ASK THE VET

Encouraging New Allergy Relief

By Michael Andress, DVM

A newly approved treatment has promised to change how we treat canine allergies. Cytopoint is an injectable medication that is given to dogs every four to eight weeks for allergy control. One of the most common reasons that people seek veterinary care is to help alleviate their dog’s suffering from skin allergies. These dogs are incredibly itchy. They will lick their paws, scratch their ears and sides; leading to hair loss, red and inflamed skin, and painful sores. These patients can really be uncomfortable.

Allergies are caused by the immune system’s overreaction to substances that would have limited effect on a normal dog. These substances include food, flea bites, pollens, and molds. To simplify things, allergies in dogs can be divided into food allergies, flea bite allergies and atopy or environmental allergies. It is important to partner with your veterinarian to help determine which of these conditions are affecting your dog. It is also critical to make sure that there is not an underlying bacterial, yeast, mange or even ringworm infection. If a food allergy is suspected, a food trial is begun by giving your dog food with ingredients that he or she has never had before. There can be drawbacks to just switching dog foods, so make sure to talk to your veterinarian. If fleas are contributing to allergies, a flea control program is started. Actually, all dogs should be on flea control. Up to forty percent of all dogs are sensitive to flea bites. There have been recent advances in flea medications that make flea control much easier.

Atopic dermatitis is a condition in which the skin is itchy and inflamed due to exposure to small environmental particles, called allergens. These allergens include plant pollens, molds and even house dust mites. Allergens trigger an inappropriate immune response in some dogs starting a cascade of events that result in compounds being released that cause intense itchiness at the skin level. Atopic dermatitis is a major cause of skin allergies in dogs. It can be seasonal or year round.

We are generally unable to remove these allergens from our pet’s environment. The treatment of atopic dermatitis centers on controlling the body’s immune system. Prednisone (cortisone) has been the mainstay of treatment for decades. This can be acceptable for a short allergy flare up. Unfortunately, this medication does have side effects which can be life altering if it is used for long periods of time. Atopica and the more recently approved Apoquel are similar to prednisone in that they block part of the immune system’s inflammatory pathway. These medications are considered safer than long term prednisone use for treatment of allergies. There are some mild to moderate side effects that are possible. Both of these drugs have been very helpful in controlling symptoms in dogs that suffer from skin allergies. Skin allergy testing is also available for dogs. After the results are obtained, a vaccine is formulated which is usually administered by mouth. It may take months to see a response, but the vaccine makes the body less reactive to these allergens. This can be an effective tool in managing allergies.

Cytopoint is an injectable antibody that targets one of the itch producing compounds in dogs. It is able to bind this itch compound, making it inactive so that the itch cycle is stopped. Recent data suggests that most dogs will respond favorably with limited side effects. Since this medication targets only a very specific part of the “itch” pathway, there is minimal impact on normal immune function. Cytopoint is unique in that there is no longer a need to give daily pills by mouth. This is an injection given in your veterinarian’s office. Veterinarians are impressed by the product’s low chance of side effects. Long term studies of Cytopoint are ongoing, but currently its future appears bright.

Skin allergies are extremely common in dogs. Patients that have these symptoms are uncomfortable and need help. It is important to team up with your veterinarian to determine the best treatment for your dog. It is exciting that this new product may become a major player in controlling skin allergies in dogs.

 

 

Food Allergy, Adverse Food Reactions and Dietary Trials

By Janet J. Raczkowski D.V.M., M.S.

An adverse, immunologic reaction to a normally harmless food protein is abnormal, and it is still unknown why some animals develop allergies or adverse reactions to food proteins while others do not. Cutaneous (chronic itching) and gastrointestinal symptoms (chronic and recurrent vomiting and/or diarrhea) are common symptoms associated with food adverse reactions (“FAR”). In some studies, 57% of documented feline cases and 20% to 40% of documented canine cases of chronic itching and/or GI symptoms have been attributed to “food allergies.” A reaction to a dietary allergen can be classified as a food allergy (an immune-mediated adverse reaction to a food antigen), adverse food reaction (an abnormal response to a dietary constituent), or food intolerance (food poisoning or an idiosyncratic or metabolic reaction to a food). In clinical practice, the term “food allergy” is commonly used to refer to food adverse reactions.

In most cases, the classic symptoms that dogs and cats experience as a result of an immune-based reaction to dietary allergens start at a young age (less than six to nine months old) and tend to have a non-seasonal occurrence pattern. However, food allergies can develop at any time throughout an animal’s life as the type of food allergy is directly connected to dietary habits and because an animal cannot become allergic to an item that he or she has never been exposed to before. Since most of our pets eat a variety of treats and food items and their diets are constantly changing, they can develop food adverse reactions at any age. Additionally, dietary allergies by their very definition are related to previous exposure to the allergen. As such, it is very important to remember that animals can develop an allergic reaction to a food that “they have always eaten before.”

Cutaneous signs of food allergies can consist of itching around the face, ears, ventral abdomen, paws, axillary, inguinal and perianal regions. Sometimes the skin changes can be quite severe and can develop crusting, ulcerations and severe redness, mimicking immune-mediated skin disease. Gastrointestinal symptoms can involve vomiting, diarrhea, increased frequency of bowel movements, straining to defecate, excessive “scooting” and/or intermittent blood or mucus in their stool. There is a genetic predisposition to food allergies, as some dog breeds (such as Retrievers and German Shepherds) are overrepresented.

When diagnosing food allergies, a thorough examination of veterinary history and a diagnostic work up (if appropriate) is always warranted as with any other chronic conditions, as it is important to have ruled out other potential conditions before diagnosis. The symptoms of chronic itching can be related to environmental allergies (atopy) and there is also the possibility of cross-reactivity, meaning that many patients that have atopy can also suffer from food adverse cutaneous reactions (prevalence is as high as 20%). Contact hypersensitivity, secondary bacterial (pyoderma) and yeast (Malasezzia) dermatitis or otitis (ear infections), parasitic hypersensitivities (like flea allergy), and parasites (mites) can also contribute to chronic skin disease. Intestinal parasites, infiltrative gastrointestinal disease, inflammatory bowel disease, gastrointestinal cancer and many other GI conditions can cause chronic GI symptoms.

Dietary trials are the gold standard for diagnosis: we feed them a diet that contains a single novel (never eaten before) protein and a single (preferably novel) carbohydrate for a minimum of 12 weeks. If improvement is noted, the food allergy or intolerance should be confirmed by challenging the pet with the original diet. Hydrolyzed protein diets that are commercially available by prescription only are also a great option. The basic idea behind hydrolyzed protein diets is that that the protein allergen has been “hydrolyzed” or broken down to a molecular size that is so small that is considered non-allergenic (typically chicken or soy based). This is due to the fact that the majority (98%) of the food adverse reactions are due to protein allergens. Therefore, it is critical to note that a “grain-free” diet (if it contains the same protein your pet is currently eating or has been exposed to before) is not a true limited antigen diet! Additionally, there is a risk of cross contamination during the manufacturing and packaging of many of the over-the-counter commercially available diets, so please make sure that you read the fine print on the label.

Dietary trials need to be discussed with your pet’s doctor. Your veterinarian should be familiar with your pet’s medical history and is trained in nutrition, which makes him or her a better source of information than “Dr. Google” or the retail sales representative at your local pet store. A thorough examination of veterinary history is extremely important for selection of your pet’s diet as well as proper feeding recommendations. Treats, chewable parasite preventatives, and supplements should also be discussed. In addition, it important to note that dietary trials cannot be conducted on a “free-roaming” pet since we need complete control of what they are eating. Everyone in the family must be committed to the trial since even if it is “just a little piece of chicken”, as this can invalidate their response to the dietary trial. A good analogy I relate to my clients is peanut allergies in people: you only need to eat one peanut to have a severe reaction! Finally, if you choose to cook for your pet, you must ensure that it is nutritionally balanced and provides adequate macro and micronutrients, which means this should only be done after an appropriate nutritional consultation.

 

 

Ask the Vet columns can be downloaded by clicking on any of the links below:


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