Atopic dermatitis is a much more complex disease than Insect Bite Hypersensitivity, which is described above. It is less well documented in horses and therefore the methods of treating atopic dermatitis in other species are mostly applied to horses. Some of the factors involved can be a genetic predisposition - the most common of which are several deficits in the normal skin barrier that allow allergens to enter the body, secondary bacterial or fungal infections, drying or irritating chemicals, allergens and stress factors that can be inherent behavioural issues or imposed stress, such as caused by performance.
Avoiding allergens Although strategies for avoiding allergens should be explored, it can be a drawn-out exercise in frustration. It is critical that the offending allergens are identified as there are a wide variety of candidate allergens and, in some cases, a combination of allergens is responsible, making it more challenging to identify them all. In Australia, the most common allergens (similar to atopic dermatitis in other species) are pollens. Moulds, which are more common internationally, are less seen, possibly due to the shorter time that Australian horses spend in housing, where moulds are more common. Allergies to dust mites may also be a factor in this condition, but the role of these allergens is less clear.
Immunotherapy If the offending allergens can be identified, it may be possible to develop a treatment regime involving injecting increasing amounts of the allergen(s). This desensitising therapy stimulates a change in the responses of various immune cells in the blood, aiming to produce a less severe response with little or no clinical symptoms.
Assuming the appropriate allergens can be detected, this therapy has a relatively good success rate, approaching 80%. This type of therapy is more suited to severe allergic reactions, unavoidable allergens or where the side effects of symptomatic therapy are severe or owners prefer not to use medications.
Symptomatic therapy Although this is the most common form of therapy used for atopic dermatitis, it comes with some risks and its success in the horse is more variable than in other species. We may recommend treatments such as antihistamines, steroidal antiinflammatories, fatty acids, such as linseed or fish oil and antibacterial therapies if a secondary bacterial infection has occurred.
Several topical products can also prove useful, including some types of shampoos (avoid drying shampoos), moisturisers and topical corticosteroids, which avoid the side effects of oral or injectable ones. Individual horses will react differently to various combinations of these therapies. If injectable or oral corticosteroids are required, we will likely recommend that they are used as little as possible to minimise side effects. |