Seasonal Allergies And Your Pets

Pollens are high and so are symptoms of ATOPY

ATOPY

Atopic dermatitis (AD) is a genetically predisposed, inherited, inflammatory, and itchy skin disease with characteristic clinical features. It is most commonly associated with IgE antibodies to environmental allergens. The expression of typical clinical signs can be seen in dogs and cats with IgE-mediated skin disease, food allergy, or a condition called "atopic-like dermatitis" (ALD). ALD is defined as an itchy skin disease in dogs and cats with characteristic features of atopic dermatitis but negative serum and skin test results for specific pollens, molds, insect proteins, and animal or human dander. Feline atopic dermatitis has many similarities to canine atopic dermatitis.

Etiology and Pathogenesis

The etiology and pathogenesis of Atopic Disease (AD) are complex and involves a genetic predisposition, impairment of the normal barrier function of the skin, and immunologic aberrations. Animals with AD are thought to be genetically predisposed to become sensitized to allergens in the environment. Allergens are proteins that, when inhaled or absorbed through the skin, respiratory tract, or GI tract, evoke allergen-specific IgE production. These allergen-specific IgE molecules affix themselves to tissue mast cells or basophils. When these primed cells come in contact with the specific allergen again, mast cell degranulation results in the release of proteolytic enzymes, histamine, bradykinins, and other vasoactive amines, leading to inflammation (erythema, edema, and pruritus). The skin is the primary target organ in dogs and cats, but rhinitis and asthma can also occur in ~15% of affected animals.

HOW DOES ALLERGIC SKIN AND EAR DISEASE HAPPEN? 

Pollens that your dog’s immune system overreacts too, surge and become high in your dog's environment.  Your dog's immune system is exposed to these pollens when 

  • Your dog licks himself and ingests them, then large proteins pass through the “leaky gut” that is inflamed. The intestinal tract is lined with modified skin cells and is home to a large, very important portion of the immune system.
  • Your dog breathes the air and his respiratory system, also lined with modified skin cells is exposed 
  • Your dog walks and rolls around in the grass, and pollens cross through the inflamed, bald, abnormal skin and further exposes the overactive immune system

 

Symptoms of Pollen Allergy & Adverse Food Reactions

  • Red, watery eyes, brown tear staining under the eyes
  • Rubbing of the face and eyes which results in red, thickened skin, hair loss, or brown staining of the hair under the eyes and around the mouth
  • Red, swollen, oozing, smelly ears
  • Painful or itchy ears with scales, crusts, scabs or  hair loss on the ear pinna
  • Brown/Black ear wax that has to be cleaned from the ears weekly or daily - this is not normal
  • Licking and scratching of the armpits, sides of the body, the flanks, and groin
  • Licking the feet between the toes or foot pads, brown staining on the hair of white or light-colored dogs
  • Sneezing or coughing in cats and sometimes dogs
  • Chronic intermittent soft feces, vomiting or flatulence(gas)
  • Butt Scooting or licking at the anus
  • Full, infected, painful anal glands

Once the skin is inflamed and is no longer normal, the bacteria (mostly staphylococcus) and yeast (Malassezia) which normally sits on top of the skin not causing a problem invades the dermis and further causes inflammation, itching and foul skin odor called seborrhea. Dogs that develop secondary yeast infections will have brown pigment that stains white toenails, and light-colored hair between the dog’s toes, and pads.  As the condition becomes chronic, the skin will become very thickened and dark like “elephant skin” and the body odor will be so intense that you will smell it on your hands after petting your dog and in your house where your dog resides.

Diagnosing Allergies

Adverse food reactions (a better name for food allergies) is ideally diagnosed by doing a 3-month elimination diet with novel proteins (a protein your dog or cat has never ingested) or a prescription hydrolyzed protein diet like Ultimino(by Royal Canin), Purina HA or Hills z/d.  Best time to do these is winter when environmental allergens are low. 

Another controversial alternative is a saliva test called Nutriscan.

NutriScan is novel and patented and is not testing for food allergies, but rather tests for food sensitivities and intolerance. These are different body immune responses. Food allergy is a more immediate reaction mediated by production of IgE and IgG antibodies. 

Food sensitivity and intolerance, by contrast, measures a more delayed body response to offending foods by measuring production of IgA and IgM antibodies primarily in mucosal secretions from the bowel
Antibodies to IgA measure the immune response to certain foods in secretions like saliva that have occurred over the last 2 years. Antibodies to IgM measure the body’s primary immune response to a recent exposure of certain foods within the last 6 months. 

Angelcare Skin and Ear Clinic have had good success using this test to help determine the role food is playing in your pet’s itchy skin disease. 

Atopic Dermatitis (AD) and Atopic Like Dermatitis (ALD) is a diagnosis of elimination. This means we rule out or specifically treat and resolve all other causes of itchy skin and ear disease, and then, if your dog or cat are still exhibiting the symptoms of seasonal allergies we diagnose them with Atopy or ALD. Skin testing and /or serum testing does not diagnose atopic disease. It identifies the environmental allergens likely to be causing the symptoms. It is possible to have positive reactions to the allergens being tested without them causing the clinical symptoms in your dog or cat.

For example, if your dog lives in Milwaukee, WI or Chicago, IL and has a +4 reaction to Palm trees or Bahia grass - unless you live in an indoor botanical garden these pollens would not be causing your dog or cat to itch in Wisconsin or Illinois.

 

Treating Allergies

Successful diagnoses and treatment depend on a multi-pronged approach. Treatment is lifelong and requires due diligence on the part of the owner to be successful.  The bacteria must be treated with an antibiotic that kills the organisms and has good penetration into the skin. Angelcare’s first choice for simple, acute skin infections is cephalexin - it is an inexpensive twice/day antibiotic. Chronic skin or ear infections should have cultures/sensitivities done prior to starting therapy.  This allows us to identify all the bacterial species infecting the skin and ear and tells us which antibiotics will most effectively kill the bacteria.   Your dog should be treated for at least 3 weeks, (often 3 months) as it takes that long to truly get rid of a bad skin infection.

Skin cells and exudate from the nail beds and between foot pats should be examined for the presence of Malassezia yeast. If these peanuts looking organisms are present, then your dog should be treated with oral ketoconazole daily for 3-4 wks. Yeast is very itchy and if it is not addressed it will continue to cause your dog to lick at his feet long after the allergies and the staph are gone. They are the organisms most often responsible for “the brown boots often seen on white-footed dogs”.

Topical treatment for staph and Malassezia is available and can be successful, but it is much more labor-intensive, and you must be very dedicated to frequent, continuous application. Our favorite topicals have chlorhexidine, climbazole, and phytosphingosine and silver.  Shampooing three times a week for at least 15 minutes will remove, infecting organisms, pollens, dead skin and hair.  This will shorten your dog’s recovery time.  Once your dog is back to normal the mousse or spray products work well in maintenance and preventive protocols.

The itch that is triggered by Atopy (pollen allergies) is best treated nowadays with Apoquel or Cytopoint.  Apoquel is a great new non-steroidal anti-itch drug that has minimal side effects.  Cytopoint is a new monoclonal antibody that specifically targets and neutralizes canine IL-31. Canine Il-31 is a chemical the immunes system makes which sends the itch signal to the brain in atopic dermatitis.  Short-term use of steroids such as prednisone, or long-term use of Atopica are other drugs available to modulate the overactive immune system that is causing Atopy. Regardless of which drugs are used to control symptoms, your pet should have a CBC, chemistry panel and thyroid profile done every 6 months to monitor changes on the inside organs of his body.

Nutrition to Support and Repair Skin in Allergic disease

Nutritional support year-round can make a huge difference in minimizing, and in cases of a mild disease, eliminating the symptoms of Atopy.  For this effect, I have found a prescription Fish and Potato based diet to be the most reliable diet choice. My favorite is the new VRS codfish and potato diet or Royal Canin Skin Support. There may be some over the counter diets that will work, but to date all over the counter diets that have been independently evaluated have been contaminated with ingredients not listed on the bag and none of them will have high enough levels of the supplements that make these prescription diets “medicine in a bag”. If your dog has an adverse food reaction to FISH, then another option will need to be explored. 

There are a lot of nutraceuticals available over the counter and from Angelcare Animal Hospital that can support healthy skin and decrease the symptoms of allergic disease. One size DOES NOT FIT ALL.  Efficacious use depends on the “art” of the clinician.  Each pet is different in what they will consume, their disease states, their life stage, and their diets. For the best success, I recommend you consult your veterinary dermatologist. 

Probiotics added daily to the diet will also help with developing a good microbiome and healthy gut. Leaky guts not only cause soft stool and occasional puking, a leaky gut also allows all those grass and weed pollens the dog is licking off his coat to invade the immune system. VRS Entero TruBenefits, Purina Fortiflora, and Iams Prostora are the probiotics shown to have the most viable organisms in the package you are putting in your dog’s food.

ALLERGY DESENSITIZATION IN DOGS AND CATS

For dogs and cats who are experiencing very long year-round pollen seasons, or you are in the southern half of the U.S. where there is NO appreciable winter, then allergy testing for specific allergens your dog is reacting too with follow up allergen-specific immunotherapy (allergy vaccines) is a sensible way to go.  Desensitization takes a minimum of 6 months and for most dogs 18 mos. to see an improvement.  Therapy is usually lifelong. Therapy can be oral or injectable. The goal of immunotherapy is to decrease year-round symptoms to shorter, seasonal symptoms. 

Laser Therapy  

This is a newer treatment option that Angelcare Skin and Ear clinic has utilized with great success. Laser treatments will stimulate the immune system to fight the bacterial infections, mite infections (if present), decrease inflammation, cut healing time of the skin and gut in half ….. And in many cases, we have been able to desensitize dogs and cats to the offending allergens. A nice thing about desensitizing with the laser - you do not have to identify the allergens - we treat the dogs and cats during their symptomatic flare ups so the offending allergens are already present.

The best outcome is a symptom-free dog or cat year-round.  In the Southeast Wisconsin, Northern Illinois area, there is a very good possibility that this can be achieved with a consistent, multi-modal treatment plan.

 

IMPORTANT ACTION PLAN FOR SKIN & EAR DISEASE TREATMENT

Set up your appointment with Dr. Melodie Limpach if you think your pet is suffering from seasonal allergies, other types of allergy, or any skin condition that does not resolve in a couple of weeks.  Angelcare Animal Skin and Ear Clinic of Racine, WI can usually get your pet in for an exam within 48 hrs of your call for help. If Finances are limited, we accept Care Credit, Visa, MC, and Discover. We will also design a treatment plan that can work within your budget.  The important action plan is to get your pet in sooner than later.  The longer your pet is suffering from his skin or ear disease, the longer (and costlier) it will take to produce a happy healthy pet. Call 262-886-3337 for an appointment today. 

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