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 25-28 September, 2018 | Singapore
response. Interestingly, 49% (23/47) of dogs that had a good to excellent response to SLIT had previously failed SCIT.
SCIT vs SLIT in dogs (Table 2)
U. Giger1
1School of Veterinary Medicine, University of Pennsylvania, Philadelphia, USA
Anemia is an extremely common clinical problem in
cats and is associated with many different conditions. Despite severe anemia many cats may only show mild clinical signs particularly when chronic. In order to recognize the type, degree, and regeneration of anemia in cats, it is important to appropriately appreciate the hematological peculiarities of cats. When compared to dogs, the normal packed cell volume in cats is lower (Packed Cell Volume [PCV] 0.30-0.48/L; 30-48%), feline red blood cells are considerably smaller (MCV 38-50 fl), central red cell pallor is small (cannot see spherocytes), bone marrow iron stores are visiually lacking, and there are mostly mild regenerative responses observed. There are aggregate reticulocytes (also reflected as polychromasia) which are short-lived in circulation (like in dogs), but cats also have punctate reticulocytes, which may linger around in circulation for a couple of weeks. The best parameter to assess a regenerative bone marrow response is the absolute reticulocyte count (normally <60,000/μl), which refers to the presence of aggregate reticulocytes and is equal to the degree of polychromasia. Note nucleated red blood cells may be proportionally increased with reticulocytes or may occur independently due to bone marrow endothelial damage as in lead poisoning, sepsis and myelodysplasia. While the evaluation of PCV, total protein, and blood smear are most valuable, a complete blood cell count and specific tests are generally required to reach classify the anemia, for a definitive diagnosis and to monitor the response to therapy. A complete blood cell count with reticulocyte count of modern hematology analyzers is ideal to best assess hematological disorders, but other tests are likely needed. These may include for instance chemistry screen, urinalysis, bone marrow cytology or core biopsy, hemostatic tests, iron parameters, infectious disease screen by serology and PCR, toxicological analysis, Coombs’, and genetic/DNA tests.
Although kidney failure and some infections (flea infestation, FeLV infection and hemobartonellosis) are likely the most common causes of anemia, there are many other differential diagnoses to consider, such as bleeding disorders, toxicity, metabolic disturbances, hereditary defects, and immune-mediated hemolytic anemias. It is therefore crucial to carefully assess the feline patient by history taking, physical exam and routine laboratory tests in order to determine the cause and offer the most appropriate treatment.
 In dogs, until more studies are performed investigating the ideal dose, protocol and efficacy, SLIT is best suited for dogs where either owner or dog is needle-phobic, if the dog developed serious adverse reactions to SCIT or has failed SCIT.
Table 2: Pros and cons of SCIT and SLIT in dogs
 Extensive experience and established success rate~52-77%
 No injections required-easily given at home
     Low rate of adverse reactions
  Lower rate of serious adverse reactions with no anaphylaxis reported
     Safe long term therapy
  May be effective in patients that failed SCIT (49%)
         Allows mixing of mold extracts in same vial
 Rare but possible anaphylactic reactions
 Limited experience
     Injections required
  Unclear success rates~40 to 60%
         Patient adherence-daily to twice daily administration
       Usually more expensive vs SCIT
     Food and water needs to be withheld before and after SLIT
         May not be palatable-salty in humans
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Jutel M et al, International Consensus on Allergen Immunotherapy II: Mechanisms, standardization, and pharmacoeconomics, Journal of Allergy and Clinical Immunology, 2016: 137: number 2
Mueller RS et al, Allergen immunotherapy in dogs, cats and horses-differences, similarities and research needs, Allergy, 2018, [Epub ahead of print]
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