It’s a new Dawn for Dogs with Allergies

I am just back from a fascinating weekend at the Biltmore house in Asheville, NC where my sisters and I took the Butler’s tour. This basement tour took guests to the basement of this magnificent house to explore the staggering, innovative achievements of George Vanderbilt in 1895 (Otis elevator, coal-powered steam heat, indoor plumbing, and full electrical power which was both AC& DC wired due to suggestion of friend Thomas Edison.)  A surprisingly interesting  side note to our lesson in innovation was the medical recommendations for shock in the electrical room. A bit of a spoiler alert as it does not involve “mouth to mouth” but rather another orifice! 

As I witnessed the sunrise over the estate and took in all that I had learned, I reflected on new introductions in the veterinary world and at Creature Comforts in 2014. Probably the most significant new innovation available in 2014 for pet owners is allergy treatment. So for this week's blog I'd like to explore the topic of allergies allergies.

What are the most common signs & factors of allergies in pets?

These signs include chewing at the feet, rubbing at the face, inflamed/red ears, and licking of the rear end. Onset is under 3 years of age (unless moved to a new climate).This is due to environmental allergens and defects in the outer skin (epidermal) barrier. Pets living mostly indoors and are responsive to steroid use can be typically spared from itching. 

Although allergies to grasses and plants outdoors are often mentioned as causes of allergies & itching, why does my pet have skin issues year round?

Although in North Carolina allergies to grass, trees, and other plants are common sources of misery for pets, many dogs and cats are allergic to  house dust, mold spores, specific foods, and storage mites (mites found in pet food). Thus pets can itch year round, even in snowy weather. 

I have read bathing a normal pet too frequently could dry out the skin; yet, I was recently told to bathe my itchy pet weekly. Why?

The key words here are normal vs. itchy pets.  If a pet is itching it no longer is in the normal category. I advise clients that allergy pets are like giant “Swiffer mops” in the environment, thus maintaining a constant source of irritants on the paws, skin, and fur. By frequent bathing with non- irritating shampoos, owners are decontaminating the fur thus decreasing the cumulative irritant factors of allergens.

Besides bathing what are some of the traditional methods to deal with allergies in pets?

Once eliminating other causes of itching such as primary infections (mange mites, fleas, ticks, lice, ringworm, yeast, and bacteria), veterinarians start with supportive care such as anti-histamines (Benadryl, Zyrtec, & Chlortrimaton) and steroids (prednisone, prednisolone, Medrol, and triamcinolone) for specific, seasonal periods of the year. When pets are uncomfortable with prolonged itching, the self- trauma of scratching may lead to opportunistic skin & ear infections (yeast and bacteria).  Topical spot treatment steroids (Genesis spray) of non-infected areas such as the feet,  veterinary anti-bacterial  wipes (Preva & Malaket), and simply wiping off the feet, belly, and rectum with warm water wiping after being outside is helpful. Oral fish oil (wellactin) is another helpful product as well. Topical application of  a product to restore the lipid barrier  such as Douxo Seborrhea Spot-on  pipettes have added benefits.

What are some the concerns of prolonged use of steroids?

The increase in appetite leading to weight gain, urinary accidents as a result of increase in thirst, and silent urinary tract infections are the most frequent complaints.  Other concerns are changes in the behavior of pets that vary in the spectrum from depression to hyperactivity.  

With frequent bathing are there concerns that topical products for fleas & ticks could be washed off?

Yes, that is one of the reasons the new product, NexGard, was mentioned in the last blog.

What is a food allergy trial and how is it performed?

For pets showing specific signs of allergies, that are repetitive, a food trial that eliminates proteins that are in current or previous diets for 8 to 12 weeks is recommended.

What are some of the ingredients in these hypoallergenic diets?

For dogs that would typically be:  beef, chicken, soya, egg, and milk. 33 years ago, when I was first in practice, lamb was the typical main ingredient in these hypoallergenic diets.  For cats it is typically fish or chicken based diets. Currently, since lamb is in many pet foods, diets of rabbit, duck, and kangaroo are recommended. One new challenge is that specialty pet food companies are combining the multiple, innovative proteins in premium diets, thus finding a diet with novel proteins is often difficult. Working with veterinary nutritionists, some new possible food trials include such staples as fish, pinto beans and quinoa for dogs. In cat diets new proteins are often rabbit, pork, and venison. There are also available hydrolyzed diets with super small proteins the body cannot easily detect. The secret in these diets is lack of exposure  to  food allergens combined with similar avoidance in  chewable heartworm preventatives, treats, and edible toys.  The risk of pure food allergies  in pets are estimated to range from 12 to 33% in pets.

Assuming the food trial makes no improvement in a pet itching, what is the next step?

 Blood testing for offending allergens after being off oral anti-histamines for 7 to 10 days, and steroids for at least a month is recommended. This may be combined with a skin patch test as well. There is no conclusive blood or patch testing for food allergies at this time. Then a vaccine will be formulated based on the test results. It may take up to 6 months to prove that the immunotherapy works.

What if the blood testing fails to make a conclusive diagnosis, or the allergy vaccine fails, what are the next options?

Besides long term use of bathing, anti-histamines, and steroids along with good flea/tick control, up until this point immune-suppressive therapy with cyclosporine (Atopica) has been suggested. Atopica (first came to the veterinary market in 2003) is administered daily for up to 45 days, then alternate day dosing (on an empty stomach) is recommended to find the lowest dose that works. Atopica may take up to a month to work and can result in vomiting ( try freezing capsule and give with a small amount of food), skin warts (viral), swollen gums, reddish ear flaps, and thickened foot pads. By suppressing the immune system this may allow hidden infections to develop and in rare cases, some cancers.  Another drawback is the cost.

What is the new medication for controlling allergies, Apoquel? 

It is an oral medication for dogs over 6 lbs, at least 12 months of age, that may be administered with or without food. It has not been approved for breeding dogs or those nursing puppies. It starts working within 1 to 2 days, a distinct advantage over Atopica. It may be administered with vaccines, antibiotics, and other medications.  It does suppress the itch response, but in a manner different from Atopica. It is also cheaper than Atopica but more expensive that steroids/anti-histamines.  It is administered orally twice a day for 14 days, then once a day. Supplies currently are limited as the manufacturer cannot keep up with demand. Note as in any veterinary product, the FDA advises washing of the hands after administration.  It is not recommended to pre-split tablets at the office.

Dr. Betsy Sigmon