Of all the different diseases veterinarians treat, “allergic inhalant dermatitis”, also known as “atopic dermatitis” or “atopy”, is no doubt the most frustrating for both owner and veterinarian alike. Why is this you may ask? Well in this article I will explain the many difficulties veterinarians run up against when trying to diagnose and treat a dog with “atopy”. To begin with atopy must first be diagnosed and distinguish from a number of other skin diseases which have as their main symptom itching and scratching. These other conditions which must be ruled out before the diagnosis of “atopic dermatitis” can be made include mange, yeast and fungal infections, bacterial infections, food sensitivities, fleas and contact dermatitis. To further confuse the diagnosis, pets with atopy often develop the secondary problems of yeast and bacterial
infections and consequently more than one problem often exists at the same time.
To Further add to both the veterinarian’s and owner’s frustration is the fact that atopy often causes intense itching and because the pet is so uncomfortable the pet owner is desperate to find some way to provide their pet “immediate” relief. When these atopic dogs are scratching themselves raw it is initially necessary to break the “itch scratch cycle” with some form of cortico-steroid. Although steroids are not the long term solution there is little else available that will give the necessary immediate relief. Anti-histamines, fatty acid supplements, oatmeal baths or crème rinses, and herbal anti inflammatories may help some but rarely provide the immediate relief owners are expecting. In spite of the fact that long term use of steroids has unwanted side effects, the short term use may be necessary to prevent self inflicted skin mutilation which leads to secondary bacterial infections. Once the intense itching and scratching has subsided other supplements and medications may be used to replace steroid therapy. Most veterinarians realize that steroid therapy is a stop gap measure that is simply treating the symptoms and not the cause of the problem, however, a short term, reducing dose course of steroids is often necessary until the other approaches have a chance to kick in. As a holistic veterinarian I minimize many of the unwanted side effects of steroid
therapy by using “natural hydrocortisone” rather than synthetic steroids like prednisone or prednisolone.
Another frustration veterinarian’s face in dealing with allergic inhalant dermatitis is the fact that many animals with atopy may, at the same time, have food sensitivities. Allergic inhalant dermatitis usually starts out as a seasonal problem and progresses over several years to become a year round one. Food sensitivities, on the other hand, are year round. When animals have year round itching and scratching your veterinarian must try to discover whether the problem is atopy, food sensitivity or a combination of both. If
both airborne and food allergens are causing the dogs itching and scratching then both problems must be dealt with if the pet’s itching and scratching is to be minimized. Because food allergies may be due to both the food and to chemicals added to the food, such as preservatives, coloring agents, flavor enhancers or texturizers, trying to discover the allergic component in the food is often quite difficult and requires the use of food trials that use limited ingredient diets. A limited ingredient diet is defined as a diet that is made with only a single carbohydrate and a single protein source, such as duck and
potato. When attempting to reduce itching and scratching through a limited ingredient diet trial there is further frustration because the effects of the new diet can take up to 12 weeks to see if it is going to work.
Adding to the owner’s frustration is the fact that successfully treating atopic dermatitis usually requires that the pet be given several supportive drugs or nutritional supplements in addition to weekly baths that will help treat complicating yeast or bacterial infections. It is also important to give liver and intestinal support supplements in order to reduce the number of air borne and food allergens entering the pet’s blood.
Veterinarians are well aware that giving a pet all these oral supplements along with weekly medicated bath requires a huge commitment on the part of the pet owner. Understand that this commitment to daily therapy must go on for months.
If a pet owner makes this commitment and has conscientiously applied the therapeutic strategy for months with poor results then the next step would be to have the pet allergy tested in order to find which airborne allergens are causing the intense itching. Once the offending airborne allergens have been identified a “hyposensitizing serum” made up of these allergens can be prepared and the owner can be taught how to give simple periodic injection just under the skin. Unfortunately allergy testing and subsequent desensitization can be expensive and is not guaranteed to work. To add to the frustration it can take up to 9 months of allergy serum injections to determine if the hypo- sensitization approach will provide the answer.
By now I think it should be obvious that diagnosing and treating a dog or cat with allergic inhalant dermatitis is huge undertaking for both veterinarian and pet owner alike. A thorough exam and careful history is just the beginning. Periodic recheck exams at 3 to 4 week intervals will be necessary to evaluate the effectiveness of the treatment. Changes in treatment may be necessary depending on how the pet’s skin is responding and how uncomfortable the pet is. Following the veterinarian’s instructions to the letter is extremely important in order for him or her to judge whether therapeutic changes must be made.
Besides the above conventional approach to treating pets with skin allergies, holistic veterinarian can add acupuncture, herbal therapy, NAET, bio identical natural hormone therapy, FSM therapy, and monolaurin therapy.