Immunotherapy Works in up to 75% of Cases
Allergen-specific Immunotherapy (ASIT), based on the results of intradermal skin testing and/or serological testing, has been found to be effective at reducing the degree of pruritus suffered in atopic dogs by at least 50% in approximately 75% of cases. In my experience I would say that approximately 50% of cases can be kept in a reasonable state of remission without any other treatment being necessary other than excellent flea control and improvement of skin barrier function with essential fatty acid supplements/spot-ons. Despite the recent developments with JAK inhibitors and monoclonal antibodies which admittedly are excellent therapies for atopic pruritus, allergen-specific immunotherapy is the only treatment that can actually modify the immune system by changing the cytokine profile from a TH2 response to a TH1 response. It is also more likely to help reduce the severity of atopic otitis ( if it works) than these novel therapies which are not brilliant anti-inflammatory medications.
I use Artuvetrin injectable immunotherapy manufactured by Artuvet. Their vaccine is an alum-precipitated product, which has the advantage that clients do not have to come as frequently for injections during the build up period, only having to come initially once every 2 weeks. The risk of anaphylaxis (which is rare anyway with immunotherapy) is much less than with aqueous extract allergens. Nevertheless, during the 2 month build-up period, clients are asked to remain at the surgery for half an hour after injection so treatment for anaphylaxis can be given immediately if it occurs (I have never seen this happen with Artuvetrin).
Since 2013 I have also been offering sublingual immunotherapy (SLIT). This has the advantage of being simple to administer, but has to to be given twice daily, usually indefinitely. There is some evidence that it may work slightly faster that injectable immunotherapy and some cases that have failed on injectable immunotherapy have responded to SLIT ( DeBoer 2012*). I currently use ACTT Allergy Drops for SLIT The cost of SLIT is slightly higher than Artuvetrin injectable immunotherapy. I have to apply for an SIC/STC from the VMD when I order immunotherapy and vaccine usually arrives within 10-14 days of ordering. * DeBoer D, Morris M. Multicentre open trial demonstrates efficacy of sublingual immunotherapy in canine atopic dermatitis (abst). Vet Dermatol 2012;23(Suppl 1):65.