Prevention is preferable to management for sweet itch, and new understanding of genetic predisposition and emerging immunotherapy offers hope for reducing the burden of this chronic condition.
Preventing sweet itch through habitat management, breeding selection, and physical protection offers better welfare outcomes than managing an established chronic condition. The genetic basis of sweet itch means that breeding programmes could, over time, reduce prevalence in susceptible breeds by selecting against severely affected animals as breeding stock. For individual horses in high-risk environments, a prevention-first approach combining paddock management to reduce midge habitat, physical protection including midge-proof rugs and stabling during risk periods, and appropriate nutritional support for skin health provides the most comprehensive welfare strategy. Emerging immunotherapy options offer genuine hope for future prevention in predisposed animals, though current availability remains limited. Climate change adaptation in sweet itch management will become increasingly important as midge seasons lengthen.