Atopy: Atopica Or Dermatologist?

Erin writes:  My sister has an 8 year old spayed female golden retriever mix who exhibits most of the signs of Atopy that you mention, particularly rubbing her face on the ground, and has since she was about a year old. We’ve taken her to multiple veterinarians, who’ve prescribed everything from steroids to medicated shampoos and put her on special diets to test for food allergies (which she doesn’t seem to have, based on her lack of improvement on grain-free diets). Some of these treatments have produced short-term improvement but nothing has had any lasting benefit. The poor dog chews her paws and skin constantly if not wearing an Elizabethan collar, she smells terrible even if bathed just hours ago, and we’re at our wit’s end trying to help her.  Our most recent veterinarian mentioned Atopica but advised trying some other (cheaper) treatments first, which we did with no real improvement. So now we’re considering asking him to prescribe Atopica. We’ve heard that a generic is an effective and more reasonably-priced alternative but some who’ve used it say that Atopica produces better results. Can you comment on Atopica vs. generic? Also, would you try the long-term antibiotic therapy you mention before prescribing Atopica, and if so, what type of oral antibiotic would you use? (The dog in question is very easy to pill, so oral meds are fine.)   Thanks for your assistance and your very educational and interesting blog!

With golden retrievers it’s not whether they suffer from Atopy, it’s when it began or will begin!

First, Erin, let me say that a grain-free diet is not generally considered a good test for food allergy in dogs. While grains can be a source of proteinaceous allergens, “the big five,” beef, poultry, egg, pork and soy are far more common offenders. While I like Hill’s Prescription Diet z/d, there are other commercial choices as well as homemade diets. Check with your pet’s doctor for options.  Click here to read our post on Food Allergy.

Atopy is as separate condition existing in the same patient, so even if she suffers from food allergy, the Atopy component has to be addressed separately.

Atopica is certainly an option for treating Atopy. I currently have one patient on it and she has seen excellent results with it.

There are two main reasons to avoid the generic:

  • There are too many reports of treatment failure with the generic cyclosporin to ignore. I don’t know whether it is a matter of patient selection, poor quality control with the generic or a multitude of other possible factors. The bottom line is that it just doesn’t work as well.
  • Medicolegal concerns: If a medication is available that is approved for use in dogs and cats most veterinarians prefer to use it. As with Atopica, it is often more effective. And, in case of an adverse event, it could be difficult to defend against the question, “Doctor, a brand of cyclosporin, Atopica, is available for use in dogs. Why didn’t you prescribe that instead?” Sadly, we can’t go to the clinic these days without having to think about the lawyers’ point of view.

For a pooch who has had such difficulty, there is another option that needs to be considered. Most communities are no longer far from access to a board-certified veterinary dermatologist. Your nearest specialist may be at a teaching hospital or a specialty practice, but their specialized training and experience can be invaluable in helping difficult-to-control patients such as yours.

See you tomorrow, Dr. Randolph.

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