The symptoms we see are due to itchy, inflammed and infected skin so treatment involves reducing the itching and inflammation and clearing up any infections that exist.
The allergy itself causes the itching and inflammation. Both the allergic reaction and the trauma from the itching causes damage to the skin surface. When the skin is inflammed and damaged from the itching it becomes infected due to bacteria and yeasts that normally live on the skin without causing a problem getting deep into this inflammed and damaged skin - these are termed 'secondary infections'. These secondary infections cause more itching - often these infections are actually a greater cause of itch that the allergy itself. The itching due to the inflammation and infection causes more damage to the skin causing more infection and inflammation and so they cycle continues. We call this the 'itch-scratch' cycle.
To stop this cycle we have to reduce the inflammation and 'itchiness' and also treat the secondary infections. We do this by using anti-inflammatories, antibiotics, medicated shampoos and occasionally oral anti-yeast medications. In many cases we have to use very long courses of treatment - usually a minimum of 3 weeks but sometimes we can prescribe for several months. In many cases life-long therapy is required, often with low dosages most of the time and increased dosages at certain times when the symptoms 'fare up' acutely. It all really depends on the individual pet and how they respond and the results of lab tests we may run.
We also always ensure that there are no skin parasites involved by using regular treatments for external parasites.
In some milder cases most of the symptomatic itching is due to the secondary infections and in these cases we try to keep the symptoms under control by regular use of medicated shampoos without having to use oral anti-inflammatories or antibiotics. This is the ideal but not always achievable.
When trying to reduce the underlying allergy the best treatment of all is to remove from your pet's environment what your pet is allergic to. For example if it was found that your pet is allergic to dust mites then if you do what you can to reduce exposure to dust mites the symptoms may resolve. However this is not always feasible - you cannot stop your pet from coming into contact with pollens in the summer for example.
Mite avoidance strategies:
If fed dry food, reduce exposure to dust and crumbs (store in air-tight plastic container, wash this out between batches, wipe animal's face with a wet cloth after feeding, keep bowls and feeding areas clean).
House dust mites:
Reduce exposure to house dust mites, e.g. by keeping the animal away from areas of highest burden (bedrooms), vacuuming in conjunction with use of anti-mite bedding protectors, perhaps using anti-mite mattress protectors on sofas and other such soft furnishings, using environmental sprays with licensed effect against house dust mite.
Assuming you cannot remove the allergens from your pet's environment (e.g. pollens) the the next best treatment would be to give your pet something that will prevent it from reacting to what they are allergic to. Unfortunately however there is no magic cure for pets - nor is there for humans with this condition. There is nothing we can do to 'cure' your pet - i.e. give them one treatment and they are fixed for life.
So assuming we cannot remove from your pet what they are allergic to and until medicine invents the magic one-off cure the next best that can be done is to use long term medications to reduce the allergic reaction. This is very similar to how humans control hay-fever by taking anti-histamines or control asthma by taking the preventative inhaler.
The best long-term preventative treatment in our experience is a marvellous drug called Apoquel - it works on nearly all dogs (but not all) and carries minimal side-effects. Other commonly used medications to reduce the allergic response in pets are anti-inflammatory corticosteroids (prednisolone), immunosuppressives (cyclosporin), anti-histamines (although they rarely work in pets) and a treatment called hyposensitisation.
In essence all of these medications work at a cellular level by blocking the allergens from causing a release of inflammatory mediators from cells in the skin and immune system. Which one to use - if any - and how much to use depends on the individual pet.
Other than hyposenstisation (more of which below), all of the other medications must usually be given daily or every second day to reduce the reaction and in turn reduce the itching and inflammation. We can also use anti-inflammatory creams and sprays if only small areas of the body are affected. For ears we can use creams that contain an antibiotic, an anti-yeast medication and an anti-inflammatory.
As all of these medications can potentially (but uncommonly) cause some undesirable side effects, particularly if used at higher doses for long periods of time. In general the idea is to use as little of these medications as possible to reduce the symptoms to an acceptable level (the aim is not necessarily to always stop the symptoms completely but rather to get the pet to a point where they are well and comfortable).
Finding the correct dose, or indeed preferably trying to find a way not to use any of the medications that can cause more serious long-term side effects, is part of the skill of being an experienced veterinary surgeon with a special interest in dermatology. Our aim in Blacklion Pet Hospital is to find a way that we do not have to use any of the potentially more harmful medications for long term treatment but unfortunately even if we do try everything else we can sometimes be left with no option but to use these to relieve your pets symptoms.
Hyposensitisation therapy works differently from the medications above. Very simply a bespoke 'vaccine' is made up for your pet against what they are allergic to (as determined by allergy testing). The 'vaccine' is then given to your pet by injection once monthly for life and the hope is that they will stop being allergic to what they are vaccinated against.
This method has the great advantage of almost always having no side effects but it has a disadvantage of only getting a complete cure in about 1/3 of pets - and only for as long as the vaccine is given every month. Another 1/3 will show improvement but will still have some, milder, symptoms and a final 1/3 will show no improvement at all. Even in the pets that show a complete cure it may approximately take six months to a year to see an improvement. For pets that show no improvement after 12 months the treatment is stopped. We only advise this treatment for pets that need long term therapy. Some pets will get flare ups once or twice a year and our opinion is that is is better to just treat these flare ups as they happen rather than use year round treatment.
Finally we often place pets on special foods that help reduce the symptoms (such as Hills Derm Defence). We also sometimes perform food trials on pets with chronic skin problems to see can we identify if it is a food which is causing a problem. This is a fairly complex procedure that can only be properly done under direction of a vet but that said in some instances an owner may have done some trial and error work themselves and found that some foods cause the problem and their pet is doing well on other foods.
Diagnosing, treating and controlling chronic skin problems in pets is all very variable and quite complex but we have reams of experience in this field and ultimately with your perseverance we will be able to successfully control the symptoms of the vast vast majority of pets that present to us. For those very few pets that we are unable to treat with success we will offer referral to a specialist veterinary dermatologist such as www.skinvet.ie.