Allergies are a very common problem in dogs. Thankfully, veterinary medicine now has lots more to offer our canine companions than just Benadryl and prednisone, the “go-to” allergy medicine for dogs in prior decades.
Dogs who suffer from moderate to severe allergies often scratch constantly, lick their paws obsessively, and battle one ear/skin infection after another. In short, quality of life ebbs for these itchy dogs. They are too busy scratching and licking to fully enjoy the simple pleasures of dogdom.
Help and hope are here
There are solutions for our four-legged companions. In this article, you’ll find:
- an example of how allergy flare-ups were treated in a Chow mix dog
- what causes allergies in dogs
- a comprehensive list of allergy medications for dogs
- additional allergy treatments to supplement medication
- how to determine if a dog has food allergies
- an infographic: Beyond Benadryl: Allergy Treatment Options for Dogs
Taming allergy flare-ups in a Chow mix dog
Recently, I met Zachory—a 65-pound Chow mix who had allergies. And he had a dilemma too.
His mom wisely realized that contorting his body in unnatural positions to scratch himself all day was the last thing he needed to be doing. She knew he needed relief from his seasonal allergy symptoms, which were at their worst in the spring. His symptoms included:
- a dry cough
- gnawing his feet
- incessant scratching of his rib cage.
For years, when
So even though Zach came to me for acupuncture of his neck, I was excited to discuss new, better, and safer options for treating his allergies. We worked with his regular veterinarian to select and administer Cytopoint®. At 65 pounds, Zach’s injection (dosed by body weight) was not cheap. It cost $97, but it should keep Zach symptom free for about a month.
Thankfully, Cytopoint® won’t interfere with his other medications and it has worked beautifully for him. Mom described it as a huge relief for both of them!
What’s behind all that itching? Uncovering the role mast cells play in allergies
If your dog suffers from allergies
In humans (and cats), the cells that mediate allergies—called mast cells—are predominantly located in the upper respiratory tract. However, for our canine companions, this is not the case.
In dogs, mast cells live in high concentration in the skin. (Remember, ears are just an extension of the skin.) So the symptoms of allergies in people and dogs are quite different. But both are driven by mast cells.
Mast cells are a type of white blood cell that lives in the connective tissues of the body. They help protect the body against foreign invaders.
Mast cells look very distinct under a microscope. They are filled with tiny granules called histamine. When mast cells sense a potential threat—in this
Now that we’ve established the role of the mast cell in dog allergies, let’s discuss our first class of drugs we use as allergy medicine for dogs: ANTI-histamines.
ANTI-histamines, such as diphenhydramine (Benadryl®),
The benefits of antihistamines are that they are cheap and may help with mild environmental allergies in dogs. The downside is that they are typically unimpressive in their effectiveness for canine atopy (environmental allergies). Therefore, they
For the complete story on potential side effects and contraindications for Benadryl use in dogs, read Benadryl for Dogs: How it Works, When it Works, Why it Works.
BOTTOM LINE: Antihistamines as an allergy medicine for dogs are generally very safe but not very effective.
Steroids, including prednisone, dexamethasone, and triamcinolone are available in a wide variety of forms including oral liquids/tablets, topical medications/shampoos, and injectable medications. They work by suppressing specific cells and chemical signals found in the immune system to dramatically reduce inflammation and itching. In fact, steroids often work like magic for itchy dogs. (For more information on prednisone, listen to my podcast: Prednisone 101.)
There are many benefits to steroids; they work rapidly, powerfully, and are relatively inexpensive. Steroids are particularly beneficial in the treatment of ear infections in dogs. Here’s why: times the swelling of the ear canal is so severe that it can be difficult to get the medication down into the ear canal to treat the infection. Because steroids reduce inflammation, they are one of the only classes of allergy medication that can open the ear canal, allowing for better treatment of the underlying ear infection.
However, and it’s a big “however,” steroids are not without side effects. Compared with other medications discussed in this article, steroid’s side effects are relatively common and disturbing. They include:
- increased thirst
- ravenous appetite
- frequent urination
- muscle wasting
- increased risk of urinary tract infections, fungal infections, mange, and bacterial infections.
BOTTOM LINE: Steroids are super effective for environmental allergies (not necessarily food allergies) but super concerning for long-term use. Chronic steroid use will likely take a toll on the dog’s body and the risks may outweigh the benefits.
Oclacitinib (Apoquel®): a newer allergy medicine for dogs
Oclacitinib (Apoquel®) is a relatively new medication for the treatment of allergies, having been approved by the FDA in 2013. Apoquel® works by suppressing the chemical signal, JK1, that signals that the body needs to react to an allergen. It should be noted that Apoquel® is markedly more expensive than steroids or antihistamines.
As with the dog in the photo above, most allergy patients respond to Apoquel® very quickly, and it is highly effective in quelling the itching, as well as managing the allergies long term. Initially, the medication is given twice a day for two weeks and then tapered to once a day for maintenance. (Some dogs show an increase in symptoms when they go from the twice-a- day dose to the once-a-day dosing.)
Like any medication, there is a risk of side effects. However, the number of dogs who experienced side effects (such as vomiting and diarrhea) was very low compared with other medications. Because Apoquel® does suppress a chemical signal in the immune system, there is a risk of suppressing the immune system at high doses. However, since Apoquel® is more specifically targeted than other medications (such as cyclosporine or steroids), there is a lower risk of immunosuppression.
Apoquel®: full disclosure
In the interest of full disclosure, some of my veterinary colleagues link Apoquel® to cancer in dogs. We do not yet have any studies documenting this, but one should be out soon. The Apoquel® product insert cautions that it’s not to be used with dogs who have cancer because it can potentiate tumor growth. Personally, I think it’s a valuable drug that has dramatically improved quality of life for many dogs who suffer from allergies. However, I play it safe. I don’t use it on dogs with documented or suspected cancers.
(If you’d like to learn more about cancer in dogs, please listen to my podcast interview with my friend and colleague, Dr. Sue —Cancer Vet: The Myths and Misconceptions of Cancer in Dogs.)
Finally, Apoquel® is labeled for the management of allergies in dogs older than one year of age, which means it cannot be used in young dogs suffering from allergies.
BOTTOM LINE: Apoquel® is a veterinarian favorite due to its ability to control allergies with minimal side effects despite “Dr. Google” claiming that it will kill your dog. While expensive, it’s not cost prohibitive. It will be interesting to read the study coming out in the near future about Apoquel® and cancer in dogs. (Check back soon for updates.)
Canine Atopic Dermatologic Immunotherapeutic (Cytopoint®)
An even more recent development in the management of allergies in
Cytopoint® starts working within one to two days after the injection and helps the dog for three to four weeks. Because it is targeting a very specific signal in the immune system, the risk of suppressing the immune system is low, so it can be used safely with other medications.
Unfortunately, because this medication targets the chemical signal associated with the itching “feeling” instead of modulating cells in the immune system, it is not as effective as steroids or Apoquel® in reducing lesions associated with inflammation from allergies such as red and irritated skin or swelling of the ear canals.
BOTTOM LINE: This is the “latest and greatest.” Perhaps better for dogs who already have an underlying medical condition. Injectable (vs. oral) administration.
Immunotherapy: the gold standard in treating allergies in dogs
Immunotherapy is considered the gold standard for treating allergies in dogs. Similar to “allergy shots” in people, this treatment works by slowly exposing the dog’s immune system to the allergen until the immune system no longer reacts to it.
The immunotherapy is given as an injection under the skin once every one to three weeks or as a medication that is given under the tongue (sublingual) every 12 hours.
There are many benefits to immunotherapy. Instead of suppressing the immune system, the treatment is directly targeted to the allergens that specifically trigger that dog’s immune system. A skin test or blood test is used to determine what allergens trigger the patient’s immune system, and the immunotherapy is customized based on that information. Between 50-80% of dogs on immunotherapy show improvement in symptoms after a year of treatment.
There are some downsides to immunotherapy. First, because the immune system is being stimulated instead of suppressed, there is a low risk of a serious allergic reaction. Second, therapy is a lengthy process usually taking between 6 to 12 months. B
Treating food allergies in dogs
In patients with food allergies, a prescription diet from your veterinarian or a home-made diet formulated by a veterinary nutritionist may help determine if your pet has a food allergy and may help control allergy symptoms. (For detailed information on homecooked diets, check out my podcast: Homecooked Diets for Your Dog with Dr. Jackie Parr.)
If a commercial kibble or canned diet is going to be used, it is important to choose a prescription diet from a veterinarian instead of an over-the-counter diet. Studies evaluating over-the-counter diets detected proteins not listed on the label due to cross-contamination of the diet. This means that it is possible that an allergic patient may unknowingly be fed the allergen.
Prescription diets, in contrast, are produced on a dedicated food production line that only processes the food on the label. This prevents contamination with other proteins. This diet usually consists of a new protein, such as kangaroo, rabbit, etc., or a hydrolyzed protein, where the protein is broken down so fine that the body cannot have an allergic response to the food for 6-10 weeks. The dog is diagnosed with a food allergy if symptoms resolve but then return within 14 days after being reintroduced to the old protein.
Food trials are beneficial but can be tricky to execute
Food trials are beneficial because they help identify and control food components of allergies and prevent exposure to allergens that can trigger flare-ups.
Although food trials have tremendous benefits, they can be tricky to perform. The diets are expensive and can be labor intensive if a homemade diet is used. The new diet needs to be fed for 6-10 weeks with no additional treats, table scraps, or protein sources. It is critical that every member of the family and even neighbors are on the same page regarding the diet trial. Taking these precautions will ensure that no one accidentally feeds your dog table scraps or treats during this period.
Supplementing allergy medicine with other treatments
Allergies often have multiple factors contributing to
- Flea Prevention – In addition to spreading diseases like Bartonella, fleas can contribute to allergy flare-ups in dogs. If your dog is flea allergic, all it takes is the saliva from one bite of a flea to trigger an allergic flare-up. Therefore, it is important to keep your dog on year-round prevention to prevent fleas. Flea preventatives come in oral and topical. Please talk with your veterinarian about which preventative is best for your dog.
- Shampoo – Medicated shampoos can be used to treat fungal and bacterial infections as well as reduce the number of allergens that build up in your pet’s fur after walking outside. Most protocols involve bathing your pet one to two times per week and letting the shampoo sit for 10-15 minutes before rinsing (contact time). Talk with your veterinarian about what is best for your dog.
Also, simply wiping a dog’s body and paws down with a cold, wet washcloth after being outdoors will remove allergens from the coat and can help reduce allergy symptoms for dogs with atopy.
- Vacuuming/washing pet beds – Dust mites are a common source of allergens in humans and pets. Although it’s difficult to completely eliminate dust mites from the environment, routine vacuuming and washing pet bedding in hot water will help reduce the number of dust mites in the environment.
- Fish Oils – Omega-3 fatty acids are anti-inflammatory and can improve inflammation in the skin. Omega 3s come in oils or capsules that can be added to your dog’s food and are relatively safe and inexpensive. In some cases, fish oils can help reduce the
amountof steroids or antihistamines that are needed to manage allergies. Why? It’s a synergistic effect (1+1 = 3). However, fish oils are generally not sufficient to manage allergies on their own, and it can take up to two months to see results.
For more information on the importance of careful storage of Omega 3s and to learn which brand I recommend, read my article: The Benefits of Omega-3 Fatty Acids for Your Dog.
Allergy medicine for dogs [Infographic]
As a summary, the infographic below is your quick reference guide to understanding how each allergy treatment option works, the dosing frequency, and the pros and cons.
Finally, there are a lot of factors that trigger allergies in dogs, including fleas, the environment, and food. As a result, there’s no magic bullet for treating allergies. Thankfully, there are a lot of options today for allergy medicines for dogs. Please talk with your veterinarian about what medication options may be best for managing allergies in your dog.
What questions do you have about allergy medicine for dogs?
Please comment below.