Allergies

Whew! Speed round on allergies! This is usually a much more involved conversation for each individual patient.

Allergies can cause itchy skin, ear infections and licking paws. The three categories for allergies are: food, environment or fleas.
In this video below I talk about how to eliminate some of those, but I am happy to talk much more through an individual Dirtbag Dogtor consult.
Book with the link in my bio and I can talk to you about your dog or cat and how to best manage their allergies! 🐶 🐱 #vetmed #vetmedicine #allergies #veterinarymedicine #veterinarianstudent #veterinarianstudent #dogallergies #catallergies #earinfection #hiking #optoutside

Allergies

Allergies are a frustrating problem to manage, and require life-long management. I wish there was one single cost-effective way to manage them but unfortunately it's not easy. 

There are a lot of things to keep in mind when we're talking about allergy management:

Fleas: Dogs like your dog who are sensitive need to stay on flea/tick prevention in flea/tick season. If they get any sort of flea-bite, it can trigger the start of a skin infection which means a visit here and antibiotics which can add to the cost of managing allergies. 

Food: A very small percentage of dogs have a true food allergy, but we certainly see intolerances primarily to the protein components of food. The most common problem proteins are egg, chicken, and beef. To rule out a food allergy/intolerance, we have to do an 8-12 week trial on a prescription hypoallergenic food (hydrolyzed protein) ($$ for a bigger dog). It's reasonable to first try other OTC foods that have different protein sources (lamb, venison, rabbit) before trying a true food trial. Any new food should be given for 8 weeks before deciding it’s not helping. Make sure not to choose "grain-free" diets that list legumes (peas, lentils, potatoes, sweet potatoes) in the first 3 ingredients as those foods may predispose dogs to developing heart disease (dilated cardiomyopathy). If you're not making headway with OTC diets, a prescription trial is recommended. 

Environment: This is the most likely cause of your dog's allergies. Your dog's likely allergic to the same types of things we are - pollens, molds, dust mites, etc. The most cost-effective way to manage these is frequent bathing. Bathing alone doesn't manage every dog. Bathing helps to strip these allergens off your dog's coat and skin - the fewer allergens your dog has on their skin, the less of an allergic response they mount. 

You can try OTC antihistamines like diphenhydramine (benadryl) or ceterizine (zyrtec), although these don't work as well in dogs as they do in people. For long-term medical management, the things we have: (least expensive to most expensive) are steroids, cyclosporine (Atopica), apoquel, cytopoint, and immunotherapy. Steroids are cheap and are a good way to control short-term flares, but they are not something we like to use long term as they have many side effects. Medicated bathing or medicated mousse (duoxxo mousse) can be really helpful to keep infections and itching at bay.

Cyclosporine - expensive when we get it started, but over time we are often able to taper it down to a maintenance dose. Cyclosporine can also have some long-term side effects, so we do like bloodwork monitoring with it at least yearly. 

Apoquel - it's a good medication in that it doesn't have many side effects but it is very expensive on a month-month basis and is only approved for dogs over one year of age. 

Cytopoint - monoclonal antibody injection that helps to bind one of the cellular messengers in the allergy pathway - it has virtually no side effects. So far with my experience with cytopoint (it came out late 2016), I feel like it works for ~80% of dogs. Those dogs it does work well in, it works really well - it's dosed once every 8-12 weeks as needed. For your dog's size, one injection would be ~$100. Immunotherapy is allergy testing and the formulation of a specific allergy vaccine for your dog - we can do this here, but I think it’s best to see a veterinary dermatologist for this. 

If we're talking about getting on long-term medication, I would encourage you to try diet changes or a hypoallergenic food trial first, because it is possible to improve your dog's skin with that and frequent bathing. I'd always rather a food change over long-term medication if that's what works. I encourage you to start trying frequent bathing if your dog will tolerate it - 2-3 times a week may be helpful.