A new approach to an old problem

posted on November 01, 2018 by Dr. Jamie Hartman

Allergies are a common complaint in our animals, with up to 15% of dogs suffering from atopic dermatitis.  Treatment focuses on diminishing exposure to allergens (special diets, bathes, HEPA filters), treating secondary skin infections, and altering the immune system so it does not react.  Antihistamines and steroids are the most common methods of changing the immune response, with immunotherapy injections being another option.  However, steroids can be broad spectrum in their effects on the body, so newer medications and modalities are constantly being researched.  There are more specific medications available such as Atopica and Apoquel.  An even newer approach is Cytopoint.

Cytopoint is an injection given every 4-8 weeks.  It differs from steroid injections in that it targets specifically itch receptors instead of the immune system at large.  Cytopoint is an antibody against a chemical called cytokine IL-31, which is a chemical that triggers the process of sending itch signals to the brain.  By targeting this signal, it is able to interrupt the itch cycle before it even starts.

Cytopoint is a safe medication as it mimics the dog’s own immune system.  It is used and broken down inside of cells into amino acids and peptides.  It is not converted into reactive or toxic metabolites in the body.  It is not metabolized by liver or kidneys, and is not excreted in the urine, meaning it should be safe to use when there are other disease processes present in your pet. (Please note, it is still up to your veterinarian to determine if it is safe to use Cytopoint in your pet’s specific condition and instance).  Cytopoint can be used in conjunction with other medications, including many that are typically used for allergies.

The local dermatologists have been using Cytopoint for a few years, and we were happy with their results, so we are now proud to also offer Cytopoint injections here at Heritage Animal Hospital.  If you feel your dog is suffering from allergies, please schedule an appointment to discuss options for your pet!

Apoquel and Cytopoint are trademarks of Zoetis.  Atopica is trademark of Elanco.

May is Asthma and Allergy Awareness month

posted on May 02, 2017 by Dr. Jamie Hartman

One of the most common issues we see in our pets is allergy issues, and the month of May is dedicated to allergy and asthma awareness.  In our pets, 90% of allergies are environmental, versus only about 10% which are due to food.

If your pet is experiencing symptoms such as eye discharge, sneezing, chewing on feet, anal gland issues (scooting or licking anal area), thickened skin, recurrent ear infections, skin infections, or overall itching, it may be allergies.  An examination by your veterinarian should be performed to determine if it is indeed allergies and then appropriate treatment can be implemented.  Cats with allergies can develop wheezing and respiratory issues (allergic bronchitis and asthma).  However, breathing issues can also be due to many other illnesses and can be an emergency.  Please seek immediate medical attention for your pet if it is having difficulty breathing.

Allergies are the immune system over-reacting to things it does not or should not need to.  The goal of treatment is to try to decrease the immune response, either by suppressing the immune system and it’s activity, or to decrease the body’s response to the items it is over-reacting to.  There are a number of ways we can try to do this.

  1. Decrease exposure:  Most allergens are through contact in pets, so decreasing contact is important.  Things such as weekly bathing, soaking the feet in Epsom salts nightly, washing all bedding, and using HEPA filters in vacuums and air filters can help decrease exposure.  If the allergy is food related, finding diets without the offending ingredients can also help.  If allergy testing is pursued, it can further help point us in the correct direction for decreasing expsoure.
  2. Control histamines:  Histamines are released by white blood cells in response to allergens, and they are responsible for many of the symptoms we see such as itching, running eyes and nose, and sneezing.  Antihistamines are a relatively inexpensive, well tolerated, and safe way of controlling these.  Often anti-histamines alone are not enough to completely stop allergies, but they can be of great help.  We can help direct you with the correct dosing of antihistamines for your pet.
  3. Suppress the immune system:  Steroids are the most common medication used to do this.  Steroids work very well to suppress the immune system, but they have side effects.  Short term, they can cause increased thirst and urination, which may lead to house soiling.  They can also cause an increased appetite, which can lead to weight gain.  Long term use can cause weakening of ligaments and muscle loss, along with elevations in liver enzymes and even potentially damage to the liver.  Steroids can also make your pet more prone to infections.  Because of these reasons, we often try to use bathing and antihistamines first, and add in steroids as a later treatment for cases that don’t respond as we would like.

Veterinary dermatologists such as Dr. McKeever or Dr. Eisenschenk have immunosuppressive medications that cause less side effects than steroids.  We now also have a medication like this, called Apoquel.  These medications are more expensive, and may still require monitoring of liver and kidney enzymes or white blood cell counts as they suppress the immune system.  However, these medications are more specific to what part of the immune system they target, reportedly have fewer side effects, and may work better for some pets.

  1. Re-training the immune system:  Lastly, allergy testing can be performed to determine what the pet is specifically allergic to.  Using this information, the environment or diet can be modified to avoid triggers.  Also, an allergy extract can be made.  This extract is injected in very small amounts and slowly increased to try to teach the immune system that the allergens in it are not to be reacted to.  Allergy testing and allergy extract injections can be costly and require a lot of follow up, but may provide your pet with very specific relief and much fewer side effects than some of the other medications available.

Allergies are frustrating for all of us because they are not easily fixed, often require life-long therapy, and flare ups are common.  However, we will try to implement many of the above therapies in the best approach for you and your pet to help alleviate their symptoms.