Scruffie – Nearly 6 year old Terrier Mix – Case Study
Scruffie was adopted as a rescue a few years ago and since his adoption, he has been a sneezer.
He sneezes a few times every day, sometimes with mucoid discharge. He has had previous biopsies, blood work up, and cultures, but the problem always seems to return. When we saw Scruffie in February, he had been through several antibiotic and anti-fungal treatments based on previous cultures. But he was only on Claritin at the time, which the owner said was providing more relief than some of his previous treatments.
Under anesthesia, Scruffie had a CT Scan which revealed no major structural damage to his nose and no evidence of sinus infection. After the CT Scan, we performed biopsies of the nose and cultured a piece of tissue to see if there was yet another bacterial infection.
Scruffie’s biopsies came back with lymphoplasmacytic inflammation with also some eosinophils. This is a tough disease to treat and is likely why he has had symptoms for so long. The underlying cause can be autoimmune and/or allergic. In Scruffie’s case, the eosinophils were an indication that this is an allergic disease. A secondary bacterial infection was also present, and treated with a month of antibiotics based on the culture and sensitivity.
But how do we treat the primary cause?
In the past, we have relied on steroids for these patients, with little success. We have had some pets do better after allergy testing and hyposensitization treatment (injections). But we do have some newer drugs available for managing allergic disease that I thought might benefit Scruffie. The first drug we tried, Apoquel, has helped more than his previous treatments.
Apoquel inhibits pro-inflammatory cytokines involved in allergic disease. It provides rapid onset of action and can be used long-term at a lower dose than the starting dose. It is for dogs 1 year of age or older. It has the benefit of being compatible with other medications, so we were able to treat both the secondary bacterial infection with antibiotics along with the inflammation using Apoquel at the same time.
Another option is an injectable drug called Cytopoint. The mechanism of action is a bit different – it is a monoclonal antibody that neutralizes IL-31, an inflammatory cytokine. Relief from the injections lasts 4-8 weeks. Like Apoquel, it can be used along with other medications. Because it is an antibody, it does not rely on the kidney and liver for metabolism, a bonus in patients with chronic issues.
Both of these drugs are approved only for dogs at this point. We are looking forward to more data on cats using Apoquel. In particular, asthmatic cats might benefit from Apoquel as an alternative to steroids, much like Scruffie did for his persistently inflamed nose.
Thanks to Scruffie’s Mom for being so diligent so that we could get Scruffie feeling better.
Jennifer S. Fryer, DVM