It sounds like such a simple diagnosis and yet it is an incredibly complex (and frustrating) condition. As much as we wish for a simple or quick fix, the unfortunate reality is that one does not yet exist. There have been significant improvements to the options for managing symptoms, but they all come with limitations. Let’s break down some of the options and how they can be of benefit to your pet.
Nutrition for allergic pets has had quite the shift over the past 15 years or so. The plan in the past was to use a “novel protein” food, which meant feeding a protein that a pet had never been exposed to in the past with the expectation they would not be allergic to it. Unfortunately, with the introduction of so many commercial foods using a combination of proteins (for example: salmon+duck, bison + chicken + lamb), novel proteins are no longer easy to find. This lead to diets being made with extremely novel protein sources such as the sheaths of chicken feathers (Anallergenic) or soy-based foods. Although these foods have excellent success, the ingredients are very specialized and therefore expensive. We now most commonly use “hydrolyzed” diets – these are diets that are basically pre-digested. The protein sources have been broken down in advance to their amino acids – allowing the pet to absorb the nutrients needed, without a protein marker to react to. These foods work for the vast majority of dogs and cats with food allergies.
When completing a food trial, it is important to use a veterinary-exclusive diet for 12 weeks, without any exposure to other foods, liquids, treats, flavored bones etc. Replacing bowls, measuring scoops, food storage containers etc is an important part of the trial. The concern with using a food other than one we recommend is that there is a risk of contamination from manufacturing practices.
The other food option that is commonly recommended would be geared more towards the support of the skin, while also being made with a less common protein source. These diets may be made with egg, pea protein, fish or other sources to provide more novel nutrition. They include added supplements, such as therapeutic levels of Omega FAs to help the skin barrier heal and stay strong.
Why do we care about the skin barrier so much? Think about your skin as a brick wall. The skin cells are the bricks and your ceramides are the mortar. Pets with allergic dermatitis, infections etc have damage to their skin. With the little chips in the mortar and bricks, airborne allergens and pollens can more easily penetrate the barrier and cause itching to be worse. When the barriers are damaged, our risk of infection with bacteria or yeast is much increased.
To help support the skin barrier, we recommend the application of topical ceramides such as Allerderm. Allerderm is a topical product that is applied once weekly for 4 weeks and then once monthly moving forwards. The addition of Omega 3 Fatty Acids can also be very helpful if your pet is not receiving therapeutic levels of them in their food.
Bacterial and yeast infections of the skin must be treated properly and this can take significant time. The skin can be notoriously difficult to treat with oral medications and it is common that we must have pets on antibiotics for 4-6 weeks if only oral medications are being used. In some cases, the addition of topical treatments can be helpful in reducing the requirements for antibiotics. Topical treatments may include bathing with a prescribed shampoo, applying antibacterial sprays or antibiotic sprays.
Shampooing is often very helpful for pets struggling with allergic dermatitis. It is important to wash according to the instruction of your veterinarian as frequency will depend on each case, however, always scrub well, allow the lather to sit for 10-15 minutes and then rinse with cool water. The most common type of shampoo used for these cases would be a Chlorhexidine-based shampoo called Pro-Hex.
In terms of medication for itch control, there are several options and classes of drugs for this purpose. In the past, it was quite common to use steroids or a combination-steroid product, but there are some unfortunate side effects associated with the long-term use of these medications. More recently, a new class of drug was introduced, including Apoquel and Cytopoint, which have fewer side effects, but they are not without risk. Here is a very basic breakdown of the more common options being used.
Apoquel is an oral tablet that is given twice daily initially, and then daily. It is an immune-modulating drug, which means that it works by altering part of the immune system – in this case, it blocks the itch receptors in the body, which prevents dogs from feeling itchy. It does not “treat” the allergy itself; it simply removes the itchy feeling. Dogs may still experience skin damage, infections etc, which is why frequent progress examinations are recommended.
Cytopoint is an immunotherapy injection that is given every 4-8 weeks. This injection also works by blocking itch-receptors, but may be of lower risk than Apoquel long-term.
Atopica/Cyclosporin is an oral liquid or capsule that is used for long-term maintenance of allergic skin disease and is in a similar class of drug to Apoquel. It works to modulate immune response to allergens.
Prednisone and Vanectyl P are considered steroid and have been used for a long time when managing the symptoms of allergies. They help to reduce the inflammation and itching associated with many allergic conditions, but also have several negative side effects associated that may be detrimental to patient health.
Antihistamines such as Benadryl or Reactine are commonly used with minimal success. It is an option to try and works best when used very consistently. They should be started prior to exposure to known environmental allergens, not after pets are already itchy for a better chance of success. Reactine is the more preferred option and it is given twice daily.
Hyposensitization, more commonly known as allergy shots, is by far the treatment of choice for atopic dermatitis. All the other medications are basically just itch relief; only hyposensitization actually changes the immune system. Some dogs are eventually able to go off all treatment and are no longer allergic after they have been on hyposensitization long enough. The younger a pet is when they start this treatment, the better the outcome will be.
Ultimately, the important thing to know about allergies is that this is a life-long condition that requires attention and care. We must use a multi-modal approach to managing symptoms and the condition in general. Skin flare ups can happen at any time and it is important to closely monitor for signs of this, such as scabbing, itching, lesions, ear infections etc.
The majority of pets with allergies will have a combination of environmental and food allergies, so it is important to consider both when making plans for treatment.
There are many resources available for more information about allergies; here are a few of our favorites:
VeterinaryPartner.com – search Allergies, Atopy, Food Allergies etc
Allergy testing and treatment – https://nextmune.com/video-gallery-pet-parent/