New allergy management strategies

Dog in grass

It is getting to be allergy time of year again, when pollens and grasses emerge and wreak havoc with our immune systems.

Human allergy sufferers often experience sneezing, runny nose and itchy eyes. For dogs, skin lesions are the most common presentation of allergies. Dogs with allergies can truly suffer.

An allergy is when the immune system mounts a response against something it considers a foreign invader to the body. We want our immune system to fight off viruses and bacteria, but when our immune system turns its powers against pollens, dusts and molds, the result can be a painful response for the patient.

In dogs with allergies, the immune system will create inflammation in the skin as a response to the allergen. This inflammation creates itchiness and the chronic inflammation can disrupt the normal skin cells.

This inflamed skin can easily get infected by the yeast and bacteria that is on the skin normally. In addition, because this condition is itchy, dogs tend to lick themselves and scratch their body, exacerbating the problem and leading to more itchiness and infection.

Allergies tend to affect the areas of a dog’s body that have less fur. Classic spots for allergy problems to arise on the body are in between the toes, the groin, around the anus and the ears.

When I graduated from veterinary school 20 years ago, we had very few good treatment options for dogs that had allergies. Our treatment strategies involved frequent bathing, topical steroids or numbing agents, antihistamines, steroids and hyposensitization treatment.

Bathing is still a very helpful tool when managing allergies. Bathing can help remove grease from the skin, as well as bacteria and yeast. However, veterinarians know that compliance with bathing is very poor. It is often a big pain to shower and shampoo your dog, especially big dogs that hate the tub.

Antihistamines are still helpful for mild allergies. I will typically prescribe Benadryl at a dose of 1 mg per pound of dog every 8–12 hours. For example, a 50-pound dog would get 50mg of Benadryl every 8–12 hours. If your dog’s allergies are not too bad, this is an inexpensive way to start to try to stop itchiness and inflammation.

Prednisone always works to clear up allergies. Prednisone is a potent steroid that suppresses the immune system. The problem with prednisone is that it has a lot of side effects.

In the short term, excessive thirst and needing to urinate all of the time is the most bothersome side effect. Long term, I describe prednisone as aging the body faster. Long-time prednisone users will have thinner skin, and it puts a stress on the internal organs.

Dogs on prednisone are also prone to infection because the steroid is suppressing the “good part” of the immune system as well as the allergic part.

With hyposensitization treatment, a dermatologist will do a skin test to see what your pet is allergic to and then can formulate a mixture of these allergens in shot form for the owner to administer in small doses at home. The theory behind this treatment is if you introduce the allergen in tiny amount, the immune system will get “bored” with that allergen and start to realize that it doesn’t need to mount a big immune response to it.

For some patients, hyposensitization treatments work. However, it can take up to a year for them to have an effect, and some patients never do improve with hyposensitization shots.

In the last several years, however, we have been blessed with some new allergy treatment medications. I say blessed because, truly, the new medications, Apoquel and Cytopoint, have relieved so much suffering in patients that previously either had the option of treatments that didn’t work very well or prednisone that had a lot of side effects.

Apoquel is the medication that came out first. The way I describe this drug to owners is that unlike prednisone, which suppresses the whole immune system, Apoquel is formulated to suppress just the allergic part of the immune system. Because of that, we don’t see the dramatic side effects that we see with prednisone.

Apoquel is not without its own side effects, however. We can see a drop in white blood cell counts when on Apoquel, and we also have seen patients that start to get elevated liver values and need to discontinue the medication.

Blood monitoring is very important for dogs that take Apoquel. A small percentage of dogs that have problems with Apoquel, and its benefits far outweigh the potential side effects when deciding whether or not to start a new patient on Apoquel.

New to the allergy arena is Cytopoint. General veterinarians were able to start using this medication in the last year or two.  It is a shot that your veterinarian gives at the clinic, and it last for 4–6 weeks in most dogs.

Where Apoquel had a narrower scope of immunosuppressive activity then prednisone, Cytopoint is an even more targeted approach to managing allergies. Scientists have discovered that there is one protein in the body that is responsible for all of the itchiness that allergic dogs develop. Cytopoint binds to and inactivates the protein, stopping the itchiness.

Because Cytopoint is new, the veterinarians at Westgate Pet Clinic recommend blood monitoring with this allergy treatment as well.

Apoquel and Cytopoint are great options for dogs with allergies. A big downside of these medications is the cost.

The treatment can range from $50–$150 a month depending on the size of your dog. However, there is certainly a cost savings if you don’t have to pay for frequent vet visits because your dog has skin or ear infections from poorly managed allergies.

Although I love Apoquel and Cytopoint, it should be noted that they don’t work for all patients. They are effective treatment options in about 90–95 percent of dogs.

I have some patients that do well on Apoquel or Cytopoint during most of the year, except when whatever they are allergic to is out in full force. Then we need to either give both medications or a short course of prednisone to get them over a really itchy period in the season.

I also have some patients that will still get the occasional yeast or bacterial infection on the skin or in their ears, in particular, because Apoquel and Cytopoint don’t seem to help dogs with chronic ear infections as much as they do dogs with chronic skin infections.

If you have a dog with allergies, I need to say I am sorry. Allergies can be expensive to treat, difficult to manage and they make your dog miserable. But with Apoquel and Cytopoint available to your veterinarian now, we have at our disposal much better ways to improve your dog’s quality of life.