Veterinary Dermatology Center
Robert G. Buerger, DVM, DACVD
Board-Certified Skin Disease Specialist

32 Mellor Avenue Suite B
Baltimore, Maryland   USA   21228
FAX 410-788-9007
Your veterinarian will need to understand your pet's medical history and
will also need to perform a complete examination.  A few simple tests will
also be necessary to help rule out other diseases that can look very
similar to allergies (some of which are very curable).   If the diagnosis of
allergic dermatitis is certain then long-term control might be a complex
process.  Allergies can't be cured, but control is often achieved with one
or more of the following:
1. Allergy injections (desensitization injections) or allergy drops (by mouth) which
are based on the results of allergy testing.
2. Flea prevention.  Please ask your veterinarian which products are appropriate
for your pet.  All dogs and cats should ideally be treated.   Refer to individual    
products for instructions and precautions.  Please don't wait until you see fleas
to begin treatment.  
3. Regular shampoos.  The doctor will prescribe the one best for your pet's
problems if this is appropriate. Shampoos may not be recommended for cats.
Always protect eyes and ears.
4. Regular weekly or twice-weekly ear cleanings with products such as EpiOtic
or TrizUltra-keto.   This is particularly helpful if there are recurring ear
infections.  If there is odor, discharge, swelling, or discomfort consult your
doctor as soon as possible.
5. Resolve secondary infections due to bacteria and/or yeast (if they're present).
Flares of itch or discomfort are often due to these infections.  Treatment
usually requires an antibiotic and/or a fungal-type medication for 4+ weeks.  
Pets with allergies are very prone to recurring skin infections.    Please read
the comments about secondary infections below.  
6. A strict hypoallergenic diet may be helpful in some cases.   One will be    
recommended if it is appropriate for your pet.
7. Physical barriers.  Some dogs scratch less if they wear a T-shirt.
8. Regular groomings.  Keep the coat well-groomed and mat-free.  Some breeds
who have long "skirts" or long fur on the paws (such as spaniels) do better with
these areas kept short.
9. Additional medication(s) may be advised if patients have an allergy flare
associated with itch or discomfort.  If flares are  mild an antihistamine may be
recommended.  If flares are severe one or more of the following may be
A. Apoquel® (oclacitinib) tablets:  This is an immunomodulatory drug, and there
are some limitations on its use.  Patients receiving it must be closely monitored.  
B. Cortisone-type drugs (prednisone, Medrol).  There may be significant side
effects with these medications, and they not be given with NSAID-type arthritis
C. Cytopoint® is a new injection given as needed (every 4-8 weeks) to help with
itchiness due to environmental allergies.  It may not help the itchiness due to
infections, parasites, or food allergies.  This is not a drug but an injectable
monoclonal antibody that blocks the effects of canine Interleukin-31 (IL-31).  
Cytopoint® has no age restrictions, no contraindications, and no major side
effects.  Injections must be given in the office.   More information can be found at
the website  
D. Atopica® (modified cyclosporine) capsules:  Atopica may not work quickly (can
take 4-8 weeks to have full effect in some cases).  This is an immunosuppressive
drug, and there are some limitations on its use.   Patients receiving Atopica must
be closely monitored.  

For pets with environmental allergies here are a few things to consider:  
For pollen and mold sensitive pets try to limit the time spent outdoors.
Wipe paws (esp. between toes and pads), belly, face, and ears with baby
wipes after any outdoor activities.
For house dust mite sensitive individuals the goal is to reduce exposure
(permanent elimination from the home is not practical):
A. Remove carpeting where possible (bare floors of wood, tile, or linoleum are
B. Leather or vinyl upholstery for furniture is better than fabric.
C. Cover mattresses, pillows, and dog beds with hypoallergenic plastic covers
(available in many department stores).
D. Wash bedding/linens, stuffed animals, and fabric toys in hot water weekly.
E. Use air conditioning as much as possible (it helps keep humidity low, too).
F. Clean/vacuum frequently when your pet is not present (since it stirs up
G. Avoid damp areas in the home like basements and laundry rooms.
H. Remove house plants or limit exposure.
Prevent swimming if your pet is prone to ear infections.  If this can't be prevented
then clean the ears with an appropriate  ear cleanser and shampoo the body   
afterwards (ask your veterinarian which shampoo is appropriate).

Secondary infections are very common.  Be alert for increasing licking,
chewing, scratching, or rubbing which can be signs of infection.  Bad odor,
sores, patchy hair loss, or head-shaking may also indicate that infection is
present.  Please call the office if you suspect that infection is present.  
There may also need to be modification(s) to the allergy treatments so that
infection is less apt to recur.  

Dermatologists are seeing greater numbers of bacterial skin infections
caused by methicillin-resistant staph organisms (including
methicillin-resistant Staphylococcus pseudintermedius [MRSP] and
Staphylococcus aureus [MRSA]).  Such bacterial infections can be more
difficult and more expensive to treat, and there is potential for people to be
affected by these bacteria (esp. people with less-than-optimal immune
function).  If any family member has health concerns please discuss them
with your physician.   A bacterial culture and sensitivity will be
recommended if infection in your pet's skin  has failed to respond to
antibiotics.  We recommend treating infections aggressively in order to
decrease the possibility of antibiotic resistance.  We will (1) treat until
infection has been resolved for at least two weeks (or a minimum of four
weeks); (2) include topical therapy with antiseptic shampoos where
possible; and (3) address underlying factors which have predisposed the
patient to infection.  We must not under-treat active infection.   We will be
washing hands thoroughly and/or use antiseptic hand gels after touching
patients.  Pet owners should do the same at home, and bedding should be
washed at least weekly.   If you have any questions, please ask during your
pet's next appointment.     
PLEASE NOTE:  Atopica, Apoquel, and cortisone drugs can have an impact on immune function and
may predispose to other health issues.  These drugs are primarily for short-term use, and patients
requiring these medications for more than a few months will need close monitoring (regular
examinations and blood tests).  Only in unique situations will we recommend using these drugs
long-term.   Finding and controlling the cause of the allergies offers the best hope for long-term control.