If your dog or cat has been diagnosed with allergies, I’m sorry. Just like in humans, allergies are a condition that can only be managed. They’ll often get better or worse throughout the year. Our goal is to minimize the frequency and severity of flare-ups, and manage all the overlying infections once flare-ups happen.
When you bring your dog or cat in, the very first things we need to do are treat the overlying infection and shut down the allergic response now. We have to make them more comfortable. Once we get the infection and reaction shut down, we need to have them back for rechecks to make sure the infection has fully resolved and shift our focus to managing the allergies to prevent flare-ups. When flare-ups do happen, we need to address them immediately. If we don’t get on them right away, the skin damage and infection are much worse than they need to be, and it takes longer and is much more expensive to get them under control.
Emergency Management:
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- Bathing: Bathe them at least twice a week. Any shampoo will usually help by washing off some of the allergens, but using a prescription shampoo designed to reduce bacteria and yeast and soothe the skin, as well as repair the skin barrier, is even better.
- Clean their ears: We recommend using a balanced ear flush such as TrizEDTA or TrizUltra to clean their ears out after every bath, grooming, or going swimming. Dogs particularly prone to infections may need specific ear cleaners to help reduce the likelihood of infection. To clean their ears, fill the canal with solution, massage to break up debris and displace the water, and then wipe away any excess solution or debris you see.
- Topical treatments: We use a lot of leave on products to soothe the skin and reduce infection from the outside. This greatly decreases the risk of building resistant bacteria. We will often use products like Douxo Pyo Mousse or Miconahex Spray daily, but please ask for specific recommendations. Be cautious of over-the-counter products as many contain essential oils and other fragrances that can make skin reactions worse, if skin is particularly raw or damaged.
- Steroids: If the whole body reaction is bad enough, steroids are usually our best option to get it under control. These may be topical, given by mouth, or a combination of both. Long-term steroids are not a great option as there are a ton of potential side effects, but sometimes, they’re necessary. We’ll help you figure out if steroids are appropriate and find the lowest effective dose.
- Antibiotics: Oral antibiotics are often necessary when the flare-up is bad enough that there are skin and/or ear infections. Every time we use them, though, we increase the risk that your dog or cat might develop a resistant bacterial population. If we need them, we need them. If your dog or cat has been given antibiotics in the past and needs them again, we might need to do a bacterial culture with drug sensitivity test to make sure the infection isn’t resistant.
- Yeast medications: Many times, animals with chronic allergies have overlying skin yeast infections, and they may have yeast sensitivity or allergy. This is particularly common in dogs, especially dogs with short hair like Boxers or Pit Bull Terriers, but we can see it in any dog and in some cats. Again, we try to use bathing and topical medications to treat it if we can, and try to prevent yeast infections by managing the underlying skin irritation if possible.
- Ear medications: Ear infections are exceptionally common with allergies and flare-ups. They won’t heal unless specific ear medications are used, and sometimes, they can take longer than normal course of treatment to clear up completely. It’s important to recheck the ear infections until we have resolved the infection and gotten any swelling or irritation resolved. We will help figure out what ear medication is going to be the best fit, when it’s needed.
- Apoquel: This medication is a potent allergy inhibitor with generally fewer side effects than steroids. In many cases, it’s just as effective. We frequently use this for emergency allergy control, intermittent allergy relief, and occasionally, longer-term management. Like any medication, it’s not without potential side effects.
Long Term Management:
Our goal with long-term management is to help reduce the background level of inflammation or irritation by identifying underlying triggers and doing what we can to address them. We use medications as needed to reduce the severity of signs and reduce the frequency of flare-ups and overlying secondary bacterial or yeast infections.
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- Allergy diets: In certain cases, allergies to specific proteins in food can increase the background level of inflammation. They can also be the cause for all signs in some patients. The most common food allergies are to the “Big 4”: chicken, beef, lamb, and pork, and allergy foods are designed to avoid that reactivity. If we recommend an allergy diet, we recommend that a prescription diet be chosen and your dog or cat ONLY get that diet for 8 to 12 weeks to see what kind of improvement we see. If an allergy diet is going to help, we usually see some kind of improvement in the first 2 to 4 weeks, but the maximum improvement can take up to 3 months. Many dogs and cats with food allergies also have environmental allergies, and vice versa.
- Hyposensitization therapy: In a dog or a cat with environmental allergies (known as atopic dermatitis), hyposensitization therapy is the only way to reduce allergies over time. This used to be done with allergy shots, but we now have oral drops available as well. Just like in humans, the shots or drops are formulated based on allergy testing for that particular dog or cat. We use a simple blood test most of the time for allergy testing. Those results are used to formulate the drops or shots. Once started, it takes several months for the dog or the cat to have improvement in their signs. Most dogs and cats will have some improvement with hyposensitization therapy; some improve a lot, some improve a modest amount, and a few won’t respond at all. Every dog or cat is different.
- Cytopoint: This is an injection with an antibody that targets a specific chemical involved in the root of dog itch. It cannot be used in cats. It’s been shown to help around 90% of dogs with a single injection, shutting down the itch for 4 to 8 weeks. We can repeat it up to every 4 weeks. In dogs with severe allergies, we will use Cytopoint to reduce the need for other medications, such as Apoquel or steroids. In some dogs, Cytopoint alone every 4 weeks is enough to keep them comfortable, but not all. When a flare-up is severe, we can often use Cytopoint to help shut down the reaction, but it’s not going to be enough by itself.
- Regular bathing, topical medications, and ear cleaning: We cut back on how often we use these once active infection and reaction is controlled to a frequency to help maintain skin health and prevent secondary infection.
- Antihistamines: Antihistamines can help some dogs and a few cats, but they usually aren’t potent enough in most cases all by themselves. Ask us what antihistamines might be useful for your dog or cat, and we can help you with doses for them.
- Other: Giving a dog or cat an essential fatty acid supplement (such as Nordic Naturals) and using topical treatments such as restorative spot-on therapies (Atopivet Spot-On, Dermoscent Essential 6 Spot-On), and restorative mousses (Atopivet Mousse, Douxo S3 Calm) can help improve the skin barrier and reduce inflammation, itch, and secondary infection. Ask us about options, and we can help find what might work best for your cat or dog.
We will never eliminate allergies, but we can make them better. It’s important to recognize when your cat or dog is flaring and intervene earlier, before they begin to lick or scratch so much they have wounds or develop yeast or bacterial infection.
Have questions? Please contact us for more information.