How can we manage recurrent ear infections?

Ear infections can have multiple causes. In order to reduce the recurrence of infections, the primary causes of the otitis should be identified and managed. Breeds predisposed to ear disease should be identified early on and clients should be given appropriate information. In most cases, regular ear flushing with an appropriate ear cleanser is recommended.

Are broken claws something to worry about?

Not all broken claws are a result of trauma. Many other diseases can result in brittle and distorted claws. Meticulous history taking and examination are needed to identify the underlying cause.

I have a patient with recurrent pyoderma, how do I go about finding out what's causing it?

A full history and ruling in or out allergies are paramount in these cases. The most common underlying cause of recurrent pyoderma is allergic skin disease; however, the pyoderma should be treated before investigating the underlying cause.

How long do I do a food trial for?

A food trial is recommended for at least 6 weeks and sometimes may need to be carried on for up to 12 weeks.

Is it necessary to treat the environment of an animal identified with flea allergic dermatitis?

Yes, an integrated flea control treatment program should be implemented. This involves using products that contain an adulticide and insect growth regulators. Often the burden of adult fleas and intermediate stages is higher in the environment than on the animal.

What is immunotherapy?

Allergen specific immunotherapy (ASIT) is a specific treatment for the management of canine atopic dermatitis. It involves administering the allergens to which the individual is sensitive in order to modulate the immune response. Gradually increasing doses of the specific allergens the patient is allergic to, are administered to increase the patient’s tolerance to these allergens, thus reducing the clinical signs associated with the disease.

Is immunotherapy successful in all dogs?

The success of treatment is variable and ranges between 50 and 70%. Efficacy is demonstrated by either a marked reduction in the clinical signs (including complete remission), or reduction in the usage of symptomatic medication. The rate of response varies between individuals and most animals that are going to benefit from ASIT tend to do so by the ninth month of treatment. It is best to complete at least the first 10 months of treatment before discarding it as a potential long term management option.

Can immunotherapy be used in cats?

Yes it can, but the success rate is more variable than in dogs; and, in any case, cats are more tolerant of long term glucocorticoid steroid use, which offers an alternative approach to treatment.

Is immunotherapy a lifelong treatment?

If allergen specific immunotherapy is effective in reducing the levels of pruritus in a patient and/or reduces the frequency of recurrent pyoderma and otitis, then yes – it should be continued for life.

Do I stick rigidly to the treatment protocol for immunotherapy, or is there some flexibility?

After the induction phase has been completed, the frequency of the maintenance doses can be tailored to individual needs, depending on the patient’s response to treatment and seasonal allergen loads. Anywhere between 3 and 5 weeks is normal. Examples when to vary the timing are: (a) If the client notices that the pruritus subsides following the injection, but starts to increase a week or two before the next dose is due, (b) If a patient is more pruritic in the summer some animals may require more frequent injections in the summer months because of increased allergen loads and less frequently in the winter.

Can I use steroids/antihistamines/cyclosporin with immunotherapy?

Concurrent treatment can be administered in those dogs where immunotherapy alone is not effective or when there is an episode of pruritus. The immunotherapy may have a steroid sparing effect in some cases allowing us to use much lower dosage, which reduces the risk of adverse effects. Ideally, though, we would like to see if we can get the patient comfortable on immunotherapy alone.

What topical treatments can I use concurrently with immunotherapy?

Antimicrobial and antipruritic shampoo, topical cortisone spray and if needed ear drops can be use to manage and prevent infections.

Recently immunotherapy has lost its effectiveness, what's going on?

There are many reasons as to why your patient has started itching again. It may have acquired a microbial or parasitic infestation, or there has been a change in the allergen load, or there is an unconnected dermatological problem. At this stage it is best to go back to first principals and reassess the case.

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