Creative solutions for feline atopic dermatitis

Treatment options for feline atopic syndrome (FASS)—also known as environmental allergies or atopic dermatitis—lag behind those for dogs, making management of the condition particularly difficult. As Sandra Koch, DVM, MS, DACVD, professor at the University of Minnesota College of Veterinary Medicine and director of the school’s Veterinary Medical Center Dermatology Service explained in an earlier video clip from an interview with dvm360 this year, management of FASS often requires a combination of strategy and creativity. In this latest installment from the interview, Koch explores alternative treatment options for the condition.

Below is a partial transcript, lightly edited for clarity:

Sandra Koch, DVM, MS, DACVD: And then thinking outside of the box, right? Because everything else is either not labeled or we don't have good studies and good evidence of efficacy.

We have to use things like Apoquel, which is labeled for dogs with allergies, but we use [it] in cats. It's not my first choice. Of course, I'm going to have lab work, baseline monitoring like I would for cyclosporine and prednisone, steroids—I should say prednisolone for cats, and so for Apoquel, the dose needs to be higher than for dogs, so like 1 mg/kg twice a day starting and then trying to taper from there.

The drug doesn't seem to stay effective for too long, so it [has] a short-lived efficacy because of the short life compared to the dogs.

It's a tablet, right, [a] formulation, so not all cats are going to take it, but sometimes I like to tell clients [to] crush [it] and give it in with a treat or something that the [cats] like. And again, we need to monitor closely.

For cyclosporine and Apoquel, the thing we worry about is toxoplasmosis, so we need to make sure that these cats are being screened for [Feline immunodeficiency virus], [Feline leukemia virus], but also toxoplasma with toxoplasma antibody titers. However, even if they're negative—even if they don't have antibodies—it can be concerning, because if they become exposed, it could lead to fatal disease. So, I like to talk to my clients about that. The cats on cyclosporine and Apoquel should not be eating raw meat. They should not be hunting. They should be not outdoors. They should be kept in [the] house. If they're unable to do that, perhaps those medications are not good options for them.