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Showing posts with label dog allergies. Show all posts
Showing posts with label dog allergies. Show all posts

Thursday, November 14, 2013

Ask the Veterinarian About Skin Rashes

by Dr. Julie Buzby
Buffer
courtesy Moyen_Brenn via Flickr.com
My dog, Maddy,  is 3 years old and has a grain allergy. She is on a grain-free diet. However, when I got her at 3 months I was not aware of her allergies. It was at 8 months we discovered it.

Our Vet initially diagnosed it as yeast from grain allergy--gave us steriods pills, inflamation drops, and ear wash to use--and it worked great. However, several months ago my husband bought some chews he thought were grain free. She developed a rash on her belly and ears and I discovered the chews were made with wheat. 

I took her in to the Vet clinic had her checked out with a new vet; he gave her some antibiotics. It seems to have somewhat gotten rid of the rash but it has since then reappeared and she has eaten no grains. 

I have done some research on this and just like to humans--antibiotics kill the natural flora in our intestines. I think she is having over active yeast growth in her ears and flaky red bumps on her belly and genital area. I have treated her ears with apple cider vinegar and water (50/50) and it healed quickly. However, the few bumps on the back hind legs that I can't seem to treat because of all the fur. I spoke to the vet and he wants to give her antibiotics again! 

What do you recommend? A second opinion? Can I give her plain organic yogurt w/ live cultures or dog probiotics? I'm confused and annoyed because several vets I have spoken to just refer the rash to an allergy? An allergy to what? She doesn't eat any grains! They never seem to mention yeast growth. At this point any advice is welcomed. I hate to see her cry when she licks her belly. Thank you!
 
Best Regards. 
Michell B.
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Dear Michell,

According to statistics, the top three reasons dogs visited veterinarians in 2012 were skin allergies, ear infections, and skin infections.  Poor Maddy appears to have all three, which is not uncommon.  The ears are just an extension of skin, and both are prone to infection secondary to allergies.

Pruritis (itchy skin) can have multiple causes and take months to sort out.  My goal is to equip you to better communicate with your vet about Maddy’s condition.

We have two issues to address:

1.  Maddy’s ear and skin infection.
2.  The underlying cause, which is most likely allergies.  We must manage her allergies to prevent recurring infections. 

I do think Maddy has food allergies, which are typically incurable in dogs, and can develop at any age.  However, she may also be affected by things in the environment.  Dogs with allergies seem to have an “allergic threshold”, meaning they have multiple allergies, but there is a point where “the straw breaks the camel’s back” and symptoms manifest.  The predominant sign of food allergy is that symptoms are year round, not seasonal.  Further, recurrent external ear infections are present in more than half of dogs with food allergies. 

The most common food allergens for dogs (in order) are: beef, dairy, wheat, chicken, egg, lamb, and soy.  About half of all dogs are allergic to more than one ingredient.  It’s important to understand that “grain free” is not synonymous with “hypoallergenic”.  Consider the ingredients in diets on which she thrives, versus the ingredients found in foods or treats that cause her to flare up.  I’m guessing there’s more to the story than just grains.  How can we determine what Maddy is allergic to? 

Blood tests for food allergies are not reliable and are a waste of your money.  A “dietary trial” is the gold standard for diagnosing food allergies.  Talk with your veterinarian about conducting a food trial.  Maddy’s doctor may recommend a prescription diet, or even home cooking a balanced recipe.  Over-the-counter diets should not be used for food trials, but can be fed once the offending ingredients have been identified.

As for her skin, the rash you describe sounds classic for a skin infection. While this is not the same thing as skin allergies, the two often go hand in hand.  This type of infection is caused by bacteria and/or yeast, and each is treated differently.

Bacterial skin infection, called pyoderma, is best treated topically and with oral antibiotics.  Through simple tests, your veterinarian can tell what types of organisms are causing her skin and ear infections and determine proper treatment.  If she requires another course of antibiotics, I would recommend administering high quality human probiotics, or a doggie product like FortiFlora, during the course of her treatment.

Ultimately, I completely understand your concerns.  Allergies are frustrating for clients and veterinarians alike, not to mention the dogs!  While, Maddy will likely always be prone to skin flare ups, I feel confident that you and your veterinarian can transition her out of a skin “crisis” to long-term successful management of her skin and allergies.


Dr. Julie Buzby is a homeschooling mom of seven, American Veterinary Chiropractic Association and International Veterinary Acupuncture Society certified holistic veterinarian, and passionate advocate for canine mobility.In her free time she serves on the Advisory Board for The Grey Muzzle Organization. She can be found at Twitter @DrBuzby and on Facebook.com/ToeGrips. You'll also find more of Dr. Julie's posts at our Ask the Vet Archives page.

Here are a few of her articles that may be of interest:
Dr. Julie's opinion or advice does not replace an actual exam with a veterinarian.
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Tuesday, March 27, 2012

Ask the Vet: More on Pet Allergies

by Mark Nunez, DVM

Daniel Y. Go via Flickr.com
Dear Dr. Mark,
I've read that long-term use of prednisone can cause Addison's disease, Cushing's disease, and a dependence on the drug to the point where his body will not be able to produce its own corticosteroids. Is this true? Should the veterinarian be prescribing something other than Prednisone for long-term treatment of an allergy? Is there something I can be doing to help control the allergies at home? Sorry for the long questions. Thank you!
Cynthia D.
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Dear Cynthia:
Prednisone is the best medication for controlling the symptoms of allergies, no doubt about it.  However, it has a lot of side effects, especially with long-term use.  The list of side effects includes:  increased thirst, increased urine production, increased appetite, thinning of the skin and coat, dull/dry coat, weight gain, water retention, panting, vomiting, diarrhea, elevated liver enzymes, pancreatitis, iatrogenic Cushing's disease, GI ulceration, lipidemias, activation or worsening of diabetes, muscle wasting, increased susceptibility to infections and behavior changes (depression, lethargy, aggression).  Pred does not cause Addison's disease.  Cats tend to tolerate it better than dogs and side effects are rarely seen in cats.

This said, I would not, and do not, hesitate to use prednisone in my patients that need it.  There is no medication out there that works better to relieve the symptoms of a moderate to severe allergy flare up.  In some cases, it is the ONLY thing that helps.  I use pred without hesitation, but my goal is to minimize its use.  The best way to accomplish this is with allergy shots (immunotherapy, IT).  I recommend that all of my patients get allergy tested (if I suspect environmental allergies to pollen, dust, etc...) and start IT.

Nothing will cure allergies; there are only different ways of managing the symptoms.  IT is the only form of treatment that addresses the underlying cause, which is an over active immune system.  Other options only treat the symptoms.  Atopica (cyclosporin) is another long term treatment option that can take the place of pred, however, it is not without it's own set of side effects which includes: vomiting, diarrhea, anorexia, gingival hyperplasia, increased susceptibility to infections, and neoplasia (cancer) when used in combination with other immunosupressive drugs (pred).

Both pred and Atopica (the two should not be used together) also have MANY drug interactions and can be contraindicated if your dog is on certain heart medications, insulin, anti seizures medications (specifically phenobarbital), cyclophosphamide, erythromycin, mitotane, live-attenuated virus vaccines, non-steroidal anti-inflammatories (Rimadyl, Deramaxx, Metacam), antifungal medications, and synthetic estrogens.

Other medical options for controlling the symptoms of allergies include Benadryl, Claritin, Zyrtec, and Hydroxyzine.   These are all antihistamines and tend to only work on mild cases and at high doses.  There are a number of shampoos and leave on conditioners that have cortisone in them.  The most common one I use is Epi-Soothe.  This can be a good option, but is labor intensive.  Omega-3 fatty acids (fish oil), specifically Welactin, can also help and I recommend this specific brand for all allergy patients.  The brand is important because nutraceuticals are not FDA regulated and vary significantly in their bioavailability and action.

Thank you for your question and I hope I’ve helped you get a better understanding of how to treat allergies. Part I of this question was answered earlier and is linked below for reference.

Dr. Mark
courtesy M.N.
Dr. Nunez is a practicing veterinarian while also assisting patients through The Balanced Canine blog and his own online veterinary pharmacyHave a question for Dr. Mark? Send it to AllThingsDogBlog@gmail.com. You can also follow Mark on Twitter.

Want to read more from Dr. Mark? Try these, or visit his archives: 


Dogs and Allergies (Part I of this same reader's question)
Dogs Who Eat Bugs
Diabetes and Allergies Combined

Dr. Mark's advice does not replace an actual examination with a veterinary professional.

Tuesday, March 6, 2012

Ask the Vet: Dogs and Allergies

by Mark Nunez, DVM
© Lee J Haywood via Flickr.com
Itchy Itchy Allergies

Dear Dr. Mark:
Jack has suffered for allergies for his whole life. We know he is allergic to fleas, so we work very hard to keep that under control. When he comes into contact with fleas, he begins to get a rash at the base of his tail. However, he also has other allergies. We have found out through trial diets that it is not food he is allergic to, I'm assuming it's environmental. Usually it gets better over the winter; not this year. They've gotten a lot worse in general over the past 1-2 years before then we could control it without the use of corticosteroids. If we don't keep his itching in check, he gets a yeast infection in his groin and hot spots all over his front and back legs.
Our veterinarian prescribes prednisone. 2/day for seven days, 1/day for seven days, 1 every other day for 10 days. We were told that the shot and the pills (he's had both, this is the first time using pills though) tend to last about a month, which confused me as far as the pills. Does that mean they should last until a month after the first dose, or a month after the last dose? If a month after the first does, does that mean he will be needing to take pills almost every day for as long as he is exposed to whatever allergen is causing the itching?

Cynthia
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Hi Cynthia,

Allergies can be very frustrating for my patients and their owners.  The first thing I tell my clients, when allergies is the diagnosis, is that allergies are 2 things, #1 expensive and #2 frustrating.  There is no cure, only different ways of managing them.  100% flea control is a must.  I've heard many times that "we've never had a flea problem."  Unfortunately, that's not good enough.  A topical, monthly flea preventative is a must.  My favorite is K-9 Advantix because it also protects against biting flies and mosquitoes.  Anything that can cause an itch will make an allergic dog, or person, worse regardless of whether they are allergic to it or not.  

The 2 major categories of allergies are food and environmental (fleas included).  The only way to diagnose a food allergy is with a food trial.  There are may foods that can be used for this, but none of them are over-the-counter and all require a prescription.  Sensitive skin diets that are over the counter only work for the mildest cases.  My favorite diet for a food trial is Hill's Z/D Ultra.  99% of the time, the allergy is to a protein source.  The protein in Z/D Ultra is broken down into such a small size that the immune system cannot recognize them, and therefore it cannot react to them.  The other route to take would be to feed a novel protein diet that contains a protein source that your dog has never seen before, such as venison, duck, rabbit, or fish.  It is very rare to have an allergy to a carbohydrate source.  So all that talk out there about "grain free" food is mostly nonsense :-).  There are skin and blood tests for foods, but they are not accurate and should be totally ignored.

Pollen allergies, or Atopy as it is known in my world, are extremely common and have an average age of onset of 2 years, with the range usually being from 6 months-3 years of age.  The best way, in my opinion, to handle this is to have your dog tested and start immunotherapy (IT), or as it's better known, allergy shots.  This addresses the underlying issue, rather than just treating the symptoms.  There are two ways of testing, blood or skin testing.  Skin testing is the gold standard, but is expensive and usually requires anesthesia.  Blood testing methods have improved greatly over the past few years and produce much fewer false positives than they have in the past.  The goal of IT is not to cure the allergies.  Basically, IT simulates production of certain cells that will intercept the allergen before the bad cells that cause the allergic reaction have a chance to get their hands on it.  The goal is to make the outbreaks fewer and less severe so that we do not need to use Prednisone as much.  The Prednisone tablets only last for 12-24 hours, not one month.  There is a long lasting steroid injection called Depomedrol that can last 2-4 weeks, but I generally do not use it because once you give it, it cannot be taken back.  

Other options for controlling the symptoms of allergies include Atopica, anti-histamines, and shampoos.  Atopica is an immunosupressive medication (Cyclosporin) that is similar to Pred, but does not have the side effects that Pred has.  Antihistamines, such as Benadryl, Zyrtec, and Claritin tend to only work in mild cases and at high doses.  Shampoos that contain Chlorhexedine, Ketoconazole, or Cortisone can help as well.  Shampoos should be used in most cases to remove the allergens from the surface of the skin and to wash away dirt and inflammatory debris.

Fish oil is another must in patients with allergies.  Welactin is the fish oil supplement that I recommend for dogs.  The brand matters tremendously.  Not all supplements are created equally and they are not regulated by the FDA.  I know Welactin and I know it's bio-availability and it's the only one I trust.

Many times an multi-modal (using more than one of the above products) approach is much better than single agent therapy.  Remember, we cannot cure allergies.  We can only manage the symptoms.

Dr. Mark
© courtesy m.n.
Dr. Nunez
Dr. Nunez is a practicing veterinarian while also assisting patients through The Balanced Canine blog and his own online veterinary pharmacyHave a question for Dr. Mark? Send it to AllThingsDogBlog@gmail.com. You can also follow Mark on Twitter.


Want to read more from Dr. Mark? Try these, or visit his archives:


Dogs Who Eat Bugs
Diabetes and Allergies Combined
The Dangers of Animal Bones

Dr. Nunez's advice does not replace an actual exam with a veterinarian.

Tuesday, July 20, 2010

ASK THE VET: Help My Dog Stop Licking

by Jacki Bert, DVM
© Alan Boyko
Hot Spots are a Common Skin 
Problem for Many Dogs

Hello Dr. Jacki:


I have been told by a couple of vets that my dog may have something akin to OCD in humans. He cannot stop creating hotspots, and there seems to be no reason for them. We did allergy tests and tried many topical skin treatments. I spent a lot of money to get no help, but I do understand the doctor did his best.

The first time this diagnosis came from a doctor out of state. He suggested more exercise and that possibly Perkins is anxious. I guess exercise helps anxiety just like it does for humans. So I started him on a more vigorous walking regimen, even though he was 12 at that time. He is doing well physically even now, except that he is slower. I suppose I will be too when I am that age.

Anyway, the exercise didn't help. It is now two years later and my dog is still wearing a lampshade. He is pleasant, perky, friendly and easy going. No signs of anxiety except from fireworks. That really sets him off. Since Perkins shows no signs of leaving us yet, I'd like to try another suggestion. My poor vet is at a loss for words; I can't blame him. Can you offer any ideas?

Agnes
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Dear Agnes….sounds like an ordeal!!  If a full bloodwork panel was not run, then that would be the first place that I would start.  Also, were radiographs taken of the area where the ‘hot spot’ occurs?  Sometimes dogs and cats lick to ease a pain that is lying below the surface…..like arthritis. 

A true hot spot is an allergy of sorts and dogs can be allergic to the outside pollens, the food that they are on, and definitely to fleas.  If you have exhausted these considerations, I would suggest finding a veterinary dermatologist in your area and setting up an appointment.  Hot spots are treatable. 

If instead, it is a lick granuloma, then that can be different.  Still could be related to allergies or even to underlying arthritis but once the licking behavior starts, it doesn’t seem to stop.  Hence the obsessive compulsive diagnosis.  There are meds for this, but really it doesn’t hurt the animal, so it is best to occupy him as much as possible. Maybe even put a bitter tasting substance (bitter apple) on the bandage around the granuloma and keep your fingers crossed.  I hope it works!! 

Dr. Jacki, DVM
ASK THE VET on All Things Dog Blog
For more information on Dr. Jacki and her practice, you may find her at  4 Paws House Calls. A personal appointment will likely provide more specific information on your dog and your specific questions.
Dr. Jacki's opinion or advice does not replace an actual exam with a veterinarian. 

Be sure to stop in at Critter Minute to read Carrie's latest guest post: Managing Your Multiple Dog Household. 

Also, Xena has some thoughts on Dr. Jacki's idea from this post, over at my dogs' blog,
 5 Minutes for Fido. Hope you can stop in for a visit.




Finally, I want to thank Dr. Jacki for nearly a year of fine medical advice for our readers.  You can return and view her posts at any time. The link will always be available in the header or sidebar, with her archives there for your reading. 



Dr. Jacki's busy practice and growing family needs more attention now, so we bid her fond farewell. 



Watch for an introduction to your new ASK A VET Columnist, coming soon.
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