Tag: allergy

135 Cytopoint- the “new” injection for itching

All dogs itch once a while. Some dogs have seasonal allergies, and have seasonal itching and scratching. These are pretty easy to manage with oral histamines, weekly bathing, and parasite control. A few have severe allergies to pollen, parasites, or even food, and they are miserable. All that scratching and itching traumatizes the skin, it becomes inflamed, and it can get infected. In the “old days” we use steroids like prednisone to stop the itching, but it can have bad side effects. About 8-10 years ago we started using Apoquel (oclacitinib tablet), which is potent like steroids, but is not steroidal, so there is no suppression of immune system. Many of these cases used to be sent to the dermatologist for allergy testing, but Apoquel controls the inflammation quickly and orally.

Now there is an injection for itchy dogs called Cytopoint. CYTOPOINT helps interrupt the itch cycle; allowing dogs to stop scratching so damaged skin can heal. And it works by an entirely different mechanism. Instead of blocking histamine and other pro-inflammatory compounds, Cytopoint neutralizies IL 31, a cytokine that mediates the itch cycle, not the inflammation. It is the first monoclonal antibody (mAB) therapy for chronic canine allergic and atopic dermatitis. I think of it more like a vaccine for itch than inflammation.

Cytopoint won’t magically heal red or infected skin. It doesn’t stop the allergic reaction but breaks the itch cycle, which is monumental for some dogs. Allergic dogs may still need bathing to control exposure, and infected skin will still need therapy, but that darn scratching will go way down. No more constant licking feet or hearing that collar jingle from scratching face or ears ( if it is atopy triggered).

How do we assess itchiness? As vets, we ask the owner to rate the itchiness on a scale of 0-10. Zero is not itchy at all. Ten is the worst imaginable, round the clock, can’t sleep, can’t eat, bleeding skin. My clients often rate the severely affected dogs as 8 /10. Apoquel and Cytopoint should reduce the score to 3-4/10. Apoquel is a tablet given once to twice a day, safe for dogs over 12 months of age. Cytopoint is an injection that lasts 4-8 weeks, so it can be more cost effective for some dogs. And if the Cytopoint isn’t enough by itself, it is safe to also give Apoquel since they work by entirely different mechanisms.

So if your itchy dog isn’t well controlled on Apoquel, or the cost of being on it daily is cost prohibitive, come and let’s see if Cytopoint would be a better choice. At least we have options before sending you to the veterinary dermatologist.

73 The Itchy Dog

Ragweed season is here already. Ragweed is a problem for many fall allergy sufferers but this year it started really early (in mid-August after the rains), and will generally go until the first frost (average November 15). The mold counts have been high too. Dogs and even cats can be allergic to pollen and mold.

Allergies are nothing to sneeze at, really. Actually, for most dogs the primary symptom is itchiness, especially feet, ears, armpits and rear end. They usually don’t have runny eyes and nose, but a few might. And most “allergies” are to the proteins in pollen, rarely food allergies. For these pets, the immune system has an elevated, inappropriate response to these proteins that are inhaled and absorbed right through the skin. The prime skin cell that reacts is a mast cell, which is loaded with histamine granules, and releases the histamine when the specific proteins are detected by the immune system. Then the histamine triggers the itch. Licking & scratching is a symptom of itchiness.

Symptoms Include licking feet, rubbing face, shaking ears, scratching at armpits or sides, and licking/scooting on their rear. The pattern of allergy itchiness is different than flea bites, which is mostly lower back and backs of thighs. And an allergy dog with even one flea is extra miserable.
Uncontrolled allergies can lead to secondary skin and ear infections, either bacteria like Staph or yeast. If it goes on for weeks, the skin will make extra sebum and smell bad, or get flaky and crusty. Many people mistake this for “dry skin”, and stop bathing their dogs. If the itching and infections go on for longer, the skin may get thickened, turn gray, and wrinkled looking.

As pet parents, we can help these patients. First, I recommend starting with anti-itch medicine, often OTC antihistamines like Benadryl or Zyrtec. If that isn’t working well, I step up to prescription medicines like Apoquel. My last resort is steroids, which have many side effects.

Secondly, I stress cleansing the skin and ears with weekly bathing or wiping, often with gentle shampoos like aloe and oatmeal dog shampoos. If we leave the abnormal sebum on the skin, microorganisms will try to grow in it, so bathing is critical to break the allergy cycle. And washing the bedding and collars is important too. Daily washing of the affected areas ( like feet, face, ears) can help remove topically absorbed pollens and help soothe the itch.

The third component is to try to avoid whatever the allergy is toward. Pollen is hard to avoid, so keeping the pets inside more helps, but pollen gets in homes too. Keeping filters clean helps. Stepping up antihistamines and bathing helps. Many “derm” diets or supplements have higher fatty acids that can help decrease the immune symptoms.

Forth component is to avoid fleas and ticks. The flea population often spikes in mild moist weather like spring and fall. They don’t all die after the summer or winter extremes. And they never die in the house from bad weather outside. So keep allergy dogs on year round flea prevention like Credelio or Trifexis.

Allergies are nothing to sneeze at, but we can manage it so are pets are more comfortable.

For more information: https://pets.webmd.com/dogs/allergies-dogs#1-2

For more information about Apoquel,and the itch cycle.

72 Ears and allergies

This week I have seen a big uptick in my ear cases. We see dogs year round that have ear problems, ear infections, itchy ears, smelly ears, head shaking, but this week was different.

Ear infection doesn’t just happen. Yeast and bacteria don’t come out the dirt, jump in your dog’s ear and cause an infection. There has to be an underlying cause for ear problems. The common triggers are allergies (inhalant pollen or food), wet ears (swimming or bathing), hairy ears, underlying general skin problems (often hormonal like low thyroid), ear conformation ( floppy, or old scar tissue from previous ear infections), foreign bodies (like grass),and rarely parasites like ear mites or ticks. In my practice, it is usually allergies, hair ears, or swimming.

Allergies cause ear infection? Really? Most people either have some seasonal allergies to pollen or mold themselves or know someone who does. Humans experience sneezing, runny noses, itchy nose and eyes, and nasal congestion from the histamines released and can be partially blocked with antihistamines. Dogs also experience allergies to ragweed pollen and mold spores, but have different symptoms. Dogs have more mast cell receptors that release histamine on the skin of their feet, muzzle, ears, and elbow fold, than their membranes of nose and eyes. So when you see a dog frequently licking their feet, it isn’t a foot fetish, they are really itchy and trying to soothe that itch. Those ears when inflamed will make a lot more wax, and if you have a moist, waxy, hairy, folded ear you have the perfect conditions for the normal skin flora of yeast and bacteria ( usually staph) to thrive.

How do you know if your dog has an ear infection? Check Fluffy’s ears when you see head shaking, scratching at ears (or feet), and use all your senses. Look for redness and discharge. Smell for abnormal odors. Many of my clients say they can smell the yeast, because it smells like moldy bread. Listen for a wet squishy sound before you clean then. Feel the ears for warmth because an inflamed ear is often warmer than the other ear or the rest of the skin.

How do you treat ear problems at home? The biggest trick is to catch it early. Check those ears often, especially if Fido has risk factors or is itchy already. Frequent ear washing at home, during/after baths, and after swimming really helps. Using a pet ear cleaning is much better than tap water. They all contain a solution of water, mild acids, and alcohols to help “dry“ the ear when it evaporates. And they smell nicer than a nasty ear. Use ear washes frequently if Spot has ear problems.

What if cleaning isn’t enough? If home care doesn’t stop the head shaking, redness, and tenderness, it is time to come see the vet. We will gently examine the ears, collect samples to look for infection, and prescribe medicine. Occasionally, we will even prescribe pain medicine, because some dogs are truly painful and miserable with ear infections.

How do I prevent the next infection? It is all about managing those causes of ear problems: allergies with antihistamines or stronger prescription medicine like Apoquel, plucking hairy ears, washing weekly at least in allergy season, washing after swimming, and managing underlying skin diseases.

Ear infections can be prevented, treated, and managed. We can help.

For more information:
https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951507
https://www.petmd.com/blogs/thedailyvet/dr-coates/2014/june/top-five-tips-treating-ear-infections-dogs-and-cats-31848
https://www.petmd.com/dog/slideshows/7-signs-your-pet-has-seasonal-allergies