Table of Contents
Dog Atopic Dermatitis
Canine atopic dermatitis (CAD) affects 10-15% dogs, causing chronic itching, secondary infections, and quality-of-life impairment, with 20-30% showing concurrent flea allergy dermatitis (FAD) or food allergies requiring multimodal management. Apoquel (oclacitinib) provides rapid itch relief (4h onset, 24h duration) but risks immunosuppression (10% infections, neoplasia concerns), while Cytopoint (IL-31 antibody) injection lasts 4-8 weeks with fewer side effects but higher cost. This comprehensive guide examines CAD management across USA, UK, Australia, and Asian markets, analyzing Apoquel (1.5-2.5mg/kg q24h) vs Cytopoint (2mg/kg q4-8w) efficacy/side effects, FAD diagnosis (single flea bite triggers), 8-12 week hydrolyzed diet trials (salmon/poultry feather 70-80% diagnostic accuracy), immunotherapy success (60-70% long-term control), and prevention through year-round flea control.
| Feature | Apoquel (Oclacitinib) | Cytopoint (Lokivetmab) |
|---|---|---|
| Mechanism of Action | JAK inhibitor – blocks IL-2, IL-4, IL-13, IL-31 signaling pathways | Caninized anti-IL-31 monoclonal antibody – targets IL-31 directly |
| Onset of Action | Within 4 hours; peak effect ~24 hours | Within 1 day |
| Duration of Effect | 24 hours (q24h oral dosing) | 4–8 weeks per subcutaneous injection |
| Efficacy – Pruritus Reduction | ~70% reduction in pruritus within week 1 (comparable to prednisone) | 60–70% CADESI reduction; strong anti-pruritic effect (similar to cyclosporine in many studies) |
| Common Side Effects | Vomiting/diarrhea (~10%), increased susceptibility to infections (~10%), long-term neoplasia concern | Injection-site reactions (~5%), lethargy (~2%), very low systemic side-effect profile |
| Major Contraindications / Precautions | Dogs <12 months, breeding animals, history of serious infections, demodicosis, neoplasia | No major labeled contraindications; safe in most populations |
| Approximate Cost (2026 est.) | $2–3 per day (ongoing oral) | $50–100 per injection (every 4–8 weeks) |
Selection Criteria: Apoquel for rapid seasonal flares; Cytopoint for long-term control, immunosuppression concerns, or Apoquel failures.
Flea Allergy Dermatitis (FAD): Diagnosis and Prevention
FAD affects 5-15% atopic dogs; single flea bite triggers severe dermatitis lasting weeks due to salivary antigen hypersensitivity. Classic Distribution: Dorsolumbar (hip/thigh), ventral abdomen, tail base “flea triangle”.
Diagnosis: Positive flea comb (dirt = digested blood), flea allergy intradermal test, rapid response topical steroids + flea kill. 30% concurrent CAD/FAD.
Prevention: Year-round prescription preventatives (Bravecto 12w oral, Credelio monthly chew, Simparica Trio, Revolution Plus topical). Environment: vacuum daily, hot wash bedding, premise sprays.
Food Allergy Elimination Trials
8-12 Week Strict Hydrolyzed Diets: Novel protein (duck, rabbit) or hydrolyzed (salmon/poultry feather) eliminates common allergens (beef 34%, dairy 17%, chicken 15%). Trial Rules: No table food/treats/rawhides; 70-80% diagnostic accuracy.
Hydrolyzed Efficacy: Salmon (HS) = poultry feather (HPF) pruritus reduction; 50%+ CAFR need >4 weeks response.
Provocation: Reintroduce suspect proteins documenting flare confirms diagnosis.
Immunotherapy and Adjuncts
Allergen-Specific Immunotherapy (ASIT): 60-70% long-term control subcutaneous/oral; 12-month commitment.
Topicals: Shampoos (chlorhexidine 2-4%), sprays (hydrocortisone aceponate), leave-on conditioners.
Antibiotics: Cephalexin 22mg/kg BID 3-4 weeks pyoderma.
International CAD Management
USA: Apoquel/Cytopoint widely available; ASIT standard.
UK: Cyclosporine first-line pre-biologics.
Australia: FAD emphasis year-round.
Asia: Topical steroids common; biologics emerging.
Common Questions
Apoquel or Cytopoint first? Apoquel rapid relief; Cytopoint chronic/safety concerns.
FAD single flea? Yes—hypersensitivity reaction.
Food trial length? 8-12 weeks strict.
Immunotherapy success? 60-70%.
Multimodal approach (biologics + flea control + diet trials + ASIT) achieves 80-90% control preventing flares.
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