Interventions for atopic dermatitis in dogs: A systematic review of randomized controlled trials

Department of Clinical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA.
Veterinary Dermatology (Impact Factor: 1.73). 02/2010; 21(1):4-22. DOI: 10.1111/j.1365-3164.2009.00784.x
Source: PubMed


The objective of this systematic review, which was performed following the guidelines of the Cochrane collaboration, was to assess the effects of interventions for treatment of atopic dermatitis (AD) in dogs. Citations identified from three databases (MEDLINE, Thomson's Science Citation Index Expanded and CAB Abstracts) and trials published by December 2007 were selected. Proceedings books from the major veterinary dermatology international congresses were hand searched for relevant citations. The authors selected randomized controlled trials (RCTs), published from January 1980 to December 2007, which reported the efficacy of topical or systemic interventions for treatment or prevention of canine AD. Studies had to report assessments of either pruritus or skin lesions, or both. Studies were selected and data extracted by two reviewers, with discrepancies resolved by a third arbitrator. Missing data were requested from study authors of recently published trials. Pooling of results and meta-analyses were performed for studies reporting similar interventions and outcome measures. A total of 49 RCTs were selected, which had enrolled 2126 dogs. This review found some evidence of efficacy of topical tacrolimus (3 RCTs), topical triamcinolone (1), oral glucocorticoids (5), oral ciclosporin (6), subcutaneous recombinant gamma-interferon (1) and subcutaneous allergen-specific immunotherapy (3) to decrease pruritus and/or skin lesions of AD in dogs. One high-quality RCT showed that an oral essential fatty acid supplement could reduce prednisolone consumption by approximately half. Additional RCTs of high design quality must be performed to remedy previous flaws and to test interventions for prevention of flares of this disease.

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Available from: Thierry Olivry, Sep 17, 2014
    • "There also seems to be higher " reagibility " of mast cells in atopic dogs (Marsella & Olivry, 2001). However, H 1 receptor as well as H 2 receptor antagonists show only moderate effects on lesions and pruritus in atopic dogs (DeBoer & Griffin, 2001, Olivry et al., 2010). Nevertheless, the role of histamine was re-evaluated using the first findings, where the H 4 receptor might have immunomodulatory functions. "

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    • "The improvement in pruritus scores could be perceived rather than real and might provide evidence for the more subjective nature of the assessment of pruritus. PUFAs are considered less efficacious than, for example, glucocorticoids (Olivry et al., 2010) or cyclosporin (Steffan et al., 2006) in the treatment of CAD, but have been shown to be successful Table 1 Data for CADESI-03 and pruritus scores of dogs with atopic dermatitis treated with either a spot-on formulation containing essential fatty acids/essential oils or placebo. "
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    ABSTRACT: Recent studies have shown that immunological aberrations and epidermal barrier defects could be important in the pathogenesis of canine atopic dermatitis (CAD) and that oral polyunsaturated fatty acids (PUFAs) might influence the epidermal barrier. The aim of this study was to evaluate the effects of a spot-on formulation containing PUFAs and essential oils on pruritus and lesions caused by CAD. Forty-eight privately owned dogs of different breeds, ages and genders diagnosed with atopic dermatitis were included in a randomized, double-blinded, placebo-controlled, multicentre clinical trial. Dogs were treated with a spot-on formulation containing PUFAs and essential oils or placebo on the dorsal neck once weekly for 8weeks. Before and after the study, CAD extent and severity index-03 (CADESI-03) and pruritus scores were determined by veterinarians and owners, respectively. There was significantly more improvement in CADESI-03 and pruritus scores in the treatment group than in the placebo group (P=0.011 and P=0.036, respectively). Additionally, more dogs improved by at least 50% in CADESI-03 and pruritus scores in the treatment group than in the placebo group (P=0.008 and P=0.070, respectively). No adverse reactions were observed. The topical preparation containing PUFAs and essential oils was a safe treatment and beneficial in ameliorating the clinical signs of CAD.
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    • "They are often used in human and veterinary medicine (Hoare and others 2000, DeBoer and Griffin 2001, Olivry and Mueller 2003). However, a systematic review of treatments for canine atopic dermatitis did not provide conclusive evidence for the efficacy of antihistamines (Olivry and others 2010b). "
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    ABSTRACT: Antihistaminic drugs are commonly used as symptomatic therapy of atopic dermatitis in dogs. Unfortunately, their clinical benefit is largely unsubstantiated. In a double-blinded, placebo-controlled, cross-over trial, the influence of dimetinden and of a combination of chlorpheniramine and hydroxyzine on pruritus and lesions was evaluated in 19 dogs. They were treated with either product or a placebo orally for 14 days, each time followed by a 14-day washout period. Before and after each period, the dogs were examined and the Canine Atopic Dermatitis Extent and Severity Index (CADESI) determined by a clinician, and the pruritus and general condition by the owner. Dimetinden improved the pruritus significantly (P=0.014) but not the CADESI (P=0.087), the combination of hydroxyzine and chlorpheniramine improved the CADESI (P=0.049) and pruritus (P=0.05) significantly. Ten of 17 dogs improved by more than 25 per cent in pruritus with the combination of hydroxyzine and chlorpheniramine, 12 of 18 with dimetindenmaleate and only 2 of 19 with placebo. Antihistamines can help to reduce pruritus in atopic dogs, but in most cases, the improvement is limited and additional treatment may be needed.
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