Are you treating your dog’s allergy correctly? Are you “old school”? (Part 2)

Karen Helton Rhodes, DVM, DACVD

Terri Bonenberger, DVM, DACVD

Veterinary Dermatologists for YOUR dog!

Are you treating your dog’s allergy correctly?

               Are you “old school”? (Part 2)

 

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 additional 10 updates in Part 2 to make sure you are current! 

Update #11:  Infections

Bacterial and yeast infections can make the symptoms of allergic dermatitis much worse.  If topical therapy is not effective as a sole protocol, then oral medications are warranted.  The dose and duration of antibiotics should conform to standard veterinary practices.  Doses that are too low or courses of therapy that are too short may contribute to antibiotic resistant strains of bacteria. http://www.healthyskin4dogs.com/blog/2015/9/8/facts-myths-about-yeast-dermatitis-in-dogs?rq=yeast

Update #12: Relevance of stress

“There is insufficient evidence to make general recommendations regarding the importance of the environment, humidity, detergents and stress as flare factors in dogs with Atopic Dermatitis. Nevertheless, owners should be educated to observe, and then avoid or alter, the specific situations in which they see their dog’s condition worsen.”  Yep, sounds like good advice, but something that kind of goes without saying!

Update #13:  Skin Care & Hygiene

Bathe at least once weekly.  Always use lukewarm, not hot, water.  “The intensity and frequency of bathing may be the most important factor in relieving pruritus (itching).” Although emollient shampoos will be helpful, antiseptic shampoos are more appropriate in dogs with typical features of allergy: greasiness, scaling, and/or yeast/bacterial infections. http://www.healthyskin4dogs.com/blog/2015/2/19/what-is-the-best-dog-shampoo-for-you?rq=shampoo

 Update #14: Oral EFAs

EFA supplementation or diets rich in EFAs can influence superficial skin lipids and improve the gloss and quality of the coat. There is only a small benefit noted in the management of allergic patients. The limited degree of improvement expected makes the use of EFAs more beneficial if combined with other therapies (shampoos, allergy vaccines, etc).  “EFA-enriched diets provide higher amounts of EFAs than oral administration of FA supplementation.”  Beneficial results will typically take up to 2 months to recognize. EFAs are not a quick fixhttp://www.healthyskin4dogs.com/blog/2015/1/24/essential-fatty-acids-fish-oil-supplementation-for-dogs?rq=efa

 

Update #15: Topical EFA (lipid) formulations

The use of topical lipid complex containing ceramides, cholesterol, and EFAs may aid in the repair of a pre-existing epidermal lipid barrier anomaly.  This barrier is important in the prevention of allergen absorption via the skin as well as the control of bacterial and yeast overgrowth. The improvement is modest.  As such, this therapeutic should be used in conjunction with other protocols.  An extra piece of the puzzle that may be beneficial! http://www.healthyskin4dogs.com/blog/2015/1/24/why-is-the-skin-barrier-important-in-my-dogs-dry-skin?rq=skin%20barrier

 

Update #16: Allergy Vaccine

Allergen-Specific Immunotherapy (ASIT, allergy vaccine) is an “effective and safe way to reduce the clinical signs of AD (Atopic Dermatitis, Allergy) in dogs”. Anti-inflammatory drugs should be used while “waiting” on the vaccine to become effective.  It may take up to one year before beneficial results are recognized. Do not stop too soon! The goal would be that the medications would only be temporary and that the vaccine would be used as a long-term therapy. The frequency of injections (or oral drops if using the sublingual form of vaccine) can be decreased over time once the vaccine is effective……not before!  “A large retrospective survey of owners of atopic dogs having undergone one year or more of ASIT (allergy vaccine) established that nearly 2/3 of dogs had been rated as having a satisfactory-to-excellent response to this intervention.”

Update #17: Probiotics

“There is currently insufficient evidence supporting the use of oral probiotics as nonspecific immunotherapy for prevention or treatment of canine AD (allergy). Even though the pre- and post-natal exposure to the probiotic Lactobacillus rhamnosus strain GG has shown some possible lasting effect in reducing clinical signs following allergen challenges in dogs experimentally sensitized to house dust mites, this oral probiotic has yet been shown to be of benefit in dogs to treat or prevent clinical signs in dogs with spontaneous AD.”

So……it appears that there might be some mild benefit BUT it is too early to tell!  It will certainly not hurt!

 

Update #18: Steroids

Steroids should be used to induce remission of acute flares but not as a long-term therapy.  Long-acting injectable steroids should be avoided to minimize side effects.

http://www.healthyskin4dogs.com/blog/2015/5/18/steroids-not-the-only-answer-non-steroid-allergy-treatment?rq=steroids

image014.png

 

Update #19: Cyclosporine

Oral cyclosporine typically requires 4-6 weeks of treatment before a benefit is noted. Once a good response is noted, the dose is lowered or the frequency of administration is decreased from daily to every other day or even twice weekly. Generic forms of cyclosporine may be substituted for the veterinary product (Atopica).  Typically, the pet is started on the veterinary formulation and then can be changed to the generic form if a good response is noted and the symptoms are controlled. Blood screens should be used to monitor potential side effects. http://www.healthyskin4dogs.com/blog/2015/9/21/healthy-dog-healthy-skin-understanding-why-routine-blood-tests-are-an-important-tool

 

 

Update # 20: Apoquel (oclacitinib)

This drug is rapidly effective in controlling itching; beneficial effects are seen within 1-3 hours after administration. The drug is administered twice daily for 14 days and then lowered to a once daily dosing. Attempts to stop the drug should be trialed once clinical signs have resolved. Blood screens are necessary to monitor potential side effects. This drug is not approved for dogs less than one year of age. This is a new medication so caution is warranted. http://www.healthyskin4dogs.com/blog/2015/8/11/is-apoquel-as-good-as-it-sounds-10-facts-about-this-new-anti-itch-drug-for-dogs?rq=apoquel

OVERALL UPDATE  

Most dogs with allergic dermatitis will require a combination of therapies to control their symptoms of allergy!  www.healthySkin4Dogs.com

Pick the safest modalities and move up the therapeutic ladder as necessary. A veterinary dermatologist can help you streamline your dog’s therapy.  www.acvd.org