Clinical Suite: Decoding & Controlling Allergic Itch

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What Is Allergic Itch?

Pruritus is an uncomfortable sensation of the skin that provokes the desire to rub, scratch, and/or itch and is one of the most common reasons dog and cat owners bring their pet to the clinic.^1,2

Pruritus can be seen with many diseases, with some of the most common causes being due to allergies, specifically flea-allergic dermatitis (ie, flea allergy), atopic dermatitis (ie, environmental allergy), and adverse food reactions (ie, food allergy).

Why Is It Important to Understand Allergic Itch?

Pruritus can dramatically affect patient and owner quality of life. Pet owners have reported that, as the level of itch goes up in their pet, their pet’s quality of life goes down.^3-5 Research has shown most (75%) owners of pruritic dogs are concerned for their pet’s well-being.³ Emotions expressed by owners of these itchy dogs were sadness (46%), frustration (44%), and helplessness (43%).³ Studies have shown an inverse relationship between quality of life and pruritus.^4,5

Caregiver burden is defined as encountering a range of problems while providing informal care to a loved one with an illness.⁶ One study has suggested that, by the time owners bring their dog to a dermatology service, they have a higher caregiver burden than that of the typical dog owner.⁶ However, when skin disease was well controlled, caregiver burden was equivalent to that of an owner of a normal dog with no disease.⁶ Thus, controlling disease and reducing caregiver burden are important goals for long-term care.

A variety of other issues can also add to the frustration of owners of allergic pets. These can include odor, wounds or others lesions (eg, redness, crusts, pimples), inconvenient or lengthy appointments or treatments, failed treatment approaches, encountering mixed messages (eg, from groomers, pet stores, internet), and short-term and ongoing expenses. Due to all the various elements of allergic itch, it may be easy for owners of pruritic pets to feel uncertain, disappointed, irritated, and even angry. Good client communication, including empathizing with owner frustrations, can help deescalate these interactions.

The impact of allergic itch on patient and owner quality of life, as well as the potential for client frustration, highlights the importance of a consistent, thorough team approach to diagnosing and treating patients with allergic itch.

Diagnosing Allergic Itch

Different types of allergies can look the same, and patients can have more than one type of allergy at once. Clearly understanding the source(s) of the patient’s problem is essential to effective treatment.

Pruritus can be due to many various causes, including parasites (ie, fleas, sarcoptic mange), infections (Staphylococcus spp, Malassezia pachydermatis), and allergies (adverse food reactions, atopic dermatitis), and most patients have one or a combination of causes affecting them.

Recognizing relevant information in the patient’s history and clinical appearance, along with performing simple diagnostic procedures (ie, cytology), can help provide a clearer understanding of what is causing the pruritus.

A set routine or protocol for diagnosing and treating allergic itch not only helps provide consistent, high-quality care but can also help cut down on confusion and frustration, increasing client adherence to the veterinary team’s recommendations. Adjusting the initial treatment approach to the individual pet’s and owner’s unique needs is easier if everyone starts on the same page.

The Complete Allergic Investigation

How Much Itch is Too Much?

Measuring the intensity of pruritus is crucial to the diagnosis of skin disease and monitoring response to treatment. Accurate measurement of pruritus can be difficult, as it may seem subjective, which emphasizes the importance of recognizing the various ways pets can show itch, including biting, chewing, licking, rolling, scooting, and headshaking.

Measuring a pet’s level of itch can help the medical team diagnose disease and monitor how well the pet responds to treatment. The Pruritus Visual Analog Scale (PVAS) has been scientifically validated and allows owners to use a vertical line with descriptions of levels of severity of canine pruritic behavior.⁷ The scale uses a numerical score between 0 (no itch) and 10 (highest itch). Even normal dogs can have some itch (PVAS score, 1.9), which shows how important it can be to measure pruritic scores to determine if a pet’s pruritus is abnormal.⁸

Identifying Infection

Allergic pets are prone to secondary skin infections such as with bacterial and yeast overgrowth on the skin or in the ears, which can make pets itchier than normal. One of the biggest oversights in managing allergies is not performing cytology during every examination to identify secondary infection. Performing cytology during an allergic diagnostic investigation and at recheck examinations is the foundation of allergic management.

Samples should be taken from areas of crusting, redness (ie, erythema), debris, hair loss (ie, alopecia), and/or skin thickening/darkening (ie, lichenification). The use of systemic (oral or injected) and topical anti-infective therapies (eg, antibiotic or antifungal shampoos, sprays, mousses, ointments) should be justified by the presence of organisms on cytology to practice appropriate antimicrobial stewardship. Unidentified infection can also help prevent certain therapies, especially antipruritics, from appearing to be effective.

Flea-Allergic Dermatitis

Flea-allergic dermatitis (FAD) is a common skin disease in dogs, depending on the geographic region. Affected dogs may experience a hypersensitivity response to the saliva injected into their skin by fleas when they feed. FAD commonly causes pruritus in a pet’s tailbase, lower back, thighs, and/or belly, which often leads to crusting, hair loss (ie, alopecia), redness (ie, erythema), and skin thickening/darkening (ie, lichenification) in those areas.⁹

For pets with FAD, the most important aspect of management is the prevention of flea bites. FAD can be ruled out after it has been confirmed that year-round, high-quality flea prevention has been used for all animals in the household to limit the allergic pet’s exposure.

There are several reliable options that can be used to diagnose FAD and also provide continuing flea control for allergic pets. Flea preventives containing ingredients such as spinosad and dinotefuran can provide great speed of kill for fleas. In addition, the new class of isoxazolines provide protection against several types of lice and mites, specifically Sarcoptes spp. Although no isoxazolines are labeled for the treatment of lice and mites, several studies support their efficacy against these parasites.^10-12 This can be helpful during the diagnostic investigation of a pruritic dog, as many of these parasites can increase itch. Commercially available isoxazolines include sarolaner, afoxolaner, lotilaner, and fluralaner.

Cutaneous Adverse Food Reaction

Cutaneous adverse food reaction (CAFR) is caused by a negative immune reaction to an allergen in the diet. The most common offender is protein (eg, chicken, beef, lamb, fish).¹³ However, any carbohydrate or fat may be an allergen, too. CAFR can be difficult to diagnose, as it can appear similar to other allergic conditions and can occur at the same time as other allergies. Although CAFR can occur in any pets with allergies, food allergy may be more likely in pets with a history of GI upset, signs that started at <1 year of age, nonseasonal itch, and/or nonresponsive itch. If a dog presents with strictly seasonal disease, it is highly unlikely that a food allergy is present.

A dietary elimination trial is the only accurate test for food allergies. Blood (serologic) and salivary testing is available, but these tests are considered unreliable.¹⁴ The goal of a dietary elimination trial is to strictly prevent the pet from eating anything they might be allergic to for 8 weeks to see if the signs of their disease resolve or improve. In a study review, 85% of dogs with CAFR were normal after 5 weeks on the dietary trial and 95% of dogs were normal after 8 weeks.¹⁵

There are 2 general categories of food that can be used to rule out CAFR: hydrolyzed protein and novel protein diets. Hydrolyzed protein diets are modified to disrupt the proteins in the food to remove any existing allergens and stop them from causing an allergic reaction. However, palatability issues may occur with hydrolyzed diets, as peptide fragments can be bitter, and a small population of dogs may also develop diarrhea. In addition, some dogs with CAFR may still react to hydrolyzed diets, although this problem may be reduced in newer ultra-hydrolyzed diets.¹⁶

Novel protein diets can be packaged or home-prepared and work by only including ingredients the pet has never eaten before. A variety of commercial novel protein diets are available, including diets with rabbit, alligator, and kangaroo. A thorough patient history must be obtained to decide what types of proteins and carbohydrates have been given to the pet previously. It is possible for a pet to react to a protein they have never had before if it is similar to one they have eaten. The more similar the protein sources are, the more likely they are to crossreact.¹⁷ For example, beef may crossreact with lamb or venison, and chicken-allergic dogs may react to other forms of poultry like duck or turkey. Although there are several over-the-counter diets offering various sources of novel proteins, many have been shown to include additional ingredients not listed on the label.¹⁸ So, if a commercially prepared novel protein diet is chosen for a diagnostic food trial, it is critical to use a prescription diet.

Home-prepared novel protein diets can also be useful for diagnosing CAFR, although these diets can be more time-consuming to prepare and potentially more expensive, depending on the ingredients and size of the dog. However, some owners may prefer home-prepared diets, as they may view it as a way to bond with their pet or they may prefer not to feed commercial diets. Ingredients in home-prepared diets may include pork, pumpkin, beans, quinoa, ostrich, and rabbit. If the diet is going to be continued long-term, consultation with a board-certified nutritionist is recommended to ensure the diet is appropriately balanced.

A dietary elimination trial is performed strictly for ≈8 weeks. This includes restricting treats (besides those that go with the diet), rawhides, flavored chews, table scraps, and flavored supplements. Using the kibble as treats or freezing canned versions of the food (if available) within non-flavored chew toys can make the diet trial easier for the owner. If there is improvement during the dietary trial, the dog can be challenged with the previous diet to confirm diagnosis. Clinical signs usually return within 1 to 3 days, but delayed reactions may occur. Once CAFR is confirmed, individual ingredient challenges can help identify specific food allergies.

Atopic Dermatitis

In most geographic regions, atopic dermatitis (AD) is the most common form of hypersensitivity in dogs,¹⁹ although FAD may be more prevalent in certain areas. Pets with AD react to environmental allergens that do not affect other animals. Allergens can include dust mites, pollens, danders, insect particles, and molds.

Pets with AD most often develop pruritus, wounds, and/or other secondary lesions on the paws, axillae, abdomen, and face. Secondary skin infections or otitis externa caused by Malassezia pachydermatis and/or Staphylococcus pseudintermedius are common complications of AD. Although some pets may experience signs seasonally, others may be affected continuously. Most pets begin to show signs between 1 and 3 years of age, although in some breeds (eg, west Highland white terriers), >60% of dogs can exhibit clinical signs of AD by 12 months of age.²⁰ It is common for pruritus to begin seasonally and become year-round as the dog gets older.²¹ Fortunately, identifying and treating AD early can be very beneficial and help prevent signs from worsening.

AD can present similarly to other pruritic conditions (eg, parasitic diseases, infections, FAD, CAFR). Therefore, diagnosis should be based on history and clinical findings, along with elimination of other possibilities. Some cases (eg, seasonal pedal pruritus) may be straightforward, and others (eg, nonseasonal otitis) may be more difficult to diagnose. Allergy testing is not used to definitively diagnose AD but can be used to determine treatment for desensitization.

Treating Allergic Itch

There are certain foundational or “anchor” treatments for each allergic disease that contribute most to controlling the pet’s clinical signs; however, treatment plans should be developed based on each individual patient, as the specific patient, clinical signs, and comorbidities (ie, the pet's other conditions), as well as the owner’s ability to medicate, among other things, can all help determine the best therapy suited for the individual patient.

FAD and CAFR are diagnosed through the patient’s effective response to treatment, so, by the time a pet is diagnosed with one of those conditions, they may likely already be on an anchor treatment. Anchor treatment for FAD is strict, year-round flea prevention for all pets in the household—even those that do not go outdoors. Anchor treatment for CAFR is strict adherence to a hypoallergenic diet determined by a dietary elimination trial and subsequent food challenges.

For dogs with AD, anchor treatment usually includes allergen-specific immunotherapy (ie, allergy injections or sublingual therapy), Janus kinase (JAK) inhibitors (Apoquel®), lokivetmab (CYTOPOINT®), cyclosporine, or corticosteroids. Many dogs with AD require multiple types of treatment for complete control of clinical signs. Referral to a board-certified dermatologist is recommended if more than one anchor treatment is required.

Allergen-Specific Immunotherapy

Allergen-specific immunotherapy (ASIT) is formulated from allergy test results, based either on a blood sample or a skin test. The allergens in the injection should be selected based on a correlation between the test results and the pet’s history. For example, is the pollen the pet appears to be allergic to prevalent during the season the pet shows the clinical signs? During ASIT, the amount of allergen extract is gradually increased to improve the signs associated with later exposure to the allergen.

There is no single dose or frequency ASIT protocol that works for all patients, and each pet’s therapy is individualized. ASIT is the safest long-term therapy for AD but can take several months to a year for full effects to be seen. Approximately 60% to 70% of dogs have a positive response to ASIT.²² When effective, therapy is usually continued life-long.

JAK Inhibitors

Oclacitinib maleate (Apoquel®) is a JAK inhibitor that helps block the activation pathway of several inflammatory molecules that help trigger the sensation of itch, such as cytokine interleukin (IL)-2, IL-4, IL-6, IL-13, and particularly IL-31, which drive allergic inflammation.²³ The dose of Apoquel® is 0.4-0.6 mg/kg every 12 hours for ≤14 days; the frequency is then lowered to every 24 hours.²⁴ 

This medication can be used long-term for maintenance and may be particularly useful for owners who live far away from the clinic and for fearful pets that find visits to the veterinarian to be stressful. Apoquel® is a safer alternative to corticosteroids for chronic therapy. Due to its short half-life, it works well to manage pruritus while a diagnostic investigation is being performed.

Lokivetmab

Canine atopic dermatitis immunotherapeutic or lokivetmab (CYTOPOINT®) is an injectable medication for dogs that contains an antibody that specifically targets and neutralizes the inflammatory molecule canine IL-31, which is involved in sending the itch signal to the brain. Dogs receiving this therapy typically receive an injection every 4 to 8 weeks.²⁵ It has a high safety profile due to its specific mechanism of action. CYTOPOINT® has a minimum dose of 2 mg/kg administered SC in the clinic.²⁶ CYTOPOINT® can be helpful at the start of initiating ASIT, for dogs <1 year of age, in cases in which owner compliance is a concern, in cases in which owners may struggle to administer oral medications, and in patients with concurrent disease and/or a history of GI upset.

Cyclosporine

Cyclosporine helps control itch by inhibiting intracellular calcineurin in T cells. This prevents the gene transcription necessary for the production of many inflammatory molecules within those cells, including cytokines and many ILs, particularly IL-2.²⁷

Due to the enzyme that metabolizes this drug in the liver and intestines, its function can be impacted by the other drugs a pet may be receiving, especially ketoconazole, an oral antifungal used to treat some yeast infections in allergic dogs. Ketoconazole decreases cyclosporine clearance and increases cyclosporine blood concentrations²⁸; concurrent administration of cyclosporine with ketoconazole (5-10 mg/kg every 24 hours) may be as effective as 5 mg/kg of cyclosporine alone.²⁸ The dose of cyclosporine is 5-10 mg/kg every 24 hours (split into every 12-24 hours based on capsule size and patient tolerance).²⁴ The veterinary microemulsion formulation is available in 10-, 25-, 50-, and 100-mg capsules. It is also available in a 100-mg/mL liquid formulation in 5- and 17-mL bottles. GI upset is the most common adverse effect; freezing the capsule form may help minimize this.²⁹

Corticosteroids

Corticosteroids help control itch by blocking the formation of inflammatory molecules and the effects of inflammatory cells and lymphocytes (a type of WBC). Corticosteroids have several potential negative effects, including panting, excessive drinking (ie, polydipsia), excessive appetite (ie, polyphagia), high blood sugar (ie, hyperglycemia), fat redistribution, pendulous abdomen, skin thinning, poor wound healing, liver enlargement, hair loss, and calcium deposits in the skin. Owners may often seek alternative treatment options due to these effects,³⁰ and in general, long-term use of these drugs should be avoided. However, there are certain cases in which intervention with corticosteroids can be helpful (eg, dogs with other inflammatory conditions, interdigital cysts, severe cost concerns, proliferative otitis). The dose varies depending on the type of corticosteroid used and degree of pruritus. Prednisone, prednisolone, and methylprednisolone can be started at 0.5-1 mg/kg every 12 to 24 hours, then tapered based on effect. Triamcinolone and dexamethasone (0.05-0.1 mg/kg every 12-24 hours, then tapered) are alternative options and considered ≈10 times as potent. Dogs may experience different adverse effects or clinical success depending on the type of steroid prescribed.

Along with anchor treatments, concurrent therapies such as bathing, ear flushing, and supplements can also be included in the overall treatment plan and play a supportive role to help control allergic itch and prevent secondary infections.

A Team Approach to Allergic Itch

All veterinary team members are responsible for empowering pet owners to feel like a part of their pet’s medical team. They are the expert on their pet at home, and, because allergies are ever changing, their observations are essential. Plus, the beneficial effects of empowering and communicating with them while treating a pet’s skin disease can strengthen their overall bond with the veterinary team.

The Pet Owner

• Monitor the pet regularly for signs of pruritus, wounds, redness, and/or other abnormal skin lesions

• Contact the veterinary team if they note possible signs of an allergic flare and feel comfortable with the various ways a flare can appear clinically

• Let the veterinary team know about any questions, areas of confusion, and/or challenges they may be experiencing with the treatment plan

• Follow a treatment plan and recheck schedule accordingly once set and inform the veterinary team if either is not feasible

Client Service Representative

• Provide empathy and support, and be available for owners when they are in the clinic and when they contact the clinic from home

  • Empathize with frustrated owners when they call in if their pet is not responding to treatment or is experiencing a flare-up

  • Celebrate successes with the owner and commend them for looking after their pet

• Have a “big picture” idea of the value the veterinary team provides to pets with allergic disease, such as why recheck examinations and cytology are important, the importance of finding out the cause of the itch, and patient success stories

  • For example, advise that over-the-counter treatments do not provide lasting relief, pets respond to treatments differently, allergic flares are expected, and the importance of strict adherence to a dietary elimination trial

• Encourage recheck examinations, as skin changes can progress quickly, or relay a message to the veterinarian or veterinary nurse to see if guidance can be provided

• Stress to owners the importance of contacting the clinic at the first sign of a flare-up, if discharge instructions are unclear, or if they do not understand the diagnostic investigation

Veterinary Nurse, Technician, & Assistant

• Collect a thorough history during patient intake to present to the veterinarian

• Implement low-stress handling techniques during examination and sample collection

  • Dermatologic patients visit the clinic frequently, so it is essential to take the time to keep track of their emotional record (eg, what stresses the pet and what makes the pet more comfortable)

• Perform diagnostic tests such as skin cytology, ear cytology, skin scrapings, bacterial culture and susceptibility testing, and fungal culture as indicated (see Resources)

• Communicate the value of treatments and services when discussing treatment plans and estimated charges with clients

• Understand and maintain up-to-date, clinical CE regarding sample collection and basic knowledge of the allergic diagnostic investigation

• Demonstrate at-home therapies (eg, ear flushing, giving oral medications, administering SC injections, bathing protocols) to increase client success

• Continue quality client communication (eg, discharge instructions, phone conversations, emails, texts) to make the owner feel supported through management of chronic diseases

The Veterinarian

• Identify patients with pathogenic pruritus, complete their general and dermatologic histories, and perform thorough dermatologic examinations, including otoscopy

• Feel comfortable differentiating and treating common pruritic dermatopathies

• Understand and maintain up-to-date clinical CE regarding the diagnosis and treatment of allergic disease

• Establish the hospital’s diagnostic and treatment protocols for allergic pruritus

• Feel comfortable customizing the protocol based on case presentation, as well as on patient and owner needs

  • For example, if a patient is difficult to orally medicate, CYTOPOINT® may be a more reasonable option for managing pruritus

• Maintain thorough clinical records with history, clinical findings, diagnostic results, add a future plan

• Initiate quality client communication, especially regarding the importance of controlling infections, managing clinical signs, preparing for flare-ups, and developing a long-term plan

• Assure team members are appropriately trained in:

  • The basics of diagnostic investigation and treatment of allergic diseases

  • Dermatologic diagnostic and treatment techniques

    • Collection and evaluation of skin cytology (especially regarding the ability to identify infection and inflammation), skin scraping, and dermatophyte culture

    • Home care, including administering medications, ear cleaning, and bathing

  • Key elements of client communication in allergic disease

Practice Manager

• Facilitate the creation, implementation, and assessment of diagnostic and treatment protocols (see Resources)

  • Check in with medical team members regarding potential changes

  • Convene with medical decision makers regarding potential protocol changes

  • Moderate consensus building

  • Facilitate consistent team education and training

  • Assess challenges, ongoing protocol relevance, reasonable adherence, and performance

• Identify, encourage, and incentivize staff members with a special interest in dermatology

• Support clients and the veterinary team in the event of miscommunication or conflict, especially considering the potentially frustrating, chronic, and expensive nature of allergic disease

• Assure appropriate inventory of medications, diets, preventives, and topical products are maintained and evaluated

• Appropriately price associated appointments, diagnostic tests, and treatments

  • Consider product-pricing strategies appropriate to the treatment of chronic disease

• Ensure organized, up-to-date client education resources covering common kinds of allergies and secondary infections are easily accessible

• Pass along rebates, discounts, and incentives to the pet owner that may facilitate their pet’s care, and encourage them to utilize the clinic or online pharmacy (see Resources)

Talking About Allergic Itch

Set Expectations Early

Frustration can occur when owners feel blindsided or misled. When clients schedule the appointment, owners should be prepared to expect a thorough patient history to be collected, a complete dermatologic examination to be performed, and samples to be collected before an appropriate treatment plan can be formulated. Obtaining records from all recent veterinary visits, including specialists, before the appointment can help provide a clearer picture of what the owner and pet have already been through.

Owners should be asked to photograph, write down, or bring past and current medications to the appointment. Owners typically appreciate it when drugs and/or products they have previously purchased can continue to be used and incorporated into the new treatment plan. If previously purchased medications may not be right for the new treatment plan, owners typically appreciate when it is communicated why they may need to invest in new/additional therapies to achieve the best outcome for their pet.

Efficient History Collection

Providing a thorough questionnaire that the client can fill out in advance of the appointment can be helpful and save time. This can allow for better efficiency and help guide the conversation at the time of the examination.

Recording the PVAS score initially and then at all follow-up examinations can also help with drug selection and evaluating treatment success. This can help provide a more objective view of pruritus severity. Owners should be educated to understand the variety of ways a pet can show pruritus, including scratching, licking, chewing head shaking, and rubbing.

Open-ended questions should be asked and owners given the opportunity to share their story. Usually, owners just want to be understood and have their frustrations recognized. Acknowledging those frustrations and making the treatment plan a team effort moving forward can help deescalate past distress.

Establishing an Effective Follow-Up Approach

Clients should be made to feel like a part of the team, as this can help with follow through. There are various ways the veterinary team can work to get owners to adhere to the established plan:

• Write an outline or diagram, and share it with the owner. Some people are visual learners and can become lost in an audible conversation—especially the allergy conversation, as it can be a long and confusing one.

• Address the owner's short- and long-term concerns. Assure the owner that their dog’s current itch will be relieved immediately with an antipruritic but, to prevent recurrences of itch and infection chronically, the root cause needs to be investigated.

• Provide handouts that go more in-depth so the owner has a reference at home and they do not go searching for information somewhere else, like the internet. Handouts can include a disease summary, frequently asked questions, and adverse drug effects, among others (see Handout).

• Periodically stop and check in with clients. Assess their understanding of the conversation and treatment plan. Every owner is different in how easily they comprehend information or become overwhelmed. Some owners have a medical background or have had allergies themselves and have no problem following along. Others may get lost after the first drug is mentioned. The veterinary team should not be afraid to go step-by-step if it is easier for the owner. Discussions and treatment plans should be tailored to each individual.

Provide Financial Options

Providing treatment plans with estimated costs for examination fees, diagnostic tests, and treatment options can be helpful. Emphasize the value of a treatment when discussing estimates and the long-term cost that can be incurred if the disease is not managed appropriately. The best medicine should always be offered, but the veterinary team should have the ability to scale back the recommended approach if it is not realistic for the owner’s budget. If the owner cannot afford a particular treatment plan at the time of the visit, they may be able to afford a different treatment plan in the future if they are informed in advance and can plan accordingly.

Different flexible methods of payment should be offered, and the veterinary team should consider discussing pet insurance. Although the patient’s current condition may not be covered by pet insurance, pet insurance may help reduce the financial impact of future illnesses for the patient and other animals in that patient’s household.

Owners need to be aware that dealing with chronic allergies is not “one and done.” The longevity of treatment should be explained and plans discussed for financing continued care.

Prepare for the Flare

Even well-controlled allergic pets experience flares—seasons change, food gets dropped, flea control gets missed. Owners should be educated to understand that flares happen and should understand what that looks like. Routine recalls should be established to check in so the owner feels supported. In addition, providing different methods of contact such as phone, email, text messaging, and communication apps can help the owner feel at ease in a communication method that best works for them.

Recognize Client Concerns

Figuring out the owner’s main goal is essential when starting a diagnostic investigation for allergic disease. Every client has a different priority or definition of success for their pet.

• Do they want their pet to stop itching today?

• Do they care most about getting rid of the odor?

• Are they proactive owners who want to pursue a diagnostic investigation on day one?

• Do they dread systemic antibiotics but are willing to bathe daily?

Put It in Writing

Home care instructions beyond what medications are being sent home should always be documented. Veterinary visits can be overwhelming, and owners can easily forget what was discussed. Even just a sentence can help an owner more completely understand the journey of owning an allergic pet.

• Infections are a secondary issue related to allergies. It can be confusing for an owner to realize allergies and infections are different issues that can still impact one another. When owners understand this relationship, they are often more willing to commit to multimodal therapy, including frequent bathing and ear flushes.

• Flares happen. Owners should be guided to monitor for the various signs of flare-ups, even if their pet is currently doing well. Having a proactive mentality should be encouraged.

• Allergies are not cured but managed. Continued therapy and an ongoing veterinary relationship will be required the rest of the pet’s life.

Do Not Forget about Referral

It is never too early to refer to a board-certified dermatologist. Even if the allergies and infections are not severe, a dermatologist can intervene with safe therapies to prevent more severe clinical signs. The veterinary team should be proactive and let owners know the option is available. Referral can help develop a relationship with local dermatologists, as many cases may need to be co-managed, and cases can be discussed before they are referred to maximize diagnostic results on initial examination. For clinics that do not have board-certified dermatologist within their area, telemedicine companies are available to provide consultation options regardless of location.