By Dr. I Elizabeth Borgmann. We’re finally there! We’ve gone through the skin creepy and crawlies, and the infections. Now the secondary infections are gone. You’ve removed possible irritants from the home. You’ve fiddled with diet. We’ve cleared up all those issues. The skin looks great. And your pet is still itchy. Now what?

Originally Published 05/10/10 On Chilliwack Today.

Ideally, if the skin looks great and you are experiencing clinical signs (primarily itchiness), this is the best time to biopsy the skin. The pathologist will have the easiest time interpreting those biopsies when the secondary issues are eliminated. Your vet may chose not to biopsy, but if there is any doubt in their mind that you are dealing with allergies, they will probably recommend it.

OK. The biopsies came back as allergies or atopy. Where do you go from here?

Most pets are not allergic to only one thing. And our goal is to use the least amount of medications as possible to deal with allergies. That means we need to eliminate potential allergens and use anti-inflammatory nutraceuticals whenever possible.

Reduce potential allergens by using a hypoallergenic diet (see the previous article) and compatible hypoallergenic treats. Don’t cheat! (That applies to about 75% of pet owners with animals on hypoallergenic diets!)

Remember to keep your home as free of possible irritants as you can. Vacuum often to remove dust and pollens. Switch over to hardwood or laminate. Get air conditioning instead of opening the windows to allergens. Do not use any products that contain fragrances (that means your hair and body products in the bathroom, too). Wash bedding often. Consider an air purifier.

Rinse your pet often and bathe them weekly or as directed by your veterinarian.

Add omega-3 fatty acids to their diet in consultation with your veterinarian.

A new area being explored further is the use of topical products to improve skin structures to reduce the need for medications. Many shampoos and sprays are becoming available. Allerderm Spot On is an exciting product that will be available in Canada soon and helps improve the skin barrier to the irritants responsible for the allergies. These products are where most of the research is now centered because they believe it may be problems with the skin barrier that allows the allergies to develop in the first place. Exciting things will happen on this front! Stay tuned!

We’ve covered the easy starting spot. Next comes allergy testing and medications.

There are two types of allergy testing – from blood and on skin. The first one is easy for your regular veterinarian to perform. They take a large blood sample and send it out to a laboratory which then tests for immunoglobulin presence to common allergens. The intradermal skin allergy testing requires referral to a dermatologist who will then shave the side of your pet and look for reactions to a set of allergens that are injected into the skin or scratched into the skin.

Which is better? That is a huge controversy. Neither testing is great. Neither testing is awful. And you will find dermatologists debating the merits and pit falls of both systems.

After the testing a series of serum vials are produced and you give your pet injections on a preset schedule. The desensitization takes up to two years.

What is the success rate of desensitization injections? Expect 50% of the pets to respond and become at least 50% better. In other words, half of the dogs show significant improvement.

That success rate may seem small but it is worth it in younger animals if it means you end up using less medication to manage the remaining symptoms. Remember – the goal is to use as few medications as possible.

The other two groups of medication used are anti-histamines and immunosuppressive drugs (like steroids and cyclosporine).

Not all pets respond to all anti-histamines in the same manner. You may need to try a few different anti-histamines to find one that helps and you may need to rotate and change the anti-histamine every now and then. Your vet will help you with this.

The mainstay of allergy treatment is immunosuppressive drugs.

The goal of all of the above is to help you use the least amount of these drugs as possible.

Cyclosporine, or ‘Atopica’, is a relative newcomer that helps suppress the immune system with many fewer side effects than prednisone and its relatives. It is an expensive but effective drug that will work in many, but not all, allergy cases. You start with a daily dose and hopefully will eventually be able to wean down to an every other day dose. It is often used as an aid to lower the amount of steroid required to control clinical signs.

Prednisone, prednisolone and methylprednisolone will be the final drugs that get used to control itchiness. They are very effective but will potentially shorten the life of your pet. It’s a catch. Maybe (not always) will the life be shortened but they will have a better quality of life. This drug is not without its side effects. Too much given daily can induce a condition called Cushings (Iatrogenic Cushings). It is best to use this medication on an every other day basis rather than daily.

The injectable long lasting steroids should be a last resort medication due to their side effects. These drugs work so well that they will sometimes be used immediately to give your pet relief while your vet adds on other treatments to try and reduce the steroid dosage.

To summarize, allergy treatments involve: hypoallergenic diets; environmental control; omega-3 fatty acid supplements; topical skin treatment; allergy testing and desensitization; anti-histamines; cyclosporine; and steroids. I didn’t say it was going to be easy! Now, when you look back at the first article in the series, you can see why it is a long and hard journey to the comfortable pet. Good luck!

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Dr. Borgmann has been practicing in the Fraser Valley for over 11 years and can be reached at the Whatcom Road Veterinary Clinic