 6 and 12 months. The latter were performed daily for 7 days before each revisit. Medication scores and a total clinical score were calculated and compared between each group and time point. Results: There was no significant difference in CADLI and PVAS scores, or CADLI and medication scores between groups at any of the time points. A significant improvement with both ILIT and RIT was seen in total and pruritus scores, respectively. An owner global assessment of good-to-excellent treatment efficacy was seen in 40% of the dogs; total scores improved by 27% and 35% in the RIT and ILIT group, respectively. Adverse effects were not seen. Conclusions and Clinical Relevance: Induction of AIT can be conducted either as RIT or ILIT with no loss in efficacy.

Efficacy of short‐term combination of intralymphatic allergen immunotherapy and lokivetmab treatment in canine atopic dermatitis: A double‐blinded, controlled, randomised study

“…However, other ILIT studies have shown improvement in clinical scores within three to six months. 25,26 Moreover, in the study by Mueller et al 27 significant improvement of total score (skin lesion, pruritus and medication scores) was already seen from one month of treatment.…”

“…By contrast, most dogs treated with ILIT in previous studies were classified as having mild-to-moderate AD. [25][26][27] Another factor contributing to the lower efficacy rate also may be related to more stringent concurrent medication use in this study in combination with more severe disease. Just enough systemic medication was given to keep clinical signs ethically acceptable without the reduction of pVAS and CADESI values to normal levels (Figure S1).…”

“…These are lower success rates than expected based on previously published studies. 6,7,[14][15][16][25][26][27] This may be the result of the more stringent predefined outcome measurements used in our study. When the success of treatment was determined using less stringent criteria, clinical efficacy would have been higher in both groups (Table 3).…”

“…23 Recent studies have shown that ILIT is a safe treatment for dogs with cAD. [24][25][26][27] Different treatment protocols with both aqueous and alum-precipitated allergens have been used with variable efficacies at various time points. [24][25][26][27] Clinical efficacy is not expected to be seen during the induction phase of ASIT in general.…”

“…[24][25][26][27] Different treatment protocols with both aqueous and alum-precipitated allergens have been used with variable efficacies at various time points. [24][25][26][27] Clinical efficacy is not expected to be seen during the induction phase of ASIT in general. Therefore, it would be unethical to leave atopic dogs without supportive medication during this period.…”