Skin allergies are the most common, yet most misunderstood and over complicated concerns we see. Bulldogs in particular are very over represented for allergies.
Initially we will break our allergy discussion down to reasons, treatments, then how our clinic effects long term control. We will also explain how best to use specialists and how to understand their limitations before you see one.
Causes
Allergies largely fall into four main categories, a thorough history from an experienced veterinarian can usually help determine what the most likely cause is. It’s amazing that when we see second opinions for allergies, often occurring for years, our clients tell us they have no idea what may be the cause. Within just a few short questions, on most occasions we can let them know what’s highly likely causing them. Communication with your vet is really important with skin allergies. The four main categories are:
That’s it in a nutshell. Just from us obtaining your pets history and from the above, we can very likely let you know what your dog is allergic to.
Here’s a major point that needs to be understood with management of allergies
As most allergies are pollen and grass related, symptoms are going to be ongoing for life, to a mild, moderate or significant degree depending on the dog. This is why so often, when symptomatic treatment is stopped, it’s only a matter of time before symptoms come back. Owners get frustrated because of the following:
Here is what is really important – Initially we work out the likely allergy from your pets history, then it may take a little juggling to find the lowest dose but most effective treatment for your individual dog. Once this is established, a long term plan of minimal intervention as required is discussed, going back to occasional pulse treatment for 5-14 days as required if signs really flare, or in more severe and sensitive cases, a very low dose two times weekly ongoing treatment even when things seem reasonable.
We teach you to self maintain the allergy at home, without the need to come rushing to the vet every time it flares.
You can pick up the medications you need as required, simply by calling us first. You don’t need to have a consultation each and every time they flare. This is the essence of long-term management of allergies when we see you at our clinic. Once the ongoing nature is understood, in most cases long term management is easy. Occasionally it’s not so easy, in which case specialists should be considered.
So how do we treat allergies?
Mild Treatment Options
Veterinary Treatment Options
With the above in mind we need to discuss an important aspect of allergies, their diagnosis and treatment. Antibiotics are significantly overused. Steroids are significantly underused. Here’s why:
Initially, the main problem is inflamed skin caused by the allergen and the scratching the dog does that exacerbates the inflammation. Often the skin looks red due to this. It is not necessarily secondarily infected until sometime later if good control of the dog scratching, and inflammation caused by the allergen, has not been well controlled early. Often at this point owmers visit their vets who prescribes antibiotics. We would guestimate 80% of the time these are totally useless. They do not stop inflammation or stop the dog scratching. Hence are of no use if secondary infections are not yet significant (i.e.: early in the disease when there is just inflammation, and no infection). We need to stop the dog scratching and stop the inflammation in the skin, before the bacteria take hold and take over.
Almost always, steroids do this instantaneously and effectively. Alternatively, you can also use the other treatments above such as Apoqel and Cytopoint if that’s your preference, but these may take longer, or not be as effective. Hence our clinic often just starts with the basics above, discusses an initial long-term plan, and assesses initial response to each anti-inflammatory, without any of the expensive tests or antibiotics (also often very expensive, hence you don’t really want to be paying for them when not indicated). If not responding quickly, and as expected, you can always add antibiotics.
When truly concerned about secondary bacterial infections, then ideally a simple tape prep test should be done on the spot which looks for obvious overgrowth of bacteria and/or yeast. If found, we can then monitor this for effectiveness to antimicrobial treatment, as often as 3-6 weeks is needed. It’s most important follow up fortnightly tape preps are done to check for actual effectiveness of antimicrobial therapy, as if it isn’t effective, a different approach is needed. However, we rarely do this first up, except in more obvious or severe cases.
Food Allergies
These are the most over diagnosed cause of allergies and least understood. If conducting a food trial this is what we recommend:
Natural Diets or Raw or Home Cooking
There is a theory that better quality diets may in fact help all allergies merely by virtue of the fact you have a healthier dog with a better functioning immune system. Hence many of the non-food allergies may have their threshold for clinical signs improved by just being on a better diet. We have two things to say about this theory:
So our advice is this:
Dermatology Specialists – Their Overuse and Limitations
Dermatology specialists are great when needed for difficult refractory or complicated cases. However we find in our practice when we see second opinions for chronic allergies, very few of the above basic steps or options have been explained or trialled. When we see social media posts about owners going off to the dermatologist to “work out what’s going on” we find the same thing – very few basics have been done.
Hence as good as the specialists are for truly complicated cases, we feel many people are sent off to them far too early. We also find that people have rarely been explained the limitations of dermatologists. So before exploring this option we advise the following:
In summary, we recommend the following:
A final word on steroids
Many pets just suffer the occasional allergy. They’re not very sensitive, so don’t necessarily have ongoing long-term problems, but just 2-4 times a year, or every few years, have an acute allergy. We feel these cases really should start with steroids, as the most important thing is effectively reducing that skin itch and inflammation before longer term problems set in: Secondary infections and thickened skin due to the excessive scratching of the dog.
In these short term occasional cases steroids, 98% of the time, just stops everything in it’s tracks. The other options often don’t work nearly as effectively or quickly (let alone cost), increasing the chances things become overly complicated. Hence, we advise before refusing steroids, keep this in mind.
Option 1: For short term occasional allergies 1-2 weeks steroids. If not required any more than 4-5 x per year, and fine in between times, that’s the most effective way to nip allergies in the bud.
Option 2: If allergies are recurring too quickly from short term 1-2 week treatments (i.e.: within 6-8 weeks) then there are 2 options: go to Apoqel or Cytopoint, or consider a very low dose ongoing steroid at 2-3 times weekly (just a tiny dose) to minimise, but not necessarily 100% stop allergies. Then on occasion they flare you can still use your 1-2 week higher dose before tapering back down to a tiny two times weekly dose to keep the allergy in check.
Both steroid options above are extremely unlikely to cause any significant side effects long term. And if they do, you can simply stop and go to Apoqel or Cytopoint. The main point here is using a tiny maintenance dose.