Welcome to the third week of our allergy blog series! From our previous two blogs you have learned about:
- Allergy symptoms
- How critical your historical information can be in contributing to a diagnosis
- Common diagnostic tests used to better understand the symptoms
- Conditions that need to be ruled out prior to diagnosing allergies, especially in more severe cases
- The potential complexity of an allergic patient – allergies can be tricky to diagnose, and sometimes secondary issues like skin infections can complicate the process
This week we are going to discuss the large variety of allergy treatment and management options available. We encourage you to keep in mind that patients with allergies, especially severe allergies, have the most successful treatment and management strategies when our pet owners and veterinary team communicate and work together to address the symptoms. Your feedback is invaluable in helping us understand what treatments are helping your pet the most.
When considering treatment options, we must keep some important considerations in mind:
- What are the symptoms?
- What part(s) of the body are affected?
- Are the problems focal or extensive?
- Is there evidence of skin barrier disruption?
- Is secondary infection (typically bacteria or yeast) present?
- Is the skin greasy or dry?
The answers to questions like the ones above will help us decide on the type (topical versus systemic) and number of treatments needed (e.g. one therapy or multiple therapies added together). Allergies are best managed when we not only treat the symptoms, but also identify and manage the underlying cause. Potential underlying causes can include environmental allergies, food allergies, contact allergies, or flea allergies.
Here is an overview of a variety of different management strategies that could be implemented for an allergic patient:
- Avoidance: Symptoms will be minimized or eliminated if the allergen can be avoided.
- Year-round flea control, especially in flea-allergic dogs
- Novel protein or hydrolyzed protein diet for food-allergic dogs
- Removal /avoidance of contact irritants (bedding, detergents, etc.)
- Minimize environmental allergen contact if specific allergens are known
- Treat Secondary Skin or Ear Infections: Once the skin becomes inflamed, it is common for infections to develop from an overgrowth of some of the normal skin flora. Treatment can be topical or systemic (or both), depending on location and severity.
- Topical Shampoos and Sprays: Many allergic patients can be managed with topical therapies, especially when symptoms are mild. Shampoos work to remove allergens and organisms that can be contributing to the problem, and they also exert topical effects on the skin. Sprays are an option to use in between baths or when patients resist bathing (especially cats). There are a lot of choices in this category. The product selected will be dependent on the clinical signs of the patient. Many are combination products that perform one or more of the following functions:
- Moisturizing / nourishing
- Follicle flushing
- Medicated Wipes: Medicated wipes work to remove troublesome organisms like bacteria and yeast. They also exert topical effects on the regions being wiped. Wipes are excellent tools for focal problems on the skin, and they are especially helpful in breeds prone to secondary infections from skin folds.
- Nutrition / Supplements: Of course, if a food allergy is suspected, a prescription novel protein or hydrolyzed diet should be used. Additionally, there is information to suggest that nutritional modifications (through diets or supplements) may be beneficial for environmental allergy sufferers. Nutritional modifications might include:
- Prescription Allergy Diets: We have seen great success with the new Hill’s Prescription Derm Defense diet with many of our allergy patients.
- Dermatological oral or topical supplements that contain things such as fish oil, essential fatty acids, vitamin E, etc.
- Antihistamines: Multiple antihistamine options are available; individual responses can be variable to the different products. Often, we will pick one antihistamine and try it for a week or two to see if there is a positive response. If there is not a good response, that medication is discontinued and then a different antihistamine is attempted.
- Pharmacological Interventions that Reduce the Immune Allergic Response:
- Corticosteroids: These tend to work great (unless it’s a food allergy), and we often see rapid relief for the patient. Steroids also come with some annoying side effects like increased thirst, increased urination, and hunger. Additionally, long-term use of steroids creates the possibility of many problematic side effects such as liver enzyme elevations, muscle wasting, decreased energy, cardiac problems, and the list goes on.
- Atopica: The active ingredient in Atopica is cyclosporine. At the doses used for allergic skin disease, the product works to modulate the immune system’s response to allergens. The product is available for dogs and cats.
- Apoquel: This is one of the newest products available for dogs. Oclacitinib maleate is the active ingredient, and it is classified as a selective Janus Kinase Inhibitor. The product works to inhibit Interleukin 31 (IL-31), which is a cytokine that causes itching in allergic dogs.
- Immunotherapy: Pets with moderate to severe allergies may benefit from allergy testing followed by immunotherapy. Not all pets will respond to immunotherapy, and results may take a year or more to be seen. When pets do respond, the therapy can be quite helpful.
Other therapies are in development and under evaluation, so our choices for treating skin allergies will only continue to expand. In summary, many treatment options are available, and the choice of therapies is largely dependent on the individual patient’s symptoms and response. If a treatment regimen does not prove successful, then we regroup and try something different. By working together as a team, we are able to provide your dog or cat with the most successful level of allergy relief. Is your pet suffering from allergies/ Then schedule an appointment today!
Author: Dr. C. Noureddine, DVM, MS