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Canine atopic dermatitis (AD) is a common, genetically predisposed, inflammatory and pruritic skin disease. The variation in clinical presentations, due to genetic factors, extent of the lesions, stage of the disease, secondary infections, as well as resemblance to other non-atopic related skin diseases, can complicate a diagnosis of canine AD. A s...
Context in source publication
Context 1
... non-seasonal (e.g., dust mites, food) [42]. At the beginning the pruritus may be alesional or associated with primary skin lesions such as erythema and occasionally papules (Table 2) [43,44]. The face, concave aspect of the ear pinnae, ventrum, axillae, in- guinal area, perineal area and distal extremities are most commonly affected in canine AD (Fig. 8) [43], but breed- associated variations of body sites affected by canine AD have been identified (Table 3, Fig. 9) [3]. In more chronic stages secondary skin lesions (Table 2) will occur due to self-trauma, chronic inflammation and secondary in- fections. Typical secondary skin lesions are excoriations, alopecia, lichenification, ...
Citations
... However, a single-nucleotide polymorphism in the filaggrin gene was strongly associated with AD in Labrador retrievers from the UK, suggesting the potential role of filaggrin in specific breeds and geographical locations. 12 Such findings may help explain breed-specific phenotypes in canine AD. 13 Because of these contrasting data, although filaggrin is recognised as an important component of the skin barrier, its involvement in the pathogenesis of AD remains unknown. ...
Background
Canine atopic dermatitis (AD) is a complex inflammatory skin disease associated with cutaneous microbiome, immunological and skin barrier alterations. This review summarises the current evidence on skin barrier defects and on cutaneous microbiome dysfunction in canine AD.
Objective
To this aim, online citation databases, abstracts and proceedings from international meetings on skin barrier and cutaneous microbiome published between 2015 and 2023 were reviewed.
Results
Since the last update on the pathogenesis of canine AD, published by the International Committee on Allergic Diseases of Animals in 2015, 49 articles have been published on skin barrier function, cutaneous/aural innate immunity and the cutaneous/aural microbiome in atopic dogs. Skin barrier dysfunction and cutaneous microbial dysbiosis are essential players in the pathogenesis of canine AD. It is still unclear if such alterations are primary or secondary to cutaneous inflammation, although some evidence supports their primary involvement in the pathogenesis of canine AD.
Conclusion and Clinical Relevance
Although many studies have been published since 2015, the understanding of the cutaneous host–microbe interaction is still unclear, as is the role that cutaneous dysbiosis plays in the development and/or worsening of canine AD. More studies are needed aiming to design new therapeutic approaches to restore the skin barrier, to increase and optimise the cutaneous natural defences, and to rebalance the cutaneous microbiome.
... Canine atopic dermatitis (cAD) is one of the most prevalent, distressing, chronic, and allergic skin diseases, affecting approximately 20-30% of dogs [1,2]. The most common and clinically significant feature of cAD is moderate to severe pruritus, often accompanied by dermatological lesions, such as erythema, self-induced alopecia, excoriations, hyperpigmentation, and lichenification [3][4][5]. These lesions can vary in body location, extension, and severity [3][4][5]. ...
... The most common and clinically significant feature of cAD is moderate to severe pruritus, often accompanied by dermatological lesions, such as erythema, self-induced alopecia, excoriations, hyperpigmentation, and lichenification [3][4][5]. These lesions can vary in body location, extension, and severity [3][4][5]. Furthermore, the affected dogs' skin is frequently affected by secondary infections, exacerbating both pruritus and lesion severity, leading to an unpleasant skin odour and complicating clinical management [6,7]. cAD is the most common primary cause of otitis externa [8], a highly prevalent condition in atopic dogs, with reported incidences ranging from 17 to 80% of cAD cases [9,10]. ...
Simple Summary
This paper addresses the pressing issue of canine atopic dermatitis, a common and distressing skin condition in dogs. It affects up to 30% of dogs, causing severe itching and skin problems. Additionally, it leads to secondary infections, further complicating treatment. This condition significantly reduces the quality of life for both dogs and their owners, causing emotional and financial strain. This paper emphasizes the need for prevention strategies for this disease, rather than just treating the symptoms. While treatments exist, they often come with limitations and can be expensive. It also emphasizes the importance of understanding the skin barrier’s role in canine atopic dermatitis development. This paper suggests that focusing on preventing this condition in the first place would be more effective and cost-efficient. Drawing parallels between canine atopic dermatitis and its human counterpart, this paper highlights the potential for shared prevention strategies. The authors propose that restoring the skin barrier before the disease’s mechanisms can lead to a vicious cycle of further damage could be a key approach to prevention. Overall, research regarding the primary prevention of canine atopic dermatitis has the potential to greatly improve the well-being of dogs and their owners by offering effective and accessible preventive measures.
Abstract
Canine atopic dermatitis (cAD) is a common and distressing skin condition in dogs, affecting up to 30% of the canine population. It not only impacts their quality of life but also that of their owners. Like human atopic dermatitis (hAD), cAD has a complex pathogenesis, including genetic and environmental factors. Current treatments focus on managing clinical signs, but they can be costly and have limitations. This article emphasizes the importance of preventing cAD from developing in the first place. Understanding the role of the skin’s protective barrier is crucial, as its dysfunction plays a vital role in both hAD and cAD. hAD prevention studies have shown promising results in enhancing the skin barrier, but more research is needed to support more robust conclusions. While hAD primary prevention is currently a focal point of intensive investigation in human medicine, research on cAD primary prevention remains under-researched and almost non-existent. Pioneering effective prevention strategies for cAD holds immense potential to enhance the quality of life for both dogs and their owners. Additionally, it bears the promise of a translational impact on human research. Hence, further exploration of this crucial topic is not only relevant but also timely and imperative, warranting support and encouragement.
... After a clinical diagnosis of atopy, the IDT ( Figure 2) stands as the veterinary allergy first-line diagnosis method for implicated species. Currently, most suppliers provide allergen extracts in well-defined concentrations for most groups of allergenic species [42], although standardization still needs improvement to ensure better reproducibility [43]. ...
... Despite its clinical relevance, not many studies have been published in veterinary medicine regarding Malassezia-derived animal conditions [43]. In 2021, Di Tomaso et al. [48] reported the results of sera evaluation from 45 dogs, in which 11 showed positive for Malassezia. ...
... A total of 68 allergic dogs were selected for conditions related to Malassezia overgrowth and/or other fungal complications from the University of Évora Veterinary Hospital (Évora, Portugal) dermatology and allergy outpatient consultation. Primary allergy diagnosis/selection was made through a comprehensive query for anamnestic and clinical criteria, according to Hensel et al. (2015) [43] and Olivry and Mueller (2020) [54]. The owners of all animals presented for consultation at the Veterinary Hospital of the University of Évora were informed and consented to the collection and storage of data, including for research purposes. ...
Most fungal species are commensals and non-pathogenic to plants, humans, or animals. However, several species of the Alternaria, Aspergillus, Trichophyton, and Microsporum genera are common causes of disease, even for immunocompetent individuals. Besides mucosal damage, fungi may contribute to a skin barrier impairment, favoring sensitization and allergy development. A total of 68 allergic dogs were selected from a veterinary dermatology and allergy outpatient consultation for conditions related to both Malassezia overgrowth and other fungal complications. The allergy diagnosis was made through anamnesis and current clinical criteria, with the involved allergenic species being identified by intradermal tests (IDTs) and allergen-specific immunoglobulin E (sIgE) determination in serum. Dermatophagoides farinae, Dactylis glomerata, and Malassezia pachydermatis showed as the higher sensitization species from house dust mites, grass pollen, and fungi, respectively. Significant correlations at p < 0.05 were found between sensitization to Dactylis glomerata and Phleum pratense grass pollens, Dermatophagoides farinae and Dermatophagoides pteronyssinus, Acarus siro, Tyrophagus putrescentiae, and Lepidoglyphus destructor dust/storage mites, and between fungi like Aspergillus mix and Penicillium or Alternaria alternata. A significant correlation was also found between sensitization to the Aspergillus mix and D. farinae, D. pteronyssinus, or A. siro. Rather severe dermatitis was observed when a positive IDT to Malassezia pachydermatis was found, regardless of the detection of circulating sIgE, allowing us to consider the usefulness of both the IDT and the sIgE for a systematic diagnosis of allergy to fungi.
... Canine atopic dermatitis (DAC) is a disorder resulting in chronic inflammation and pruritus (1,2). DAC is multifactorial and its pathogenicity is not well elucidated. ...
Introduction
Dermatological consultations represent a great part of the small animal medical clinic routine. Canine atopic dermatitis (CAD) is a common skin disease that affects a significant amount of dogs, making it a relevant consideration in clinical practice. The role of the endocannabinoid system on skin homeostasis has been described and its deregulation contributes to dermatopathies. Its function in specialized skin cells reveals an expressive therapeutic potential. Due to the difficulties and the growing scientific evidence of the therapeutic benefits of cannabis on animals, this work aimed to evaluate the anti-inflammatory effects of cannabis-derived oil in the treatment of CAD.
Methods
Fourteen canines diagnosed with CAD were divided into two groups: T: full spectrum high cannabidiol (CBD) cannabis oil, 2,5 mg/kg; and C: control group (treated with olive oil alone). The effectiveness was evaluated based on the degree of pruritus, dermatological evaluation (CADESI-4) and histopathological evaluation of the skin including mast cell count.
Results
Despite the theoretical basis, there were no significant results obtained between the compared treatments.
Discussion
Thus, it can be concluded that although full spectrum high cannabinoids therapy presents a promising approach to immunological diseases, further research is required in order to establish the actual effective cannabinoid ratio within the myriad possible combinations and for multi-target therapy of CAD.
... Shiba Inu dogs diagnosed with cAD at Animal Medical Centre, Faculty of Agriculture, Tokyo University of Agriculture and Technology and private veterinary practices in Japan were recruited for this study. All dogs with cAD fulfilled more than five of Favrot's diagnostic criteria, and other potential causes for pruritis, such as ectoparasite infestations and bacterial or fungal infections were excluded, according to a detailed guideline [29]. CADESI-04 scores for the same case were monitored by the same veterinary clinicians (TO and YS). ...
Background
Like its human counterpart, canine atopic dermatitis (cAD) is a chronic relapsing condition; thus, most cAD-affected dogs will require lifelong treatment to maintain an acceptable quality of life. A potential intervention is modulation of the composition of gut microbiota, and in fact, probiotic treatment has been proposed and tried in human atopic dermatitis (AD) patients. Since dogs are currently receiving intensive medical care, this will be the same option for dogs, while evidence of gut dysbiosis in cAD is still missing, although skin microbial profiling in cAD has been conducted in several studies. Therefore, we conducted a comprehensive analysis of both gut and skin microbiota in cAD in one specific cAD-predisposed breed, Shiba Inu. Additionally, we evaluated the impact of commonly used medical management on cAD (Janus kinase; JAK inhibitor, oclacitinib) on the gut and skin microbiota. Furthermore, we genotyped the Shiba Inu dogs according to the mitochondrial DNA haplogroup and assessed its association with the composition of the gut microbiota.
Results
Staphylococcus was the most predominant bacterial genus observed in the skin; Escherichia/Shigella and Clostridium sensu stricto were highly abundant in the gut of cAD-affected dogs. In the gut microbiota, Fusobacteria and Megamonas were highly abundant in healthy dogs but significantly reduced in cAD-affected dogs. The abundance of these bacterial taxa was positively correlated with the effect of the treatment and state of the disease. Oclacitinib treatment on cAD-affected dogs shifted the composition of microbiota towards that in healthy dogs, and the latter brought it much closer to healthy microbiota, particularly in the gut. Additionally, even within the same dog breed, the mtDNA haplogroup varied, and there was an association between the mtDNA haplogroup and microbial composition in the gut and skin.
Conclusions
Dysbiosis of both the skin and the gut was observed in cAD in Shiba Inu dogs. Our findings provide a basis for the potential treatment of cAD by manipulating the gut microbiota as well as the skin microbiota.
Ca3VFqKyuZt1ZAdyvGK8SgVideo Abstract
... Bee and wasp allergen extracts (Venomil, Bencard Allergie GmbH, Munich, Germany and Allergen Extrakte Dr. Weyers, Labor Dr. Weyers, Aachen, Germany) were administered by skin pricking using a lancet (Stallerpoint, Stallergenes S.A., Antony, France) and intradermal injections using BD Micro-Fine 0.3 mL insulin syringes (Becton Dickinson, Allschwil, Switzerland). All test solutions were applied on the patient's left lateral thorax, and 15 min later, the test reactions were evaluated subjectively based on erythema and wheal size formation, as described previously [24]. A positive SPT and IDT were defined as wheal formation and an erythema score of ≥2 on a 0-4 subjective grading scale (Figure 1). ...
... Bee and wasp allergen extracts (Venomil, Bencard Allergie GmbH, Munich, Germany and Allergen Extrakte Dr. Weyers, Labor Dr. Weyers, Aachen, Germany) were administered by skin pricking using a lancet (Stallerpoint, Stallergenes S.A., Antony, France) and intradermal injections using BD Micro-Fine 0.3 mL insulin syringes (Becton Dickinson, Allschwil, Switzerland). All test solutions were applied on the patient's left lateral thorax, and 15 min later, the test reactions were evaluated subjectively based on erythema and wheal size formation, as described previously [24]. A positive SPT and IDT were defined as wheal formation and an erythema score of ≥2 on a 0-4 subjective grading scale. ...
... VIT is currently the only treatment that specifically addresses the cause for such reactions. This is the first published prospective clinical trial on the efficacy of VIT in dogs, confirming efficacy similar to that for humans [11] and previous anecdotal or retrospective reports in dogs [17,19,20,24]. In our study, none of the re-stung dogs developed systemic allergic reactions. ...
Simple Summary
Insect venom allergy is a potentially life-threatening allergic reaction following a bee, wasp, or ant sting. The only treatment to prevent further systemic sting reactions is venom immunotherapy (VIT), with an efficacy of up to 98% in humans. Prospective clinical data on VIT efficacy in dogs are currently lacking. In this investigation, 10 dogs with severe allergic reactions to either bee or wasp stings were treated with VIT. All dogs tolerated the therapy without adverse effects and the dogs which were re-stung tolerated the sting. This means that VIT is not only safe, but also efficacious in these patients. Furthermore, it was also shown that in addition to skin testing, two serum allergen-specific IgE tests were reliable to identify the underlying patients’ insect sensitization pattern.
Abstract
Hymenoptera allergens are the main triggers for anaphylaxis in susceptible dogs and humans. Hymenoptera venom specific immunotherapy (VIT), the only disease-modifying treatment, has the potential to prevent future life-threatening reactions in human patients. Prospective clinical data on VIT efficacy in dogs are currently lacking. Therefore, the aim of this study was to show that VIT is not only safe but also efficacious in preventing anaphylaxis in dogs allergic to Hymenoptera. This uncontrolled prospective clinical trial included 10 client-owned dogs with a history of anaphylaxis following repeated Hymenoptera stings. The sensitization to bee and wasp allergens was demonstrated by intradermal testing (IDT) and allergen-specific IgE serology. For VIT induction (induction phase), dogs received a shortened rush immunotherapy protocol with aqueous allergens, which was then followed by monthly injections of 100 µg of alum-precipitated allergen (maintenance phase). VIT efficacy was determined by observing patients’ clinical reactions to re-stings. No systemic adverse events were seen during the induction and maintenance phases. From the seven re-stung dogs, only one developed a mild angioedema at the site of the sting; the remaining dogs were asymptomatic. These results show that VIT represents a safe and effective treatment option for Hymenoptera-allergic dogs.
... The diagnoses were based on compatible clinical cutaneous signs, exclusion of other pruritic skin disease and performance of a dietary trial with provocation according to published criteria. [28][29][30] Thirty-one (16.3%, 95% exact CI 11.4%-22.4%) had a diagnosis of cAD, whilst 19 (10.0%, 95% exact CI 6.1%-15.2%) ...
Background
Few studies report the treatment and recurrence rate in anal sacculitis (AS).
Objectives
Retrospective study reporting the management, recurrence and concurrent diseases in dogs with AS in a primary care practice.
Animals
One hundred and ninety privately owned dogs in Sweden.
Materials and Methods
Clinical records of dogs diagnosed with AS between 2018 and 2021 were reviewed, and management, time until clinical resolution, number of recurrent episodes and comorbidites were recorded.
Results
The 190 dogs developed 290 episodes of AS. The most common management, in 235 of 290 (81.0%) episodes, was flushing ± infusion of an antimicrobial product into the sacs ± prescription of a nonsteroidal anti‐inflammatory drug (NSAID), providing resolution in 213 of 235 (90.6%) episodes. Median time to resolution was one week (range 1–16 weeks), with resolution seen within one week in 205 of 290 (70.7%) episodes. A single episode of AS developed in 126 of 190 (66.3%) dogs. Dogs with concurrent cutaneous allergic disease were more likely ( p < 0.001) to have recurrence of AS when compared to dogs with other comorbidities. Cutaneous allergic disease occurred more often ( p < 0.001) in dogs with AS than in the practice population.
Conclusions and Clinical Relevance
Local treatment of the anal sacs ± systemic NSAID was the most common treatment, inducing clinical resolution in the majority of dogs. Cutaneous allergic disease was the most common concurrent diagnosis, with higher recurrence rate of AS compared to other diseases and occurring in higher prevalence than in the practice population. Further studies are needed to determine if management of cutaneous allergic disease would reduce the risk of AS.
... Dogs with allergic or atopic dermatitis suffer concurrent skin and ear infections (1)(2)(3). Staphylococci, in particular, have increased adherence to inflamed and atopic skin (4,5). Treatment often requires topical and/or systemic antimicrobial therapy (2,6), but this must adhere to the principles of judicious antimicrobial use. ...
Introduction
Dogs with allergic dermatitis often suffer concurrent skin and ear infections. The objective of this study was to retrospectively quantify the number of systemic and topical antimicrobial transactions in dogs with allergic dermatitis, following administration of oclacitinib or a glucocorticoid, compared to dogs that did not receive a pruritus therapy when there is an initial diagnosis of pyoderma. A secondary objective was to demonstrate that dogs on oclacitinib use fewer antimicrobials and concomitant therapies over time and have improved quality of life.
Materials and methods
This was a retrospective case–control study using a large, centralized database to identify canine patients receiving pruritus therapy along with a concurrent diagnosis of pyoderma. For the second objective, 58 client-owned dogs diagnosed with allergic dermatitis were enrolled in a prospective owner and dog quality of life and treatment satisfaction (QoL&TS) study that also evaluated concomitant therapy use over time. In Part A, data consisted of anonymous transaction records from 1,134 hospitals across the United States, representing pyoderma visits between December 2018 and December 2019. Odds ratios comparing the relative odds of having additional antimicrobial agent transactions were calculated, given initial pruritus therapy compared to dogs that did not receive pruritus therapy. Parametric bootstrapping was used to calculate goodness-of-fit statistics. In part B, dogs entered the study on Day 0 and returned for examination on Days 14, 21, 30, and 60. Owner determination of QoL&TS was performed on Days 0, 1, 3, 14, 21, 30, and 60. On Days 0, 14, 21, and 60, a veterinarian assessed concomitant therapies and dermatitis severity scoring. Least Squares Means and Standard Errors for QoL&TS, and Dermatitis Vet VAS (Visual Analog Scale) Scores were calculated using a Linear Mixed Model Approach for Repeated Measures (α = 0.05). The percent reduction in therapies was also calculated.
Results
Dogs that received oclacitinib (n = 5,132) or a glucocorticoid ( n = 7,024) had reduced odds (OR: 0.8091; p = 0.0002 and OR: 0.7095; p < 0.0001, respectively) of having a follow up antimicrobial drug transaction after initial antimicrobial therapy compared to dogs with no pruritus therapy at the initial visit ( n = 12,997). In part B, oclacitinib demonstrated a statistically significant improvement in QoL&TS scores over time QoL ( p < 0.05). Veterinarian assessment showed a 70% reduction in dermatitis severity over time ( p < 0.05), supporting oclacitinib’s anti-inflammatory effects. Oclacitinib therapy was also associated with an 83% reduction in concomitant treatments, including a 100% reduction in systemic antimicrobial therapy over eight weeks.
Discussion
Dogs receiving oclacitinib showed no increase in antimicrobial therapy transactions compared to glucocorticoid recipients at the initial pyoderma diagnosis. Having a pruritus therapy at the index pyoderma visit reduced the odds of subsequent antimicrobial transactions. In addition to reducing concomitant therapy usage, oclacitinib improved owner and pet QoL, suggesting a paradigm shift in treatment success that could reshape allergic pruritus therapy recommendations. The study provides empirical evidence of oclacitinib’s reduction in antibacterial therapy, supporting its therapeutic value and antimicrobial stewardship.
... Currently, most suppliers present allergen extracts in well-defined concentrations, which have been presented for most groups of allergenic species [41]. However, standardization still needs improvement to assure better reproducibility [42]. Malassezia is another relevant genus from a lipophilic group of yeasts [43], in veterinary medicine. ...
... Skin becomes erythematous, evolving to keratosebaceous skin thickening [46]. Not many studies have been published in veterinary medicine, regarding Malassezia-derived animal conditions, despite its clinical relevance [42]. In 2021, Di Tomaso et al. reported the results of sera evaluation from 45 dogs, in which 11 showed positive for Malassezia [47]. ...
... From a veterinary dermatology and allergy outpatient consultation, at the University of Évora Veterinary Hospital (Évora, Portugal) a total of 68 allergic dogs were selected for conditions related to Malassezia overgrowth and/or other fungal complications. Primary allergy diagnosis/selection was made through a comprehensive query for anamnestic and clinical criteria [42,53]. ...
Most fungal species are commensals, not pathogenic for plants, humans, or animals. However, several species from genera Alternaria, Aspergillus, Trichophyton and Microsporum are common causes of disease, even for immunocompetent individuals, contributing to skin barrier impairment. A total of 68 allergic dogs were selected from a veterinary dermatology and allergy outpatient consultation, for conditions related to Malassezia overgrowth or other fungal complications. Allergy diagnosis was made through anamnestic and clinical criteria and allergy-implicated species were identified by intradermal testing (IDT) and serum determination of specific immunoglobulin E (sIgE). Dermatophagoides farinae, Dactylis glomerata and Malassezia pachydermatis showed as the higher sensitization species from each group. Significant correlations at p<0.05 were found between Dactylis glomerata and Phleum pratense grass pollens, Dermatophagoides farinae and Dermatophagoides pteronyssinus, Acarus siro, Tyrophagus putrescentiae and Lepidoglyphus destructor dust/storage mites, and between fungi like Aspergillus mix and Penicillium or Alternaria alternata. A significant correlation was also found between sensitization to Aspergillus mix and D. farinae, D. pteronyssinus or A. siro. Rather severe dermatitis was observed where positive IDT to Malassezia pachydermatis was found, regardless of the presence of circulating sIgE, allowing us to perceive the usefulness of both sIgE and IDT for allergy diagnosis to fungi.
... All test solutions were applied on the patient's left lateral thorax and 15 minutes later the test reactions were evaluated subjectively based on erythema and wheal size formation, as described previously. [25] A positive SPT and IDT was defined as wheal formation and an erythema score of ≥2 on a 0-4 subjective grading scale. Figure 1. ...
... The lyophilized extracts were kept at -20'C until use and were reconstituted on the day on VIT with sterile 0.5% phenol-buffered saline (Stallergenes, Dietlikon, Switzerland), rather than human serum albumin to avoid a potential adverse immunological reactions to xenogens, as previously recommended. [17,25,26] On the first day the dogs received a cumulative allergen dose of 101.1 µg divided into six subcutaneous injections given at 20-minute intervals. Six days later, the dogs received an allergen dose of 100 µg divided into 2 injections at a 20-minute interval. ...
Hymenoptera allergens are the main triggers for anaphylaxis in susceptible dogs and humans. Hymenoptera venom specific immunotherapy (VIT), the only disease-modifying treatment, has the potential to prevent future life-threatening reactions in human patients. Prospective clinical data on VIT efficacy in dogs are currently lacking. Therefore, the aim of this study was to show that VIT is not only safe but also efficacious in preventing anaphylaxis in dogs allergic to Hymenoptera. This uncontrolled prospective clinical trial included 10 client-owned dogs with a history of anaphylaxis following repeated Hymenoptera stings. The sensitization to bee and wasp allergens was demonstrated by intradermal testing (IDT) and allergen-specific IgE serology. For VIT induction (induction phase), dogs received a shortened rush immunotherapy protocol with aqueous allergens, which was then followed by monthly injections of 100 g of alum-precipitated allergen (maintenance phase). VIT efficacy was determined by observing patients’ clinical reactions to re-stings. No systemic adverse events were seen during the induction and maintenance phase. From the seven re-stung dogs, only one developed a mild angioedema at the site of the sting; the remaining dogs were asymptomatic. These results show that VIT represents a safe and effective treatment option for Hymenoptera-allergic dogs.
