Allergy Advances | Heska’s Sublingual Immunotherapy
Allergy Advances | Heska’s ALLERCEPT Sublingual Immunotherapy
A new breakthrough in allergy treatment—sublingual immunotherapy—holds promise for treating challenging cases.
If you are in small animal practice, you probably see allergic dogs and cats at least weekly, if not daily. With estimates of up to 10 percent of office visits focused on allergic pets, these patients may comprise a significant and rising portion of your caseload. That’s great for business, but the diagnosis and management of allergic disease can be challenging for the practitioner, the pet owner and the itchy, uncomfortable pet. In fact, tens of millions of animals suffer from allergies, but only a small fraction are properly tested, diagnosed and treated.
The good news is that by taking advantage of advances in allergy technology, you and your team can build a thriving allergy practice and help alleviate your patients’ discomfort.
Before testing for allergies, it’s important to rule out other conditions that could cause itching, such as parasites (fleas, lice, mites and intestinal parasites), skin infections (bacterial, yeast and fungal) and metabolic diseases. Allergy should always be considered in pets with unexplained hair loss, recurrent ear infections, or signs of excessive self-grooming.
Allergic patients are often managed with a combination of antihistamines, fatty acids and shampoos. These products can provide relief, but it may be limited or temporary. Steroids also provide short-term relief, but prolonged use can have serious side effects.
To date, the safest, most effective treatment for dogs, cats and horses with allergies is immunotherapy, which has been found effective in approximately 60 percent of patients.
Allergen-specific immunotherapy, or ASIT, is a treatment modality whose success depends on accurate determination of the patient’s specific sensitivities, by either intradermal or serum IgE testing. Then, extracts of the identified allergens are mixed together and administered to the patient. The goal is to desensitize the patient by starting with very tiny doses and gradually building up to very large doses.
Immunotherapy can be delivered through subcutaneous injections or new sublingual drops.
If you have arrived at a diagnosis of atopic dermatitis and selected immunotherapy as the appropriate treatment, Heska Corporation offers two options. Formulated with proprietary technology and developed through years of trials in hundreds of dogs, ALLERCEPT® Therapy Drops are the latest innovation in immunotherapy from Heska Corporation. Therapy Drops are administered sublingually and offer a more palatable solution for many owners whose pets are suffering from hard-to-control allergies and for which subcutaneous Therapy Shots are not a viable option (because of owner or pet aversion to shots, shot failure or anaphylaxis).
Allergy drops have been used around the world in humans for more than 50 years, and numerous studies validate both their safety and effectiveness. In fact, the World Health Organization has endorsed sublingual immunotherapy as a viable alternative to injection therapy in humans.1 The Cochrane Collaboration, an international organization dedicated to reviewing healthcare treatments, recently concluded that allergy drop immunotherapy significantly reduced allergy symptoms and the need for allergy medications.2
Sublingual immunotherapy works via many of the same mechanisms as injectable immunotherapy. However, in humans, additional mechanisms demonstrate that sublingual immunotherapy may be effective even if allergy shots are not. Studies point to the importance of the abundant and unique type of dendritic cells found in the oral mucosa, which appears to be able to rapidly modulate the immune response in many patients.3
Advantages of Drops
Using Heska’s ALLERCEPT® allergen-specific IgE test to identify the important allergens, selection of allergens for sublingual treatment is performed in exactly the same manner as for the company’s Therapy Shots. However, with ALLERCEPT® Therapy Drops, the extracts themselves and the formulation principles are quite different than for allergy shots. This leads to two important benefits: First, mold extracts can be mixed with other allergens in the treatment sets, rather than being administered separately. Second, the treatment set does not require refrigeration—an additional client convenience.
Another strong advantage of Therapy Drops is that they are much easier to administer. A small, customized hook on the dispenser pump fits over the pet’s lower teeth, directing the solution under and around the tongue area. Maximum contact with the sublingual oral mucosa is necessary, so the drops cannot be mixed with food or squirted into the mouth and swallowed, as with most oral liquid medication. Dogs readily accept treatments, which are done twice daily, every day, for the entire duration of therapy. Therapy Drops can also be used in cats. The palatable base aids in the success of long-term oral administration.
Shots or Drops?
Each patient will respond differently to immunotherapy, and some may respond better to one formulation than the other. Because both methods are effective, clients may choose the best method based on their preference for administration and factors such as the pet’s temperament. Many clients find it easy to give injections to their pets, and infrequent administration (only once every week or so) is a plus for those with busy schedules. Pet owners who are needle-shy or have rambunctious pets, however, may prefer the drops, even though they must be given twice daily. If a pet has significant mold allergy, drops may be the best option because the mold extracts can be mixed in with the same treatment set.
With the new availability of ALLERCEPT Therapy Drops, you can look forward to fewer exam-room complaints about recurring or continuing pet discomfort, side effects of certain drugs and general frustration with the difficulty and expense of treating an allergic pet. ALLERCEPT Therapy Drops are an important part of the ALLERCEPT Testing and Treatment program, which was designed to provide both veterinarians and pet owners the tools they need to confidently manage pet allergies.
- While working with allergic pets can seem daunting, advances in allergy technology and a systematic approach will aid you in building a thriving allergy practice.
- The ALLERCEPT Testing and Treatment program from Heska is designed to provide both veterinarians and pet owners the tools they need to confidently manage pet allergies and provide long-term relief from allergic symptoms.
- New ALLERCEPT Therapy Drops are an innovative solution for many owners whose pets are suffering from hard-to-control allergies, and for which subcutaneous Therapy Shots are not a viable option.
- ALLERCEPT Therapy Drops are easy to administer, with just two pumps under the tongue twice per day and convenient room- temperature storage.
1 Bousquet PJ, Cox LS, Dunham SR, et al. Sub-lingual immunotherapy: World Allergy Organization Position Paper 2009. World Allergy Organization Journal 2:233-81, 2009.
2 Radulovic S, Wilson D, Calderon M, et al. Systematic reviews of sublingual immunotherapy. Allergy 66:740-52, 2011.
3 Allam JP, Novak N, Fuchs C, et al. Characterization of dendritic cells from human oral mucosa: a new Langerhans’ cell type with high constitutive FcERI expression. Journal of Allergy and Clinal Immunology 112:141-8, 2003.
The Team Approach
Learn more about sublingual immunotherapy for the treatment of atopic dermatitis. Heska’s website (www.heska.com) provides research and self-paced continuing education. After you decide how allergy case management fits into your business, discuss a plan for product pricing, team education and implementation of this new therapeutic option with your practice manager.
Discuss with veterinarians your clinic’s strategy for allergy case management. Schedule a team meeting to review immunotherapy treatment options. Determine team member roles in educating clients. Direct the team to the allergy education modules and other resources at www.heska.com.
With a definitive diagnosis of allergy, collect and process a blood sample for serum IgE testing. Educate clients about administration, re-ordering and compliance. Monitor patient progress during recommended recheck visits.
Your role begins once the doctor has recommended and prescribed Therapy Drops. Follow-up calls for re-checks, re-orders and to determine how the patient is responding will be very important to treatment success. Help clients avoid frustration with the process or clinical relapse that might occur if there is an unexpected therapeutic gap, or if the allergy drops are discontinued prematurely.
Hitting the Mark
Tests and tools to increase your success rate in allergy treatment.
Accurate identification of the allergens to which your patient is sensitive is a critical first step for effective allergen-specific immunotherapy. Immunotherapy treatment based on erroneous test results may include unnecessary allergens, or exclude necessary allergens. Heska’s ALLERCEPT IgE Test is the only test to use a patented receptor technology that measures only allergen-specific IgE), thus significantly decreasing the chance of false positives.
Using the ALLERCEPT IgE Test, you get accurate, easy-to-read results with a single blood sample, and immunotherapy recommendations within 48 hours of Heska receiving the test sample.
The ALLERCEPT program provides tools to confidently manage allergic patients, such as:
- Step-by-step workbooks for both veterinarians and pet owners who want to closely manage allergic patients placed on immunotherapy.
- Two different options for administering immunotherapy, the newest of which is an easy-to-use pump that dispenses drops under a patient’s tongue.
- Literature for pet owners that explains the steps involved in testing and treating their allergic pet, as well as ways to manage a pet’s environment.