Rush immunotherapy in a dog with severe ragweed and grass pollen allergy

The safety of rush immunotherapy in the management of canine atopic dermatitis-230 cases

BACKGROUND

The duration of the induction phase of allergen-specific immunotherapy conventionally is a period of several weeks, during which the volume of an allergen solution, administered by injection, is gradually increased until the maintenance dose is reached. In rush immunotherapy (RIT), the induction period is abbreviated to achieve a faster improvement in clinical signs of atopic dermatitis (AD) compared to conventional immunotherapy.

OBJECTIVE

The aim of this retrospective study was to evaluate the safety of RIT in 230 dogs with AD and report any adverse effects (AE).

ANIMALS

Two hundred thirty client-owned dogs.

MATERIALS AND METHODS

Medical records of dogs receiving RIT between 2012 and 2021 were analysed and observed AE were investigated. All dogs underwent RIT following a protocol of subcutaneous allergen extract injections, given hourly with an incrementally increasing volume from 0.1 to 1.0 mL.

RESULTS

Adverse effects were documented in 6 of 230 (2.6%) dogs. Five of these dogs (2.2%) showed mild gastrointestinal signs (1 of 5 vomiting, 4 of 5 diarrhoea) and one patient an increase in body temperature by 1.5°C. These occurred at different stages of the RIT protocol. All AE were graded as mild and self-limiting.

CONCLUSIONS AND CLINICAL RELEVANCE

Based on these data, supervised RIT in dogs appears to be a safe procedure to achieve the maintenance dose of allergen immunotherapy earlier with infrequent and mild AE.

Idiopathic lymphoplasmacytic rhinitis in 33 dogs

Idiopathic lymphoplasmacytic rhinitis (LPR) is recognised frequently in dogs with clinical signs typical of other chronic nasal diseases. The purpose of this study was to determine clinical signs, survey radiographic, rhinoscopic and histologic abnormalities and the response to therapy in dogs with LPR. It was a retrospective study of 33 client-owned animals of various breeds and ages that had been diagnosed with LPR. During the study period, a total of 110 dogs were diagnosed with nasal disease, of which 33 (30%) were diagnosed with idiopathic LPR. The median age was 9 years (range 2.3–17 years) and there were 15 female and 18 male dogs. The majority of dogs showed a mucoid nasal discharge, bilateral stertor and no overt radiographic changes. The most common finding on rhinos copy was hyperaemic nasal mucous membranes with mucoid material accumulation within the nasal cavity. In all 33 dogs bacterial culture yielded no pathogenic bacteria and fungal culture was negative. Histologically, all 33 dogs showed lymphoplasmacytic infiltration within the nasal mucosa. All 33 dogs were treated with systemic and topical corticosteroids for varying lengths of time and dosing intervals. Eleven dogs were treated with concurrent cyclosporine and three dogs underwent allergy testing followed by desensitisation therapy. The best response was seen in the dogs that underwent desensitisation therapy, followed by those treated with corticosteroids and cyclosporine.

Idiopathic lymphoplasmacytic rhinitis in dogs: 37 cases (1997-2002)

OBJECTIVE

To determine clinical signs and rhinoscopic, computed tomographic, and histologic abnormalities in dogs with idiopathic lymphoplasmacytic rhinitis.

DESIGN

Retrospective case series.

ANIMALS

37 dogs.

PROCEDURE

Clinical information was obtained from medical records. Nasal computed tomographic images and histologic slides of biopsy specimens were reviewed.

RESULTS

Dogs ranged from 1.5 to 14 years old (mean, 8 years); most (28) were large-breed dogs. Nasal discharge was unilateral in 11 of 26 (42%) dogs and bilateral in 15 of 26 (58%) dogs. In dogs with unilateral disease, duration of clinical signs ranged from 1.5 to 36 months (mean, 8.25 months; median, 2 months), and in dogs with bilateral disease, duration of signs ranged from 1.25 to 30 months (mean, 6.5 months; median, 4 months). Computed tomography (n = 33) most often revealed fluid accumulation (27/33 [82%]), turbinate destruction (23/33 [70%]), and frontal sinus opacification (14/33 [42%]). Rhinoscopy (n = 37) commonly demonstrated increased mucus and epithelial inflammation; turbinate destruction was detected in 8 of 37 (22%) dogs. Bilateral biopsy specimens from all 37 dogs were examined. Four dogs had only unilateral inflammatory changes. The remaining 33 dogs had bilateral lesions; in 20, lesions were more severe on 1 side than the other.

CONCLUSIONS AND CLINICAL RELEVANCE

Findings suggest that idiopathic lymphoplasmacytic rhinitis is a key contributor to chronic nasal disease in dogs and may be more common than previously believed. In addition, findings suggest that idiopathic lymphoplasmacytic rhinitis is most often a bilateral disease, even among dogs with unilateral nasal discharge.

The ACVD task force on canine atopic dermatitis (XXIV): allergen-specific immunotherapy

Allergen-specific immunotherapy (ASIT) has been used for years to treat dogs with atopic dermatitis (AD) and humans with atopic diseases. The efficacy of ASIT has been well documented for humans with respiratory atopic diseases and stinging insect allergy, but its effectiveness seems more controversial for patients with AD. In spite of insufficient evidence derived from randomized controlled trials, multiple open studies and a large body of clinical observations suggest that ASIT is effective in controlling the clinical signs of dogs with AD. As a result of the scarcity of evidence from controlled trials, the true efficacy of ASIT, and the optimal protocols for allergen dose and frequency of injection are currently unknown. Allergen-specific immunotherapy nevertheless may be included in the treatment of canine AD because of its potential advantages and limited disadvantages compared to other forms of therapy. There is no evidence, however, for the preference of any specific treatment protocol. The predictive value of historical, clinical and immunologic features related to the efficacy of ASIT in dogs with AD are discussed in this paper. Adverse reactions, and the requirements for monitoring of patients receiving ASIT, then are reviewed and detailed. Finally, this review highlights aspects of ASIT where further research and controlled studies are needed.