The main symptoms of atopy in dogs are itching and recurrent infections. Dogs relieve itch by licking, chewing, scooting, rubbing, or scratching. Dogs rarely perform these behaviors out of boredom or anxiety, although being bored or anxious makes things worse. Infections are typically yeast and/or bacterial infections of the skin and ears. The ears may be the only affected area in a younger pet, progressing to the full body usually before age 6 years. Another area typically affected is the feet. If you look between the toes you may notice the skin there is red or your dog chews the feet or licks the legs. Then the axillary regions, abdomen, chest, under the neck, and anal area are often affected- the skin may be red, greasy, smelly or itchy. With long term issues, the skin becomes darker and thicker. The hair may be missing or shorter due to infections and chewing. Some dogs lick huge sores on their lower legs. Some dogs have red, runny eyes and may sneeze due to allergies other reasons are red managed fungus, bacteria, fleas and autoimmune disease.
The main symptom of atopy in cats is itching. Cats will scratch, bite their skin, pull out hair, and over groom to help relieve itch. Cats rarely perform these behaviors out of boredom or anxiety, although being bored or anxious makes things worse. Cats with atopy get skin and ear infections much less often than dogs do, but they certainly occur. Cats most often make bald patches on themselves, usually the lower abdomen is the worst area, and with progression, raw areas are created with the cat’s raspy tongue. Cats often will scratch at the head with the hind leg and create scabs around the eyes and ears. Cats can manifest allergies with asthma too, fleas, fungus and autoimmune disease, but it is fairly rare to have asthma and skin symptoms at the same time.
What Type of Atopy Could My Dog or Cat Have?
There are two basic types of atopy that cause skin itching and recurrent infections once parasites are ruled out- food allergy and environmental allergy. Pets can have both of these allergy types at the same time. Atopy in dogs typically start with symptoms between the ages of 1-6 years. Symptoms can wax and wane, but typically worsen up to the age of 6 and level off. As pets with atopy get older, they tend to get more frequent infections along with itchiness.
Food Allergies & Atopy
If your pet had allergy symptoms starting at younger than 1 year of age, the symptoms are year round, or there are any gastrointestinal signs like vomiting, loose stools, or having more than 2 bowel movements per day, food allergies are more likely. Most pets with allergies don’t have food allergies, only about 5-10% of dogs and perhaps 30% of cats do. There is no diagnostic test for a food allergy other than an elimination diet trial. If a pet responds to a food trial, then we can go about the tedious task of determining exactly what they are allergic to, or we can simply find a diet they do well on and stick with it.
Over 80% of all pet allergies are reactions from environmental allergies. Some may be seasonal with outdoor allergies, or year round with indoor allergies. Most pets have a combination of indoor and outdoor allergies. To determine what allergens in the environment are causing your pet to have symptoms, we can perform allergy testing.
Treatments for Allergies in Dogs and Cats
If there is a food allergy, the offending foods must be avoided. To control environmental allergies, sometimes short courses of medications are needed. If allergic symptoms recur quickly when treatments are stopped, long term treatments are needed. Some pets need antibiotics and antifungals in addition to medications that control the inflammation in the skin. When the inflammation is controlled, the itch resolves.
Why Allergy Test?
Allergy skin testing determines what things in the environment are causing your pet to be itchy. From the results of the test, allergy injections can be formulated to desensitize to what the pet is allergic to. Avoidance of allergens would be ideal, but unfortunately most allergens in the environment are airborne and cannot be avoided. Examples of common allergens include pollens, dusts, and molds.
Some pets are not good candidates for allergy testing and allergy shots. We will discuss if this is a good option for your pet at your appointment.
Allergy -- General in Dogs
In the dog, the most common symptom associated with allergies is itching of the skin, either localized (in one area) or generalized (all over the body). In some cases, the symptoms involve the respiratory system, with coughing, sneezing, and/or wheezing. Sometimes, there may be runny discharge from eyes or nose. In other cases, the allergic symptoms affect the digestive system resulting in vomiting and diarrhea.
How Common are Allergies in Dogs?
Unfortunately, allergies are quite common in dogs of all breeds and backgrounds. Most allergies appear after the pet is six months of age with the majority of affected dogs over age one or two.
Process for Cats
The process is similar for cats, only they typically need a little stronger sedation. Cats are different from dogs in their response to allergy testing and shots, we can discuss if your cat should be skin tested or not at your appointment.
Allergy injections (hyposensitization) are a long-term treatment that changes your pet’s immunity to allergens. The treatment vials contain a purified combination of these problem allergens. The concentration of the injections is slowly increased over time to de-sensitize your pet to these allergens. Allergy shots are one of the most effective options for the treatment of allergies that does not involve suppression of the immune system. This option is effective for treating allergies from pollen, molds, house dust, and other common airborne substances, but is not recommended for food allergies. Food allergies are determined with diet trials, then avoiding the offending ingredients.
Allergy injections take between 3-12 months to reach maximal effectiveness. If the injections are not helping your pet after 12 months, then they are discontinued. Allergy hyposensitization is helpful in about 70% of dogs. When the injections control the allergy symptoms, it may be possible to extend the time between doses, but allergy injections will be necessary life-long. Injections need to be given year round even if the pet’s symptoms are seasonal.
Our staff will guide you through the process of administering injections, how to track the progress, and how to care for your pet in other ways, including oral medications, topical treatments, baths, and appropriate diets. Click here for a video on how to give your pet an allergy shot. Success depends on finding what works best for your pet. Many pets do not follow the dosage schedule exactly. This should not be a stressful process for your pet or you. Remember, we are available to help you if you are unable to give the injections yourself.
Unfortunately, there is still no cure for allergies. The closest treatment we have to a cure is to do allergy testing and allergy shots. Allergy shots do not cause any degree of immunosuppression, unlike most other treatments for allergies. Allergy shots may take a while to work and so other medications are needed while waiting for the allergy shots to have maximal effect. Of course, there are adjunctive treatments for allergies, like antihistamines (Benadryl), shampoos, topical steroids or moisturizers, and omega-3 fatty acids. If a pet has mild allergies, these other treatments may be sufficient.
What combination of therapies is best for your pet depends on your individual pet, their personality, type and locations of infections, seasonality, skin and hair type, and of course what they respond best to. It often takes several visits with a dermatologist to find the perfect combination of treatments, especially with severe cases, but our goal is that your pet ultimately has less flare ups, infections, and vet visits. Our whole team is there to help you and your pet, to make sure your pet gets relief and you have peace of mind.
What else could be causing my pet’s itching and infections?
There are many other causes of itching, including parasites. For example, if ear margins are affected, and the pet is minimally or not responding to glucocorticoid (steroid) and antibiotic treatments, then your pet has a much higher likelihood of having sarcoptic mites. If the area of the back over your pet’s back legs to the tail is affected, then your pet has a higher chance of having fleas or a mite called Cheyletiella, both of which can be caught from the environment, rabbits, cats, or dogs. Skin infections with yeast and/or bacteria can be very itchy. The underlying reason why your pet got an infection in the first place should be investigated- if your pet is young and has recurrent infections, the most likely cause is allergies. There are other diseases we would need to rule out if an older dog or cat suddenly develops itching or infections.
Why is My Cat or Dog Losing Hair?
There are several reasons why cats and dogs can lose their hair. The first thing to look at concerns if they are itchy or not. Losing hair because the skin is inflamed has different causes than non-itchy hair loss. Licking, biting, scratching, or rubbing the skin are all considered itching.
The Car or Dog is Itchy & Losing Hair
--Bacterial infection (most commonly staph)
--Fungal infection (yeast or ringworm)
--The pet is barbering the hair- which means they are chewing and pulling out their hair as a
--way to itch the skin.
--Allergies to food, fleas, or environmental allergens like dust mites or pollens.
--Autoimmune diseases like pemphigus foliaceus
The Cat or Dog is Not Itchy & Losing Hair
--Hypothyroidism (thyroid level too low) in dogs
--Hyperadrenocorticism (cortisol levels too high, also called Cushing’s) in dogs
--Demodicosis- a type of hair follicle parasite
--Bacterial infection (most commonly staph)
--Fungal infection like ringworm in cats
--Color dilute alopecia- seen in blue and silver colored animals
--Congenital or hereditary- certain breeds like dachshunds
At your appointment, we will take samples from the surface of the skin and determine if infections or parasites are playing a role. Infections of the skin are often secondary to an underlying process like allergies, especially when the pet is itchy. We will work with you to diagnose the underlying cause and discuss treatments to prevent the problem from returning.
Cytology - Fine Needle Aspiration (FNA)
Cytology is the microscopic examination of cells that have been collected from body tissues. By examining the appearance of these cells and looking for inflammation or infection, it is often possible to diagnose specific diseases or determine the nature of a pet's illness.
When is cytology by Fine Needle Aspiration performed?
Fine needle aspiration (FNA), also called fine needle biopsy, is the most frequently used technique in cytology and is typically used to sample 'lumps and bumps' found on the body. However, it is also used to evaluate:
--Internal organs such as the liver, lung, lymph node, or kidney
--Body fluids such as urine or joint fluid
--Abnormal accumulations of fluid (called effusions) usually found in the chest and abdomen, and sometimes around the heart.
What happens to the collected cells?
When solid tissue is sampled, a small amount of material accumulates in the hub of the needle. This material is immediately and gently expelled onto a clean glass slide, spread in a thin layer, and rapidly dried by waving the slide in the air or by placing it in front of a fan or portable hair dryer. This is called making an "air-dried smear"
When a fluid sample is collected, air-dried smears are often prepared directly from the material in the syringe, and the remaining fluid is placed in transport tubes or containers. The smears and the containers are then sent to the laboratory for further analysis. This typically includes measurement of the cellularity and protein content of the fluid, as well as preparation of additional slides. If the sample is very thin and watery, sometimes the sample is concentrated before the slides are made, which provides more cells to look at. The slides are then stained with special dyes, and examined.
Why Remove Skin Masses?
--They may be cancerous
--They are chronically infected (common with cysts)
--They bother the pet
--They get nicked when pet is groomed
--The pet scratches or licks at them
--What types of tumors can be removed?
Almost any tumor can be removed under general anesthesia. General anesthesia is very appropriate for large, spreading, or deep masses. Anesthesia may be needed for pets of certain personalities, or for masses on the ears or near the eyes.
We specialize in removing small superficial tumors without the need for general anesthesia using a local nerve block. The most common masses we remove are sebaceous adenomas. These are non-cancerous and often small (less than 2cm), but these can be itchy and bother many pets. These are unsightly on pets because they bleed easily, become infected easily, and may exude a waxy substance. Many pets have large numbers of these warty masses, we can take off several at a time.
Benign (to the right)
We do not use lasers to cut skin or remove masses because this type of laser (CO2) uses heat to destroy tissue which causes wider damage and more pain than a blade. Laser use has an increased risk for igniting the hair, can damage the eyes, and produces harmful smoke. Surgeons for humans rarely use CO2 lasers because of these same issues.
Ear Disease & Ear Infections
In veterinary medicine, dermatologists have the role of managing ear diseases. This is because many skin diseases in pets manifest with ear issues. Dr. Jewell & his staff has extensive training in procedures to remove ear canal masses, manage infections in the middle ear, and correct chronic inflammation and infection of the ear canals. Most of the anesthetized procedures we perform in our clinic involve the ears. We have elongated grasping tools, specialized scopes, and precise techniques to insert tools into and take samples from the middle ear for cultures and cleaning. This often involves a myringotomy, a technique to make a hole in the eardrum to pass instruments through, usually to flush infection or pus that has built up behind the eardrum.
Why does my dog or cat keep getting ear infections?
The short answer to this question is that the underlying problem is not controlled. If an underlying problem cannot be found, then long term therapy is likely needed or the infection will come back. There are 3 main types of underlying problems that cause ear infections to keep coming back (or not go away) when they are treated: allergies, an object in the canal (mites, tumors, foreign material),a middle ear infection and Atopy in dogs.
Ear infections can be very painful for the dog or cat and should be treated right away. Routine care of the ears and management of the underlying problem will help prevent the problem from coming back. Veterinary dermatologists specialize in the treatment of ear diseases and the underlying causes of most infections and can perform specialized procedures to help treat these problems.
When some dogs (especially cocker spaniels) have infections in the ear for a long time, the ear canal swells closed. If the canal cannot be opened with aggressive treatment, the infections can be very difficult to manage. Ear infections are painful. If left untreated, severe or long term ear infections can cause a head tilt, paralysis of that side of the face, calcium deposits in the ear canal, and dry eye.
The ear canal is commonly affected when dogs and cats have allergies. Allergies cause the skin to be inflamed, which allows overgrowth of otherwise normal yeast and/or bacteria. This overgrowth causes itchiness and pain, and scratching and rubbing contribute to making the infection and inflammation worse. Because it is inflamed, the ear canal secretes large amounts of wax. The ears may develop an odor from the infection.
Seasonal Atopic Otitis Eplema can occur when it is non-seasonal and typically the allergies can get worse. Otitis Media (middle ear infection) occurs when a cold, allergy or respiratory infection. The presence of bacteria or viruses lead to the accumulation of pus and mucus. The condition can last a few weeks or months if not properly treated.
Pseudomonas aeruginosa is a type of bacteria that is found all over in the environment. Normal animals do not develop infections when this organism gets on the skin or in the ears. When a pet has damage to the ears because of chronic recurrent ear infections, pseudomonas happily starts growing. Then the ear infection takes on a new appearance. The canals become very sore with pus exuding or moisture can be heard deep within the ear. A strong smell may develop, and the pet may be lethargic with pain. The eardrum often ruptures and the bacteria contaminate the middle ear. Strong oral and topical ear medications must be used aggressively to control this infection.
Middle Ear Infections
With long term infections of the ear (from any cause), the bacteria can move past the eardrum and get into the middle ear. These infections are more difficult to treat and require long term medications. Often, pseudomonas bacteria are involved. Sometimes ear infections need to be treated with a special procedure to clean out and infuse treatments directly into the middle ear while the pet is under anesthesia.
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