October Pet of the Month - Millie

There are very few natural events that can bring joy in the hearts of different species. One of the most noticeable is the switch between winter and spring. The birds start singing, all the small insects crawl out of their diapause space and plants are looking green and some even bloom. Unfortunately pollens and animal dander also start coming out. If you have any allergies you probably know what that means: Itchy nose, runny eyes and sneezing is on the forecast for the next few months. Fortunately there are a few antihistamines out there that you can choose from. Your dog, on the other hand, may need more than just antihistamines. Millie, a beautiful 4 year old cocker spaniel, knows it all too well.
 
When Millie comes in the clinic, I cannot help but say hello to her. Millie will always wag her tail so hard she actually wags her entire body. She always has this really nice smile and unless your heart is made of stone you will find it hard to resist the temptation of petting her. The first time she came to us she was licking at all her paws. Poor girl needed some help to relieve all the itchiness.
 
Licking and chewing on paws, scratching ears and body, and shaking their head are the most common signs of allergy flare ups. There are multiple types of allergies but we will only go over the environmental allergies in this text. Dogs can be allergic to anything we can be allergic to (dust, pollen and sometimes even grass). Some dogs itch themselves raw, other lick themselves raw. All the itching and licking, if left untreated, can create inflammation of the skin and consequently infection. The infection here would create more itching and the cycle continues. Allergies can also cause some anal gland issue in dogs (anal glands are scent glands located to either side of the rectum and are usually expressed every time they have a bowel movement). Millie has had some problems with hers over the years. Fortunately we can always express the anal glands to help relieve some of the discomfort.
 
So what are these allergies, how do they work and how do we “fight” this enemy? Well allergies are just a condition that makes your immune system overreact to foreign substances (in this case an allergen). The body releases histamines (which are stored in mast cells that can be found in skin, nose, blood and lungs) which will migrate to the “affected” area to increase blood flow which in turns increases fluids in that same area. This is why your nose becomes runny (the membrane lining the inside of nose gets thinner as a response to histamines). Just imagine an overly reactive car alarm. If you drop something on the floor (you could even be 10 feet away) that makes a sound and the alarm goes off, you find yourself scrambling for your keys to stop that alarm before someone calls the cops. I bet you would take that car to the mechanic to get that taken care of sooner rather than later. Just like in this case, we take steps (antihistamines, steroids or itch blocking medications, avoid allergens) or change our lifestyles to prevent flare ups.
 
Now let’s talk about “fighting” the allergies. The best is always to avoid exposing your dog to what he is allergic to but this can be hard if you do not know what creates the allergic reaction. So the next option is controlling symptoms. This can be done with antihistamines which would prevent the histamines from attaching to the cells of the body thus stopping allergy flare ups. Dogs can get antihistamines (please consult your veterinarian before giving any kind of medications to your dog) just like us to suppress the symptoms. If antihistamines work this is a great choice of treatment. But since antihistamines do not address the underlying allergy, they are just a temporary fix to the problem and not all dogs respond to this treatment. Fatty acid supplements can be given in conjunction with antihistamines to “boost” the latter if it is not quite taking care of the problem. Steroids are an option as well. Steroids would reduce inflammation and itch but come with some side effects: polydipsia, polyuria and polyphagia (increased drinking, increased urination and increased appetite respectively). Since steroids can affect other organs (like the liver and the kidneys) if given long term, this option is typically kept on the short term and at a reducing dosage of administration. Of course all of these options would only work if Fido takes the medicine. Some dogs are just too smart and know you are trying to sneak some “poison” in that suspicious meatball. Fortunately there are topical antihistamines out there and like the oral ones, these would control itch. There are some new non-steroidal options available which are great at blocking the itch with fewer side effects, but they come at new drug price. Apoquel which is a daily oral medication or Cytopoint (injectible administered every 4-8 weeks) are good example of non-steroidal medications.
 
With all these options available, taking care of a dog with allergies can become an art of balancing treatments that the dog would tolerate and those that owners can keep up with. In most cases this is sufficient, but not easy. Sometimes, because symptoms cannot be kept under control or cost of treatment keeps climbing, allergy testing may be the best option. There is the blood test and the intra-dermal test. The blood test consists of testing a small sample of blood from the patient for reactions to geographically appropriate allergens. The intradermal testing is done by injecting these same allergens under the skin and the Doctor monitors for any reactions. Millie’s owners elected to try the blood test first followed by oral hyposensitization therapy. They did not achieve adequate control so they pursued with the intradermal allergy test. The intradermal test tends to be more accurate than the blood test. Her allergy test revealed that she had seasonal allergies especially to grass. This is a tough one to be allergic to for a dog. The test also showed that wool, dust mites (which are not seasonal) and pollens would all stimulate the allergy reaction in Millie. Currently Millie gets that “allergy serum” as an injection. They are given 1-2 times per week (which will drop to every other week soon) increasing the dose of allergen over time. This will allow the body to build tolerance or immunity to that particular allergen.
 
This day Millie is as happy as ever. Her smile may even be a little bigger than before. Her allergy shots are given weekly and for now seem to be progressing well.
 
Written by Ando