Allergies: Itching, Skin Rashes, Foot Licking and Chronic Ear Infections
All of the above can be signs of allergies. When addressing any of these symptoms we first investigate allergies. The most common allergens are fleas, food allergies or environment irritants (grass, pollen, etc). Sometimes allergies can be caused by a combination of fleas, food and environmental allergies.
The absolute most important thing for animals with allergies is to keep ALL the pets in the house FLEA FREE. For this reason we recommend strong flea control with oral flea products such as Bravecto or Nexguard for dogs and Revolution for cats. If a collar is to be used then a Seresto collar is the only one we recommend, and if that is not working then try one of the products previously listed .
Since it is impossible to eliminate environmental triggers we recommend performing a food elimination trial next. We usually start with either a novel protein source food such as Hill's D/D Duck or Rabbit, or a Hydrolyzed diet such as Hill's Z/D. We do not recommend starting with an OTC brand novel protein source food as studies have shown evidence of cross contamination during the manufacturing process with chicken, beef, lamb, etc. Additionally, there is new evidence that some of the OTC novel-protein grain-free foods may cause a life threatening heart condition called Dilated Cardiomyopathy. Therefore, we recommend only using a prescription novel protein food such as Hill's D/D or Hydrolyzed Diet such as Hill's Z/D.
When doing a food trial the ONLY thing that enters your pet's mouth for EIGHT WEEKS is water and that food. NO TREATS, DENTAL CHEWS, PEOPLE FOOD, ETC. You need to treat your pet like a kid with peanut allergies. If after 8 weeks their itching, feet and/or ears are looking better then it is a food allergy and your pet should remain strictly on this diet forever. You can then start to add ONE item at a time back into their diet in 30 day increments to see if that starts their symptoms again. If it does then that food item should be permanently removed from your pet's diet.
If there is little improvement with the initial food elimination diet then we would recommend trying a different flavor of Hill's D/D or switching to Hill's Z/D and doing another round of diet elimination. If after 2 or 3 different trials with food there is no improvement with your pet's allergic condition(s) then we can say it is most likely not a food allergy but rather an environmental allergy. If there is some improvement with food, but not completely resolved then it is most likely your pet has combination allergies with food and environmental triggers. In this scenario your pet will benefit from staying on a strict food protocol long term while also addressing environmental allergies. Doing food elimination diets to investigate allergies is a long process that requires strict control and patience.
If it turns out to be an environmental allergy then we have a few options with either doing allergy testing and desensitization with immunotherapy or using immune-modulating medications such as Atopica (dog & cat), Apoquel (dog only) or Cytopoint (dog only).
Allergy testing can be performed in two ways; blood testing and intradermal skin prick testing. There is conflicting evidence if one is better than the other so we usually start with blood testing as it is the least invasive and less costly of the two options. Once your pet's allergy profile is determined then a "serum" of your pet's specific allergens is manufactured. We then start giving this "serum" either by injection or as a drop given under the tongue in the hopes that we can begin to desensitize your pet to their allergens. This can be effective in 50-75% of pets.
If allergy desensitization does not improve your pet's condition, or you chose to forgo allergy testing, then we can start them on immuno-modulating medications such as Atopica, Apoquel or Cytopoint. Often times these medications can be combined with topical products and washes to help manage your pet's allergies.
In addition to the above mentioned products we often will also recommend oral medications or topical control with bathing, wipes and conditioners to help control secondary symptoms such as bacterial and fungal skin infections. These often never fully control an allergic pet but can help control symptoms. It is important to remember that there is no cure for allergies, just management options. Also, allergies can change significantly over the years, change with season, weather or other factors and need "tweaks" to the management scheme at times.