Karen Helton Rhodes, DVM, DACVD
Terri Bonenberger, DVM, DACVD
Veterinary Dermatologists for YOUR dog!
2015 Updated Guidelines for the treatment of Allergies from the International Committee on Allergic Diseases in Animals (ICADA): guidelines are updated every 5 years
Check out these 10 updates to make sure you are current!
Update #1: Multiple Causes
The cause of allergy is multifaceted. It is NOT just a histamine-controlled reaction. In fact, histamine is not even the primary mediator of itching in dogs. Treatment should be a combination of therapies to try to reach multiple variables that may be contributing to itching. http://www.healthyskin4dogs.com/blog/2015/5/18/steroids-not-the-only-answer-non-steroid-allergy-treatment?rq=allergy%20treatment
Update #2: Infections
Bacterial and yeast infections of the skin and ear are common causes of flares in dogs with allergy (Atopic Dermatitis). These infections should be managed with topical therapy rather then oral medications if possible. The emergence of antibiotic resistance (partly from frequent overuse) emphasizes the need to focus on shampoos, lotions, creams, etc. Avoid topicals that are drying or irritating.
Update #3: Shampoo choice
Bathing with an emollient shampoo is helpful in control itching. The shampoo should contain emollients (ceramides, lipids, phytosphingosines) and an antiseptic. (ex:Recovery Shampoo @ www.HealthySkin4Dogs.com) “The intensity and frequency of bathing may be the most important factor in relieving pruritus (itching).”
Update #4: Short Course Topical Therapy with Steroid Sprays or Creams
Topical steroid sprays should ONLY be used for local flares of short duration. Remember that topical steroids are still absorbed and have the ability to create systemic side effects (insert steroid side effect link). They should be considered “rescue” medications to “put out the fire”………NOT long-term medications.
Update #5: the best “quick fix” meds
Steroids (cortisone): Use as low a dose as possible. Use it as infrequently as possible (not every day!). Do NOT use long term injectable steroids (DepoMedrol) as they may cause symptoms associated with iatrogenic Cushings Syndrome.
Apoquel (oclacitinib): This med appears safe to use twice daily over a 14 day course to rapidly reduce itching.
To date, it is NOT recommended to use these two medications (steroids & Apoquel) together. If no response is noted with either of these medications…..RETHINK the diagnosis and/or consider infection or parasite as a potential problem or complication!
Update #6: Meds that are Not the best “quick fix
These medications are considered unlikely to help with an acute flare in itching. Antihistamines should actually be given prior to an allergic event! They may provide only a mild benefit but are very safe! EFAs are not useful in the short-term but may provide some benefit long-term; especially when combined with other therapies. The slow onset of action of topical tacrolimus (Protopic ointment) & oral cyclosporine (Atopica) make them not helpful as an immediate fix short-term therapy BUT they are great at controlling and preventing inflammation long-term.
Update #7: Food Allergy
The gold standard for the diagnosis of food allergy remains the diet restriction trial with a novel or hydrolyzed diet for a 2 month duration. Three independent studies have shown that over-the-counter pet foods, including those supposedly containing a limited ingredient, frequently contain traces of ingredients that are NOT listed on the label. These diets are not valid for food allergy testing.
NO other “tests” (blood, hair, or saliva testing) have proven to have any validity!
Update #8: Flea control
Flea control must be used year-round for all dogs with both environmental and/or food allergies.
Update #9: Allergy Testing
Allergy testing is used for the identification of offending allergens (environmental NOT food) NOT to decide IF a dog has allergies. The test is not used to diagnose allergy but, rather, to find out which allergens are acting as a trigger. The intradermal skin test is still considered the gold standard for identification of environmental allergens, withIgE serology (blood tests) as another option. Keep in mind, that blood tests results can vary dramatically between laboratories. There are also a wide number of false positive and false negative results noted with these blood tests.
Update #10: House Dust Mites
“House dust mites are the most important source of allergens for canine AD (atopic dermatitis, allergy), worldwide.” Decreasing exposure to house dust mites can help reduce the flare from other environmental allergens. Allergen load (the cumulative load of all the allergens) is vitally important. Another reason to bathe your dog frequently...since bathing helps lower the allergen load.