Itching, scratching, licking, and skin, ear, and anal gland infections may all be indicators of underlying allergies. Unfortunately, allergies are fairly common in our canine patients. To address allergies we break them up into three categories: skin parasites, food, and environmental. We will walk through the most common allergies and considerations to work through with your dog’s doctor.
Skin Parasites
The most common skin parasites include: fleas, ticks, and mites. While this group of allergen-inducing bugs are unwanted they are easy to treat and prevent. A once-monthly preventative will eliminate this allergen group. Working up and treating other potential allergies may be misdirected and ineffective unless your dog is on a consistent parasite preventative. Parasite
reactivity is very common regardless of whether the pests are observed on the pet or not.
● We recommend Simparica Trio© (chewable) , or Revolution© (topical).
Food & Diet
Even though food reactivity is not the most common factor in skin reactivity, we address it second after potential parasites. Food reactivity can be determined by a food trial. Dogs are individuals and food allergies can vary greatly. The key is recognizing that the allergen-inducing aspect of food is almost always the protein source. Early on in the allergy investigations simply switching protein sources is a good place to start. However, if allergies are severe or long-standing, then it is recommended to feed exclusively a prescription allergy diet that includes novel or hydrolyzed proteins. Please speak with your vet about the details of a diet exclusion trial as there are many guidelines to consider.
Additionally, we recommend adding omega 3 fatty acids to the diet as they offer natural skin protection, health, and anti-inflammatory effects. We recommend nutramax supplements (Dermaquin or Welactin)
Allergy Medications
● Antihistamines are mildly effective in treating environmental allergies, but they have a ceiling effect. The most commonly used antihistamines are Benadryl, Zyrtec, and Hydroxyzine.
● Cytopoint is a monoclonal antibody that directly inhibits the dog itch mediator. It is
extremely targeted and thus side effects are limited. Cytopoint is an injection under the skin that is given at the clinic and lasts 4 – 8 weeks.
● Apoquel is a JAK kinase inhibitor which impacts the dog itch, lick and scratch mediators. Similar to cytopoint it is very targeted and thus side effects are limited. Apoquel is a once to twice daily pill and takes effect immediately.
● Immunosuppressive Drugs are reserved for refractory and severe cases. The reason for this is immunosuppressive drugs like steroids and cyclosporine carry much more extensive side effects than other drug classes.
● Secondary Infections are a large component of allergy treatment. These infections are typically from normal bacteria and yeast on the skin that manifest as infection when a patient causes self-trauma and inflammation. Your veterinarian will utilize topicals, systemic antibiotics & antifungals when indicated, but recognize these are not long-term solutions or treatments.
Diagnostic Considerations
● Skin & Ear Cytologies are crucial to help guide treatment of secondary skin & ear infections.
● Blood Work is extremely important to rule out underlying endocrinopathies involving the thyroid & adrenal glands. These conditions can drastically affect skin & immune health and function.
● Allergy testing can be performed on blood as well through intradermal skin testing. Both food and environmental allergens can be detected. The goal of allergy testing is to identify possible allergens and develop an individualized desensitization allergy medication. While this all sounds great, it is not a miracle fix and is just a piece of the puzzle. Allergy testing is best reserved for allergies that can not be controlled with the above methods.
● Skin Biopsy requires anesthesia and it is reserved for extreme skin infections and immune conditions.
Summary
Remember Fleas, Food, Environment. In treating allergies we likely will not find success with any one thing. Our best solution is often a collaboration of multiple treatment modalities. The most important aspect of allergy management is setting realistic expectations. It is not our goal to cure a pet’s allergies. We hope to manage them and make them livable for the pet. We understand treating allergies can be frustrating. Stay connected and persistent.