VetInfo Digest   April 2002

This Month:

   Allergies in Dogs and Cats

    Definitions

    Types of Allergies

    Diagnosing Allergies

    Testing for Allergies

    Treatment of Allergies

 

This month's newsletter will be devoted almost entirely to allergies affecting skin health. It is too large a topic to really cover well in eight pages and there are entire books on allergic disease in pets, but it is an important topic so we're going to give it a try.

Allergies are reported to be much less common in areas in which parasitism occurs commonly. This is thought to be due to the fact that the portion of the immune system that reacts to foreign substances leading to allergies is the same portion of the immune system whose normal responsibility is to control parasites. This may be due to the production of IgE (immunoglobulin E) in response to pollens, molds and dander since there are not enough worms, protozoans, fleas and other parasites to keep the immune system busy.

I'm pretty sure that none of my clients would want to allow worms in their pets in order to reduce allergies but perhaps someday we can come up with another way to keep this portion of the immune system happy without having to have allergies.

 

Definitions

Anaphylaxis: this is an extremely rapid hypersensitivity reaction that can cause death in some cases. It is most commonly associated with bee-stings and vaccine reactions and is an extreme form of allergy. While most of the time this is a reaction that involves many body systems, it can be restricted to the most sensitive region, such as the gastrointestinal tract, respiratory tract or skin. In most cases anaphylactic reactions require previous exposure to the substance inducing the reaction, so they tend to occur on second, third or fourth vaccinations rather than first vaccinations.

Allergens: this is the name for substances that can cause allergies, such as pollens, dust mites, cat dander, molds, etc.

Antibodies: substances produced by the body in response to a specific disease organism or stimulus. In the case of allergies, the antibodies produced by the body are Immunoglobulin E (IgE) antibodies.

Atopy: this is the term used in humans to denote genetically determined (follows family lines) immediate hypersensitivity reactions, such as "hayfever" reactions. In dogs and cats it is usually used to denote the form of allergy that we think of most predominantly as "inhalant allergies", although some researchers now suspect this is a combination of inhaled exposure and contact exposure in many dogs.

Immunotherapy: the use of special preparations made from antigens that are causing allergies injected on a regular schedule to try to desensitize the patient to the allergens. These are often referred to as "allergy shots" but this term is used loosely and some veterinarians describe periodic injections of corticosteroids used to control allergic symptoms as allergy shots. It is important to understand the difference.

Types of Allergic Reactions and Types of Allergies

Allergies come in several forms. In dogs and cats the main divisions in allergy type are food allergies, insect exposure allergies and atopy. Contact allergies do occur in pets, but are less common than the other allergies.

The body's reaction to allergic stimuli is also classified into several groups, from Type I hypersensitivity to Type 4 hypersensitivity. From the standpoint of allergies, Type 1 (immediate hypersensitivity) and Type 4 (delayed hypersensitivity) reactions are the most important. Atopy is thought to be primarily a Type 1 reaction. Food allergies are thought to be primarily Type 1 but some appear to be Type 4. Flea allergy usually has both a Type 1 and Type 4 reaction. In some dogs with flea allergy the immediate reaction is more noticeable and in other dogs the delayed reaction is the most prominent type. It is possible for the type of reaction associated with flea or insect bite allergy to vary over time in individual dogs. Contact allergies are usually Type 4 allergies and have been associated with a large number of allergens, including plastic food bowls, carpeting, topical medications, carpet cleaners and many other things. Even though many contact allergens have been documented, the overall incidence of contact allergies still seems to be very low. The delayed response to contact with the allergen makes it harder to diagnose contact allergy and so a high degree of suspicion for this condition is sometimes necessary in order to successfully make a connection between a contact allergy and the appearance of clinical signs.

Thinking about the type of reaction associated with a specific type of allergy is important for several reasons. Since atopy is usually a Type 1 reaction, a pet becomes itchy very quickly after exposure to the allergen and if the pet can be shielded from the allergen the reaction will also stop pretty quickly. Flea allergy is very different, in that a single flea bite may cause a delayed reaction that starts several hours after the bite and continues for as long as three weeks. This can make the diagnosis of flea allergy based on clinical signs very frustrating, since the signs appear much later than the bite and the pet may have successfully removed the flea or fleas prior to the time that symptoms appear. This is also true for other insect bite hypersensitivities, such as reactions to tick bites and mosquito bites. Our experience with food allergies is that they are relatively easy to diagnose if they are the Type 1 reactions and much much harder to diagnose if they are delayed hypersensitivity reactions, since it may take weeks of avoiding a particular food ingredient before the symptoms go away.

Most veterinary clients and even many veterinarians tend to think of allergies to insects in terms of flea allergy alone. However, this is probably an inaccurate assumption. In people there are documented allergies to ticks, flies, mosquitoes, and cockroaches. In the case of the cockroaches, at least, bites are not necessary for the insect origin allergy to occur in people. Mosquito bite allergy is well documented in cats and probably also occurs in dogs. We believe that tick bites are often irritating and that the hard lumps that occur after tick bites are a form of allergic reaction in many pets. We see a large number of dogs in our practice with sores on the tips of their ears or at folds in the ears due to fly bites. Almost certainly a large number of these dogs are actually allergic to the fly bite, rather than having sores from being bitten by excessive numbers of flies. Treating this condition as an allergic response rather than a physical injury can be very helpful, especially in severe cases. Flea allergy sometimes occurs in young dogs but more commonly begins in early adult to middle aged dogs. There is no upper limit for the onset of flea allergy.

The classic contact allergy problem in veterinary medicine occurs from plastic food bowls. Eventually, most veterinarians will see a cat or dog with irritation of the chin or muzzle region that resolves when plastic food bowls are replaced with stainless steel or ceramic bowls. Cedar chips sometimes cause contact allergy and there is reported to be an allergic reaction to the combination of concrete and disinfects in some dogs. Poison ivy is a contact allergen in humans that doesn't affect pets nearly as often, probably due to reduced skin exposure due to the presence of long hair protecting the skin surface.

The term atopy is borrowed from human medicine. My 1972 Stedman's Medical Dictionary defines atopy as a condition occurring only in man, characterized by immediate hypersensitivity and a tendency to follow family lines. My more current Bailliere's Comprehensive Veterinary Dictionary defines atopy as a Type I hypersensitivity reaction characterized by itchiness of the feet, face and ventral body. We used to think of atopy as "inhalant" allergies, based on the concept that pollens and other irritants were inhaled and led to the allergic symptoms. Currently it is thought that skin contact with allergens is also an important component of this disease, so the term "inhalant allergies" may be misleading. In any case, Type I hypersensitivity reactions to allergens in dogs are usually referred to as atopy or inhalant allergies.

Food allergies as a cause of skin irritation are not as common as atopy or insect bite hypersensitivities but they still represent an important portion of the allergic disease in dogs and cats. At the present time it is felt that some pets with food allergies will exhibit both skin irritation and gastrointestinal irritability evidenced by chronic vomiting or diarrhea. When these conditions occur at the same time in a pet it is important to remember the possibility of a food allergy. In cats, deep awful looking sores that are not responsive to antibiotic, antifungal or corticosteroid therapy can be associated with food allergies. It is probably worthwhile to consider a food trial for allergies in any pet who requires frequent use of corticosteroids to control skin irritation.

 

Diagnosing Allergies

There are many ways to try to differentiate between the types of allergic disease. It is very important to recognize that dogs and cats can have food allergy or flea allergy and/or atopy, at the same time, so symptoms may be present from more than one type of allergy. In some reviews of allergy case histories as many as 60% of the patients had more than one type of allergy, usually insect bite allergy and atopy simultaneously.

It is really important early in the diagnostic process to rule out other causes of itchiness, to the extent it is possible to do so. Skin itchiness and hair loss can occur for a number of reasons other than allergies. It is a good idea to try to rule out flea infestation in both dogs and cats, sarcoptic mange in dogs, cheyletiella mange in both dogs and cats, ringworm in cats, intestinal parasitism in both dogs and cats, bacterial and yeast skin infections (primarily in dogs) and even to consider treatment for fleas when they are not found. If more than one puppy or kitten in a litter exhibits signs of itchiness that start at an early age, an infectious cause is more likely than allergies. It can sometimes be very hard to obtain a medical history for a pet's siblings but when it is possible to obtain historical information about the whole litter it can be very helpful.

Certain breeds of pets are more prone to allergies than other breeds. This has been documented better in dogs than in cats. Various authors who have compiled lists of breeds prone to allergies have disagreed some on which breeds are most likely to be affected, but there is general consensus over several breeds. These include shar peis, West Highland white terriers, Cairn terriers, miniature schnauzers, dalmatians, Boston terriers, English setters and golden retrievers. From our practice experience, I think I would include Labrador retrievers and cocker spaniels but these breeds don't seem to make it onto other lists. Since it is possible for the breed lines to vary widely in different areas of the U.S. and the world, it is highly likely that there are strong variations in the affected breeds in different geographical areas. Atopy has been documented in most breeds in at least a few individuals so it is not possible to use breed predisposition to rule in or rule out atopy.

Atopy typically starts at a younger age than insect bite allergy. Most dogs with atopy are between the ages of 6 months and 3 years when symptoms appear. A few dogs start with atopy signs earlier in life. It is very rare for a pet to develop atopy after it is middle aged, except for dogs who are moved from one environment to another, such as dog who is moved from California to the East Coast. Food allergies sometimes start very early in life. We have seen inflamed feet and ears in puppies as young as 10 weeks from food allergies. Food allergies can also occur very late in life and are probably the most likely allergy when an older dog suddenly show symptoms of itching or ear and foot inflammation that does not have another discernible cause. Insect bite allergies may show up as an immediate hypersensitivity reaction in young dogs and cats and then progress to a more persistent delayed reaction as the pets age. It seems to be possible for pets to develop insect bite allergy at any time in life but most affected pets probably show signs by the time they are three to four years of age. Contact allergies also seem as if they can occur at any time in life, which may be due to the intermittent nature of exposure to most contact allergens.

Itchiness that is seasonal is strongly associated with insect bite allergies in areas of the country in which insect exposure is seasonal. Atopy usually starts out as a seasonal disease but may be a year round problem when pets have both indoor and outdoor sources of allergens. Food allergies tend to be a year round problem in most affected pets, although there may be waxing and waning of symptoms as food ingredients in the diet change. Contact allergies may be intermittent or may be continuous, depending on exactly what the pet is allergic to and how often contact occurs.

The pattern of skin disease and itchiness can be very helpful in determining the most likely type of allergy. Food allergies tend to cause itchiness of the feet and ears and may also be associated with gastrointestinal signs. Atopy causes itching of the feet and ears as well. Atopy is the leading cause of ear inflammation in dogs but doesn't seem to affect the ears in cats very often. Flea allergy usually causes itchiness and hair loss around the base of the tail and down the rear aspect of the rear legs in dogs and scabbiness around the same area and the neck in cats. Fly bite dermatitis primarily affects the ears in dogs. In cats contact allergy is pretty strongly associated with plastic food bowls and inflammation of the chin area.

To see this information in table form, click here: www.vetinfo.com/subscriber/apriltable.html

 

Testing for Allergies

It is critically important to treat any secondary bacterial or yeast infections that may have resulted from allergies prior to trying to make a specific diagnosis of the allergy type. If this stops the itching entirely, it is a sign that the infection was primary and the itching not due to allergies. Treating the secondary infection first often seems like the wrong approach to pet owners, especially when it takes weeks of therapy to eliminate a bacterial or yeast infection. It is difficult to get a good diagnosis of the allergy type when secondary infection is present, though. It is sometimes necessary for us to dispense just enough corticosteroids to stop itching and prove the point that we can control it, in order to get a client to proceed through the rest of the diagnostic process. I have done this on several occasions where clients are coming to us for a second opinion when their veterinarian was following a reasonable diagnostic process but had not convinced the clients that eventually their pet's problems could be resolved.

It is also imperative to eliminate fleas prior to moving on to a diagnosis of allergic skin disease. It is almost impossible to overstate the importance of fleas in skin disease in dogs and cats. Prior to the availability of the new flea control products, just within the last five years, we saw at least three to four times as many skin disease cases each year as we see now. If your pet is itchy and you are not treating all pets in the household with fipronil, imidocloprid, selamectin or lufenuron/adulticide combination therapy you should start one of these therapies prior to moving on the diagnostic process, unless fleas are not a problem at all where you are (some high elevations and very dry climates).

Sarcoptic mange in dogs and ringworm in cats are two disorders that are sometimes overlooked that can mimic allergic skin disease. If these were not eliminated as possibilities prior to a diagnosis or treatment of allergic skin disease it may be necessary to go back and consider them again if response to treatment of the suspected allergic disease is poor. In both dogs and cats Cheyletiella mites can cause itchiness that is easy to misinterpret as allergic in origin.

While food allergies are not the most common allergy, they are often the first one that veterinarians want to test for. There are several reasons for taking this approach. Food allergies can be eliminated by removing the offending food ingredient or ingredients from the diet. Contact allergies and food allergies are the only allergies where control of exposure to allergens is relatively easy, making it possible to avoid the allergic response entirely. If response to a food trial is very good, there may be no need for further testing. Since it is not too unusual for a dog to have more than one type of allergy, a strong reduction in itchiness is suggestive that part of the problem is food allergy, even if a total response does not occur. Knowing that there is a complicating factor can make the diagnosis of other allergies less complex.

Food allergies are diagnosed by feeding a diet that contains low molecular weight proteins that are not likely to cause allergic responses (Hills z/d (tm), Purina's HA (tm)) or by feeding a single source of protein that the dog has never eaten before, such as duck, ostrich, alligator, venison, salmon, and others. There are a number of novel diets made commercially. Dermatologists seem to favor feeding a home made diet when trying to rule out food allergies, though.

Home made diets eliminate preservatives, food coloring and contamination or changing of ingredients to a greater degree than feeding commercial diets. One of the real ironies of canine dietetics occurred because many vets used lamb and rice diets as their food trial diets. When veterinary clients noticed that many dogs with skin disease were put on lamb and rice diets by their vets a demand developed for these diets and was met by the dog food companies -- which essentially destroyed the usefulness of lamb and rice diets as a method of detecting food allergies.

When doing a food trial it is imperative that the pet be fed ONLY the food trial diet. No treats, even including beef flavored medications such as heartworm preventatives. This is extremely hard to accomplish in households with multiple pets, small children or adults who do not believe in the necessity of the food trial.

I think that many more dogs and cats would be diagnosed with food allergies if veterinary clients actually stuck to the proper diet for a food trial for at least six to eight weeks. Partial responses to food trials are important since more than one type of allergy may be present but controlling all sources of itchiness is best. We sometimes see really dramatic responses to food trials. We have one patient whose ear canals were swollen shut by an allergy to beef who had absolutely normal ears within two to three weeks of feeding a diet that did not contain beef. Most responses are not this dramatic.

To conclusively diagnose food allergy it is necessary to add possible food allergens back into the diet one by one until the offending ingredients are recognized. Food allergies are most common to beef, milk, chicken, wheat, corn, soybean and other common dog and cat food ingredients. I have no clients who have allowed us to properly diagnose specific food allergies. Most of my clients don't care what the offending food ingredient is when there is a dramatic response to a hypoallergenic diet. They just want to stay with the diet that works. Others stop the food trial as soon as one or two offending foods are recognized and just avoid those foods. Usually this works OK but we always wonder how many additional foods the pet might be allergic to. As long as they are doing well, though, we are content, too.

The best diagnostic test for atopy is still considered to be intradermal skin testing. This is done by shaving an area of skin to remove the hair, then making tiny injections of allergens directly into the skin and judging the response to the injections. It is usually best to check the reaction within a few minutes and again in twenty-four hours, although the second check is not always practical. An alternative to skin testing is serologic testing. In this case, an effort is made to identify specific types of IgG antibodies to various allergens. The best serologic tests are the ELISA tests. Serologic testing sometimes includes tests for food allergies and it is important to remember that serologic testing for food allergies works very poorly and can not be relied upon.

The correlation between skin testing and serologic testing is getting better and it is possible to use serologic testing effectively. However, it is really important that the person interpreting the test be very aware of likely allergens in the region the pet lives in and how likely a positive test for these allergens might correlate with actual allergic disease in a particular patient. A veterinarian with a very strong interest in skin disease, particularly allergic skin disease, is going to have much better success diagnosing and treating allergies from either intradermal skin testing or serology than a veterinarian who is unaware of which positive and negative results to take very seriously and which may be ignored. A plan for therapy should be laid out and explained in some detail. If symptomatic therapy using antihistamines or corticosteroids is considered it is important to know how long to continue therapy and the side effects to watch for. If immunotherapy using allergens chosen specifically for your pet are going to be used it is imperative that your pet see the veterinarian on a regular basis during therapy to assess the response to therapy and to watch for secondary complications. Treating atopy successfully really requires close cooperation between the veterinarian and the pet owner. If this can not be achieved, success is likely to be limited. Find a veterinarian who is knowledgeable and enthusiastic about treating for allergic skin disease and work with him or her as a team to keep your pet as comfortable as possible.

Never forget that allergies are usually a lifelong problem. They can be managed well in many cases but it is rare to totally "cure" an allergic pet. You must commit to a long term search for best combination of effective therapy and minimal side effects. This may take a great deal of effort over a long period of time, perhaps even the entire life of your pet. Often pet owners think that treatment for allergies is not successful because the allergy symptoms return when treatment is stopped. This is not a sign of treatment failure, it is a sign that successful management of the allergic disease is possible but that it will require a longer term effort on the part of both the vet and the pet owner.

 

Treatment of Allergies

Simply avoiding the allergen is useful in some forms of allergy. If a food trial shows an allergy to beef, don't feed beef. Flea allergy can be controlled entirely in indoor pets by controlling fleas. Mosquito bite allergies can be lessened by not taking a pet outside around dawn or dusk. Dust mite allergies can be decreased by allowing a pet to be outside more, by vacuuming frequently (especially with HEPA filter vacuums) and using a dehumidifier. Controlling mold growth as much as possible can help with mold allergies. Avoidance isn't always possible but it is a good idea to explore all possible means of avoiding allergens.

When avoidance isn't possible, allergies are treated with antihistamines, corticosteroids, essential fatty acid supplementation, immunotherapy, psychoactive medications and immunosuppressants other than corticosteroids. The use of anti-parasitic medications, flea control medications, antibiotics and antifungal agents may be necessary to control secondary symptoms. Like the allergies themselves, secondary symptoms may reappear when medications are discontinued. All of these medications have some drawbacks.

For generalized itchiness it can be helpful just to give a cool bath followed by an oatmeal conditioner rinse. This will often provide up to 24 hours of relief for mild itching and several hours for moderate itching, which is sometimes enough to get through the night until a visit with your vet can be arranged.

There are shampoos and conditioners with cortisones or local anesthetics (pramoxine HCl) that are helpful in controlling itching, as well. It is rare for bathing to control itching entirely but it can be a helpful addition to other therapies.

Corticosteroids are powerful anti-inflammatory agents. There are number of corticosteroids used but the most common one is prednisone. In cats there is some evidence that the use of prednisolone or methylprednisolone may be better than the use of prednisone. This is something to consider when response to therapy with prednisone is marginal in a cat. Injectable methylprednisolone acetate (DepoMedrol Rx) sometimes works when oral cortisones will not in cats. In dogs oral use of prednisone is usually effective. Corticosteroids cause an increase in drinking, increased in appetite, increased urination and decreased immune system protection. It is best to use corticosteroids for the minimum time possible and to use them on a alternate day schedule (one day on, one day off) whenever possible. With long term use corticosteroids can induce diabetes and pancreatitis. If it is necessary to use corticosteroids for more than 2 to 3 months a year it may be best to consider immunotherapy as an alternative, especially when treating young patients. It is often possible to use corticosteroids in "pulse therapy" or "crisis control" therapy in which they are used for 3 to 5 days to break a severe itching cycle then discontinued for at least a week or two. Having a small amount of prednisone to help in crisis situations can make it easier to pursue other therapies with less side effects by giving pet owners an alternative for really bad days.

Type 1 hypersensitivity is usually responsive to cortisones and Type IV is only partially responsive, or in some cases even non-responsive, to corticosteroid therapy. This is an important point, because upping the dosage of corticosteroids when Type 4 hypersensitivity is present may not be effective and may even lead to an increase in secondary infections. So corticosteroids are better for atopy than they are for flea allergies. On the other hand, control of fleas is usually possible and this may eliminate the need for any form of itch control.

Topical medications work for some dogs with mild itching or localized reactions to allergies, such as inflammation between the foot pads, ear infections or "hot spots". We have reasonably good success in a number of dogs using topical corticosteroids for control of persistent ear inflammation associated with allergies and with NeoPredef (tm) powder for dogs who only exhibit inflammation of the feet. We like NeoPredef as a first line of defense against hotspots but many veterinarians have other topical preparations that seem to work better for them.

Antihistamines work for some pets with allergies. There is some evidence that antihistamines are more effective when combined with essential fatty acid supplementation. In dogs, the two antihistamines that seem to work the best in studies are diphenhydramine (Benedryl tm) and clemastine (Tavist tm). Hydroxyzine (Atarax Rx) is also effective in many dogs. The dosage for diphenhydramine is 1mg/lb of body weight and clemastine is dosed at 1.34mg per 60 lbs. of body weight, making it more appropriate for larger dogs. In cats, chlorpheniramine (Chlortrimeton tm) seems to be the most effective antihistamine. The most commonly recommended dosage is 2mg/cat every 12 hours.

Essential fatty acids are the omega-n6 and omega n-3 fatty acids. For inflammation the omega n-3 fatty acids are more effective. Marine fish oil is considered to the best source for these and is found in the veterinary product 3V Capsules (tm) and in many generic formulations available over the counter. The dosage to control inflammation is higher than the usual recommended dosage on the supplement bottles. It may be necessary to give 180mg of combined n3 fatty acids per 10 lb. of body weight per day. It may be helpful to supplement at the recommended dosages with DermCaps (tm), OFA Plus EZ-C (tm) or similar omega fatty acid supplements full time and to use the higher dosages of the omega3 acids only when itching and inflammation are present. In either case, it is necessary to start fatty acid supplementation before the anticipated start of allergy season for best success in using these products.

Several medications that were originally thought of a antidepressants appear to help control itchiness in some pets with allergies. Doxepin and amitriptyline are tri-cyclic antidepressants that may be useful in controlling itchiness. The dosage for doxepin is usually 0.5 to 2mg/kg every 12 hours, amitripyline is dosed at approximately 1mg/kg. Like the antihistamines these medications often work better as part of a combined therapy with fatty acid supplementation. We have two or three patients whose itching is controlled entirely with the use of amitriptyline alone.

Corticosteroids work better than any other medications for the control of itching in atopic dogs and cats and work for many to most pets with other forms of allergies. Prednisone, prednisolone, methylprednisolone acetate, triamcinolone and dexamethasone are commonly prescribed corticosteroids. It is best to use corticosteroids for the shortest possible time period and at the longest possible dosing interval in order to minimize side effects. In general, if corticosteroids can be used for less than 4 months of the year and dosing every 48 hours or longer works after the initial loading dosages (daily dosing for a few days), serious side effects are rare. Corticosteroids are available as injectable, oral and topical medications. If topical therapy will work it is preferable, followed by oral and then injectable preparations. The side effects that bother owners the most are appetite increases and increases in drinking and urination. The side effects that bother veterinarians the most are increased susceptibility to secondary infections and predisposing patients to pancreatitis and diabetes. Trimeprazine tartrate combined with prednisolone (Temaril-P Rx) is reported to control allergies in some pets better than prednisone alone. If this combination can be used on an every other day schedule after a short initial dosing period of daily use, this may be a way to reduce overall corticosteroid use.

Some veterinarians have begun using cyclosporin, the medication usually used to prevent rejection of transplanted organs, as a treatment for allergies. Cyclosporin for allergies is dosed at 5mg/kg once every 24 hours. It may take a month or more to see strong beneficial effects from this use. Cyclosporin is relatively expensive and has many side effects, including vomiting, diarrhea and increased susceptibility to secondary infections but it offers an alternative to long term corticosteroid use for patients that need continuous medications.

Two other alternatives to corticosteroids for patients with long term anti-itching requirements are pentoxifylline (Trental Rx) and misoprostol (Cytotec Rx). Pentoxifylline is usually dosed at 10mg/kg twice a day and seems to be able to be given long term with minimal side effects. Misoprostol is usually dosed at 3 to 6ug/kg every 8 hours. It is reported to control itching in about 50% of dogs for which it is used. This is a good medication for pets that must be on nonsteroidal anti-inflammatory (NSAID) medications for orthopedic conditions who also have allergies, since misoprostol was originally marketed as a means of controlling gastrointestinal ulceration and is used as a protective agent in pets sensitive to the ulcer creating effects of the NSAIDs. It is generally best not to use corticosteroids and NSAIDs at the same time. The dosing schedule and cost generally limit the use of misoprostol in pets, otherwise.

There are probably other medications and other therapies that I have not covered. It is important to remember that allergies are a problem that must be dealt with over a long time. They are not a disease that can be easily "cured" and there are no currently available medications that will stop an allergic response permanently. In some dogs it is possible to lessen the severity of allergies or to allow the dog to get over them by using immunotherapy (hyposensitization) but even this takes several years. It may be necessary to use combinations of several of the medications listed above that help in the control of allergic symptoms in order to lessen the side effects of any one of the drugs. Allergies require a diligent effort. This is a disorder that is best treated by a veterinarian with a genuine interest in working with allergies and a client who is committed to a long term process. This can be a hard concept for pet owners. We have a number of clients who really wonder if we are doing a good job treating their pets because they really want a pill or injection given to their pet that will stop the problem for all time. This is not an available option. You and your vet must be willing to work out the individual treatment necessary for your pet to maximize the effect of the least harmful medications and to use the more risky medications sparingly to provide a good quality of life. Finding the right balance is challenging but worthwhile.

 

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The VetInfo Digest is published by TierCom, Inc., P.O. Box 476, Cobbs Creek, VA 23035. The opinions expressed in this newsletter are those of Michael Richards, DVM., author. Please send e-mail for Dr. Richards to mervet@inna.net

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