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Discussion on Treatment regimen for hives

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s.miley
Member
Username: lindac

Post Number: 40
Registered: 10-2002
Posted on Wednesday, Jun 23, 2010 - 11:55 pm:   Edit PostPrint Post

My horse came down with hives about 2 weeks ago. Since her initial treatment of a steroid and antihistamine injection she's had 3 flare ups and as per my vet was treated with 25cc's of oral prednisolone on those occasions. This definitely helped but did not control the problem, so my vet started her on a 2x/day dosage of oral Hydroxyzine last week. Although there was improvement, the hives did not completely go away. So this week my vet added a 1x/day dose of oral prednisolone. The combination of these 2 meds has completely cleared up her hives. Unfortunately my vet told me once she was hive free for a couple of days to take her off the Hydroxyzine and just continue with the prednisolone. Well I did this yesterday and the hives came back this afternoon. So in reality she's only had 3 days of the "full" treatment described in your article. I'm not sure why the vet has had me take her off the Hydroxyzine so soon. I'm confused by this? The prednisolone treatment is to continue for the next month in weekly declining doses (i.e. - 25cc/20cc/15cc/10cc) and it only makes sense now after reading the article that the Hydroxyzine should be included in her daily regimen while the steroid dosage gets reduced. Is this not correct? Trying to figure out how to approach my vet without stepping on toes here .... sigh. Any advice/help would be very appreciated.
Thanks.
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Dee Dee
New Member
Username: rioh

Post Number: 1
Registered: 6-2010
Posted on Thursday, Jun 24, 2010 - 9:33 pm:   Edit PostPrint Post

Hi, I'm new here and just thought I would share what I have been doing for my AQHA gelding that I have had for 3 years. For the month of May he was broke out in hives every morning. I did some research and decided to try Vet skin & allergy supplement from Platinum Performance. I don't like to use medication anymore than I have to but after 3 days on this supplement and keeping him in at night with fly spray that has done the trick. No more hives. I believe he was very sensitive to mosquitoes. The supplement helps keep histamines at a normal level I believe. Thanks for a great place for everyone to learn.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 24922
Registered: 1-1997
Posted on Friday, Jun 25, 2010 - 5:02 pm:   Edit PostPrint Post

Hello s.miley,
Actually I usually have more success with steroids with hives but we must take into account the reality of your experience. I am sure if you call up your veterinarian he will gladly put her back on the antihistamine when he hears the facts. Let me ask what is the concentration of the pred liquid? Only then can we know what the dosages you are giving is.
DrO
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s.miley
Member
Username: lindac

Post Number: 41
Registered: 10-2002
Posted on Friday, Jun 25, 2010 - 10:00 pm:   Edit PostPrint Post

Hi Dr.O
The label on the bottle says Prednisolone Acetate 20mg/ml oral liquid suspension. My horse weighs just over 1100lbs. For the last 5 days she's been getting 25cc/day and has 2 more days to go before being reduced to 20cc/day for the next 7, then 15cc for the next 7, and finally 10cc for the last 7.

The addition of the steroid has really helped in her treatment as the antihistamine alone was not doing the job. It's interesting that you've had more success with steroids than antihistamine. I'm beginning to wonder now if it's actually my steroid dosage that may be the problem and not the addition of the antihistamine.

Since last Sunday (the start of her treatment plan 5 days ago) she's had 2 little flare-ups. Both happening just before her next prednisolone dose is due. Is this a normal reaction as her system begins to settle down or is it possible that her steroid dosage is too low? Would she be better off on a different dosage given 2x/day instead?

Also, when I asked my vet about an ADT after the last week I was told just to stop the treatment and not worry about it. I'm a bit concerned about this as I always thought ADT was the best way to go before completely stopping a treatment plan.

Once again, appreciate your input. Thanks.
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s.miley
Member
Username: lindac

Post Number: 42
Registered: 10-2002
Posted on Friday, Jun 25, 2010 - 11:13 pm:   Edit PostPrint Post

Dr.O
Me again, just checked her weight from the last time she was at a large animal clinic in November/09. She came in at 1183 lbs. and has put on some weight since then so is more like 1200 lbs. rather than 1100 lbs.

I just went over the dosages given in your article and if I'm correct in my calculations a 1200 lb. horse should actually be getting a 600mg/day dosage or 30cc/day of a 20mg/ml concentration. A 1000 lb. horse would get 25cc/day. This would mean she is slightly under-dosed ..... is this correct?

Also, just realized this is actually day 6 of her treatment and one of the small flare-ups I mentioned in my previous post occurred today just before her next pred. dose was scheduled. Since tomorrow is day 7 (last day) of the 25cc dose, I'm now wondering if her dosage is a bit low. Would an extra 5cc/day make a difference and help with flare-ups?
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 24927
Registered: 1-1997
Posted on Sunday, Jun 27, 2010 - 9:28 am:   Edit PostPrint Post

It might help to increase the daily dosage and I would prefer once daily treatment than twice daily treatment. But splitting the daily dosage if necessary to control symptoms is not out of the question. These need to discussed with your veterinarian.

ADT is not a method of getting horses off long term steroid treatment and prevent a Addison's Crisis. That is done with slowly declining daily doses. ADT is a method to use steroids long term and prevent shut down of the adrenal glands which is called iatrogenic Cushing's Disease. You can read more about this at HorseAdvice.com » Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » Steroids, Overview of Antiinflammatory Use.
DrO
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s.miley
Member
Username: lindac

Post Number: 43
Registered: 10-2002
Posted on Sunday, Jun 27, 2010 - 3:05 pm:   Edit PostPrint Post

DrO,
As much as I would like to discuss this with my vet she unfortunately is not returning my calls. Instead she has her office assistant (who has no veterinary background) call instead. The last response took 3 messages and 4 days only to be told I should take my horse for allergy testing as the Dr. has done all she can do and can no longer help me.

Needless to say I'm a bit stunned. It's only been 2 weeks since this hive thing started and it's only been the last week in which a consistent treatment regimen was initiated. The addition of a daily steroid treatment was actually my suggestion to the vet after reading your article. I'm guessing since my horse did not respond in a "textbook" fashion after the first 3 days of treatment we got written off the radar. That is why I've turned to this board for help.

As for my horse, her hives seem to have settled down even more the last couple of days. She's not had any major flare-ups but still does get a few small isolated patches that go away after her steroid dose is administered. Maybe it's just a matter of building up an effective loading dose in her system. As per your advice I will increase her up to the 30cc/day dose. I'm planning to take her off the antihistamine this evening. If things go well do you think I should bring her back down to 25cc/day mid-week or wait to till the next week before I start reducing her?

Unfortunately, my horse will not eat this in her food and therefore it must be syringed into her mouth requiring (of course) 2 people to do to this. Due to our schedule we've had to administer this at dinnertime this past week, however starting this week I can change her over to an AM treatment as per the recommendation in the article. Can this pose any problem to suddenly switch her over from 6PM one day to 6AM the following day? Could you expand further on the reasoning behind this AM treatment? It does mention hormones but really doesn't go any further in the explanation.

The reason I asked about the ADT is that I noticed a lot of posters who have hive issues with their horses use ADT so I thought that was the way to go. If not, what do you suggest is the lowest daily dose/day to just stop the treatment regimen at?

Thanks.
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s.miley
Member
Username: lindac

Post Number: 44
Registered: 10-2002
Posted on Monday, Jun 28, 2010 - 8:37 am:   Edit PostPrint Post

DrO,
Guess I spoke too soon in terms of flare-ups. She's had another one. The steroid is keeping it at bay, sort of, but it's still hanging on 12 hrs. later. That's on 30cc's given yesterday at 6pm. Not as bad as her original bout 2 weeks ago though. I want to keep her doses in a safe margin, be effective, but not risk over-dosing. The chart in the article you referenced noted the dosage range for prednisolone was 0.2-4.0 mg/kg. Should her dosage be increased a bit more and if so how high (35cc/40cc/45cc ?) would I go with the 20mg/ml concentration for a 1200 lb. horse. If it can be increased, how long can that level be continued (1 wk./2 wks. ?) before being reduced?

I'm planning to leave her inside today. The one time I did leave her inside 1 1/2 wks. ago (due to weather) her hives gradually went away over the course of the day and she was normal the following day. So it would appear that it's something outside .... the needle in a hay stack. Unfortunately I can't control her outdoor environment. I did mow the field she's in and will mow it down again but that's pretty much the extent of controlling her outdoor life. So I'm left with treating her symptoms, trying to pull her through this, and hoping this is just a seasonal one-time speed bump for her. Is what I'm experiencing,(i.e. the ups & downs in her treatment) typical and I just need to give this time?
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s.miley
Member
Username: lindac

Post Number: 45
Registered: 10-2002
Posted on Monday, Jun 28, 2010 - 2:08 pm:   Edit PostPrint Post

DrO,
Sorry for all the posts. Although I did raise her steroid dose yesterday to 30cc's, I also stopped her daily 2x/day antihistamine dose. I'm now wondering if the loss of the Hydroxyzine in her daily regimen yesterday may have been too abrupt for her system and contributed to the flare-up. Kind of like a rebound effect and it needs time to settle.

At last check (1pm today) the hives were still present, not worse, but not much better either. She was given her 30cc steroid dose at that time. I'm hoping this will turn things around for her as she's pretty itchy. Since you haven't had time to respond to my previous post regarding the steroid dosage time change I am moving her back gradually so that by tomorrow (tues)she will get her dose at 6am. Please let me know if you think this steroid dose should be increased and by how much.

Should I add the Hydroxyzine back into her regimen for now or just sit tight for the next couple of days and see how this plays out on steroids only? If it's added back in, is there a safety factor as to how long a horse can be on Hydroxyzine? She's been on it 2 weeks now.

Thanks again.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 24933
Registered: 1-1997
Posted on Tuesday, Jun 29, 2010 - 1:55 pm:   Edit PostPrint Post

I am sorry s.miley, I cannot give you specific recommendations on treatment, this has to be done under the advice of your veterinarian. I do agree the discontinuing of the antihistamine might be the cause of the exacerbation. Hydroxazine is fairly safe long term medication. As to how long prednisolone can be given safely depends on other health issues the horse may have, the dosage, and frequency of dosage, for more on this see both:
  • HorseAdvice.com » Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » Steroids, Overview of Antiinflammatory Use
  • HorseAdvice.com » Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » Prednisone, Prednisolone, Methylpred

If your vet will not return your calls it may be time for a new veterinarian.
DrO
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