Allergy/Itching Medications

We are fortunate that new products are available in veterinary medicine to help dogs and cats get relief from their allergies, and the misery of itching, scratching, chewing that goes with the allergies.  While no perfect product exists, having more choices makes it easier to find the right medication for your pet to prevent the endless itching and chewing.  Let’s look at what’s new and what’s old, and how to decide which product is best for your pet.

NON-CORTISONE / NON-STEROID PRESCRIPTION CHOICES: Meaning, that we have to see your pets.

FOR ITCHY DOGS AND CATS: ATOPICA Capsules (for Dogs) and ATOPICA Oral Liquid (for Cats)

Atopica (Cyclosporine) has been available for a number of years, but still serves as an excellent product for allergies for both dogs AND cats.  As with Apoquel and Cytopoint, we find it effective in ~80-85% of the pets who try it.  It takes patience to use at the beginning since it is given once a day for 30-45 days, BUT it takes ~30 days before it even begins to work !  However, once it starts working, in most cases, the dosage can be reduced to twice a week, or given every other day as needed, depending on how the pet responds.   And when given with fish oils / Omega-3 fatty acids, we see even better results with Atopica.  Since we are able to reduce the dosage to 2 or 3 times a week with the majority of pets, it can actually be much cheaper than Apoquel in the long-run.  One of the other great features of Atopica is that it is very useful for treating many other conditions in pets other than allergies.  The most common side-effect is intestinal upset.  We fully expect most pets will vomit at least once in the first 2 weeks after starting the Atopica.   Rarely is the vomiting an on-going problem, and if it is, we naturally advise to stop using it.

FOR ITCHY DOGS:  APOQUEL TABLETS 

Apoquel (tablets given by mouth) has proven to be a great benefit for most itchy dogs.  We are finding it does a great job for ~80-85% of the dogs who use it.  Of course, that means that nearly 1 out of 5 dogs won’t see much improvement.  We especially like it for 2 reasons: 1) it does a great job of helping itchy dogs.  And 2) it does not have an adverse effect on the adrenal glands in the body (which steroids / cortisone do).  However, Apoquel will often make an existing infection worse, so we need to be very cautious about using it or avoid it altogether if the dog has an existing infection anywhere in the body (anything from a skin infection, to a bladder infection, to a respiratory infection, etc).   It is recommended for dogs 1 year or older, and it cannot be used in breeding, pregnant or nursing dogs.  The most common side effects are vomiting and diarrhea.  It is available in 3 different dosages, and the price is $2.10 per tablet.  The dosage given depends on the weight of the dog.

NEW FOR ITCHY DOGS:  CYTOPOINT Injection (Canine Atopic Dermatitis Immunotherapy)

This is the newest treatment available in veterinary medicine for skin allergies (for dogs only).  In my handout on Allergies, I discuss briefly allergy testing and hypo-sensitization to ‘de-sensitize’ your pet to specific allergens (things that cause your pet to break out and itch, such as grass, weeds, dust, fleas, etc.).   With Cytopoint, it is not selective … it does not target just dust or weeds or fleas, etc.  I hate calling it a ‘shotgun’ approach to de-sensitizing your pet, but that’s sort of what it is.  In one sense, it de-sensitizes your pet to ANY environmental allergen that may cause allergies. It is given as an injection, with the expected benefit of 2 to 8 weeks.  And like the Atopica and Apoquel, we find that it works in ~80-85% of the dogs.  Most of the dogs that do not respond to Apoquel will get relief with Cytopoint.  There are virtually no side-effects (although a small number of dogs may experience intestinal upset).   The cost depends on the weight of the pet as it comes in 4 different dosages.  While available for any size dog, it gets pretty pricey for dogs more than 40 lbs.   But since it can last for several weeks in many dogs, it can actually be quite economical.   5-10# = $27 / injection    …    10-20# = $33 / injection   …   20-30# = $38   …   30-40# = $44  …  40-50# = $71  …  50-60# = $77  …  60-70# = $82  …  70-80# = $88.

CORTISONE INJECTIONS

Allergy / Cortisone Injection for Skin allergies (Kenalog Injection for Dogs –  $23 )  (DepoMedrol for Cats – $19) –– I use Kenalog (Triamcinolone) for Dogs, and Depo-Medrol for cats. In general, cats are more tolerant of cortisone than dogs are, so we typically use the longer-acting Depo-Medrol for cats.  The expected benefit of Kenalog is 3 to 5 weeks, and it starts working pretty quickly (in ~12-15 hours).  However, we are limited in how often we can use it.  Since cortisone is a powerful, but effective medication, I want to limit the use to only a very few times a year … and never more than 2 months in a row.   But, we hear it from clients over and over and over again how much happier their terribly itchy pets are when they receive a cortisone injection.   A common side-effect is increased thirst and urination for ~1 week after the injection is given.  For cats, we can generally expect to see benefits for ~4 to 6 weeks, and we do not expect to see cats drinking and peeing more than usual.

I get occasional questions about the use of cortisone / corticosteroids in pets.  I think it’s unfortunate that some veterinarians are misinforming their clients about the use of cortisone.  Because of bad publicity involving athletes and the ABUSE of corticosteroids, society has been painted a picture of fear about the use of cortisone.  To be honest, cortisone / corticosteroids can provide significant benefit to the quality of a pet’s (and a person’s) life when used as therapy.   We are only using cortisone as therapy … not for outright abuse !  Sadly, sensationalism is far more common than good science.  The benefits of cortisone for terribly itchy pets can dramatically improve that pet’s overall comfort and well-being … even if for only 3 to 5 weeks.  While we definitely want to limit the use of cortisone, it does have great value for dogs and cats with skin allergies.  Ultimately, of course, the decision to use cortisone … or ANY other medication, whether it’s flea medication or heartworm prevention or antibiotics or pain medication, etc … is in your hands.

SOAPBOX TIME: 

By the way, to take this discussion one step further, would you take a medication with the following potential side-effects ? :

  • Swelling of the eyes, face, lips, tongue or throat
  • Wheezing or difficulty breathing
  • Fast heartbeat
  • Fast breathing
  • Cold, clammy skin
  • Ringing in the ears
  • Loss of hearing
  • Bloody vomit
  • Bright red blood in stools

Just so you know, I personally have taken this medication nearly every day for the past 30+ years … and I will continue to take it.  What is it ? Aspirin !  What’s the difference between medicine or poison ? It’s the dose that makes a medication a poison, and that dose can vary widely from individual to individual.  It’s helpful to understand that EVERY bite of food (whether kale or a Dorito), every medication you take (whether PeptoBismol or Xanax), anything you swallow (whether water or wine) or rub onto your skin (hand lotion or suntan cream), or anything you inject into your body will have a biochemical effect on your body … for good or bad.  That’s why I believe that FOOD is the most powerful ‘drug’ in the world since we are constantly affecting our well-being (again, for good or bad) with the dietary choices we make several times each and every day of our lives.

OK, I will climb off my soapbox now and get onto your pet’s health …

Now, let’s mention a common product available for itchy pets that do not require seeing a veterinarian: Omega-3 Fatty Acids.

NON-PRESCRIPTION CHOICES:

OMEGA-3 FATTY ACIDS = The Good Stuff  ~ What you Need to Know !

Every veterinary dermatologist (skin specialist) enthusiastically agrees that every itchy pet should be on Omega-3 Fatty Acids (FA) !  And for dogs and cats, that means marine / fish oils.  Omega-3 FA have a number of health benefits throughout the body (joints, kidneys, skin, eyes, nervous system), but for our purposes, we will just talk about the skin benefits.  The most significant benefits are the anti-inflammatory properties of Omega-3s as well as their ability to repair and fortify the ‘skin barrier’ that keeps allergens / pollens from entering the body.  Proper dosing is crucial to providing any itching relief, and far too many products recommend an inadequate dose.

The Proper Way to Dose Omega-3s:

– First, look for the “NASC” (National Animal Supplement Council) seal on a container to insure proper quality control.  If there is no “NASC” seal, I would not trust the quality in this unregulated supplement industry ~ let the buyer beware.

– Rather than looking at how many mg of Fish Oil are in a product, look at the amount of EPA + the amount of DHA.  They should be listed on the nutrition label.  Simply add the EPA + DHA.   If you don’t see DHA and EPA listed, don’t buy the product !

RECOMMENDED DOSE:  Give 30 to 35 mg of combined EPA + DHA per pound of the pet’s body weight … give Daily.

– Example:  An itchy dog weighs 20 lbs.  The proper dose for a 20 lb dog is 600 to 700 mg per day (20 lbs x 30mg = 600 mg … 20 lbs x 35 mg = 700 mg).  So, if a bottle lists EPA = 400mg / DHA = 300 mg … Add them together and you get 700 mg.  700 mg per day would just right for a 20 lb dog.    Likewise a 10 lb dog needs ~300 mg … a 30 lb dog needs ~900-1000 mg … a 40 lb dog gets ~1250 mg … a 50 lb dog gets ~1500 mg … and so on.

Our Products (all of which, of course, have the NASC seal of Guaranteed Quality):

EZ-CHEW 450 mg Max Strength Omega-3 for Small & Medium Dogs and Cats – 60 chewable tablets – $21 (If you order online or via telephone, there is a $7.50 mailing fee due to the heavy weight of the EZ Chews)

EZ-CHEW 900 mg Max Strength Omega-3 for Large / Extra Large Dogs – 90 chewable tablets – $37  (If you order online or via telephone, there is a $7.50 mailing fee due to the heavy weight of the EZ Chews)

FreeForm Snip Tips Omega 3 – Small Dogs and Cats – 60 twist off gel caps – $18

FreeForm Snip Tips Omega 3 – Medium & Large Dogs – 60 twist off gel caps – $26

Why Omega-3s May Not Work:

It could be from incorrect dosing or poor quality control of product (very true for both human supplements as well as pet supplements).  While flax seeds and chia are sources of Omega-3s, they are virtually unusable for dogs (and not usable at all for cats), so do not waste your money providing a flax seed supplement to your pet thinking it will get Omega-3 benefit.  Also, definitely do not waste your money on krill oil ~ it has shown no additional benefit over fish oil in human studies and it costs about 10 times more than fish oil and krill is consumed by whales, so best not to remove a significant food source from endangered whales.

What About Coconut Oil ???

Many pet owners add coconut oil to their pets’ food.  Keep in mind that coconut oil is an Omega-6 fatty acid (it is NOT an Omega-3 fatty acid like fish oil), so for an itchy pet, it does not help with the itchiness.  In fact, because Omega-6 fatty acids are what we call pro-inflammatory (the opposite of anti-inflammatory), coconut oil can actually aggravate/ worsen the itchiness of an itchy pet.  If you want to use coconut oil, it is best used on the surface of the skin of a pet where its inflammatory properties can actually be protective for the skin.  Just do not give it internally.