Steroids: NOT the only answer: Non-steroid allergy treatment

Are Steroids the ONLY treatment for my dog with allergies? NO- read more!

Is your dog scratching or itchy? Does your dog develop frequent skin or ear infections? Then your dog likely has dog skin allergies! The most common allergies in dogs are flea allergy and environmental allergies (atopic dermatitis or “doggy eczema”). Food allergies can also cause itchy skin and ear disease but are considered the least common allergy. 

If your dog has a history of hot spots or diagnosed with skin allergies then you may already be familiar with a class of drugs known as steroids (“corticosteroids”, “glucocorticoids”). These drugs can be a major source of comfort your dog but must be used with caution and at as low a dose as possible. Long-term use is not ideal and not recommended. Steroid medications can have a number of mild to significant side effects depending on the dosage, interval, and type given. The most obvious change that you will notice soon after beginning this medication is that your pet will drink and urinate more. These symptoms are “normal” while taking this medication but sometimes excessive and not ideal in dogs that must spend a long time indoors without a potty break. When your dog is taking these medications make sure to always have plenty of water available and plan on more frequent walks outside. Although your pet will appear hungrier than normal, there is no need to feed more food. If you do, be prepared for weight gain!!

Steroids can also cause more severe side effects such as gastrointestinal (GI) inflammation; insulin resistance and can lead to (or exacerbate) diabetes mellitus with chronic use. Chronic steroid use may also predispose your dog to other diseases including iatrogenic Cushing's disease, calcinosis cutis (mineralization of the skin), and urinary tract infections. Chronic steroid use can also cause the skin to become very thin and fragile. At high doses, steroids will suppress the immune system. This may result in a higher rate of skin and urinary tract infections. It is because of all of these side effects that many pet parents want to avoid steroids.

Other therapies are available for treatment of canine allergy!

Fortunately, steroids are not the only option! In fact, over the past 10 years we have learned more about allergy immunotherapy (allergy vaccine therapy) and we have had the addition of new non-steroidal drug therapies.  Listed below are the top 3 non-steroidal therapies you should be aware of: Allergy immunotherapy, Atopica® and Apoqel®.

Allergy Vaccine Therapy – “Immunotherapy”:
You may already be familiar with allergy vaccine therapy (often referred to as immunotherapy) as it is a common therapy in people with allergic rhinitis (“hay fever”), allergic asthma and stinging insect allergy (anaphylactic reactions to bees/wasps, etc.). This therapy is also sometimes referred to as “desensitization” or “hyposensitization” therapy. Many studies in veterinary dermatology have confirmed that immunotherapy is an effective therapy to lessening the symptoms of atopic dermatitis and can help to prevent the development of new allergic sensitizations. Allergy vaccines are available in a subcutaneous injection (typically easily given by pet owners with instructions) or an oral vaccine (sublingual- not given with a snack or meal). When allergy immunotherapy is prescribed and monitored by veterinary dermatologists the success rate can be up to 70%. The exact mechanism of how this occurs is not known but it believed to be similar in dogs and people. This can involve increase in allergen-specific IgG (often referred to as blocking antibodies), a decrease in allergen-specific IgE (the primary antibody involved in allergy), and a change in the immune system’s response to allergies (suppression of a Th2 response with movement toward a Th1 response when allergens are encountered). The allergy vaccine must be based on an allergy test- typically either a skin test (prick testing) or a blood test (serum allergy test). Most veterinary dermatologists prefer skin testing over blood allergy testing but there are specific indications when a blood test may be preferable in an individual dog. Veterinary dermatologists are the allergists in the veterinary world- find one in your area using http://www.acvd.org/tools/locator/locator.asp?id=16

Atopica® (Modified Cyclosporine)

Atopica® was approved by the FDA more than 10 years ago and is used for controlling signs and symptoms of atopic dermatitis. Response to the medication is typically seen over the initial 4-6 weeks of therapy (this medication does not help immediately like a steroid). For dogs, is available as a gelcap and typically given once daily for the first month. If your dog responds well, the dose can often be reduced to every 48 hours or in some cases less frequently. It is then given long-term, or at least during the seasons that your dog itches from allergies.

 

Atopica® does affect the immune system. An allergy is, after all, an overactive immune system. Atopica® does effect T-cell lymphocytes so this medication has the potential to increase the risk of dogs getting infections (viral papillomatosis, fungal infections) and certain types of neoplasia (the medication is contraindicated in dogs with a known history of cancer). However, in reality, this is uncommon at recommended doses. Atopica® is associated with decreased appetite, vomiting and diarrhea as the most common side effects. Usually, veterinarians and pet owners can overcome this, with a slight modification of dosing.

 

Apoquel® (Oclacitinib)

Apoquel® was approved by the FDA and launched by Zoetis in January 2014 for the treatment of itch, most often caused by allergic dermatitis. Unfortunately, the demand quickly exceeded the manufacturing capacity and this led to limited availability and backorders. Remember this if you have asked your veterinarian about Apoquel® but were unable to try this medication for you're your own dog. In many cases, only veterinary dermatologists have increased access to this medication. Zoetis anticipates increased availability of the drug in the summer of 2015. The drug has a rapid onset of action with decreased itching often noted within a few days. This medication is typically given twice daily for 2 weeks, and then tapered to once daily. Because the drug has a short half-life, tapering to lower doses is typically not possible.

 

Apoquel® does affect the immune system and is classified as a biologic by the FDA. It blocks one of the pathways of itch sensation in addition to other effects on the immune system. Like Atopica® it can be associated with increased risk for certain infections (demodex, viral papillomatosis and less commonly pneumonia in puppies). Apoquel® should not be prescribed or used in dogs less than 1 year of age.

While drug therapy can be highly effective at controlling the symptoms of itch and allergy, only allergy immunotherapy has the potential to change the long-term outcome of your dog’s allergy symptoms. That is why veterinary dermatologists are so passionate about this therapy!  If you have a dog with challenging allergy symptoms find a veterinary dermatologist in your area using this link http://www.acvd.org/tools/locator/locator.asp?id=16