The Dreaded Wait—Steroid Withdrawal

You have likely been in the position of needing to withdraw glucocorticoid medications from a confirmed atopic patient in order to prepare for serum IgE testing or intradermal skin testing (IDST). Because this can be such a formidable feat for some clients and their pets, it can result in continued symptomatic treatment with steroid agents, with testing never becoming reality.

For patients that are not on glucocorticoid medications, or have only had limited exposure to them within the 90 days prior to testing, the road to serum IgE testing is simple since there is no need to withdraw other supportive medications. Before IDST, in addition to steroid withdrawal, depending on the veterinarian performing the procedure (usually a dermatologist), there is often an additional need to discontinue antihistamines, fatty acid supplements, NSAIDs, and all topical treatments for approximately 7 days prior to testing.It is well known that allergen-specific immunotherapy (ASIT) is the most effective and safe long-term treatment for atopic patients, with efficacy ranging from 65% to 80%. ASIT offers the advantage of appropriately targeted therapy toward problem allergens that other medical options cannot provide. This should be the overarching motivation for following through with the often challenging task of drug withdrawal. The good news is that you can offer alternative therapies during this period to make the experience less daunting for the client and more comfortable for the pet.