Allergies

Allergies are one of the most common problems we see in this area of NC.  Besides being an incurable and highly uncomfortable condition, they can also be frustrating and expensive to manage.  Add to that the numerous dubious products and supplements that have no actual benefits, misinformation especially from dog food companies, and generalized confusion, we totally understand why our clients are so desperate to get help for their poor pets.  

What are allergies anyway?  Allergies are an over-exuberant reaction of the immune system against things that should not cause a problem.  The more a pet is exposed to the allergen, the worst the reaction will be.  So here's MYTH BUSTER #1: If your pet has food allergies, it is precisely because she has been on the same food for a long time.  It's virtually impossible to be allergic to something the first time you are exposed to it.  It takes the immune system a few exposures to get itself all wound up and react so violently.  That's why people who are allergic to bees don't die the first time they are stung.  We have an opportunity to buy an epi-pen so the NEXT time we get stung, and have a worse reaction, we have a treatment available.  So the argument "but she's been on the same food for years" is EXACTLY why we may suspect a food allergy!

The symptoms of allergies in dogs are usually itching, with ear infections being a close second.  Some dogs with food allergies have diarrhea but that's an uncommon cause of diarrhea in dogs.  With cats, itching is the most common allergy symptom followed by wheezing.  Yeah, cats are weird.  Allergic bronchitis is a really common problem in this area.  We see it sometimes in dogs too.  

Let's start with the most common cause of allergies: FLEAS.  Yes fleas.  People will often comment that they have never had a problem with fleas before, or they are positive their pet doesn't have fleas, yet on exam I see both live fleas and flea dirt (which is actually dried blood that the fleas poop out.  Yeah, fleas are gross).  Some flea control products have just lost efficacy over the years.  The fleas in this area have developed a resistance to fipronil (the ingredient in frontline) for example.  So even when you're using the right products you might have an unlucky flea resistance situation.  Thankfully there are many good products available, many only available by prescription, but if all you have to do is switch flea control products, consider yourself extremely lucky.  

WARNING- some people are tempted to use natural flea products.  Absolutely zero have been proven to work.  And cats can DIE due to severe respiratory disease from essential oils as found in common topical natural flea products.  I can't believe these products are still on the market for cats.  Those companies should be ashamed of themselves.  Many other products that are safe for dogs are deadly to cats.  NEVER use any flea control product that is labeled for dogs only on your cat, even at a reduced dose.  

The next category of allergens is impossible to control- environmental allergies.  And there is PLENTY of stuff for pets to be allergic to in this area- trees, grasses, weeds, pollens, molds, dust mites, feathers, other insects, wool, cotton, and the list goes on and on and on.  Unfortunately unless you move to a desert and live in a concrete home with no linens or carpeting, you can't eliminate environmental allergies.  Even if your pet never goes outside, your HVAC will happily blow all those fabulous allergens right into your home along with your cooled or heated air.  HEPA filters can definitely help a lot.  So can no smoking near your pet, especially cats with allergic bronchitis.  The only thing you can do if your pet is allergic to things in the environment is manage the symptoms, forever.  Ugh.  

 

There are 2 basic ways to manage environmental allergies.  One is immunotherapy, which to basically retrain the immune system so it stops thinking things like trees and grass are a problem.  For immunotherapy to work, we need to do an allergy test in your pet.  Luckily the simple blood test is almost as accurate as the skin test, so we go with the easy way and just draw some blood.  The lab will give us a printout of all the things your pet is allergic to.  Which is fun to look at but not entirely helpful, because you can't avoid the allergens on the list, as previously mentioned.  But what we can do is have a customized immunotherapy medication made up, based on exactly what your pet is allergic to.  Then we give your pet a teeny tiny dose of the allergens, either by injection or by sublingual drops, to retrain the immune system not to react so badly.  In most pets, immunotherapy dramatically reduces the need for symptomatic treatment.  A few very lucky pets are actually cured with long-term immunotherapy!

The other way to manage environmental allergies is symptomatically.  Often we use steroids at first to get the inflammation under control and make the pet comfortable.  For pets with mild seasonal allergies, this may be all we need to do.  But steroids can't be used long term.  They cause immune suppression (which is why they work against allergies- they are suppressing the abnormal immune response), can cause muscle loss, tendon and ligament weakness making it more likely for a dog to blow an ACL and need expensive surgery, increased thirst and urination which can cause a pet to pee in the house or outside the litter box, increase hunger which can cause weight gain or even food aggression, and more.  Clearly they are only to be used as short term relief.  Other medications such as apoquel and cytopoint (dogs only) injections can be used to manage the symptoms of allergies.  

Food allergies are the least common type of allergy.  A certain pet food manufacturer has spent billions of advertising dollars convincing people that grains are the cause.  MYTH BUSTER #2: Only 25% of allergic dogs have ANY food allergies, and only 5% of them have allergies to grains.  If you're doing the math correctly, you already figured out that only 1.25% of dogs are allergic to grains.  Furthermore, grain-free foods in dogs has been associated with a potentially FATAL HEART DISEASE in dogs.  Switching to a grain-free food most likely won't fix your dog's allergies, it might actually KILL your dog.  So don't do it!  It's not worth the risk.  More information can be found here on the FDA's website about this serious problem.  Cats are fine without grains, and they aren't allergic to them either.  

The most common food allergies in dogs and cats are beef, chicken, lamb, dairy, and egg.  For cats, add fish to the list, which makes sense considering cats originally came from the desert so why would fish be a natural part of their diet?  Gluten is another ingredient that certain pet food manufacturers have "criminalized" but that is an *extremely* rare food allergy in dogs and has not been documented at all in cats.  Click here for more information.  

MYTH BUSTER #3 You can test for food allergies.  Well, check that, you CAN test for food allergies, by properly doing a food allergy trial, but you can't do a blood test for food allergies.  So why do we do it?  Frankly because the lab I use comes with food allergies as part of the test panel.  Unfortunately the results of the blood test do not correlate well with what ingredients your pet may be allergic to in real life.  Do we use it sometimes as a shopping guide?  Sometimes.  If your pet comes up VERY positive to certain ingredients we may avoid them.  But a lack of positive food antigens doesn't mean your dog doesn't have any food allergies.  

The real way to conduct a food allergy trial is to use a hypoallergenic prescription diet like Hills Prescription Diets z/d or Purina HA, and give your pet that food and water ONLY for at least 12 weeks.  That means no treats, no people food, no chewies like rawhides or dental stick, NOTHING but that prescription food and water gets ingested for 12 weeks. If the pet gets better, you give the pet the original food.  If the pet shows symptoms of allergies by switching back to the original food, she's allergic to it.  Go back to the prescription diet and start to test one ingredient at a time.  One week, feed chicken, if no reaction, then chicken is safe.  Try a very simple chicken and rice dog food.  If the pet doesn't show any improvement after 12 weeks of being on a prescription hypoallergenic pet food, then they most likely don't have any food allergies.  Yay.  You can feed your pet whatever complete and balanced food you want, except grain-free foods for dogs.  

If you can't perform a food allergy trial in your pet, whether that's due to kids dropping food on the floor or people acting like children who feed the pet things they shouldn't even though they "know" better, then don't bother doing a food allergy trial. You're not going to be able to keep the pet from getting things they shouldn't anyway, so don't buy the expensive prescription foods at all.  Save your money for the treatment of environmental allergies or symptomatic treatment.  

Sometimes pets who have allergy symptoms don't actually have allergies.  We've been seeing a lot of scabies recently, which causes intense itching in dogs.  Demodectic mange can look like allergies too although the symptoms are more hair loss and not so much itching unless there is a secondary infection.  I've diagnosed a few pets with immune-mediated skin disease such as pemphigus and furunculosis.  

So what should you do if your pet starts showing signs of allergies?  First thing is to get effective flea control.  We recommend prescription strength products like Nexgard or Bravetco, or Simparica Trio or Revolution Plus which have the heartworm prevention included as well.  Obviously you need a current relationship with a veterinarian in order to get prescription products- in NC that means having the pet examined within one year.  We aren't allowed to prescribe or renew any prescriptions for longer than one year after an exam.  If that doesn't help, your pet needs an exam and diagnoses, sometimes testing.  

We have a value-packed Allergy Diagnostics Add-On Package for pets who need allergy testing and treatment.  It includes multiple exams and follow ups, the Allergy Diagnostic Panel, and a 10% discount off treatments except food.  Check it out and give us a call!  We can make the whole dealing with allergies thing SO much easier for you and give your pet much needed relief.