Pets visit veterinarians for many reasons, but allergies are one of the most common reasons(1, 2). Because of this, many veterinary health insurance policies will not fully cover veterinary allergy visits. At any major veterinary continuing education meeting you can count on packed attendance in any lecture entitled, "Newest help for allergies," but sadly most of these lectures are simply the same old stuff as pharmaceutical companies find more and more ways to suppress and turn off parts of the immune system and nervous system.
Many consumers desire better solutions for their allergic pets, but sadly there is no one way to best address allergies. In most cases this is a very individual condition and it requires an individual approach to navigate our way towards better health (3). In any case, it is evident that well informed clients get better care for their patients.
People frequently come to our office stating, "His itching is making him miserable. The sucking and licking sounds keep me awake at night. I need my sleep and you have to do something now!"
It's understandable that we want to make our pets more comfortable and get some rest. These are good things for sure. And for many dogs and cats we can sensibly use drug therapies to reduce itching for short periods of time to accomplish this goal. Reducing itching also helps reduce secondary ear and skin infections with bacteria and yeast and keeping the itching controlled actually helps us to reduce the amount of other antifungal and antibiotic drugs which makes it medically important, too.
But it is important to do more than just stop the itching -- drugs that simply block immune responses or important biological regulation systems often have strong and undesirable side effects. Medications that simply stop itching never help a patient recover or improve their innate immune response, which means they are stuck with their allergies. While stopping the itching is a good thing and allows pets to rest and feel better, in the long haul no suppressive therapy ever results in a resolution of allergies. Drugs that stop itching and reduce inflammation do let the skin heal and reduce infections of the skin and ears, and they also allow a pet's owner to get some sleep at night.
Allergies result when a particular form of antibody called IgE binds to special "allergy" cells known as mast cells. Mast cells are basically big bags of chemicals that cause redness, swelling and itching when they release their contents. Once an allergen binds to the IgE antibody which is bound to the mast cell, it triggers the mast cell to automatically explode and release its itchy-skin allergy warhead and signs of allergies develop. These IgE molecules bind permanently once the body decides to use the allergic response, so this makes it very hard to "cure" allergies. One of the main chemicals in these mast cells is "histamine," a powerful chemical that is also toxic to the body. Histamine causes red, swollen, itchy skin.
There are several categories of drugs that suppress itching in veterinary allergy patients:
- Antihistamines block the release of histamine by various tricks and may greatly help reduce the symptoms of allergies, but they do nothing to address the reason for the allergy, and they do not cure the cause. They merely reduce the severity of signs. Examples of antihistamines include diphenhydramine, hydroxyzine, clemastine, chlorpheniramine, and many others.
These represent the most common and safest drugs used to treat allergies. Individual pets can have varying responses, so what works well for one pet may not work at all for another. Also, pets can get overly sedated, groggy, or have altered personalities on these medications, so more than one may be tried before the best medication is located.
- Corticosteroids, also called cortisone, corticoids, or steroids, represent a powerful and commonly used therapy for allergies (4). Their use affects many more organs and may decrease the body's overall immune protection. They can cause a host of adverse effects including increased appetite, increased water consumption, personality change, panting, pacing, urinary accidents, bleeding ulcers, diarrhea, thinning of the skin, calcium deposition in the skin, heart disease, diabetes, liver disease, seizures, and suppression of other glands such as the thyroid, pituitary and adrenal glands. They can also cause abortion and loss of pregnancy so their use must be supervised by a licensed professional. Veterinarians tend to try and use these drugs sparingly and topical use is less damaging, however, long term topical use can cause unhealthy skin conditions to occur.
- Other immunosuppressive drugs such as cyclosporin which allows for the use of less steroid but is a powerful drug that absolutely affects the patient's immune system. It causes vomiting in 25 percent and diarrhea/soft stools in 15 percent of the patients receiving the drug (5). In higher doses cyclosporin causes cancer, but veterinarians have yet to document increased cancer risks in dogs placed on lower doses for itching. Still this makes many people concerned about putting their pets on such a medication. Pregnant patients should not receive this drug as it can cause pregnancy loss and birth defects. Caution is warranted in pets that are viral carriers.
A wonderful and safe therapy for allergies involves finding out precisely what a pet is allergic to and then taking small amounts of those pollens, molds and epidermal agents and giving regular allergy shots to reduce the body's sensitivity and allergic symptoms. This is called "hyposensitization" (using small amounts to reduce sensitivity). The use of allergy shots helps about 70 percent of canine allergy patients to feel better and have fewer allergy bouts, but allergies are rarely totally resolved by this method. Allergy testing and the shots may be more expensive but if they allow a pet to take less medication and have fewer presentations to the clinic, then they may actually save money in the long run.
Regular bathing with plain shampoo or with products like oatmeal colloid can help in reducing itching by removing pollen grains and potential toxins from the skin. Other topical products can create a barrier to allergenic materials and protect a patient from as much exposure.
Simply wiping your pet's feet off after a walk outdoors can greatly reduce allergen exposure and itching in some dogs.
A host of natural therapies exist to assist in management of veterinary allergies (6, 7). The scientific evidence varies for these methods (8). A short list includes:
- Changing the diet to a limited antigen diet. Many pets have concurrent allergies to several things such as specific meats (beef or chicken are common ones), grains (wheat, corn and soy are common problems), and other food ingredients. Some pets are not truly allergic, but they have adverse reactions to food from other complex and unpredictable reactions to chemicals in foods. Your veterinarian can assist with the selection of the best diet to help eliminate food allergy signs, but please do not add anything to those diets and that can invalidate the entire food trial. Pets must eat a new diet for up to 60 days before we can tell if it is helping or not. Pets that are prone to food allergy are more prone to worsening after routine vaccinations so minimize vaccinations in these pets (9). Feeding wild, organic, locally farmed honey assists some allergy patients by calming their allergic reactions at the level of the intestines.
- Nutraceuticals are nutritional items that are used like pharmaceuticals. The most effective of these is the use of fish oil, which helps up to 20 percent of patients with pollen allergy to either avoid or reduce the amount of allergy drug required to control their symptoms(10). High dose vitamin C is an antihistamine and anti-inflammatory as well as an antioxidant. Long term, high dose vitamin c therapy can aggravate or cause kidney stones in some pets. Vitamin A is useful in treating skin issues, and skin problems may respond to additional zinc and selenium in the diet.
Coenzyme Q-10 supports energy metabolism and helps allergy patients in a general sense. The bioflavinoid quercitin has antihistaminic effects and may help some pets. B vitamins may help some pets but not all. Pycnogenol has been used by many holistic veterinarians and was recently shown to be of use in treating humans with birch pollen allergy (11).
- Digestive enzymes help digestion and in some cases reduce the degree of itchy feelings and are often tried in allergic pets. Incompletely digested food allows for proteins to over stimulate the pet's immune system. Many allergic pets have troubled digestive organs and the key to their allergic skin and ear problems may reside in handling their guts properly. Don't underestimate the importance of this in addressing itchy pets.
- Western and Chinese herbs can be used to reduce toxicity and support the skin (12). Burdock is a commonly selected herb for this purpose. Aloe protects the gut and is useful for soothing the skin. Dandelion supports liver function as does other green foods such as kale, greens, and chlorophyll. Supporting the liver is important because allergic pets have stressed livers. The liver is working overtime to handle all the histamine and other toxic materials created by the allergic response. I've seen pets markedly improve when their sole allergic treatment involved liver support.
The most effective way to use herbs in treating skin problems is to apply Traditional Chinese Veterinary Medicine (TCVM) to diagnose the pet's energy pattern and treat that pattern and not the specific allergy symptoms. This can be amazing, especially when coordinated with dietary changes.
- Detoxification therapies combine a wide variety of differing methods, but since the liver is often overwhelmed in allergic patients and since varying degrees of environmental and innate toxicity are present and may even play a part in the causation of allergic responses, working with a professional to do detoxification often reduces allergic signs. In some patients, like myself, allergic responses can vanish entirely following long term and appropriate detoxification treatment.
- Glandular therapy involves using whole foods and gland extracts to support the body's natural repair and maintenance systems. This is an important part of supporting any allergy patient. In our office nearly every allergy patient we treat naturally receives this type of treatment.
- Homeopathy and Homotoxicology use small amounts of substances that cause similar signs to a patient's disease picture. They gently stimulate natural healing and evidence is starting to accumulate to the usefulness of these agents (13). I flew to Baden-Baden, Germany this last October to present a paper on this topic to interested physicians and veterinarians at the annual International Society of Homotoxicology and Homeopathy meeting (14). In our veterinary hospital nearly every naturally treated allergy patient will receive some type of homeopathic or homotoxicology agent in the course of their therapy. This type of therapy is complex and is best directed by an experienced veterinary practitioner.
- Acupuncture can help reduce symptoms but usually doesn't cure allergies. However, since some patients that appear to have allergies actually have weaknesses in their primary organ systems, in some cases great improvement can come from regular acupuncture. If we use Traditional Chinese Veterinary Medicine and herbals along with this the effect can be even greater.
- Bathing and air filters can help reduce the amount of material present in the environment. Less allergens means less itching, but beware of indoor air purifiers that generate ozone as the presence of ozone can greatly worsen allergies and even cause asthma in sensitive patients. Also be sure to change filters regularly as mold can grow in your air purifier's filter and this can make the whole thing that much worse.