Cyclosporine for atopy appears to be a work in progress, and we still are adding to the list of side effects seen with long-term
use. Some owners will start using cyclo sporine for the more rapid relief of allergy symptoms, then elect to start immunotherapy
injections because of the expense.
While steroids can give immediate relief to atopic patients, the key is to use them infrequently, at low doses (preferably
short-acting and every other day) and monitor their use.
Because they do tend to work well, owners get in a habit of administering them as a daily routine without regard to whether
the pet actually needs the drug.
Soon you have an iatrogenic Cushingoid dog that you as the veterinarian see, but the owner has no idea what they've created.
So be stingy in dispensing steroids and maintain close communication with the owner, so that the dog is not on prolonged steroid
One way to use less steroid is to change to Temaril P, which is a combination of anti histamine (not to be used in seizure
patients) and steroid. It can be a good first attempt of getting a patient from using prednisone 20mg daily to one or two
tablets of Temaril P daily, which would total 2 mg to 4 mg prednisolone daily — quite a reduction.
Short-term use of low-dose, alternate-day, short-acting steroids such as prednisone may be acceptable in getting the atopic
patient through a tough few weeks of their season, but now that cyclosporine is available as an alternative, or even topicals
such as Resicort may suffice, try those first instead.
Alice Jeromin DVM, Dipl. ACVD
Dr. Jeromin is a pharmacist and veterinary dermatologist in private practice in Cleveland, Ohio. She is a 1989 graduate of
The Ohio State University College of Veterinary Medicine and an adjunct professor at Case Western Reserve University's College
of Medicine in Cleveland.