In veterinary dermatology, immunotherapy is the only causal treatment option for patients with atopic dermatitis. The effectiveness of this therapy is largely determined by two crucial factors: the careful selection of clinically relevant allergens and the sustained administration of the therapy over a sufficiently long period of time.
From a clinical and immunological point of view, the choice of allergen is more important than the number of allergens in the therapy. A single, relevant allergen can achieve targeted and efficient immune modulation. On the other hand, administering multiple, possibly irrelevant allergens can lead to a diffuse immune response, which can reduce the effectiveness of the therapy.
Qualitative selection - tailored to the individual symptom profile - is essential for therapeutic success.
If only one allergen tests positive and this finding is consistent with the clinical picture, customized monovalent therapy is preferred.
Immunotherapy works by gradually building up immunological tolerance, a process that usually only shows clinical improvement after a few months. Scientific evidence and practical experience show that a treatment duration of at least 12 months is necessary to achieve stable immune regulation. Early termination of therapy, for example after temporary improvement, often leads to relapses and undermines the goal of long-term tolerance induction.
The desensitization and immune modulation that underlie immunotherapy take time. T-cell regulation, isotype switching from IgE to IgG, and reduction of cytokine production are processes that develop gradually. Discontinuing the therapy before these processes are completed results in suboptimal clinical results.
(modified from Ramió-Lluch et al., Vet Record, 2020)
Maintaining therapy for at least 12 to 18 months (second treatment vial duration) is crucial before evaluating effectiveness.
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