When my son got chiggers at camp, he asked his mom what to do about the itching. She suggested the traditional remedies of Benadryl cream, Chigarid, or clear nail polish. He didn’t care for those alternatives, so I facetiously suggested that he "scratch them till they are bloody sores". He gave me a quizzical look and walked off. Two days later, he informed me that he had indeed scratched the chiggers till they were bloody sores. "How did that work?" Not very well. "Better listen to your mother next time."
Dogs and cats with allergies have itchy skin as their most common problem. When they itch all over, they scratch all over, sometimes until they get "bloody sores". At this point they’ve exhausted their repertoire and have no alternate plan. Despite the fact that they’re still itchy, self-trauma is all they can do about it. It’s not surprising that the people who love them would like to try a different approach.
So, having determined that you don’t have mange mites (by skin scrapings), or fungus (by culture), or yeast (impression smears), or fleas (careful combing under bright lights), and having taken a careful history and thorough physical examination (since skin problems are often the only visible part of whole body problems), we come to the conclusion that your pet is an allergy sufferer. Whaddayagonnado about it?
I’ll discuss the most common approaches to allergy treatment. If you’re into "alternative medicine", I highly recommend Dr. Ava Frick. She is the best, and not far way, in Union, Missouri.
Since the allergy is a malfunction of the immune system (see yesterday’s post), we can suppress the immune system with some form of cortisone (there are lots of synthetic drugs in this category). This relieves inflammation and stops the body’s over-reaction to the allergens (pollen, mold, house-dust, etc.). Unfortunately, it also affects your adrenal glands, your liver, your carbohydrate metabolism, your mood, your appetite, your urine output, and a lot of other stuff. This means that it may work great to shut down your allergic reaction, but you can’t eat it like popcorn. High doses are pretty safe for short periods of time, but if your allergy is year-round instead of seasonal, high doses are not going to be safe. Low doses given every two or three days are pretty safe for most (but not all) individuals. We manage a lot of dogs this way. It’s very inexpensive and for many it is effective and the side-effects are liveable.
A newer approach to suppressing the immune system is cyclosporine (trade name is Atopica). This drug does not have the side-effects of the cortisone derivatives. It works really well for most patients. Unfortunately, it is hideously expensive: think ten dollars a day for a forty-pound Boxer. Yow! I’ve treated several dogs with it, but mostly very small dogs.
Antihistamines don’t suppress or prevent the allergic reactions. When you have an allergic reaction, histamine and other chemicals are released (and make you miserable). The antihistamines are drugs that have effects that are the opposite of the allergic chemical mediators. If the allergic chemicals are making the blood vessels open up someplace, the antihistamins are closing them down. Instead of preventing messes, we try to clean up messes. In people, this works pretty well. In some people it works great! In most animals, it works lousy. Eighty percent of pets receive absolutely no benefit from antihistamines. Of the twenty percent that do benefit, it’s hard to predict which drug will work. Benadryl might help a dog, while Atarax does nothing for him. You try three or four before you quit. Some of the best ones for people help NO dogs. Sometimes the antihistamines just make the pet too sleepy to scratch. He still itches, but it’s too much trouble to move that leg.
Hyposensitization therapy is great when it works. You test the pet to see what it is allergic to (and the bad allergy sufferers usually turn up with a dozen or so culprits). Based on the test results, the allergy lab mixes up a sterile bottle of allergens. You get a little medicine vial with tiny amounts of sterilized mold, pollen, house-dust, and so forth. We inject this under the patient’s skin, starting with practically nothing, and gradually building up to a pretty good dose over a period of several weeks. After a few months, you’re just giving one shot every two to three weeks. When this works, the pet builds up a tolerance to these things and his immune system quits being so crazy. When someone says they are getting "allergy shots", this is what they should be talking about (as opposed to long-acting cortisone shots, which are rather unpredictable, and usually not the best choice).
Allergies are things you manage, not things you cure. But, hey, what if none of the above seem to be working? Stay tuned…