Show Notes
In Episode 6 we were delighted to be joined by one of the giants of global veterinary dermatology - Ralf Mueller (Dr. med. vet., MANZCVSc (Canine Medicine), Dip. ACVD, FANZCVSDc (Dermatology), Dip. ECVD). Ralf has published over 250 studies, articles, book chapters and books and given more than twelve hundred seminars, lectures and talks all over the world - plus at least one podcast now! Log this CPD with 1CPD here
Introduction (00:00) John introduces the podcast with co-hosts Sue and Paul; Sue introduces us to Ralf Mueller and his work in dermatology.
Chapter 1 - Why Immunotherapy?
(02:37) Sue welcomes Ralf and asks him to introduce himself. Ralf shares details of his wealth of experience in dermatology and allergy.
(03:23) Sue asks about Ralf's approach to allergies and Ralf shares that firstly he makes sure he is happy that the patient is allergic and without other skin issues. Following this he would ensure thorough ectoparasite control to prevent flea allergy confusing the matter, before ruling out food allergy with an elimination diet in order to ascertain an environmental; then he would discuss this management long term with the owners.
(04:53) Sue asks if this approach would change depending on the patient or if this is set in stone and Ralf says he would build it around the patient and the owners and what will work for that case - with Allergen Specific Immunotherapy (ASIT) being his number one preference for environmental allergies as well as liking monoclonal antibody therapy; but he also uses a variety of other medications depending on the lifestyle, symptom and needs of that patient and owners.
(05:50) Sue asks for Ralf to clarify what ASIT is; Ralf clarifies it as 'taking an allergen a patent is allergic to and injecting them with it to expose them to it until the immune system tolerates it'.
(06:45) John asks Ralf to walk through the advantages and disadvantages. He says the first big advantage is relatively low side effects - anaphylactic reaction being one, however he has only seen 5 cases of this in 30 years in dogs and 2 or 3 in cats, so it's very rare. He mentions there is occasionally increased pruritus initially from the therapy, but this can be managed by tweaking the therapy regime. The other big advantage is how specific the therapy is, with other medications being like a band aid and immunotherapy approaching the problem directly by normalising the immune system. The third big advantage is that (medium to long term) it is one of the cheaper therapies. He counters that the disadvantages are that is doesn’t always work for every patient - working well in one third of patients, working not so much in another third and not at all in the final third. It can also take time for the patient to improve and Ralf asks his owners to stick with the therapy for a year before deciding it hasn’t worked. But it is the best long term treatment option available for those patients it does work for.
Chapter 2 - How Immunotherapy?
(11:13) Sue then asks how you select the right allergens to put in the vaccine. Ralf shares his approach - which is firstly to use allergens specific to that dog which has been shown to be more effective than using random allergens. Then he also discusses the number of allergens which can be added to a vial. He listens to the history of the patient - whether it is seasonal and how much they go outside and where - before looking at an allergy test and the positive results on it, in order to to ascertain which allergens are most relevant. Ralf then lists some examples with specific patient lifestyles to demonstrate this process and build a vaccine with the 4 to 10 most relevant allergens, taking into account the prevalence of those allergens in the area the patient lives.
(15:52) Sue then asks if an unsuccessful experience from a vet with immunotherapy may be down to them having simply added all the allergens in a positive test to a vaccine. Ralf feels like this co
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