For a quick overview on allergies in pets, the most common cause of itching & scratching, click on this link to download and audio podcast called Scratch and Sniffle from the AVMA featuring Veterinary Dermatolgy Specialist Dr. Karen Kuhl, from Buffalo Grove, IL.
Click to visit Novaritis Animal Health
ITCHY AND SCRATCHY PETS
Is your pet driving you nuts with his itching and scratching? Is your pet losing hair or developing a rash? These are common symptoms of Atopic Dermatitis. What in the world is causing this and how can we make it stop? We hear this question all the time! It is a very frustrating problem!
On this web page we are providing a brief overview and summary of treatment options for the itchy and scratchy pet. Beneath this introductory summary, you will find a helpful library of informative links and handouts, on why pets get itchy and how we can offer relief for this annoying and distressing problem. Scroll on down for more helpful info!
In most cases itching and scratching is caused by allergies. What in the world could your pet be allergic to?? Well many things are possible. It may be seasonal allergens in the environment such as tree, grass, and weed pollens. It may be fungi and molds. There may even be allergens in your home like the notorious house dust mite. It might be ingredients in their diets or treats! Or it just might be a combination of many of these allergens.
Before we do an in depth allergy up, we need to start by making sure the itch is not due to skin parasites. Allergic reactions to flea saliva can frequently cause Flea Allergy Dermatitis. In fact, fleas are the "best" kind of allergy to have, since fleas can be easily and effectively prevented, while most other allergens can not be eliminated. Other parasites that can casue itching include the Sarcoptic Mange mite in dogs, or a Demodex mite in cats.
Allergies start out by causing inflammation. Unlike humans, dogs and cats rarely get hay-fever like symptoms with inflammation in the nose and eyes, although this can happen. More commonly the inflammation strikes the skin of our pets. Often the itch starts in the ears, or on the paws, or tummy. At first there may not be any obvious sign other than the constant itching and scratching.
But left untreated, the irritation caused by the traumatic scratching leads to obvious redness and sores. Again, if left untreated, the inflamed, red, and irritated skin areas and ears can become secondarily infected with bacterial or yeast organisms. The skin infection and/or ear infection creates additional inflammation and itch and a vicious cycle ensues.
This diagram will help you Understand Your Itchy Dog. It illustrates how the primary causes such as allergies and parasites such as fleas start the itch, and how secondary problems such as yeast and bacterial infections intensify the itch. It will also explain how a few allergens can be well tolerated but if multiple allergens are added together, it sends the pet over the itch threshold.
Before we can rule out fleas as a contributing factor, we have to make sure we have consistently applied a quality flea preventative such as Vectra 3D, K9 Advantix or Feline Advantage Multi, Revolution, or Frontline Plus to ALL household pets for several months. Not seeing fleas on cats or dogs DOES NOT rule out fleas. We don't want to miss the most easily treated cause of itchy skin before looking for these other causes. Diligent flea control is the first step for all itchy pets!
The Itchy Cat: If It's Not Fleas, what else could it be?
This link to Pet.webmd.com's Slide Show of Skin Problems in Dogs shows how some nice pictures of how skin infections and allergy problems can look.
Is there anything else you can do at home? Yes, there are some steps you can start at home but veterinary evaluation is always recommended. But in the meantime, the first thing you can do is to bathe often, but once you have your pet's appointment scheduled it is best NOT to bathe for several days before the exam! This might also be considered for cats but they are usually not as agreeable to frequent bathing.
eVet Sites Photo
Frequent bathing (as often as several times a week) will wash off surface allergens to prevent their absorption through the skin, and can help treat and prevent the secondary bacterial and yeast infections that worsen the itch. Bathing is also very soothing to irritated itchy skin. In the short term a regular pet shampoo can be used, but medicated products may be needed. After your pet's exam, your veterinarian will determine the most ideal shampoo and bathing protocol for your pet. There are multiple therapeutic options including those that have ant-itch ingredients or anti-microbial properties.
If the ears are affected, cleaning the ears every week or two with a medicated ear cleaner can help. Before trying this, ask your vet for instructions and to recommend a safe or medicated ear cleaner. Ears that are already infected will need medications as well. Ear cleaners will not be able to resolve an active infection, but when used regularly they can be helpful to prevent recurrent infections.
Remember, Flea prevention is crucial for allergic pets! Fleas and flea allergy are one of the most common causes of allergy symptoms, EVEN IF FLEAS ARE NOT READILY VISIBLE ON THE PET! A single flea bite can significantly worsen allergy symptoms. Be sure that your pet is wearing an effective flea preventative that holds up well to frequent bathing, such as Vectra 3D or Frontline Plus, every month ALL YEAR ROUND! In some cases, additional methods of flea control are needed both for the pet and the environment
If paw licking is a problem, daily or every other day paw washings can help. Again, ask your veterinarian for appropriate shampoo products. Depending on the case, your vet may recommend a basic anti-itch shampoo, or perhaps a medicated antibacterial or anti-yeast shampoo. Other topical products, such as sprays and wipes to control infectious agents, soothe the skin, and decrease the itch may also be recommended.
Is there any simple medication you can give at home? Yes, there are some things you can try, but if symptoms are moderate to severe, a thorough evaluation by your vet is needed! Often the first line medication your vet will recommend for mild symptoms is an antihistamine. Antihistamines are often successfully used for human allergies and hay-fever. They may have some mild benefits in our pets as well, but usually by themselves are not as effective in pets. If combined with other therapies such as bath therapy they may help.
We often recommend starting with an over the counter antihistamine such as Benedryl (or generic diphenhydramine) in dogs. For cats we often start with the antihistamine called Chlorpheniramine. The dose and frequency will depend on the weight of your pet so be sure to ask your veterinarian for dosing instructions before doing this on your own. When purchasing over the counter antihistamines it is very important to make sure the products DO NOT contain other ingredients such as decongestants or pain relievers like acetaminophen or aspirin.
Additional antihistamine options are available. Often several different antihistamines will need to be tried before the most effective antihistamine for your individual pet is found. Schedule an appointment with your veterinarian to discuss antihistamine options, doses, and trials to determine the best antihistamine option for your pet.
Adding an Omega 3 Fish Oil Supplements to other therapies such as antihistamines may also help. Proper dosing and ratios of these supplements can be difficult to achieve especially when using over the counter human supplements. Please schedule an appointment to see if Omega 3 supplementation would benefit your pet and to discuss products and dosing recommendations. Quality high potency supplements such as from the Nordic Naturals product line are strongly recommended over drug store human supplements. For Questions & Answers on the Use of Fish Oils, click this link. These excellent information is provided by Dr. Sally Perea, a Board Certified Veterinary Nutritionist.
To prevent gastrointestinal side effects with high doses, a gradual dose increase is recommended. Omega 3 supplements do not work instantly and should be started at least 4-6 weeks prior to the onset of allergy season if possible. Ideally they should be used year round as they can take up to 2-3 months to see maximum benefit. The Omega 3 fish oil supplements can often improve the efficacy of antihistamine therapy when they are used together.
If frequent bathing, over the counter antihistamines, and Omega 3 fish oil supplementation is not providing enough relief, it is time to see your veterinarian to discuss other Treatment Options.
Your veterinarian will also look for SECONDARY SKIN INFECTIONS that may be further compounding the itchiness of allergies. Allergies are a complex problem so your veterinarian will want to spend a substantial amount of time with you during an allergy appointment. Your vet will want to thoroughly evaluate your pet and to go over the complex nature of this disease and its multiple therapeutic options.
Your veterinarian will want to tailor a very specific treatment plan that will fit your individual pet. There is no magic single medication that is effective and safe, and no one treatment plan fits all. Periodic followup visits will be important to assess response, evaluate the control of secondary infections, monitor for drug side effects, and to fine tune treatments.
It is important to understand that most allergies cannot be cured. Our goal is to control them as much as possible, realize that recurrent flare ups will occur, and work to prevent secondary infections that worsen the symptoms. Multiple treatment modalities are usually needed to get things under control. Realistic expectations and goals are important for both veterinarian and pet owner to understand. Your veterinarian will usually start with the mildest forms of treatment, these also usually have the least side effects, and the least expense. However many of them can be labor intensive such as frequent bathing and ear cleaning.
Your vet will want to do a thorough physical exam of your pet, even if your pet has had similar symptoms in the past, an exam is needed each time the problem flares. Before recommending more potent medications the current health status of your pet needs assessment. It will be important to check for secondary infections in the ears, on the skin and on the paws. Your vet may need to perform microscopic cytology exams of the skin to determine the type of infection present to determine the best treatment.
Other diagnostic tests your vet may want to run might include skin scrapings or therapeutic trials for mites, fungal or bacterial cultures, skin biopsies, and hypoallergenic or novel ingredient diet trials. To cover all of the diagnostic options and tests may take some time and multiple visits. Again realistic expectations are important.
If the problem worsens with time, or responds poorly to the milder treatments, more potent options may be needed. This may include the use of corticosteroids such as oral prednisone, or the use of the newer immunomodulating allergy drug called Atopica (also known as cyclosporine). Prednisone is very inexpensive and effective, but can have significant side effects especially with chronic use. We try to use it at the lowest possible dose for the shortest amount of time. To keep the dose of steroids low and short term, combining them with the other modes of therapy (bath therapy, flea control, antihistamines, fatty acids, topical treatments) is always needed. Atopica is a recent treatment option that can really help minimize or eliminate the use of steroids but does involve significantly more expense. Click this link for more FAQS on Atopica.
Apoquel is a promising new drug for dogs that is on the horizon and should become available in 2015. It is an amazing drug for several reasons. It can work quickly, with most patients showing some improvement in their itch the very first day. It is better tolerated with fewer side effects than steroids (prednisone) or Atopica (cyclosporine). There may be several scenarios where Apoquel will benefit allergic dogs. It will benefit dogs needing rapid, short term relief for brief allergy flares. Apoquel may also benefit dogs starting a food allergy trial. Because a patient may continue to scratch for several weeks even after the diet change, Apoquel can provide comfort during this “lag time” before the food helps. Many allergic patients are allergy tested and then started on some form of immunotherapy (desensitization). But since it can take several months (or longer) before the desensitization is helpful. Apoquel can therefore be used in the beginning of such a program to provide relief until desensitization becomes effective. Apoquel will also be a welcome treatment addition for severely allergic patients who just cannot get enough relief from the traditional therapies and can improve the success of multi-modal therapy plans.
If secondary infections, parasitic skin mites and fleas, and food allergies have been ruled out, testing to determine your pet's specific allergens may be recommended. Allergy testing is an important consideration if the symptoms are severe, or last for more than 3 months of the year. To determine your pet's specific allergens, a referral to a Veterinary Dermatology Specialist for intradermal skin testing (IDST) is often recommended. IDST is the gold standard test for determining environmental allergens. Another option might be the use of blood testing to identify the specific allergens. Allergy blood tests are becoming more popular and are reasonably accurate in most cases. In severe cases a combination of both skin and blood testing to determine the allergens may be needed.
Once the specific allergens are identified by blood or skin testing, we can try to remove them from the environment if possible. In many cases elimination of the allergens is impossible and we use the allergy test results to make a special "vaccine" to immunize your pet against the allergens. This is also known as Allergen Specific Immunotherapy or ASIT. It can be very effective and may be the closest thing to a "cure or partial cure" for allergice pets.
Immunotherapy is the Gold Standard and most ideal treatment for severe allergies. However there is some expense involved, periodic injections are needed (most owners learn to do at home), may take 3-12 months to become effective, and may only work in 75% of patients. Recently a new oral immunotherapy option has been developed and eliminates the need for giving injections at home. If the other treatments are ineffective, if the side effects of other treatments are unacceptable, if allergies are severe and long term, allergy immunotherapy may be the ideal treatment. Click here for more info on Immunotherapy
Is Your Pet Itching For Allergy Relief? If so, then click this link to learn what every pet owner should know about allergies and their treatment.
If your pet's allergies are severe, or Intradermal Skin Testing and Immunotherapy are needed, we will often recommend a referral to a Veterinary Dermatology Specialist. With a Dermatology referral, we become a team together with the specialist to provide the highest level of care to the allergic pet to achieve the best results. Below are some links to Dermatology Referral Centers that we recommend. Many of these links will provide further helpful information and handouts directly from the Specialists.
VCA Aurora Specialty Hosptial-Dermatology Service
Veterinary Specialty Center-Buffalo Grove-Dermatology Service
Animal Dermatology Center of Chicago This site has some great handouts on the various conditions they treat, click to learn more!
Univ. of IL at Urbana Veterinary Teaching Hospital-Dermatology Service
Below is a collection of library materials regarding allergies in dogs and cats. You will find handouts and links to great information regarding environmental (airborne and absorbed via the skin) allergens, as well as flea and food allergies. Many of these handouts come from our Pet Library, provided by the Veterinary Information Network (VIN) and from the client handout section from the 7th Edition of The Textbook of Veterinary Internal Medicine.
Dermatology Handouts from the Louisiana State University Vet School
Canine Atopic (Allergic) Dermatitis
Itching and Allergies in Dogs
Itching and Allergies in Cats
Pollen.com Allergy Forcast
National Allergy Bureau Pollen & Mold Report
Immunotherapy for Allergies
Allergy Immunotherapy Guidebook
Hot Spots or Acute Moist Dermatitis "Hot Spots" are intensely itchy lesions that flare up within a few hours on dogs. Initially there is no lesion, but the itch and licking is so intense that within a few hours there is a red, moist, and oozing lesion that is not only itchy but also painful! They are usually allergic in origin. Click this link for more information.
Fur Mowing in Cats Many owners discover that the hair on their cats bellies, or thighs, or rump is disappearing! What may be happening is "Fur Mowing"! The cats are secretly over grooming their skin with their sandpaper like tongues breaking off the fur and leaving stubble. We speculate that many of these cats are actually "itchy" and this is why the cats over groom. Itch is a hallmark sign for allergies! Other causes may be pain or discomfort such as bladder pain in lower urinary tract diseases or arthritis. In some cats this may be a behavior problem or an obsessive compulsive act.
Feline Eosinophilic Granuloma Complex The eosinophilic granuloma is an incompletely understood condition in cats. For now it is best to view it as an extreme symptom of allergic skin disease.
Food Allergy Myths
Novel Antigen/New Ingredient Diets for Food Hypersensitivity
At Home Tips for Food Allergy Diet Trials