ENVIRONMENTAL/SEASONAL ALLERGIES

ENVIRONMENTAL & SEASONAL ALLERGIES & HOW TO MANAGE THEM
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One of the most common conditions veterinarians see in their practice is also one of the most frustrating.  Allergies.  Any pet owner who suffers from allergies themselves can understand the misery that allergies can cause their pets.  While allergies can plague both pets and people year-round, they are often a seasonal problem.  There are dozens of different pollens and ’proteins’ that we breathe in (or come into contact with) that can trigger allergies, and these allergens come and go from day to day, week to week and season to season.  Local weather forecasters often include a “Pollen Index” as a warning to allergy sufferers. 

What Effect Do Allergies Have

Many pet owners are surprised to discover that pets are allergic to the exact same things that people are.  So why do pets scratch, bite, lick and chew while people have problems with congestion and runny eyes and noses?  Quite simply, one key factor (among many factors) is a mast cell.  These mast cells within our body contain histamine.  Whenever a pet or person has a sensitivity to a particular allergen (anything that triggers an allergy such as pollens, house dust, etc.) and the allergen makes contact with that mast cell, the mast cell then ruptures and releases histamine.  This histamine release leads to a series of events that result in the miserable effects of allergies.  Since the effect is the same in people and pets, the only difference is the location of these mast cells.  In people, mast cells are mainly found in the upper air passages and sinus areas of the face.  That’s why we sniffle and sneeze and get congested.  In pets, the mast cells are located mostly in the skin, and that’s why our dogs and cats scratch, bite, lick and chew.  Since the mast cells release histamine, one way we can find relief is by using an anti-histamine!

Can Allergies Be Cured?

While it seldom occurs, allergies can be cured … but ONLY through Immunotherapy.  Our goal at CVPC is to control and manage the allergies and find relief for the misery associated with them.

The Seasonality of Allergies

As mentioned before, there is a strong seasonal nature to allergies.  And, of course, there can be an overlap of these seasons.

Spring is a time for pollens from flowers and trees.

Summer is a time for grass allergies.

Autumn is a time for allergies to weeds (ragweed, goldenrod, etc), and fleas are typically at their peak.

Winter in North Carolina, we do not have active pollens, but we do have house dust, dust mites and molds and mildews indoors

And there are also many other allergens that can be potentially year-round problems:  house dust & dust mites, fleas, molds and mildews, cigarette smoke, feathered pillows and comforters, wool in fabrics, and even food allergies (which require a totally different method of management).  So you can see that there are endless sources of allergies for both pets and people.

Controlling Allergies: While we can’t cure allergies, there are a number of things we can do to help your pet get needed relief.

***FOR MILD to MODERATE ALLERGY CASES (Mild to moderate itchiness… little to no loss of hair… mild skin irritation)

Frequent “Sponge Baths”:  If there is one simple, but powerful strategy I recommend for every pet with allergies, this would be the one thing I would do several times a day !   This simple procedure can really make a difference for indoor pets, but it requires a little effort and a disciplined pet owner. Quite simply, every time your pet goes outdoors and comes back inside, take a clean, damp cloth (WATER ONLY — do NOT use Baby Wipes) and give him / her a full-body wipe-down, focusing attention on the feet (tops and bottoms), the chest and belly, the hind end, and the face, nose and neck.  We want to wipe off as many of the pollens and allergens as possible that get onto the fur and work their way to the skin, and then migrate into the body where they will trigger the effects of allergies.  Removing them as soon as possible can make a huge difference for your pet.  Also, we find that putting a t-shirt or clothing on your pet when it goes outside can be extremely helpful as well. 

Antimicrobial Therapy: Bacterial infections of the skin (pyoderma) and Yeast infections are commonly seen in allergic pets and can be a significant source of itching.  Yeast infections in particular can be extremely itchy and irritating, as well as creating an odd ‘Dorito” odor to the skin.  We have available Keto-C Skin Wipes (50 pads in a tub) and Keto-C Flush (for both ears and skin) which, when applied frequently to affected areas of the skin, can help treat both yeast and bacterial infections.  In very ‘yeasty’ dogs and dogs with extensive pyoderma (bacterial skin infection), I recommend frequent (3 times weekly, then taper) bathing in our Keto-C Shampoo along with daily application of a Chlorhexidine Mousse.  This combination will help us minimize the problems with antibiotic resistance we are seeing more and more of in pets … just like in people.

Omega-3 Fatty Acids / Fish OilsEvery itchy pet should get extra Omega-3’s in the form of fish oils!  Why ? Fatty acids can greatly enhance the ‘epidermal barrier’, the protective layer of the skin.  The better the barrier, the better the skin can repel pollens and dusts, and prevent the loss of needed moisture in the skin.  Also, fatty acids have an anti-inflammatory benefit to help (slightly) relieve any itching.  But you must give adequate doses.  Unfortunately, many available Omega-3 pet products do not recommend the correct dose, so many pet owners don’t see much benefit.  So here is how to measure the proper dose …

* The most important issue when dosing Fish Oils is the amount of EPA + DHA … not just the total quantity of Fish Oil.

* Pets need 30 to 35 mg per pound of body weight of combined EPA + DHA daily

* For the correct dose, add the EPA + DHA listed on the label.  Example:  A container listing 180 mg EPA + 120 mg DHA on the label = 300 mg TOTAL.  This 300 mg would be the correct dose for a 10-pound dog.  A 20 lb dog should get combined EPA + DHA of 600 mg to 700 mg each dayA 50 lb dog would get a combined 1500 mg to 1750 mg per day … and so on.

* Alternatively, you can give your pet wild caught salmon, anchovies or sardines daily.  Flax and chia seeds have Omega-3’s, but are virtually unavailable as a source of Omega-3’s in dogs, and not usable at all for cats, so they won’t help.

* We carry 2 different veterinary formulations of Omega-3 supplements: “Free Form SnipTips” (gel caps given by mouth or squirted into food) and “EZ-CHEW Omega-3 Fatty Acid” (low allergen chewable tablets).

* IMPORTANT: Look for “NASC” Seal on labels of veterinary Omega-3 supplements for guarantee of quality!

* Additionally, Omega-3’s are extremely valuable for joint, heart and kidney health. Highly recommended for people, too! If you want to give Omega-3’s for your pet’s joints, you need to double to dosage that you give for skin: Give 60 to 70 mg per pound.

Flea Control: Allergies from flea bites are responsible for the itchiest dogs and cats that we see!  If your pet has fleas, you MUST eliminate them ~ it can significantly improve the itching.  It truly has never been easier to get rid of fleas ~ there are a number of great products available.  Ask us for details on flea control and flea products, or ask for my handout for best results.

Non-Cortisone / Non-Steroid Medications that We Have Available

1) Apoquel (Oclacitinib):  This  prescription tablet has proven to be very effective in controlling itching in most dogs.  It is popular since it works so well for dogs. Initially, we give it twice a day for 2 weeks … then once a day as needed. It does not have the potentially harmful effects on the body’s adrenal function like steroids do.  It is not approved for cats. 

2) Cytopoint/CADI (Canine Atopic Dermatitis Immunotherapy): Cytopoint is an injection that mimics the body’s natural immune (defense) system. Given during the ‘itchy season’ for allergic dogs, ~80% of dogs get significant relief from the itching within 3 days.  Some dogs will get continued relief for 4 to 8 weeks.  It is not a steroid, and side-effects are minimal (a few dogs may be sluggish or vomit).  The cost makes it more suitable for dogs less than 40 lbs.  It is not approved for cats.

3) Atopica (Cyclosporine):  Atopica has proven to be effective at controlling allergies in many dogs AND cats, but it takes about 4 to 5 weeks to begin working.  Once it takes effect (usually after 6-8 weeks), most pets can be tapered off the medication to once or twice a week, so it is cheaper than Apoquel in the long run.  When given with Fish Oils, Atopica has been shown to work even better.  One other advantage of Atopica is that it can be used to treat a variety of other conditions we see in both dogs and cats, not just allergies.  Expect that most dogs and cats will vomit once or twice in the first 2 weeks after starting the medication.  It does not have the potentially harmful effects on adrenal glands like steroids do.

BATHING:  Cool Water Bath + Cool Rinse + Towel Dry (No hot-air blow dryer) + Bathe OFTEN (MORE is BETTER) !

GOOD – If your dog is intensely itchy, a COOL WATER BATH followed by a COOL WATER RINSE (then TOWEL DRY ~ do NOT use a heated blow dryer !). This alone should provide temporary relief.  Water soothes the skin, re-hydrates the outer skin layers, and washes away allergens and pollens that can be absorbed through the skin.  While relief may last only a few hours, it can be easy to do (depending on the pet!) and cheap.  If you cannot bathe your pet, at the very least use a damp cloth and wipe them down several times during the day, focusing on the face, the feet and legs, the chest and belly, and the rump area.

BETTER Aloe & Oatmeal shampoos can be extremely helpful for the short-term (~24 hrs) relief of itchy pets.  I definitely encourage frequent bathing of dogs in need of relief.  Every time you bathe with Aloe & Oatmeal shampoos, you will be moisturizing the skin ~ not drying it out!  We have a piña colada-scented Aloe & Oatmeal Shampoo available at our events.

BEST – For best results, use the appropriate shampoo for a particular skin condition.  For extremely itchy dogs, a shampoo with a topical anesthetic (such as Pramox-1 with Oatmeal Shampoo ~ available at our events) can be extremely helpful.  I already discussed the Keto-C Shampoo (and Keto-C Spray, Flush or Wipes) for dogs with bacterial and/or yeast infections.

IMPORTANT #1 NEVER bathe your itchy pet in warm/hot water as it will often intensify the itchiness!  Be COOL!

IMPORTANT #2 – Leave medicated shampoos on the skin for at least 12 to 15 minutes for best benefit.  And medicated shampoos do not lather as much, so avoid wasting more than you need. 

IMPORTANT #3 – Please do not use people products for pets!  (… and that includes Dawn!  Save it for your dirty dishes)

Antihistamines:

Antihistamines work best when the itching is mild … when bacterial and fungal infections are under control … and when fatty acids/Omega-3 supplements are given at the same time.  Just as with people, we don’t know which one will work, if any!  Since there are different types of antihistamines, if one doesn’t work after 7 to 10 days, then try a different one.  Here are 4 over-the-counter (OTC) products + 1 prescription medication that are well worth trying.

1) Allegra (Fexofenadine) 60mg Tablet – Dogs: 1 to 2 mg per lb once a day
* Toy dogs (5-15 lbs) 1/2 tablet (30mg total) daily
* Small dogs (15-25 lbs) 1 tablet (60mg total) daily
* Medium dogs (25-50) 1½ tablet (90mg total) daily
* Large dogs (50-75) 2 tablets (120mg) daily

2) Claritin (Loratadine) 10 mg Tablet – Dogs: Give 1 mg per 5 lbs of body weight once a day
* Toy dogs (5-15 lbs) 1/4 tablet daily
* Small dogs (15-25 lbs) 1/2 tablet daily
* Medium dogs (25-50 lbs) 1 tablet daily
* Large Dogs (50-75 lbs) 1½ tablets daily

3) Zyrtec (Cetirazine) 5mg and 10 mg tablets
* Toy dogs (5-15 lbs) – One 5 mg tablet once a day
* Small / Medium dogs (15-40 lbs) – One 10 mg tablet once a day
* Medium/Large dogs (40+ lbs) – 10 mg twice daily

4) Hydroxyzine (Vistaril) 10 mg – 25 mg – 50 mg (Requires a Prescription) ~ somewhat similar to Zyrtec –
Dogs: 1 mg per pound of body weight 2 to 3 times per day (Ex. 25 lb dog gets a 25 mg tablet 2 or 3 times a day)

What about Benadryl (Diphenhydramine)?
You can try it, but I find that Benadryl is rarely helpful for stopping itching, but can be useful for dogs with sinus issues (runny eyes and nose and sneezing). Give 1 mg per pound of dog’s weight 2 to 3 times daily (Ex. A 25 lb dog gets 25 mg 2 or 3 times daily). For mildly irritated, runny eyes, you can try Alaway drops, available at any pharmacy.

***FOR MODERATE TO SEVERE ALLERGY CASES (The pet is very itchy & chewy … quite a bit of hair loss … very red and irritated skin… often with a skin infection)

Cortisone / Corticosteroids:   In some situations, it is extremely helpful to use corticosteroids (cortisone) to give temporary relieve your pet’s discomfort.  While we get excellent results from cortisone, the side-effects make it undesirable for long-term use.  In the short-run, we see an increase in thirst and urination, increase in appetite, increased panting and sometimes pets appear more anxious or agitated.  The long-term use can have a profoundly negative effect on the body’s adrenal glands.

Understand, we only use cortisone as therapy for managing allergies … not for ‘steroid abuse’ ! 

Immunotherapy: Allergen-Specific ImmunoTherapy (ASIT) based on intradermal skin testing or blood/serum testing can be a safe and effective way to control itching due to allergies.   However, it requires skin or blood tests, it’s more expensive than other forms of treatment (count on ~$300-600 for just the testing alone), and it may take weeks to months before results may be seen once treatment is started.  But … it is possible to cure the allergies of some dogs that are severely itching and chewing.

Typically, each dog is tested for 60-80 different items.  Among the items are local grasses, weeds, ragweed, pollens from trees and shrubs, flowers, molds and mildews, house dust, epidermals (cat skin, dog skin, etc), miscellaneous items (tobacco, kapok, cotton, wool, etc), feathers, house dust, and fleas.  Yikes !  As you can see, there are endless allergens that pets can be allergic to, and that doesn’t include food allergies (btw, there is no reliable test for food allergies !).

Once it has been determined what a pet is allergic to, immunotherapy can begin.  The idea is to “de-sensitize” the pet to whatever it is they’re allergic to.  Pets (like people) receive either injections, or drops (in the mouth) or a spray (in the mouth) regularly for the desensitization process.  Some pets may need to continue treatment for life.  Although it may take weeks to months to see results, most pets respond well, so it’s worth trying if you can afford it … and if you have patience.  And, as mentioned, some dogs can be cured of their allergies.  At CVPC, we do not offer ASIT.