Maybe better phrased is– with the current advances in the treatment of canine atopy-IS there still a role for AIT? Since therapy for atopy preferentially should be individualized for each patient, the answer is “YES”! Atopy therapy is not “cookie cutter” meaning we should not pigeon hole every patient into one therapy. We need to choose a therapy based on the owner’s capability, finances, clinical history of the patient and state of the patient’s current condition to include age, chronicity of the allergy, and temperament of the pet.  Some pet owners want to use a “natural” route of therapy for their atopic pet due to their own beliefs or after reading about medications used for atopy and their adverse effects. AIT is perfect for those owners provided they realize that it is a lifelong therapy that requires observation of the pet. It is also a mode of therapy that may enable the pet owner to use fewer oral medications to keep the pet under control as opposed to taking medications year-round. 

AIT, both injectable and oral, has been prescribed for dogs for 80 and 15 years, respectively[1]. It is a therapy that has been tested by time and the only treatment for atopic dermatitis that is able to change the pathogenic mechanism of the disease i.e. elicit a “cure”. Success rates for both injectable and oral are comparable with a good-excellent response in two-thirds of dogs evaluated.[2] In cases of injectable AIT that did not produce good-excellent results, changing to oral AIT maybe helpful in achieving success.[3]

An important factor in achieving success with AIT is proper evaluation of the atopic patient. Atopy is diagnosed based on history, clinical examination, and after ruling out differential diseases such as food allergy, demodicosis, and ectoparasites. Skin and serum testing should not be used to PROVE that a pet is atopic but rather to determine what allergens should be included in the immunotherapy.  The success rate of AIT appears to be the same when allergens are chosen via skin or serum testing.[4] A caveat to this success is that the clinical history of the patient needs to match the positives on the allergy test. An allergy test indicates potential sensitization, not necessarily clinically relevant disease. It is not enough to just take all the positives on the allergy test and include them in an immunotherapy solution. One needs to correlate the positives with the time of the year the pet has clinical symptoms in order to decide which allergens should be used.

[1] Mueller R. Update on allergen immunotherapy. Vet Clin Small Anim 49 (2019);1-7.

[2] Mueller R. Update on allergen immunotherapy. Vet Clin Small Anim 49 (2019);1-7.

[3] DeBoer D, Morris M. Multicentre open trial demonstrates efficacy of sublingual immunotherapy in canine atopic dermatitis (abstract). Vet Dermatol 2012;129:1290-6.

[4] Olivry T, et al. Treatment of canine atopic dermatitis:  2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis. Vet Dermatol 2010;21: 233-248.