Veterinary Dermatology Center
Robert G. Buerger, DVM, DACVD
Board Certified Veterinary Dermatologist

32 Mellor Avenue Suite B
Baltimore, Maryland   USA   21228
FAX 410-788-9007
Dr. Buerger 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.  Dr. Buerger 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.   Follow labeled instructions.  
4. Regular weekly or twice-weekly ear cleanings.  This is particularly helpful if
there are recurring ear infections.  The presence of odor, discharge, swelling, or
discomfort may indicate that infection is present.  
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.    
6. For pets with pollen or mold sensitivity try to limit the time spent outdoors.  
Wipe paws (esp. between toes and pads), belly, face, and ears with baby wipes
or a clean washcloth after outdoor activities.
7. A strict hypoallergenic diet may be helpful in some cases.   One will be    
recommended if it is appropriate for your pet.
8. Physical barriers.  Some dogs scratch less if they wear a T-shirt.
9. 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.
10. 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 (prednisolone, Medrol):  There may be significant side
effects with these medications, and they cannot be given concurrently with
NSAID-type arthritis/pain drugs.  
C. Cytopoint® is an injection given as needed (every 4-8 weeks) to help with
itchiness due to 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
are administered in the office.   
D. Atopica® (modified cyclosporine) capsules.  Atopica may not work quickly (it
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.  

Secondary infections are very common.  Be alert for increased 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 more 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).  A bacterial
culture and susceptibility test 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
PLEASE NOTE:  Atopica, Apoquel, and cortisone drugs can have an impact on immune function and
may predispose to other health issues.  Our goal is to use these drugs for short periods of time.  Patients
receiving 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.