Clinical Guidelines for the Use of Antipruritic Drugs in the Control of the Most Frequent Pruritic Skin Diseases in Dogs
Abstract
:1. Introduction
2. Materials and Methods
2.1. Consensus Method and Evidence Grading
- Good-quality patient-oriented evidence;
- Limited-quality patient-oriented evidence;
- Other evidence, including consensus guidelines, opinion, case studies, or disease-oriented evidence.
- Recommendation based on consistent and good-quality patient-oriented evidence;
- Recommendation based on inconsistent or limited-quality patient-oriented evidence;
- Recommendation based on consensus, opinion, case studies, or disease-oriented evidence.
2.2. Search Strategy
2.3. Inclusion Criteria
2.4. Exclusion Criteria
2.5. Clinical Situations
- Flares in canine atopic dermatitis (AD);
- Long-term treatment of canine AD;
- Allergen-specific immunotherapy treatment (ASIT) of canine AD;
- Surface and superficial infectious skin disease (bacterial or Malassezia overgrowth, bacterial superficial pyoderma) with canine AD;
- Sensitization tests (e.g., intradermal skin test (IDST)) and elimination diet period;
- Parasitic skin diseases;
- Animals with neoplastic diseases (mast cell tumor, histiocytoma, and lymphoma) or chronic diseases (hepatic diseases, renal failure, urinary tract infection, and diabetes mellitus).
2.6. Presentation of the Results
- In atopic dogs, excluding the induction period of ASIT:
- ◦
- Speed of action and efficacy;
- ◦
- Reduction in the dose/frequency of administration;
- ◦
- Combination of antipruritic molecules;
- ◦
- Use in superficial bacterial pyoderma or microbial overgrowth;
- ◦
- Adverse reactions.
- In atopic dogs, during the induction period of ASIT.
- In atopic dogs, during allergologic tests.
- In atopic dogs, during dietary trials.
- In pruritic ectoparasitic dermatoses.
- With vaccines.
3. Results: Levels of Evidence
3.1. Systemic Glucocorticoids
3.1.1. In Atopic Dogs, excluding the Induction Period of ASIT
Speed of Action and Efficacy
Reduction in the Dose/Frequency of Administration
Combination of Antipruritic Molecules
Use in Superficial Bacterial Pyoderma or Microbial Overgrowth
Adverse Reactions
3.1.2. In Atopic Dogs, during the Induction Period of ASIT
3.1.3. In Atopic Dogs, during Allergologic Tests
3.1.4. In Atopic Dogs, during Dietary Trials
3.1.5. In Pruritic Ectoparasitic Dermatoses
3.1.6. With Vaccines
3.2. Topical Glucocorticoids
3.2.1. In Atopic Dogs, excluding the Induction Period of ASIT
Speed of Action and Efficacy
Reduction in the Dose/Frequency of Administration
Combination of Antipruritic Molecules
Use in Superficial Bacterial Pyoderma or Microbial Overgrowth
Adverse Reactions
3.2.2. In Atopic Dogs, during the Induction Period of ASIT
3.2.3. In Atopic Dogs, during Allergic Testing
3.2.4. In Atopic Dogs, during Dietary Trials
3.2.5. In Pruritic Ectoparasitic Dermatoses
3.2.6. With Vaccines
3.3. Antihistamines
3.3.1. In Atopic Dogs, excluding the Induction Phase of ASIT
Speed of Action and Efficacy
Reduction in the Dose/Frequency of Administration
Association of Antipruritic Molecules
Use in Superficial Bacterial Pyoderma or Microbial Overgrowth
Adverse Reactions
3.3.2. In Atopic Dogs, during the Induction Period of ASIT
3.3.3. In Atopic Dogs, during Allergologic Tests
3.3.4. In Atopic Dogs, during Dietary Trials
3.3.5. In Pruritic Ectoparasitic Dermatoses
3.3.6. With Vaccines
3.4. Ciclosporin A (Aka Cyclosporin A, Cyclosporin, Ciclosporin)
3.4.1. In Atopic Dogs, excluding the Induction Period of ASIT
Speed of Action and Efficacy
Reduction in the Dose/Frequency of Administration
Association of Antipruritic Molecules
Use in Superficial Bacterial Pyoderma or Microbial Overgrowth
Adverse Reactions
3.4.2. In Atopic Dogs, during the Induction Period of ASIT
3.4.3. In Atopic Dogs, during Allergologic Tests
3.4.4. In Atopic Dogs, during Dietary Trials
3.4.5. In Pruritic Ectoparasitic Dermatoses
3.4.6. With Vaccines
3.5. Oclacitinib
3.5.1. In Atopic Dogs, excluding the Induction Period of ASIT
Speed of Action and Efficacy
Reduction in the Dose/Frequency of Administration
Association of Antipruritic Molecules
Use in Superficial Bacterial Pyoderma or Microbial Overgrowth
Adverse Reactions
3.5.2. In Atopic Dogs, during the Induction Period of ASIT
3.5.3. In Atopic Dogs, during Allergologic Tests
3.5.4. In Atopic Dogs, during Dietary Trials
3.5.5. In Pruritic Ectoparasitic Dermatoses
3.5.6. With Vaccines
3.6. Lokivetmab
3.6.1. In Atopic Dogs, excluding the Induction Period of ASIT
Speed of Action and Efficacy
Reduction in the Dose/Frequency of Administration
Association of Antipruritic Molecules
Use in Superficial Bacterial Pyoderma or Microbial Overgrowth
Adverse Reactions
3.6.2. In Atopic Dogs, during the Induction Period of ASIT
3.6.3. In Atopic Dogs, during Allergologic Tests
3.6.4. In Atopic Dogs, during Dietary Trials
3.6.5. In Pruritic Ectoparasitic Dermatoses
3.6.6. With Vaccines
4. Recommendations
4.1. Systemic Glucocorticoids
4.1.1. In Atopic Dogs, excluding the Induction Period of ASIT
During Flares (Reactive Therapy)
In Non-Flare Periods (Proactive Therapy)
In Dogs with Superficial Pyoderma or Microbial Overgrowth
In Dogs with Specific Problems
4.1.2. In Atopic Dogs, during the Induction Period of ASIT
4.1.3. In Atopic Dogs, during Allergy Testing
4.1.4. In Atopic Dogs, during Dietary Trials
4.1.5. In Pruritic Ectoparasitic Dermatoses
4.1.6. With Vaccines
4.2. Topical Glucocorticoids
4.2.1. In Atopic Dogs, excluding the Induction Phase of ASIT
During Flares (Reactive Therapy)
In Non-Flare Periods (Proactive Therapy)
In Dogs with Superficial Pyoderma or Microbial Overgrowth
In Dogs with Specific Problems
4.2.2. In Atopic Dogs, during the Induction Phase of ASIT
4.2.3. In Atopic Dogs, during Allergy Testing
4.2.4. In Atopic Dogs, during Dietary Trials
4.2.5. In Pruritic Ectoparasitic Dermatoses
4.2.6. With Vaccines
4.3. Antihistamines
4.3.1. In Atopic Dogs, Excluding the Induction Period of ASIT
During Flares (Reactive Therapy)
In Non-Flare Periods (Proactive Therapy)
In Dogs with Superficial Pyoderma or Microbial Overgrowth
In Dogs with Specific Problems
4.3.2. In Atopic Dogs, during the Induction Period of ASIT
4.3.3. In Atopic Dogs, during Allergologic Tests
4.3.4. In Atopic Dogs, during Dietary Trials
4.3.5. In Pruritic Ectoparasitic Dermatoses
4.3.6. During Vaccines
4.4. Ciclosporin A
4.4.1. In Atopic Dogs, excluding the Induction Period of ASIT
During Flares (Reactive Therapy)
In Non-Flare Periods (Proactive Therapy)
In Dogs with Superficial Pyoderma or Microbial Overgrowth
In Dogs with Specific Problems
4.4.2. In Atopic Dogs, during the Induction Period of ASIT
4.4.3. In Atopic Dogs, during Allergologic Tests
4.4.4. In Atopic Dogs, during Dietary Trials
4.4.5. In Pruritic Ectoparasitic Dermatoses
4.4.6. During Vaccines
4.5. Oclacitinib
4.5.1. In Atopic Dogs, excluding the Induction Period of Allergen-Specific Immunotherapy
During Flares (Reactive Therapy)
In Non-Flare Periods (Proactive Therapy)
In Dogs with Superficial Pyoderma or Microbial Overgrowth
In Dogs with Specific Problems
4.5.2. In Atopic Dogs, during the Induction Period of ASIT
4.5.3. In Atopic Dogs, during Allergy Testing
4.5.4. In Atopic Dogs, during Dietary Trials
4.5.5. In Pruritic Ectoparasitic Dermatoses
4.5.6. With Vaccines
4.6. Lokivetmab
4.6.1. In Atopic Dogs, excluding the Induction Period of ASIT
During Flares (Reactive Therapy)
In Non-Flare Periods (Proactive Therapy)
In Dogs with Superficial Pyoderma or Microbial Overgrowth
In Dogs with Specific Problems
4.6.2. In Atopic Dogs, during the Induction Period of ASIT
4.6.3. In Atopic Dogs, during Allergy Testing
4.6.4. In Atopic Dogs, during Dietary Trials
4.6.5. In Pruritic Ectoparasitic Dermatoses
4.6.6. With Vaccines
5. Discussion and Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AD | atopic dermatitis |
ASIT | allergen-specific immunotherapy treatment |
CADESI | Canine Atopic Dermatitis Extent Severity Index |
pVAS | pruritus Visual Analog Scale |
LoE | level of evidence |
SoRT | strength of recommendation taxonomy |
SoR | strength of recommendation |
sid | once daily (semil in die) |
bid | twice daily (bis in die) |
tid | thrice daily (ter in die) |
eod | every other day |
IDST | intradermal skin tests |
QoL | quality of life |
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Clinical Situation | Molecule | LoE1 | LoE2 | LoE3 |
---|---|---|---|---|
In atopic dogs, excluding the induction period of allergen-specific immunotherapy | dexamethasone | - | [10] | - |
methylprednisolone | [11,12,13] | [14,15,16,17,18] | [19] | |
prednisolone | [20,21,22,23,24,25,26] | [18,27,28,29,30,31,32,33,34,35] | - | |
In atopic dogs, during the induction period of allergen-specific immunotherapy | methylprednisolone | - | [36] | - |
prednisolone | - | [37,38] | - | |
In atopic dogs, during allergologic tests | prednisolone | - | [39,40] | - |
In atopic dogs, during dietary trials | prednisolone | - | [41,42] | - |
In pruritic ectoparasitic dermatoses | - | - | - | - |
Antipruritic Drug | Reported Adverse Reactions |
---|---|
systemic glucocorticoids | polyphagia, polyuria–polydipsia, digestive signs, superficial pyoderma |
topical glucocorticoids | skin atrophy, polyphagia, polyuria–polydipsia, digestive signs |
antihistamines | sedation |
ciclosporin | digestive signs, anorexia, infectious skin complications, polyphagia, hypersalivation, abdominal pain, weight loss, gingival hyperplasia, papillomatous lesions, hypertrichosis, lethargy, weakness, pruritus, neurological signs |
oclacitinib | digestive signs, otitis, pyoderma, pododermatitis, urinary tract infection |
lokivetmab | - |
Clinical Situation | Molecule | LoE1 | LoE2 | LoE3 |
---|---|---|---|---|
In atopic dogs, excluding the induction period of allergen-specific immunotherapy | hydrocortisone aceponate | [43,44,45] | [46,47] | [48] |
triamcinolone acetonide | [49] | - | - | |
In atopic dogs, during the induction period of ASIT | - | - | - | |
In atopic dogs, during allergologic tests | hydrocortisone aceponate | - | - | [50] |
In atopic dogs, during dietary trials | - | - | - | |
In pruritic ectoparasitic dermatoses | hydrocortisone aceponate | - | [51] | - |
Clinical Situation | Molecule | LoE1 | LoE2 | LoE3 |
---|---|---|---|---|
In atopic dogs, excluding the induction period of allergen-specific immunotherapy | AHR-13268 | - | [52] | - |
cetirizine | [53] | [54,55] | [56] | |
clemastine | - | [18,57,58,59,60,61] | - | |
cyproheptadine | - | [57,58,62] | - | |
chlorpheniramine | - | [57,58,61] | - | |
dimetinden | [63] | - | - | |
diphenhydramine | - | [61] | - | |
fexofenadine | - | [17] | [19] | |
hydroxyzine | - | [57,58,61] | [56] | |
oxatomide | - | [64] | - | |
pheniramine | - | - | [34] | |
promethazine | - | [57] | - | |
terfenadine | - | [65] | [66,67,68] | |
trimeprazine | - | [57] | - | |
Chlorpheniramine + hydroxyzine | [63] | [69] | - | |
In atopic dogs, during the induction period of ASIT | - | - | - | - |
In atopic dogs, during allergologic tests | cetirizine | - | - | [40,70,71,72,73] |
diphenhydramine | - | - | [72] | |
hydroxyzine | - | - | [70] | |
loratidine | - | - | [73] | |
terfenadine | - | - | [73] | |
In atopic dogs, during dietary trials | - | - | - | |
In pruritic ectoparasitic dermatoses | - | - | - | [66,67,68] |
Clinical Situation | LoE1 | LoE2 | LoE3 |
---|---|---|---|
In atopic dogs, excluding the induction period of allergen-specific immunotherapy | [12,13,20,24,26,47,74,75,76,77,78,79] | [32,33,80,81,82,83,84,85,86,87,88,89,90,91] | [92,93,94,95] |
In atopic dogs, during the induction period of ASIT | - | - | - |
In atopic dogs, during allergologic tests | [96] | - | |
In atopic dogs, during dietary trials | - | - | - |
In pruritic ectoparasitic dermatoses | - | - | - |
Clinical Situation | LoE1 | LoE2 | LoE3 |
---|---|---|---|
In atopic dogs, excluding the induction period of allergen-specific immunotherapy | [23,44,74,100,101] | [32,86,102,103,104,105,106,107,108] | - |
In atopic dogs, during the induction period of ASIT | - | [109] | - |
In atopic dogs, during allergologic tests | [105] | ||
In atopic dogs, during dietary trials | - | [42] | - |
In pruritic ectoparasitic dermatoses | - | [110] | - |
Clinical Situation | LoE1 | LoE2 | LoE3 |
---|---|---|---|
In atopic dogs, excluding the induction period of allergen-specific immunotherapy | [75,111,112,113] | [114,115] | [116,117] |
In atopic dogs, during the induction period of ASIT | - | [109] | - |
In atopic dogs, during allergologic tests | - | - | - |
In atopic dogs, during dietary trials | - | - | - |
In pruritic ectoparasitic dermatoses | - | - | - |
Clinical Situation | Molecules That Can Be Recommended | |
---|---|---|
Dog with atopic dermatitis | During flares (reactive therapy) | oral glucocorticoids ((SoR A)) 1 topical glucocorticoids ((SoR C)) antihistamines (mild AD flares) ((SoR C)) oclacitinib (SoR A) lokivetmab (SoR A) |
In non-flares periods (proactive therapy) | topical glucocorticoids (SoR A) antihistamines (SoR B) ciclosporin (SoR A) oclacitinib (SoR A) lokivetmab (SoR A) | |
With superficial pyoderma or microbial overgrowth | Antihistamines (SoR C) ciclosporin (SoR C) oclacitinib (SoR C) lokivetmab (SoR C) | |
During the induction period of ASIT | oral glucocorticoids (SoR B) topical glucocorticoids (SoR C) antihistamines (SoR C) oclacitinib (SoR C) lokivetmab (SoR C) | |
During allergologic tests | oral glucocorticoids (serological tests only) (SoR B) antihistamines (serological tests only) (SoR A) ciclosporin (SoR B) oclacitinib (SoR C) lokivetmab (SoR C) | |
During dietary trials | oral glucocorticoids (SoR C) topical glucocorticoids (SoR C) antihistamines (SoR C) oclacitinib (SoR C) | |
In pruritic ectoparasitic dermatoses | oral glucocorticoids (short course) (except demodicosis) (SoR C) antihistamines (SoR C) oclacitinib (except demodicosis) (SoR C) lokivetmab (SoR C) |
Type of Co-Morbidity | Antipruritic Drug That Can Be Recommended and SoR 1 |
---|---|
liver disorder | topical glucocorticoids (mainly hydrocortisone aceponate) (SoR C) antihistamines (SoR C) oclacitinib (SoR C) lokivetmab (SoR C) |
renal disorder | topical glucocorticoids (mainly hydrocortisone aceponate) (SoR C) antihistamines (SoR C) ciclosporin (SoR C) oclacitinib (SoR C) lokivetmab (SoR C) |
diabetes mellitus | topical glucocorticoids (hydrocortisone aceponate) (SoR C) antihistamines (SoR C) oclacitinib (SoR C) lokivetmab (SoR C) |
neoplastic diseases | topical glucocorticoids (hydrocortisone aceponate) (SoR C) antihistamines (SoR C) oclacitinib (SoR B) lokivetmab (SoR C) |
urinary infections | oral glucocorticoids (occasional urinary tract infections) (SoR C) topical glucocorticoids (hydrocortisone aceponate) (SoR C) antihistamines (SoR C) ciclosporin (occasional urinary tract infections) (SoR B) oclacitinib (occasional urinary tract infections) (SoR B) lokivetmab (SoR C) |
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Bruet, V.; Mosca, M.; Briand, A.; Bourdeau, P.; Pin, D.; Cochet-Faivre, N.; Cadiergues, M.-C. Clinical Guidelines for the Use of Antipruritic Drugs in the Control of the Most Frequent Pruritic Skin Diseases in Dogs. Vet. Sci. 2022, 9, 149. https://doi.org/10.3390/vetsci9040149
Bruet V, Mosca M, Briand A, Bourdeau P, Pin D, Cochet-Faivre N, Cadiergues M-C. Clinical Guidelines for the Use of Antipruritic Drugs in the Control of the Most Frequent Pruritic Skin Diseases in Dogs. Veterinary Sciences. 2022; 9(4):149. https://doi.org/10.3390/vetsci9040149
Chicago/Turabian StyleBruet, Vincent, Marion Mosca, Amaury Briand, Patrick Bourdeau, Didier Pin, Noëlle Cochet-Faivre, and Marie-Christine Cadiergues. 2022. "Clinical Guidelines for the Use of Antipruritic Drugs in the Control of the Most Frequent Pruritic Skin Diseases in Dogs" Veterinary Sciences 9, no. 4: 149. https://doi.org/10.3390/vetsci9040149