Treatment of Canine Atopic Dermatitis: Updated Guidelines From the International Committee on Allergic Diseases of Animals ( ICADA )

ABSTRACT Background Canine atopic dermatitis (cAD) is a genetically, aetiologically, immunologically and clinically complex disease requiring both individualised immediate and long‐term management. Objectives These updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA) aim to substantially revise previous recommendations by organising treatment according to mechanism‐of‐action and by distinguishing two therapeutic phases: reactive therapy to resolve existing pruritus and skin lesions, followed by proactive therapy to maintain remission and reduce flares. Materials and Methods The literature was reviewed and recommendations are based, where possible, on randomised controlled trials and systematic reviews, with evidence graded using the Strength of Recommendation Taxonomy. The guidelines review skin barrier care, antimicrobial and microbiome‐modulating interventions, avoidance of nonallergenic and allergenic flare factors, allergen‐specific immunotherapy, and anti‐inflammatory, antipruritic and immunomodulatory treatments. Results Rapid‐acting broad‐spectrum drugs, particularly glucocorticoids, are recommended for reactive treatment. Janus Kinase (JAK) inhibitors and lokivetmab may be effective depending on lesion type, severity and inflammatory complexity. Secondary infections and flare factors must be addressed. Proactive management essential to prevent repeated cycles of inflammation may include skin barrier support, infection control, allergen avoidance, allergen immunotherapy, topical glucocorticoids, ciclosporin, tacrolimus, lokivetmab or JAK inhibitors, selected according to the patient's disease pattern and response. Conclusions and Clinical Relevance A number of interventions are suitable for the treatment of cAD. Interventions are neither universally required, interchangeable nor effective in all cases. Treatment selection should take into account efficacy, safety, practicality, cost, the quality‐of‐life of both dog and owner, and the legal regulations applicable in the country of use.