You know I’m always on the lookout for treatments for allergy dogs, especially diabetic allergy dogs, that don’t involve steroids. Remember that steroids cause insulin resistance amongst other unpleasant side effects. Steroids can derail a diabetic’s blood glucose regulation in a New York minute. Until recently, we didn’t have a lot of effective treatments for severely itchy diabetic dogs. We would use antihistamines, food trials, omega 3 fatty acids, avoidance of the allergen, etc. In general, veterinarians use immunosuppressive drugs if needed to give allergic dogs relief from itching and scratching. Immunosuppressive drugs include steroids and cyclosporine and more recently Apoquel.
A new drug has just been released that may help dogs with atopic dermatitis – that’s the fancy name for hay fever. This new medication works in a similar fashion to Apoquel, but it has some neat twists. Both drugs are made by the same company and affect cytokine function. Cytokines are proteins that cells use to communicate with each other, particularly for inflammation and allergic itch. Apoquel stops numerous cytokines from causing itch by inhibiting an enzyme within cells after cytokines attach to a cell. Cytopoint binds up one particular (very important) cytokine from causing itch by binding the cytokine while in circulation, preventing it from attaching to cells. Cytopoint affects just one cytokine, but it is an important cytokine for atopic pets.
Let’s talk about both drugs and how they work and how they are administered.
Last year I wrote one of these newsletters when I was all excited about Apoquel, an oral drug that helps prevent cytokines from causing itch. Unlike steroids, it does NOT cause insulin resistance, so it is a good option for allergic diabetic dogs. However, it is still immunosuppressive like steroids. And it can’t be used in dogs less than a year old. Its use is extra-label in cats, meaning the FDA hasn’t approved it for cats. Apoquel works for any kind of allergy—food allergy, atopic dermatitis, contact allergy and parasitic allergy. It blocks an enzymatic pathway and prevents cytokines from successfully signaling itch within cells. For dogs it works fast, usually within a day. For the majority of dogs I’ve given Apoquel to, it has been a wonder drug. Still, I have had a couple allergic patients who did not respond to it.
Of course most drugs have fine print. I borrowed the following paragraph from the manufacturer: “Do not use APOQUEL in dogs less than 12 months of age or those with serious infections. APOQUEL may increase the chances of developing serious infections, and may cause existing parasitic skin infestations or pre-existing cancers to get worse. APOQUEL has not been tested in dogs receiving some medications including some commonly used to treat skin conditions such as corticosteroids and cyclosporines. Do not use in breeding, pregnant, or lactating dogs. Most common side effects are vomiting and diarrhea. APOQUEL has been used safely with many common medications including parasiticides, antibiotics and vaccines.”
Cytopoint is similar to Apoquel, but it binds up the most important cytokine that causes itch in atopic dermatitis. It is a monoclonal antibody to that one very important cytokine. The antibody is made in a lab and injected into the pet. Cytopoint won’t work for food allergies nor on flea allergies. Cytopoint only works on atopic dermatitis. I see lots of atopic dermatitis patients year-round here in south Florida with all the grasses and lush plants and trees we have. In many colder parts of the country, atopy is a springtime issue. Atopic dermatitis dogs often present with an itchy face and ears and itchy underside of the dog. Atopic dogs often lick or chew at their feet. Initially owners may see a seasonal component. As dogs age, or move to Florida, they may be itchy year-round.
So when would we choose Cytopoint over Apoquel? If we know it is atopic dermatitis and want to get a pet through a flare up it is a great choice. If the pet has a serious infection, we could still use Cytopoint as it is not immunosuppressive. It’s also a great choice for atopic diabetic dogs. If you have an atopic dog who is difficult to pill, it would be dandy as it is an injection given in the vet office and it lasts for 4 to 8 weeks. It can be used with other treatments, and it has no known side effects. What an amazing idea this is. What cool science this is!!! I’ve been in the veterinary field for 30 years, and sometimes I am awed at the novel treatments researchers invent.
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NOTE: Consult your veterinarian first to make sure my recommendations fit your pets special health needs.