Shots or drops? Considerations when selecting injection vs. sublingual ASIT for dogs

• The client's schedule and convenience factors. Some clients may find it easier to give an injection every 14 days or so than to consistently administer SLIT every day; others may find regular daily administration easier. Some clients may find it desirable that some SLIT formulations do not require refrigeration (injection formulations do).

• Client aversion to needles. Some clients find injections easy to give to their pets, but others are fearful of needles and will be relieved to have the availability of oral SLIT administration.

• Patient cooperation factors. Most pets tolerate injections at home quite well; however, some may be extremely resistant. Most pets find SLIT formulations palatable and view administration as a treat, although some head-shy animals may be difficult to medicate with allergy drops.

• The importance of mold or fungal allergens. If molds are an important allergen, experts recommend that fungal extracts for injection should not be mixed with other extracts but rather given by separate injection. Fungal extracts can be included within the same vial for some SLIT formulations (those that include stabilizers in the vehicle), so separate administration is not necessary.

• History of anaphylactic reactions to injection ASIT. In people, anaphylactic reactions to SLIT formulations are much less common than anaphylactic reactions to injections. For pets, SLIT formulations can be safely given to pets that have had reactions to injection ASIT. However, it is important to advise your suppliers of this history as they may recommend a modified administration schedule for such patients.

• History of failure with injection ASIT. Patients that previously experienced no clinical benefit from injection immunotherapy may experience benefits from SLIT. A substantial number of dogs that failed to improve with injection ASIT have improved with SLIT.1

Editors' note: Dr. DeBoer is a consultant to Heska, manufacturer of Allercept Therapy Drops, but has no financial interest in any sublingual immunotherapy product.

Douglas J. DeBoer, DVM, DACVD Department of Medical Sciences School of Veterinary Medicine University of Wisconsin Madison, WI 53706

REFERENCE

1. DeBoer D, Morris M. Multicentre open trial demonstrates efficacy of sublingual immunotherapy in canine atopic dermatitis (abst). Vet Dermatol 2012;23(Suppl 1):65.