In episode 79 of The Derm Vet podcast, I’m joined by Dr. Jennifer Schissler, DVM, DACVD. We discuss the canine allergic workup and the importance of communication to owners of allergic pets. Communication can be accomplished through handouts, exam room posters, and discharge instructions. There is a simple flow chart available at ScienceofStrongerBonds.com/resources that can help educate clients.
The beginning of the workup can be more time-consuming and costly for the owner, but it will lessen veterinary visits and costs long term. Every owner is going to have a different threshold for the allergic workup. Some are willing to do a lot all at once; some need to spread out the steps.
One of our biggest passions in the dermatology field is the importance of cytology in itchy pets to rule out bacterial and yeast infections. There are various types of cytology- direct impression, tape, claw fold, and swab for skin or ears. Clinical signs such as erythema, scaling, crusting, brown claws, etc., all warrant cytology. But the skin doesn’t have to look “bad” to have an infection that could be contributing as a flare factor. If a pet is particularly pruritic to a certain area, cytology samples should be considered.
At the start of an allergic workup, we want to rule out easy things such as ectoparasites. Isoxazolines are well tolerated, fast-acting, and control many different ectoparasites, including fleas.
A strict prescription or home-cooked diet trial is the only way to definitively diagnose cutaneous adverse food reactions. At the start of the diet trial, use of antipruritics can be used to alleviate pruritus. Apoquel® (oclacitinib tablet) can be a great option due to the quick onset of action. The short half-life also allows the practitioner to attempt discontinuing it at the end of the diet trial. This allows appropriate evaluation of the diet’s success in controlling pruritus on its own. For dogs under 12 months of age, Cytopoint® is an option to relieve pruritus while starting a diet trial.
The diagnosis of atopic dermatitis is one of exclusion. If ectoparasite control and a diet trial have not controlled pruritus, then this diagnosis can be made. It is important to recognize that allergy testing (serum or intradermal) is not performed for the purpose of diagnosis. The purpose of allergy testing is to combine the results with the clinical history of that dog to formulate allergen-specific immunotherapy for long-term desensitization.
Again, client communication is very key in managing allergic patients long-term. Having a client proactive with allergic flares and adopting a multimodal approach to treatment will provide more successful long-term management.
This podcast was sponsored by Zoetis, the makers of Apoquel and Cytopoint. Zoetis is dedicated to changing the way we approach canine pruritus to protect the bonds between the pet, the owner, and the veterinary team. Visit ScienceofStrongerBonds.com for more information.
APOQUEL-IMPORTANT SAFETY INFORMATION
Do not use Apoquel in dogs less than 12 months of age or those with serious infections. Apoquel may increase the chances of developing serious infections and may cause existing parasitic skin infestations or pre-existing cancers to get worse. Consider the risks and benefits of treatment in dogs with a history of recurrence of these conditions. New neoplastic conditions (benign and malignant) were observed in clinical studies and post-approval. Apoquel has not been tested in dogs receiving some medications, including some commonly used to treat skin conditions such as corticosteroids and cyclosporines. Do not use in breeding, pregnant, or lactating dogs. The most common side effects are vomiting and diarrhea. Apoquel has been used safely with many common medications, including parasiticides, antibiotics, and vaccines. For more information, please see the full Prescribing Information at Apoquel.com/pi.
Control of pruritus (itching) associated with allergic dermatitis and control of atopic dermatitis in dogs at least 12 months of age.
Cytopoint has been shown to be effective for the treatment of dogs against allergic dermatitis and atopic dermatitis.