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Paper 204 DISC

Veterinary Dermatology 2000, 11, 8398

Review article
Therapy, control and prevention of ea allergy
dermatitis in dogs and cats
DIDIER N. CARLOTTI and DENNIS E. JACOBS*
Cabinet de Dermatologie Veterinaire, Heliopolis B3, av. de Magudas, F33700 Bordeaux-Merignac, France
*Department of Pathology and Infectious Diseases, The Royal Veterinary College (University of London),
North Mymms, Hateld, Herts AL9 7TA, United Kingdom
(Received 12 March 1999; accepted 24 October 1999)

Abstract This article reviews contemporary concepts underlying the design of control strategies for the
management of ea allergy dermatitis in dogs and cats. The limitations of palliative symptomatic approaches
are noted, as is the fundamental requirement to dierentiate simple pulicosis from true hypersensitivity. In the
latter case, eradication of eas from the aected animal and its surroundings has to be an essential aim. The
dierent biological properties oered by modern chemotherapy are dened and the range of techniques for
applying active compounds to the animal and its environment described. Factors for consideration when
formulating control strategies and selecting chemotherapeutic agents are discussed in the context of the
complexities of the ea life-cycle, the host-parasite relationship and client concerns.
Keywords: cat, control, Ctenocephalides felis, dog, FAD, ea allergy dermatitis.

INTRODUCTION
The cat ea, Ctenocephalides felis felis, is the most
important ectoparasite of both dogs and cats in many
parts of the world.1 Associated dermatological signs
are frequently mild, resolving once the eas are
removed. However, ea infestations (pulicosis)
should never be overlooked as the cat ea can bite
other host species and may transmit potentially
zoonotic pathogens such as Bartonella henselae, an
organism associated with cat scratch fever.2 Additionally, uncontrolled ea populations on dogs and
cats can quickly increase to levels provoking pruritus,
self-inicted trauma and even anaemia. Clinical signs
are normally transient. In some individuals exposure
to eas eventually leads to the more serious condition
of ea allergy dermatitis (FAD) also known as ea
bite hypersensitivity (FBH). Once sensitization has
occurred, recrudescence of lesions can be initiated in
some cases by just a small number of bites, although
the threshold of sensitivity probably varies between
individuals. Restoring such animals to health often
requires time, patience and considerable clinical skill.
Correspondence: Didier N. Carlotti, Cabinet de Dermatologie
Veterinaire, Heliopolis B3, av. de Magudas, F33700 BordeauxMerignac, France. Fax: + 33 556 34 35 95.
E-mail: dncvetderm@aol.com
# 2000 Blackwell Science Ltd

1. SYMPTOMATIC AND PALLIATIVE

THERAPY
Successful management of the FAD case ultimately
depends on eliminating the source of allergenic
challenge the ea. While striving towards this ideal,
the veterinary practitioner must also modulate the
disease process to alleviate and curtail the suering of
the patient.
1.1. Symptomatic antipruritic therapy
If the pruritus in FAD is not causing undue
discomfort or self-injury, it is probably better to
avoid the use of symptomatic antipruritic therapy as
scratching may be the only practical indicator
available for monitoring the progress of an antiparasitic strategy. If such therapy is necessary, then
pruritus may be controlled with glucocorticoids
(bearing in mind that dogs may suer serious sideeects from the repeated use of long-acting injectable
forms). Short-term oral glucocorticoid treatment (e.g.
prednisolone, 1 mg kg71 twice daily for 57 days,
followed by 1 mg kg71 on alternate days) may prove
benecial unless bacterial folliculitis is present.3 In cats,
glucocorticoids are well tolerated in both oral and
long-acting injectable forms. Generally, oral antihistamines are not very eective in dogs but may be used
in succession until a result is achieved. Chlorphenir83

Paper 204 DISC

84

D. N. Carlotti and D. E. Jacobs

amine (1 mg kg71 day71) can be eective in cats.4

For localized lesions (erythema, excoriations, pyotraumatic dermatitis), topical steroids or nonsteroidal
topical agents, such as those containing menthol or
hammamelis, may be used. Colloidal oatmeal shampoos and sprays may also relieve pruritus. In general,
symptomatic treatments tend to be either poorly
tolerated (as in the case of the glucocorticoids),
tedious to apply or variably eective.
1.2. Palliative specic therapy
It is not known whether natural desensitization occurs
in dogs or cats continuously or intermittently exposed
to eas but spontaneous remissions in an infested
environment are not commonly seen in practice.
Any casual approach to FAD control, with or
without symptomatic treatment, is therefore unlikely
to provide lasting benet.5 A reliable means of
inducing desensitization, such as that used in canine
atopy, would obviously be of great value in the
management of FAD. A state of nonreactivity
induced by immunotherapy would ameliorate suering in dogs and cats in circumstances where
reinfestation with eas was unavoidable. Immunotherapy (desensitization, hyposensitization) is,
however, primarily eective against type 1 hypersensitivity reactions (as seen, for example, in atopic
dermatitis) and these, unfortunately, form only part
of the complex pathogenesis of FAD. Although
antigen administration may be eective against other
types (particularly type 4) in some situations, the
animals most likely to respond to immunotherapy are
those showing evidence of a type 1 hypersensitivity to
eas (i.e. a positive intradermal test reaction developing within 15 min). Even then, the outcome of
treatment is uncertain and dependent on the relative
prominence of other contributory components of the
immunopathogenic process, as this varies between
individuals. The success rate will be further diminished if concomitant atopic dermatitis and/or bacterial folliculitis is present.
A number of clinical studies have been performed
to evaluate the benet of immunotherapy in FAD. It
is dicult to draw conclusions from these as few
include placebo controls. In addition, a variety of
experimental designs were employed. Carlotti and
Heripret6 reviewed seven open studies in the dog.
Four trials were apparently successful (although
concomitant parasite control measures could have
inuenced the result of one study). Temporary
remission was recorded in one study and there was
no detectable clinical benet in two others. Owing to
the nature of the disease, only double blind studies
can be regarded with condence. Halliwell7 carried
out such a study in dogs displaying positive
intradermal reactions at 15 min. He administered
one intradermal injection each week for 6 weeks,
using a placebo in one group and commercially
available ea extracts in the other. The result was
clearcut no benet was derived from treatment.
# 2000 Blackwell Science Ltd, Veterinary Dermatology, 11, 8398

More recently, Halliwell8 presented the results of a

second double-blind study, again in the dog. This
involved 16 weekly subcutaneous injections of ea
extract in an aluminium hydroxide adjuvant. This
study also failed to show any signicant dierence
between immunotherapy and the placebo treatment.
Only one double-blind study has so far been reported
in the cat. In this, intradermal or subcutaneous
injections of a ea extract were given over 24 weeks.9
There was no signicant dierence between treatment
and placebo groups. Thus, these studies provide no
convincing evidence that immunotherapy is benecial
for FAD control in either the dog or cat. There is
hope that better results may be possible in the future
using dierent allergens and treatment protocols. For
example, Kwochka and coworkers10 have recently
reported, in abstract form, encouraging early results
in a carefully designed double-blinded trial using 22
dogs with FAD. In this, rush immunotherapy with a
proprietary mixture of Ct. felis ea salivary antigens
controlled clinical lesions and pruritus signicantly
better than a placebo.
Until reliable immunotherapy becomes generally
available, preventing the sensitized animal from being
bitten by eas remains the only option for successful
management of FAD cases. This is because symptomatic therapy is of variable ecacy and may be
poorly tolerated.
2. APPROACH TO FLEA CONTROL
The veterinarian must distinguish between simple
pulicosis and FAD if appropriate advice is to be
given. In the former case, a satisfactory clinical result
can be achieved relatively easily without stringent
preventative measures. With FAD, however, the
control objective must always be total elimination
of the ea population within the household. This goal
is not easy to attain as the ea has a high
reproductive capacity and a complex life-cycle.
Eradication therefore requires considerable commitment and expense.
2.1. Diagnosis of FAD
Consequently, if FAD is suspected then a denitive
diagnosis11 is a desirable prerequisite to any control
programme. Intradermal reactions to ea antigens
provide a useful diagnostic tool for use in dogs but
are less reliable in cats. Until more rened and
reliable diagnostic aids are developed, the veterinarian often has to rely on circumstantial evidence, such
as clinical response to ea control, to support clinical
judgement. To complicate matters further, dogs with
FAD are often simultaneously aected with atopy or
other allergies.12 Ideally, a full diagnostic allergy
work-up should be routinely undertaken. Otherwise,
signs attributable to atopy, dietary allergy or intolerance may mask the benets of parasite control and
undermine the owner's condence in the chosen

Paper 204 DISC

Therapy of ea allergy dermatitis
preventative regime. Good communication with the
client is essential.
2.2. Principles of ea control
Single or occasional insecticidal treatments may be
adequate to keep simple pulicosis under control, but
this approach will not break the epidemiological
cycle. The presence of eggs, larvae and pupae in the
domestic environment will ensure that the treated
animal soon becomes reinfested by newly emerged
host-seeking eas. The modern home with tted
carpets and central heating provides ideal conditions
for the development of these life-cycle stages. Fleas
are prolic egg-layers, producing on average 27 eggs
per day which soon drop o the animal.13 Larvae
hatch out and crawl deep into the weave of carpets
and upholstery, under furniture and appliances, and
into cracks and crevices.13,14 New adult eas may
appear within 2 weeks, but emergence from the pupa
can be delayed for more than 5 months,15 so
reinfestation will occur as soon as the residual eects
of the insecticide have disappeared.
As only a few ea bites are needed to induce severe
hypersensitivity reactions in some allergic animals,
the creation of a totally ea-free environment has to
be the objective for FAD control. This requires a
stringent, co-ordinated approach. Thus, ea control
is a three stage process:16

. rstly, to rid each animal in the household of its

resident ea population;

. next, to protect the animals against continuing

assault by host-seeking adults from the environment;
. nally to eliminate the environmental reservoir of
developing eggs, larvae and pupae.

Regular combing of pets with a ne toothed comb

can reduce ea burdens, but is unlikely to remove
more than 2530% of the infestation.17 General
cleanliness and hygiene, particularly energetic vacuuming, can substantially reduce the number of eggs
that succeed in hatching, but only a small proportion
of larvae and pupae are removed.18 Consequently, we
are still largely dependent on chemicals for eective
management of ea-related problems.
3. ADULTICIDES USED IN FLEA
CONTROL
Many insecticidal compounds have been developed
for ea control on animals but the majority belongs
to a relatively small number of chemical groups
(Table 1). How and when they are used in veterinary
practice is often determined by subtle dierences in
their biological and therapeutic characteristics. These
attributes are generally inherent in the molecule but
may be modied by formulation. Care is therefore
needed to select a product that is appropriate both
for the particular circumstances of each individual

85

case and the control objectives set. For example, on

highly sensitive animals, newly arrived adult eas
must be killed quickly to minimize the number of ea
bites; while for in-contact, nonallergic animals, the
primary consideration is to kill adult eas before they
start to lay eggs.
3.1. Adulticidal ecacy
Adulticidal ecacy is the lethal eect of a product
on those eas present on an animal at the time of
treatment (the resident population). It is primarily a
curative eect providing relief from ea infestation.
By itself, it contributes little or nothing to long-term
control as treated animals in a contaminated
environment will soon become reinfested. If applied
as a spray, spot-on or tablet at the correct dose-rate,
most modern products will give close to 100%
adulticidal ecacy.19
3.2. Speed of kill and knock-down
Following treatment of an animal, the lethal eect of
a product on a ea population may start within
minutes or may take up to 48 h, depending on the
rate at which eas absorb the active compound, its
mode of action, the formulation and route of
administration. Speed of kill is also dependent upon
the concentration of the active compound on the
skin or coat and therefore declines with time
following treatment.
Speed of kill is of practical signicance in three
separate contexts:

. when animals harbour a large resident ea burden,

the quicker the parasites are killed then, obviously,

the more rapid is the relief from the irritant eects
of that infestation;
. secondly, the speed at which newly arrived eas are
killed is of importance in the case of hypersensitive
animals exposed to reinfestation as the more
quickly these succumb, the smaller the exposure
to ea bite antigens and the lower the risk of FAD
lesions persisting or of a relapse occurring;
. nally, in longer term preventative programmes, it
is important that newly arrived eas should be
killed before they start to lay eggs at 2436 h after
taking their rst blood meal.1
`Knock-down' is a term that has been used very
loosely with respect to ea control. Bourdeau19 points
out that in pest control jargon this term describes the
ability of aerosol formulations to bring down ying
insects while on the wing. The eect need not be lethal
but can be achieved by temporary paralysis. He
observes that it is therefore incongruous to use the
phrase `knock-down' to describe the cumulative
insecticidal ecacy of a pulicide over 24 h (the rst
observation point in most ecacy studies). He argues
furthermore that, if this term is to be used for
nonying biting insects, it should indicate a rapid
lethal or paralysing eect capable of controlling
feeding activity. Fleas normally initiate feeding within
# 2000 Blackwell Science Ltd, Veterinary Dermatology, 11, 8398

Paper 204 DISC

86

D. N. Carlotti and D. E. Jacobs

Table 1. The main insecticides and insect growth regulators used against eas on animals and/or in the environment
Chemical group

Mode of action

Organochlorines

not well understood,

lindane
inhibition of cytochrome
oxidase, inhibition of GABA
cholinesterase
chlorpyrifos, coumaphos,
inhibition (irreversible)
crotoxyphos, cythioate,
diazinon (dimpylate),
dichlorvos/fenitrothiona,
fenthion, iodofenphos
tetrachlovinphos
cholinesterase
carbaryl, propoxurb
inhibition (reversible)
bendiocarb

Organophosphates

Carbamates

Examples

Comments

Natural pyrethrins

enzyme inhibition
(including cytochrome
oxidase)

`pyrethrin' (extracted
from several species of
Chrysanthemum)

Synthetic pyrethroids

act on Na channels of
nerve axons causing
initial excitement then
paralysis
targets NADH oxidation
and subsequent
generation of ATP

bioallethrin, cyuthrin,
cypermethrin,deltamethrin,
fenvalerate, umethrin,
permethrin, sumithrin
extract of roots from
papilionaceous plants
(sometimes combined with
piperonyl butoxide)
pronil

Rotenones

Phenylpyrazoles

Chloronicotinyl
nitroguanidines
Avermectins
Mineral insecticides
Activated orthoboric
acid
Insect growth
regulators (IGRs)

noncompetitive
inhibition of gamma
amino butyric acid
(GABA)
binding to nicotinyl
receptors on the post
synaptic neurone
open specic glutamate
chloride channels in
post-synaptic membranes
desiccation
desiccation
benzoyl urea derivatives
inhibit chitin synthesis
juvenile hormone
analogues disrupt
development of eggs,
larvae and pupae
triazines disrupt insect
growth regulation

imidaclopridc
nitenpyramd

long residual activity

selemectin
silica gel
diatomaceous earth
sodium polyborate
diubenzuron, ufenoxuron
lufenuron
fenoxycarb, methoprene,
pyriproxifen
cyromazine

very persistent; polluting;

toxic to cats; banned from
use in some countries
topical or systemic action
(fenthion, cythioate);
short residual action;
chlorpyriphos may be
encapsulated;
a
in combination
weak residual action;
b
sometimes combined with
umethrin
immediate knock-down eect;
inherently weak residual action
improved by use of synergist
(piperonyl butoxide); may be encapsulated.
fast knock-down; some
also repellent; inherently
moderate residual action
can be extended by formulation
weak residual action

long residual activity, skin detritus

has larvicidal eect
d
short acting, no published
information at time of writing*
earlier compounds in this group
inactive; attributes of selemectin
not yet published**
for environmental use; adulticidal;
moderate residual action
for environmental use; active against
larvae; long residual action
IGRs primary action is not
adulticidal, but their activity
on developing stages can be
used to break the ea life-cycle;
long residual activity; often used
with an adulticide

Notes: the list is not comprehensive; some of the compounds listed are not for use on animals and may not be available in all countries; many
are potentially toxicsee data sheets for information on safe use. *one paper subsequently published:78 **only preliminary data available at
time of writing;79 for information subsequently released see Proceedings of the American Association of Veterinary Parasitology, July 10-13
1999, New Orleans.

minutes of nding a host. In one recent study,20 100%

of male eas and 96.2% of females were found to have
taken blood within an hour of being placed on cats.
There are few published data on speed of kill, but
some formulations containing dichlorvos or permethrin are acknowledged to have a particularly rapid
onset. In one series of controlled studies reported in
abstract form, a potent knock-down eect was
reported when dogs were experimentally infested at
weekly intervals from one day after treatment with a
permethrin/pyriproxyfen combination applied as a
spray or spot-on (line-on).21,22 In weeks one and two
# 2000 Blackwell Science Ltd, Veterinary Dermatology, 11, 8398

more than 90% of the eas had fallen from the dogs
within 15 min. At weeks three and ve, a similar result
was achieved within one and four hours, respectively.
In another study,23 imidacloprid gave almost 90%
control of a residual ea population within 8 h and
100% within 12 h. On reinfection, 93100% control
was achieved within 2 h up to three weeks following
treatment and within 8 h after 28 days.
3.3. Repellency and ushing eects
There are two forms of repellency. In the rst, eas
are deterred by the vapour phase of a compound.

Paper 204 DISC

Therapy of ea allergy dermatitis
Examples include DEET (N,N-diethyl-m-toluamide)
and some citrus oils, such as Oil of Citronella.24
Although very eective in vitro, the extent to which
such substances prevent host-seeking eas from
jumping onto treated animals is unclear and so in
FAD this approach should be regarded as an adjunct
to, rather than a replacement for other control
measures. In the other form of repellency, the ea
has rst to come into physical contact with the
substance and then moves away. In pest control
jargon, this is known as a `ushing eect' and is the
mechanism exhibited by some synthetic pyrethroids.19 This eect probably contributed to the
knock-down potency of permethrin described in
3.2. above.21,22
3.4. Antifeeding eects
When controlling FAD, particularly in highly sensitive animals, there is an obvious advantage in
selecting treatments that deter as many eas as
possible from biting. When animals become reinfested after treatment, the proportion of eas that
succeed in taking a blood meal varies according to the
compound and formulation used, the dose and the
time that has elapsed since the last treatment. The
reduction in the number of eas that succeed in
feeding is the summation of several possible contributory factors including repellency and/or ushing
eects and nonlethal and/or lethal knockdown
activity. The observation that living, unfed eas are
sometimes seen after several hours insecticidal
exposure may indicate an additional `anti-engorging
eect', perhaps analogous to that reported for ticks
exposed to sublethal concentrations of amitraz.19
Few comparative data have been published on
summated antifeeding eects, but Franc and Cardiergues20 showed that the proportion of eas feeding
on cats within one hour of infestation was reduced by
more than 90% for 7 days after permethrin treatment
and by more than 80% for 3 days after use of a
dichlorvos/dinitrothion preparation. Relatively little
antifeeding activity was observed with pronil and
imidacloprid during this rst hour with most
recorded values being around 35% for pronil and
varying between 2 and 50% for imidacloprid during
the corresponding period. Dryden (reported in
abstract form25) also found that a high proportion
(3189%) of eas on cats killed by pronil and
imidacloprid had taken a blood meal before succumbing. Similar trends have been recorded with the
treatment of ea infestations on dogs.21
3.5. Persistent ecacy
Persistent ecacy is a valuable adjunct to short-term
adulticidal activity as it protects against reinfestation
and reduces egg production for a prolonged period.
The initial curative eect (section 3.1) is therefore
supplemented by a preventative eect. Duration of
activity varies from a few hours to several weeks,
depending on the inherent properties of the active

87

compound, the dosage, formulation and method of

administration. Care is needed in interpreting persistency data from experimental studies as ecacy values
may be aected by factors such as the interval between
infestation and counting.16 Residual action is generally
more prolonged in dogs than cats. In one series of
trials, for example, the ecacy of fenthion three weeks
after treatment at recommended dosage rates was 99%
and 41% on dogs and cats, respectively.26,27 Persistency may result from the active compound binding to
hair or skin, being released slowly from a body
reservoir (for example, the sebaceous glands in the case
of pronil28) or from a special formulation (a collar or
microencapsulated particles).
Preparations such as pronil (reported in abstract
form29,30), imidacloprid16,31 and some formulations
containing permethrin21 have considerable residual
activity extending 4 weeks, or sometimes more, from
the time of treatment. A high percentage of hostseeking eas arriving on a treated animal during this
period will be killed, thereby aording protection
against reinfestation, although, as noted in section
3.2, the speed of kill will decline with time and vary
with compound. Fleas seen on a treated animal under
conditions of heavy challenge do not necessarily
indicate failing ecacy as these may be new arrivals
that have not yet been on the animal long enough to
receive a lethal dose. This is particularly true in the
case of synthetic pyrethroids. These compounds
initially produce hyperexcitability and aected eas
are readily visible on the pelage.
3.6. Larvicidal eects
Trace amounts of some adulticidal preparations may
be transferred from an animal to its immediate
surroundings in quantities sucient to kill ea larvae.
For example, dermal debris from imidacloprid
treated dogs reduced ea numbers by more than
96% for 42 days in an experimental room.32 In a
controlled study, ea development on blankets used
by caged cats during the rst and fourth weeks after
treatment with imidacloprid was reduced by 100%
and 75%, respectively.33 There is an indication that
early larval stages may succumb if they come into
contact with hair from pronil treated dogs (reported
in abstract form34).
3.7. Other biological properties
As well as being ecacious, products recommended
for ea control should be safe to use and well
tolerated by the treated animal. Safety is an
important consideration during the regulatory process and so there should be no problem with licensed
products if used strictly as directed. Nevertheless,
some preparations have greater safety margins than
others and, before selecting any particular control
measure, veterinarians should take account of the
potential risks and consequences of accidental overdosage35 or human exposure. Products containing the
same active compound do not necessarily have an
# 2000 Blackwell Science Ltd, Veterinary Dermatology, 11, 8398

Paper 204 DISC

88

D. N. Carlotti and D. E. Jacobs

identical safety prole. This may be inuenced by the

nature of the formulation and the concentration of
the chemical in the product. Some products licensed
for use in dogs may be toxic if given to cats. Labels
and data sheets should be read carefully and any
contraindications, expiry dates or other specic
advice heeded.
4. INSECT GROWTH REGULATORS
Insect Growth Regulators (IGRs) dier from adulticides in that their primary action is to disrupt
developmental processes. They fall into two main
categories: the Juvenile Hormone Analogues (JHAs)
and Insect Development Inhibitors (IDIs). JHAs are
absorbed through the insect cuticle and prevent the
activation of genetic switches determining the sequential development of organs and tissues in
immature insects.36 Eggs laid by eas on animals
treated with methroprene37 or pyriproxifen38,39 will
fail to hatch. JHAs also cause cytological damage in
insects and, with prolonged exposure, pyriproxyfen
may prove lethal even to adult eas.36 IDIs inhibit
chitin synthesis, thereby disrupting the normal
formation of cuticle, mouthparts and other chitinous
structures. Lufenuron, for example, acts systemically
so that female eas taking a blood meal from a
treated animal will lay infertile eggs.40
IGR ecacy can persist for a prolonged period on
the animal, depending on formulation and dose-level.
For example, a high level of ovicidal activity was
maintained for at least a month with oral lufenuron40
and topical methoprene37 while a period of at least 7
weeks has been recorded for topical pyriproxyfen.38
5. ANIMAL TREATMENTS
Formulation not only inuences the biological and
therapeutic properties of a compound but provides
the veterinarian with a choice of methods of
administration (Table 2). Client compliance is extremely important in FAD cases and recommended
products must be easy to apply. Whereas lotions,
powders and sprays are useful, preference is often
shown for pump-sprays, foams and spot-ons.
5.1. Shampoos
Shampoos are aqueous solutions modied by the
addition of a tensio-active agent or surfactant (soap
and/or detergent). Additives may be included to
enhance the appearance and odour of the coat or to
soothe irritation and pruritus. Insecticidal shampoos
often contain synthetic pyrethroids chosen for their
rapid knock-down eect. These are best used as a
convenient one-o treatment to rid an animal of a
resident ea infestation. As there is usually little or no
residual action once the shampoo is rinsed o, the
treated animal is immediately vulnerable to reinfesta# 2000 Blackwell Science Ltd, Veterinary Dermatology, 11, 8398

tion by host-seeking eas. Normally, therefore,

shampoos have limited application in the long term
management of FAD. Recently, a shampoo containing deltamethrin (0.07%) has been shown to maintain
a 4 90% antifeeding eect during the hour following
challenge for one week.41
5.2. Antiparasitic collars
Antiparasitic collars are widely used to control eas.
Because of the risk of cumulative toxicity, it is not
appropriate to combine the use of collars with other
medication. Flea collars themselves may sometimes
induce a contact dermatitis (allergic or irritant).
Many are made of pliable polyvinyl chloride incorporating an insecticide which migrates to the surface
to be released at a controlled rate. The active
ingredient is released from the collar either as:

. a vapour (e.g. dichlorvos) which is active while

trapped in the air held in the animal's coat;

. a powder (e.g. carbaryl, propoxur);

. a liquid (e.g. diazinon).

In each case, the movements of the animal assist

the spread of insecticide through the coat and around
the body. Optimum concentrations build up relatively slowly42 and are unlikely to be maintained over
the whole body surface for the full life of the collar.
Thus, at least a proportion of eas will take a blood
meal before succumbing to the insecticide. This may
explain why, in the experience of many veterinary
dermatologists, ea collars fail to protect against
FAD. Collars are very popular with pet owners
because of their ease of application and long duration
of activity (several months). They may, however,
engender a false sense of security and thereby lead to
loss of interest in applying environmental control
measures. As few collars indicate when they are
depleted, they may be left on the animal after activity
has ceased. In summary, insecticidal collars are useful
for controlling simple pulicosis but should not be
considered for the treatment of FAD.
5.3. Insecticidal lotions
Insecticidal lotions are generally emulsions of insecticide (usually compounds of low solubility) which
are applied over the whole body surface of the dog.
Some are suspensions of wettable powders. Lotions
are prepared for use by mixing a measured volume
with water and are usually given subsequent to the
use of a medicated shampoo. They are very eective
for 23 days, the concentration of insecticide (e.g.
diazinon, crotoxyphos, coumaphos) at the skin surface being sucient to kill eas rapidly during this
time. In addition, a small amount of emollient may be
added to the lotion if the animal has seborrhoea. The
regular application of lotions is, however, very
astringent and owners may get tired of their
unpleasant smell. These preparations are dicult to
use in the cat and may be toxic in this species.

Paper 204 DISC

Therapy of ea allergy dermatitis

89

Table 2. Some insecticidal and IGR formulations used on dogs and cats
Formulation

Use:
dog

cat

shampoos

easy

collars
lotions
(dips)
powders
sprays
(aerosols)
pump-sprays
foams
spot-ons/
line-ons
systemic
-spot-on
-oral adulticide
-oral IGR
-injectable IGR
1

Composition

Residual
eect

Indication:
Comments
simple
FAD
pulicosis

dicult

adulticide

none

yes

no

easy

easy

adulticide
or IGR

24 months

yes

no

easy

adulticide1

23 days

yes

yes

dicult:
risk of toxicity
easy

adulticide

23 days

yes

yes

easy

dicult

adulticide

23 days

yes

yes

easy

14 + weeks

yes

yes

easy
easy

easy
easy

adulticide1
adulticide + IGR2
adulticide
adulticide
adulticide + IGR

23 days
24 + weeks

yes
yes

yes
yes

easy
easy
easy
*

easy
+
easy
easy

2 + weeks
none
4 weeks
6 months

yes
yes
yes
yes

no
no
no
no

adulticide
adulticide
IGR
IGR

rinsing removes insecticide

with most
not always completely
eective; contact allergy
sometimes occurs
inexpensive, but may be
malodorous
risk of build-up in the coat
if more than one dose given
dicult with nervous animals
good residual action;
relatively expensive
particularly suitable for cats
a recent innovation but widely
used
exposure depends on eas biting
\useful adjunct to
\adulticide treatment

may be encapsulated; 2may contain a lming agent to increase persistence; *none available at time of writing

5.4. Insecticidal powders

Insecticidal powders are inert substances (like talc)
containing one or more insecticides in solid form.
They are applied directly onto the skin after parting
the hair (either by gloved hand or with a comb) and
into the coat. They are very eective for 23 days,
especially those containing pyrethroids. The areas
of the coat where powder has been applied are
readily visible and it is therefore easy to ensure that
the whole body surface has been treated. If
treatments are repeated, powders can accumulate
in the coat. This, of course, is undesirable and may
not be detected by owners of dark or long-coated
animals. Powders are convenient for use in cats with
FAD, particularly timid individuals. They are,
however, astringent.
5.5. Aerosols
Aerosols are widely used. Very small particles of
insecticide (in liquid or solid form) are projected
under pressure by a biologically inert (but sometimes ammable) propellant onto the animal. They
are easy to use and can be applied to the whole
body surface. Most remain eective for at least
23 days if applied carefully, right up to the skin,
parting the coat either manually or with a comb.
Timid animals, especially cats, are often frightened
by the noise of emission, the coldness of the jet
and the cloud of particles produced. Sprays are
useful for short-term treatments. For example,
animals with FAD about to visit a potentially
infested environment or, alternatively, on healthy
but infested animals about to mix with an animal
with FAD.

5.6. Pump-sprays
Pump-sprays are convenient to use and cheaper than
aerosols. The liquid formulation is propelled as a
shower of ne droplets onto the animal. This form of
application is extremely eective on the animal for
one or more weeks, depending on the compound,
concentration and formulation. Some preparations
contain a lmogenous agent which is claimed to
prolong the duration of activity. Pump-sprays provided a great advance in the treatment of FAD in
dogs4345 and have been evaluated in cats.46 Copious
applications (i.e. in excess of label instructions) may
be toxic in the latter species. The veterinarian can ll
small pump-sprays with emulsions normally used as
lotions. This eases application of the lotion but
ecacy is probably reduced and blockage of the
nozzle can occur.
5.7. Insecticidal foam
A recent innovation is insecticidal foam. The formulation is supplied in a pressurized canister and
emerges as a foam when the nozzle is depressed. The
foam is propelled onto a gloved hand and then rubbed
into the coat. It is particularly convenient for use with
timid cats, especially when once or twice weekly
treatments are required for controlling FAD.47
5.8. `Spot-on' and `line-on' formulations
`Spot-on' formulations are small volume liquid
presentations which are squeezed from a single-dose
plastic pipette directly onto one spot on the skin (on
the neck or between the shoulder blades) or sometimes at two sites (neck and rump). A variation of this
theme is the `line-on' which utilizes a slightly greater
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Paper 204 DISC

90

D. N. Carlotti and D. E. Jacobs

volume deposited along the dorsal midline from

rump to neck. In either case, the insecticide spreads
from the site of application, either by diusing over
the body surface or by being absorbed and acting
systemically. `Spot-ons' and `line-ons' are very convenient and some give protection against reinfestation for at least one month, although washing or
shampooing probably reduces this period. Some
spot-on formulations (but not those acting systemically) can be eective in treating FAD in dogs with
positive skin-tests to ea extracts.48,49
Care is required in the interpretion of claims for
controlling FAD with spot-ons and other types of
formulation, as dierent experimental designs, diagnostic criteria and clinical scoring methods are used.
Diagnostic protocols in particular vary in their
stringency and dog studies do not always include
skin testing.
5.9. Systemic applications
Systemically acting compounds may be administered
by mouth (e.g. cythioate, lufenuron), as a spot-on
(e.g. fenthion) or by injection (e.g. lufenuron).
Generally, such compounds are not indicated for
the treatment of FAD as, by denition, the ea has
to bite to become exposed. Lufenuron, when used in
conjunction with adulticides, has a role in longer
term control programmes (see section 7.2). The
injectable form of this compound, currently available
only for cats, provides a subcutaneous depot of
lufenuron claimed to maintain IGR activity for up to
six months.50
6. TREATMENT OF AN INFESTED
ENVIRONMENT
Traditionally, control of eas in the domestic
environment has been achieved by applying chemicals directly onto surfaces where eggs, larvae, pupae
and emergent adults might be found (Table 3). This
approach can be very eective provided that all
potential `hotspots' (i.e. areas where large numbers of
life-cycle stages may accumulate) are covered.51
6.1. Veterinary insecticidal powders
Veterinary insecticidal powders can be used indoors on
small surfaces but they are impractical, messy and not
very eective. Application must be followed by
vacuuming. Some fresh powder should be put in the
vacuum cleaner bag in case any live eas are sucked up.
6.2. Mineral insecticides
Powders containing mineral insecticides (e.g. diatomaceous earth) are suitable for use outdoors. Inside,
sodium polyborate is remarkably eective and widely
used in North America.51 Mineral insecticides and
boric acid derivatives are metabolically inactive
exerting their eect by dessication, although the
latter has to be ingested by the ea larva.52 When
# 2000 Blackwell Science Ltd, Veterinary Dermatology, 11, 8398

applied under pressure throughout the house on rugs,

carpets, oors, cupboards and furnishings (especially
those covered in fabric) by a trained technician, the
residual action should persist for over a year, even
when regular cleaning and vacuuming is practised.
This treatment is very convenient, nontoxic and
relatively inexpensive.
6.3. Aerosols
Aerosols are available to treat the environment: these
include veterinary and general household insect
sprays. Most contain JHAs such as methroprene,
fenoxycarb or pyriproxifen, or IDIs such as diubenzuron or cyromazine.1 These may be combined
with an adulticide. Aerosols are eective but cost and
practicality often restrict their use to relatively small
areas (habitual resting places, dog-kennels, cars, etc.).
6.4. Foggers
Foggers are aerosols supplied in pressurized containers that once triggered rapidly emit all their contents.
They are easy to use and particularly suited for
carpeted areas. The choice of diusers of dierent
sizes enables all rooms in the house to be treated.
After rst calculating the amount of oor space in
each room (including passageways, corridors and
halls), they are distributed in a logical manner to
ensure complete coverage. Non-food cupboards and
wardrobes should be open during treatment, but
foodstus should not be left exposed. Fish tanks and
reptile vivaria must be carefully protected as some
insecticides (e.g. permethrin) are toxic to some coldblooded animals. Although less sensitive, cage birds
must be removed from the house. After 23 h, fresh
air is allowed to circulate for at least about half an
hour. Many foggers contain an IGR and an
adulticide. Prolonged residual ecacy (up to 6
months) is possible, although penetration depends
on particle size. The cost of such treatment is
moderate to high depending on the area to be
treated. Additional treatment of particular `hot
spots' is recommended.
6.5. Pump sprays
Pump-sprays are convenient to use in any location
and are better than aerosols for treating large areas.
They are less practical than foggers and tend to be
used outside and for the treatment of `hot-spots' in
rooms with tiled oors. Pumps-sprays emitting a
microencapsulated agent may be active for several
weeks. However, ecacy is reduced both by regular
vacuum cleaning and by uctuations in temperature.
For large noncarpeted areas (kennels, garages,
cellars, wine-cellars, attics, boxrooms, etc.), pumpsprays may be used containing either emulsions used
as lotions or, especially, suspensions of wettable
powders (such as permethrin formulations used in
stables to control ies). Large sized pumps (510 L)
are then used. Outdoor areas (sand, gravel, terraces)
can also be treated in dry weather. Ecacy can

Paper 204 DISC

Therapy of ea allergy dermatitis

91

Table 3. Insecticidal and IGR formulations used in the environment

Formulation

Target
indoor outdoor

pump-sprays

yes

aerosols
-restricted veterinary use

Residual
eect

Comments

small areas adulticide + IGR

or microencapsulated
adulticide

a few weeks
to a few
months

residual eect depends on quantity used

and cleanliness of surfaces

yes

no

a few days

residual eect depends on quantity used;

expensive

-for general use

yes

small areas adulticide + IGR

foggers

yes

no

adulticide + IGR

yes
no
yes
+

adulticide
desiccant
desiccant
adulticide

powders
-for veterinary use
-diatomaceous earth
-sodium polyborate
suspensions of wettable
powders
outdoor pump-sprays

no

small areas
yes
no
yes if dry
weather
yes

for garden-hose attachments

no

yes

Composition

adulticide

a few days to earlier products

a few months contained no IGR
* 6 months easy to use; should be distributed throughout
house

adulticide + IGR
or microencapsulated
adulticide
adulticide + IGR

persist for several weeks, except outside in persistent

wet weather.
6.6. Special devices for outdoor areas
Preparations may be specially formulated for use
with devices, such as one that can be xed to a
garden-hose, designed to facilitate application to
outside areas.
7. ON-ANIMAL ENVIRONMENTAL
CONTROL
While direct application of chemicals into the
environment should be safe if products are used
strictly according to label recommendations, some
clients have concerns about the widespread use of
biologically active substances in and around the
household. The recent development of new longacting adulticidal and IGR treatments has enabled
alternative methods to be developed that utilize
animal treatments to break the ea life-cycle. This
approach has the advantage that only trace amounts
of chemical are released into the environment and
that these are targetted to the places where the
greatest mumbers of ea eggs are likely to occur.
7.1. Adulticides
Theoretically, stringent control of adult eas on all
animals in a household will prevent any eggs from
dropping to the ground. The reservoir of o-host
developmental stages will thereby be progressively
depleted as there will be no new developing larvae to
replace `hatching' pupae. In experimental models,
this objective has been achieved by using long-acting
adulticides to kill newly acquired eas before they
start to lay eggs. In this way, monthly treatments with

a few hours
unknown
1 year
a few days to
a few weeks
a few weeks

low ecacy
not widely available
may be applied by client or by a contractor
also useable in
kennels and other uncarpeted areas
easy to use

a few weeks

easy to use

imidacloprid or pronil have been shown to provide

apparently complete protection under conditions that
provide opportunity for severe challenge, even when
new eas are put on the animals each week to
simulate the roaming animal becoming infested on a
neighbour's property.53,54 With imidacloprid, this
eect is assisted by trace amounts of the compound
in skin debris from the animals exerting a larvicidal
eect in the environment.32,33 These results suggest
that the ea life-cycle can be broken by a series of
carefully timed on-host applications of potent longacting adulticides.
Further experience is needed to determine to what
degree these experimental results are reected in the
eld, particularly in warm, humid climatic regions
where the ea life-cycle can be completed outside the
home and challenge pressure can be very high. In a
small pilot study, Dryden (reported in abstract
form25) was able to recover small numbers of viable
eggs from cats infested in the third and fourth weeks
following pronil or imidacloprid treatment. This
suggests that, where challenge is high, a treatment
interval shorter than the recommended month may
be needed to minimize the risk of resistant strains
developing. An alternative strategy would be to
combine adulticidal treatments with the use of an
IGR55,56 to ensure that any eggs produced by
surviving eas are infertile.
7.2. Insect Growth Regulators
IGRs can also be used for depleting the environmental reservoir of ea infestation as pupae cannot
accumulate if eggs falling to the ground are infertile.
The use of oral lufenuron for this purpose is now well
established and has been evaluated in experimental
models57,58 and extensively in the eld.59,60 Following
treatment of the host, eas are exposed when they
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Paper 204 DISC

92

D. N. Carlotti and D. E. Jacobs

take a blood-meal. An initial reduction in ea fertility

of 100% reducing to 98.2% at 32 days post-treatment
has been recorded.57 More recently, an injectable
lufenuron formulation has been developed which
renders eas infertile for up to 26 weeks posttreatment.50 In cases of simple pulicosis, lufenuron
has the advantage of simplicity in a domestic hygiene
programme. It may keep a ea population in check or
even eradicate it in a closed environment. However,
closed environments in an urban or suburban setting
are exceptional and some exposure to new parasitic
infestation is often unavoidable.61 Even a few bites,
received regularly, may provide sucient allergenic
load to perpetuate FAD in highly sensitive individuals. It is therefore normal to supplement IGR
treatments with an adulticide in the initial phase of a
control programme and subsequently if the animal is
exposed to challenge. In a controlled clinical trial
(reported in abstract form62), 102 dogs with FAD
were given three insecticidal treatments at fortnightly
intervals. They also received lufenuron or a placebo
at monthly intervals. Initially, clinical success was
recorded in 79 and 71% of cases, respectively. Over
the next 10 months, relapses were observed in 60% of
the `cured' placebo-treated dogs but in only 35% of
the lufenuron group.
There is less published information on the onanimal environmental use of other IGRs, but work
with an experimental spot-on formulation of pyriproxyfen38 showed that a single dose of 1 mg kg71
prevented ea reproduction on cats for seven weeks
and made substantial reductions in ea fertility for at
least two further weeks. The sensitivity of eggs to
methoprene and pyriproxyfen decreases with time
after they are laid63 and so topical animal treatments
have the advantage that the eggs, which stay on the
animal for a few minutes to a few hours before
dropping to the ground,13 are exposed to the IGR
during the period of greatest vulnerability.55
It has also been shown that sucient pyriproxyfen
may be transferred from the pelage of a treated
animal to its bedding to inhibit all larval development
for at least two weeks after treatment.38 Thus,
topically applied pyriproxyfen may accelerate the
rate at which an environmental reservoir can be
depleted, since larvae from eggs deposited before
treatment (or subsequently by nontreated animal
visitors) will fail to pupate.
7.3. Vaccination
The recent introduction of the Australian TickGARD concealed antigen vaccine for the control of
the ixodid tick Boophilus microplus on cattle64,65
provides hope that a similar vaccine might become
available for ea control. Recombinant technology is
used to produce a vaccine based on a functionally
important molecule in the parasite's gut. When a
blood meal is taken, antibodies damage this site
resulting either in the death of the parasite or in a
substantial reduction in the number of eggs it
# 2000 Blackwell Science Ltd, Veterinary Dermatology, 11, 8398

produces. Thus, the vaccine is used as an epidemiological tool to limit future numbers of host-seeking
parasites in the environment. Published experiments
with ea vaccines have, so far, had mixed success66,67
but if a suitable antigen and adjuvant can be found,
vaccination should provide a convenient way of
reducing the number of eas in a household. A
disadvantage of this approach, however, is that the
ea has to bite to become exposed to the antibody.
This will limit the usefulness of any vaccine of this
type in the short term control of FAD.
8. STRATEGIES FOR FAD CONTROL
Faced with a bewildering variety of compounds,
formulations and methods of use, how can these
theoretical concepts be synthesized into a practical
control programme? Cases vary so much with regard
to environmental conditions, presence of in-contact
animals, type of allergic animal (dog or cat, breed,
behaviour towards in-contacts, reactions to treatment, etc.), that it is impossible to propose an ideal
universal therapeutic plan; every case is unique.
Control objectives and a strategy for their attainment
have to be carefully dened. With this in mind,
products should be selected on the basis of biological
activity, ecacy, frequency and ease of administration, potential toxicity, cost, etc. The owner needs to
be questioned thoroughly and the advice given must
be clear, unambiguous and tailored to their needs and
abilities; a poor understanding of the problem by the
owner will inevitably lead to failure. It is, therefore,
the duty of the practitioner to be informative. Flea
control is often expensive and this can lead to
noncompliance and the failure of the programme.
On the other hand, the shortcomings of parasitic
control measures that compromise on cost may
present a poor image of the practitioner.
8.1. Initial elimination of eas from animal
The initial step of providing immediate relief from a
resident ea population is the simplest and the one
for which there is the widest choice of remedies. Any
product which provides a good adulticidal eect
within a reasonable period of time will achieve this
purpose. All in-contact animals should be treated as,
even if clinically unaected, they may be infested
and act as a source of ea eggs, thereby perpetuating
the problem.
8.2. Protection from reinfestation
Animals will often be exposed to reinfestation after
their rst treatment. If conned to the house, they
will encounter new host-seeking eas emerging from
pupae in carpets, furniture, etc. for several weeks.
Outside the home, pets may pass through areas where
other animals have dropped ea eggs providing foci
for transmission. Adult eas may sometimes be
acquired by direct contact with other animals.

Paper 204 DISC

Therapy of ea allergy dermatitis
Although Ct. felis is usually permanently resident on
its host,15 some eas may transfer between animals in
close proximity.68,69
Protection from reinfestation can be provided in a
number of ways and choice of product will be
determined, inter alia, by factors such as the possible
or likely challenge pressure and degree of hypersensitivity of animals at risk. Agents with a good
antifeeding eect, such as permethrin20,21 or dichlorvos/fenitrothion,20 should be selected in cases of
persistent exogenous infestation or for highly sensitive
individuals.43,47,48 Some permethrin formulations
claim to combine good antifeeding and long residual
eects.55 Moderately sensitive individuals (i.e. those
able to tolerate a few bites) can be treated with slower
acting insecticides, such as pronil44 and imidacloprid,49,70,71 which kill eas within a few hours and give
long-term benets by reducing the ea population and
hence antigenic challenge over time.55 For in-contact
animals not sensitized to ea-bites (i.e. cases of simple
pulicosis), the use of a slower acting preparation or an
insecticidal collar may also be sucient.
Remedies with residual activity lasting a few days,
such as insecticidal shampoos and some sprays, need
to be used at frequent intervals during periods of risk.
More convenient, however, are longer acting adulticides which maintain residual ecacies in excess of
95% for two to four weeks or more. In cases of FAD,
highly eective insecticidal formulations such as
pump-spray, spot-on, line-on or, for cats, foam
preparations are indicated. Systemic treatments such
as cythioate (which is no longer available in all
countries) should not be used for FAD cases but are
useful in nonallergic cats living in contact with
allergic dogs.72
8.3. Eradication programmes
In the management of FAD cases, the main benet of
using insecticidal preparations with a long residual
eect, such as pronil, imidacloprid and some
permethrin formulations, is that carefully programmed applications (as described in section 7.1)
will progressively reduce the number of host-seeking
eas in a household and, hence, the antigenic
challenge. In a closed environment, total eradication
of a ea population should be a realistic goal if a
logical strategy is applied and meticulous care is
taken (Table 4).
Whether reliance is placed entirely on animal
treatments with long acting insecticide and/or an
IGR, or whether these are supplemented by direct
environmental applications with insecticides, IGRs or
borate preparations depends on factors such as:

. the current and probable future challenge pressures;

. the degree of hypersensitivity of the patient;
. the ability of the owner to follow precise instructions;

. the opportunities for extraneous eas to be

introduced from outside the home.

93

If animal treatment is combined with direct

application of chemicals to the environment, suitable
combinations should be chosen to avoid enhancing
potential toxic hazards.
If direct application of an insecticide or IGR to the
environment is to be attempted, then careful attention should be given to the treatment of `hot-spots'.
Flea eggs have smooth shells and pass through the
pelage as the animal moves, generally falling to the
ground within a few hours.13 The highest numbers
are found where the pet spends most time, particularly where it most frequently rests or sleeps.1 High
concentrations also occur at sites of energetic activity
such as, for example, where a cat habitually jumps
onto a surface.14 The larvae move away from light
and can travel for distances of up to 46 cm, although
many go no more than 15 cm.1
Concentrations of larvae and pupae may therefore
be found in locations inaccessible to the pet such as
underneath furniture and behind skirting boards.
`Hot spots' may be easily overlooked, particularly in
less obvious places visited by the pet or other animals,
such as cellars, outbuildings, cars and, in warmer
weather, the garden. Even if foggers have been used,
sprays or pump-sprays should be used on `hot-spots'
to ensure total protection.
A signicant proportion of pupae in substrates
such as carpet can survive the application of insecticides
and IGRs. This may be due to lack of penetration of
the chemical to the sites of pupation rather than any
inherent lack of susceptibility.15 Subsequently, new
adult eas may continue to emerge for up to 4 weeks
after insecticidal treatment, although this period may
extend up to 140 days.73,74 This phenomenon, known as
the `pupal window', has to be considered in formulating
control programmes. Consequently, environmental
control products are required that provide residual
activity for at least one month. Excessive cleaning of
carpetting and other surfaces may decrease the
eectiveness of such products. Where ea problems
are seasonal, there is an obvious advantage in
initiating control programmes as early as possible,
i.e. before too many pupae have accumulated.
The `pupal window' is also an important consideration if on-animal treatments are used for
environmental control (as described in section 7
above). Protection will be given if long acting
adulticides are used for this purpose, but IGR treated
animals remain vulnerable and adulticide applications may be necessary in heavily infested premises
for the duration of the `pupal window'.
8.4. Prevention of failures
Flea control is only complete as long as reinfestation
of animals and habitat can be prevented. In reality,
the risk of reinfestation is often perpetuated by, for
example, incomplete compliance with recommendations, one of several household pets not being treated,
product ecacy being reduced by bathing/shampooing, animals becoming infested outside the home,
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Paper 204 DISC

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D. N. Carlotti and D. E. Jacobs

Table 4. Requirements for a successful eradication programme and common reasons for failure
Important points in an eradication programme

Causes of failure

Good communication with the client, including

comprehensive questioning and an appropriate follow-up

Poor client understanding;

Poor compliance;
Inadequate follow-up;
Excessive cost
Inappropriate topical product
selection (e.g. inappropriate
compound or formulation)
Inadequate treatment of one or
several animals (e.g. cats in a
house with an FAD dog)
Inadequate treatment of hot-spots
(e.g. use of foggers only);
use of short acting environmental
adulticide (reinfestation due to
pupal window); excessive
cleaning after application (e.g.
carpet shampooing)

Appropriate selection of topical products for allergic and

nonallergic animals
Treatment of all in-contact animals
Appropriate treatment of the environment (indoor and
outdoor) with particular care to identify and treat all
hot-spots

untreated animals entering from outside, etc. Anticipation of such events can reduce the risk of failure
(Table 4), but if such occurences are unavoidable,
then total eradication is unattainable and an ongoing treatment regimen becomes necessary.
8.5. Resistance
As yet, insecticide resistance in eas is not recognized
as a major problem in Europe, but authenticated
cases are reported in north America.56 A multiresistant `Cottontail' strain was recently imported
into Germany with a cat from Florida.75 The true
prevalence of resistance is unknown as most information on this topic is anecdotal. Resistance can be
dicult to demonstrate with certainty in ea populations as the adulticidal dose lethal to 50% of the
population (LD50) varies widely within a strain, yet
the ratio between susceptible and resistant strains is
narrower than is the case with many other arthropods.76 Many suspected cases are, on further
investigation, unfounded, either because the product
was incorrectly used or because the treated animal
was exposed to overwhelming numbers of newly
emerged adults. Occasional treatments are unlikely to
induce resistance as selection pressure is low.
Exposure to the compound is restricted to the 5%
of the ea population on the animal at the time of
treatment and genetic diversity is maintained by the
95% in the environment. Consequently, resistance
has been relatively slow to develop in many countries.
Nevertheless, veterinarians should be aware of this
potential problem and should employ control measures that minimize the risk of its future occurrence.
8.6. Preventing resistance
Few studies have been performed which relate specically to delaying the onset of insecticide resistance in
eas, but common-sense guidelines can be extrapolated from the literature on anthelmintic resistance.77

. Use an eective adulticide at the correct dose (weigh

the animal if necessary) and at appropriate intervals.

# 2000 Blackwell Science Ltd, Veterinary Dermatology, 11, 8398

. Do not rely on one chemical group for extended

periods (an annual rotation of chemical groups is

recommended for anthelmintics but the optimum
strategy for ea control products is unknown).
. Design control programmes that utilize chemical
groups with dierent modes of action, for example
combining a long acting adulticide and an IGR (so
that any eas surviving exposure to the insecticide
will produce infertile eggs).
. Use the minimal number of doses compatible with
control objectives (to minimize selection pressure).
. Use epidemiological principles and an integrated
approach (reduce dependence on chemicals by
good hygiene, particularly vacuuming, regular
grooming, which not only reduces ea numbers
but can also be used by owners to monitor the
adequacy of their control programmes, and by
avoiding potential sources of reinfestation).

9. CONCLUSION
FAD is distressing to both pet and owner and is
challenging to the skills of the veterinarian. Clinical
experience suggests there is a range of sensitivities to
ea bites between individuals but the position of any
new patient along this spectrum is unknown on
presentation. The assumption of a high level of
sensitivity must therefore be made. Palliative symptomatic therapy is often unsatisfactory and cannot
always be justied. Recent developments in immunotherapy hold promise for the future but reliable
treatments are not yet available. Thus, the only
eective curative and preventative treatment for
FAD currently available is to protect the animal
from eas. An integrated approach is necessary which
avoids overdependence on chemical control and
minimizes the risk of insecticidal resistance developing. To achieve this aim it is essential to have a good
knowledge of ea biology, the properties of available
insecticides and IGRs (both the compounds and their

Paper 204 DISC

Therapy of ea allergy dermatitis
formulations), and the principles underlying ea
eradication strategies. It is important to have an
awareness of potentially persistent sources of reinfestation and other factors that may undermine
progress. Ultimately success is dependent on the
enthusiasm of the practitioner and his/her ability to
communicate with the owner.
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Resume Cet article est une revue des concepts modernes expliquant la necessaire mise au point de strategies
therapeutiques pour le controle de la dermatite par allergie aux piqures de puces chez le chien et le chat. Les
limites des traitements symptomatiques sont soulignees, ainsi que la necessite fondamentale de dierencier la
pulicose simple des phenomenes d'hypersensibilite. Dans ce dernier cas, l'eradication des puces sur l'animal et
dans son environnement est essentielle. Les proprietes biologiques des molecules modernes sont rappelees ainsi
que les dierentes methodes d'application des principes actifs sur l'animal et dans son environnement. Les
facteurs a prendre en consideration pour la mise en place d'une strategie de controle et pour le choix d'une
molecule sont discutes, en fonction de la complexite du cycle de vie de la puce, des relations hote-parasite et de
la motivation des clients. [Carlotti, D. N. et Jacobs, D. E. Therapy, control and prevention of ea allergy
dermatitis in dogs and cats. (Traitement, controle et prevention de la dermatite par allergie aux piqures de
puces chez le chien et le chat.) Veterinary Dermatology 2000; 11: 8398.]
Resumen Este articulo revisa los conceptos contemporarios que son la base de las estrategias de control de la
dermatitis causada por alergia a pulgas en perros y gatos. Las limitaciones de los tratamientos paliativos
simptomaticos fueron determinados, tanto asi como fue la necesidad fundamental para diferenciar una simple
pulicosis de una hipersensibilidad real. En este ultimo caso el objetivo principal fue erradicar las pulgas del
animal afectado y de su medio ambiente. Se denieron y describieron las distintas propiedades biologicas
ofrecidas por la quimioterapia y el espectro de tecnicas para aplicar compuestos activos en el animal y medio
ambiente. Tambien fueron discutidos factores a ser considerados cuando se formulan estrategias de control y
se seleccionan agentes quimioterapeuticos de acuerdo al complejo ciclo de vida de las pulgas, la relacion
huesped-parasito y a las preocupaciones del cliente. [Carlotti, D. N. y Jacobs, D. E. Therapy, control and
prevention of ea allergy dermatitis in dogs and cats. (Tratamiento, control y prevencion de la dermatitis por
alergia a pulgas en perros y gatos.) Veterinary Dermatology 2000; 11: 8398.]
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D. N. Carlotti and D. E. Jacobs

Zusammenfassung Dieser Artikel gibt einen Uberblick uber die der Behandlung von Flohbissallergien bei
Hund und Katze zu Grunde liegenden heutigen Konzepte. Die Grenzen der palliativen symptomatischen
Therapie sowie die fundamentale Unterscheidung zwischen Flohprasenz und Flohbissallergie werden erwahnt.
Im letzteren Fall ist die Eliminierung der Flohe vom betroenen Tier und dessen Umgebung Ziel der Therapie.
Die unterschiedlichen biologischen Eigenschaften der modernen Chemotherapie werden deniert und eine
Reihe von Anwendungstechniken aktiver Wirkstoe beim Tier und dessen Umgebung werden beschrieben.
Faktoren, die beim Entwerfen der Kontrollstrategien und der Auswahl der Chemotherapeutika eine Rolle
spielen, werden im Zusammenhang mit dem Flohlebenszyklus, der Wirt-Parasit-Beziehung und Belangen des
Kunden diskutiert. [Carlotti, D. N. und Jacobs, D. E. Therapy, control and prevention of ea allergy
dermatitis in dogs and cats. (Therapie, Kontrolle and Pravention von Flohbissallergie bei Hunden und
Katzen.) Veterinary Dermatology 2000; 11: 8398.]

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