Allergies 2.0

September 12th, 2021

Eight years after my last blog post about allergies, I think it’s time we revisited this important subject. Especially because, in the intervening years, the treatment options we can offer have improved dramatically.

Two products for allergy treatment released on to the veterinary market in the last few years are the mainstays of our allergy management now. They are Cytopoint and Apoquel. Cytopoint is an injection and Apoquel comes in tablet form. Both are registered for dogs only. Apoquel can be used in cats as an off-label medication (which means as an owner you assume the risk for side-effects rather than the manufacturer or, well, me) but Cytopoint cannot.

I would struggle to say which is superior, even after several years of using them. It is true that one of the two may be more appropriate for a particular patient, and for a particular owner so let me expand on that.

Efficacy is the first consideration – does the product work? If Cytopoint works, I think it abolishes the itching and scratching associated with allergies more completely. Since Cytopoint will work for at least 2 weeks in about 99% of dogs, the question then becomes how long does it last? It’s too expensive a product to inject every fortnight. The manufacturer advises the duration of action is likely to be a month, but  a considerable proportion of owners report seven to eight weeks of relief, and they’re very happy with that. If the allergy is seasonal, even better as one or two injections a year may be all that is required.

On the other hand, the effect of Apoquel will last as long as you keep giving the tablets. This means you have to be ABLE to give the tablets. If you can’t you will appreciate the convenience of an injection of Cytopoint. Apoquel is, usually, very effective in suppressing itching. Because of the manufacturer’s pricing policy Apoquel can be much cheaper than Cytopoint for dogs of a particular weight and if your dog is that weight then this may override all other considerations. If you own a cat, Apoquel is the only one of the two you can use.

Side-effects are an important concern too, Cytopoint is a monoclonal antibody. Side effects of any kind are extremely rare. Apoquel has a lower risk of side-effects on the gut (depressed appetite, vomiting or diarrhoea) than the drug it superseded (cyclosporin) and the vast majority of patients tolerate it well, but if it does upset your dog’s tummy you will migrate to Cytopoint.

Whichever you choose, you can be confident that your choice will be much more effective than anti-histamines, and have none of the long term side-effects of prednisolone or other corticosteroids.

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