Atopy vs Food allergy

RE: Atopy vs Food allergy

Thomas Johnson — Mon, 14 Mar 2016 09:29:58 GMT

[quote user="robloxley"]

[quote user="Andrew Kent"] I don't really rate Advocate for that either so would give stronghold every 2 weeks as a trial. And are you using anything topically? I would be bathing in malaseb 3 times weekly.[/quote]

I also find that if you're bathing regularly like this imidacloprid every 4 weeks for flea control is often found wanting...

[/quote]

I doubt that any topical treatment for parasites is going to last for 4 weeks with bathing this frequently! The new oral parasite treatments make life much easier for dogs that need regular bathing.

RE: Atopy vs Food allergy

Rob Loxley — Fri, 11 Mar 2016 19:06:43 GMT

I also find that if you're bathing regularly like this imidacloprid every 4 weeks for flea control is often found wanting...

RE: Atopy vs Food allergy

Bob Russell — Fri, 11 Mar 2016 15:52:09 GMT

Stronghold excellent for sarcoptes but not licenced for demodex (not effective as far as I am aware).

RE: Atopy vs Food allergy

Anthony Todd — Fri, 11 Mar 2016 15:28:25 GMT

[quote user="Tomás Basto"]The dog GETS BETTER with steroids,[/quote]

Looking at the pictures and now knowing that steroids give relief, which I assume, means the redness obviously goes, suggests to me that this is almost certainly allergic/atopic and what I have said about steroid dose rates and frequency applies which I will repeat if you want.

Continue with the diagnostic process concurrently because if there are any other causes steroids won't affect their presence but will give the animal [and the owner!] some relief.

I'd be amazed if this was anything else, but many may disagree so read other posts as well.

RE: Atopy vs Food allergy

Tomas B — Fri, 11 Mar 2016 15:28:20 GMT

Stronghold for the internal and external, but does it work wih demodex or sarcoptes?

Thank you very much for the answers

RE: Atopy vs Food allergy

Bob Russell — Fri, 11 Mar 2016 15:23:22 GMT

Not seen any side effects from Apoquel at all. Been in almost routine use here even through the shortages. I use it for short term control of pruritus of unknown origin while the patient is being worked up.

I use Stronghold at the drop of a hat for any dog that becomes itchy out of the blue. In thirty years I have not found a whole sarcops mite on a skin scraping. Obviously not one of my strong points!

I like the idea of a demodex party and some scrapings take a fraction of a second to make a diagnosis!

I like the idea that oral flea/tick products are likely to have action against mites. I understand there are trials going on with Nexguard Spectra and both demodex and sarcoptes. Pretty good if it works effectively!

I have tried Bravecto for the first time for demodex and am looking forward to seeing if it works!!

Not much comfort to TOMÁS BASTO but I find skin problems in French Bulldogs and similar, a nightmare. They often give very little information and rarely seem to respond in the way you would like!

RE: Atopy vs Food allergy

Tomas B — Fri, 11 Mar 2016 15:07:01 GMT

The owner is a young mother that spends the day with the dog. luckly to the dog (or not) because she can stop him from scratching himself...

There is no other dogs or cats in the appartement. Everything is cleaned because they know the dog they have...

SHe does Malaseb baths 2 times a week.. did some tape test and deep scrapings also some auricular citology...no evidence of sarcoptes, no evidence of malassezia or bacteria..

THey are cleaning the ears with omniotic 1x week to prevent otitis.

The dog GETS BETTER with steroids,, but at a dose superior than she used to do...i think its normal..

I am doing ivermectine just in case.

What do you guys think should be the protocol for ivermectine? and for the medrol in order to relief the pruritus and stop for a period of time??..

Kinda lost here...i will try maybe apoquel, but ive heard that it has side effects.

RE: Atopy vs Food allergy

Anthony Todd — Fri, 11 Mar 2016 14:51:00 GMT

[quote user="Bob Russell"]Itchy in contact dogs screams sarcoptes[/quote]

And itchy people; inside of forearms, neck and frontal areas!! Dead give away IME

Looks like a pinprick but very itchy.

I don't think I can ever remember seeing sarcoptes that looked like the pictures though. Too red, not enough hyperkeratinisation???

RE: Atopy vs Food allergy

Bob Russell — Fri, 11 Mar 2016 14:35:02 GMT

[quote user="Anthony Todd"]

[quote user="Tomás Basto"]just do be sure its ot FAD..[/quote]

Any other animals in the house? Cats? Contact with other dogs or cats or houses with them?

Allergic animals usually have very few, if any, fleas present or evidence of them.

[/quote]

Very unfair one star IMO. These are critical questions. Itchy in contact dogs screams sarcoptes, poorly flea treated cats (that is most of them, sadly) shouts FAD.

The images make me want to do more and more skin scrapings for both demodex and sarcoptes!

RE: Atopy vs Food allergy

John Flynn — Fri, 11 Mar 2016 10:11:24 GMT

I've only skimmed this thread, but couple of points if of help:

1) Flea-control - don't assume this is being done to your instructions. I like "Bravecto" every 3 months now and that will kill any demodex also. Cats in house need done too etc.

2) Eliminate secondary infection - I do usually sellotape strip and cytology to see level of secondary malassezia/bacterial infection - this needs reduced if present and a chlorhexidine shampoo as often as owners are willing to do is my first choice.

3) Relieve the itch, either a glucocorticoid (I prefer dexamethasone over methylpred/pred) or "apoquel" (probably is available in Portugal I'd guess, can email Zoetis to find out; http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/veterinary/medicines/002688/vet_med_000280.jsp&mid=WC0b01ac058001fa1c )given to effect or "Cortavance" spray in some instances.

4) Do a food trial if young dog and committed owner (I rarely find these successful) and/or intradermal/blood allergy testing with view to immunotherapy trial (I rarely do).

5) Continue to bath regularly if required and maintain good quality coat with appropriate products (eg virbac range).

PS - I am not expert

RE: Atopy vs Food allergy

Andrew Kent — Fri, 11 Mar 2016 10:10:23 GMT

[quote user="Anthony Todd"]Would I be right in saying the axilla is an unusual place for ectoparasites?[/quote]

Unusual for some but very common to find sarcoptes in the axillary fold and then most of the dogs are so pruritic that they traumatise the rest of the axilla.

RE: Atopy vs Food allergy

Anthony Todd — Fri, 11 Mar 2016 09:45:23 GMT

[quote user="Andrew Kent"]The fact that the dog had a poor response to prednisolone is unusual for a truly atopic dog and should make us consider other causes.[/quote]

I would agree. The pictures scream allergy and the lack of pred response is totally contrary.

Did methylpred give a better response; the dog must be so uncomfortable!

Would I be right in saying the axilla is an unusual place for ectoparasites?

RE: Atopy vs Food allergy

Andrew Kent — Fri, 11 Mar 2016 08:38:03 GMT

Hi Tomas,

I am not a dermatologist but, looking through the feed there are a couple of things that spring to mind.

The fact that the dog had a poor response to prednisolone is unusual for a truly atopic dog and should make us consider other causes.

I think you really need to exclude parasitic or infectious causes as they could also fit with your distribution, so I would echo getting some more deep skin scrapes and get some surface cytology looking for malassezia. It may be that the dog is atopic but if there is a significant secondary change (like malassezia) then controlling that may significantly reduce the pruritus.

Even with skin scrapes we can't exclude sarcoptes and I don't really rate Advocate for that either so would give stronghold every 2 weeks as a trial. And are you using anything topically? I would be bathing in malaseb 3 times weekly.

As others have said Food Allergen testing is not a useful way for us to pick dietary proteins - it has no value either as a positive or negative predictor. So, personally, I would avoid chicken and rice and use a hydrolysed or novel protein diet.

Feel free to use or ignore!

Andy

RE: Atopy vs Food allergy

Anthony Todd — Fri, 11 Mar 2016 00:29:53 GMT

[quote user="Tomás Basto"]just do be sure its ot FAD..[/quote]

Any other animals in the house? Cats? Contact with other dogs or cats or houses with them?

Allergic animals usually have very few, if any, fleas present or evidence of them.

RE: Atopy vs Food allergy

Anthony Todd — Fri, 11 Mar 2016 00:25:26 GMT

[quote user="robloxley"]http://www.sciencedirect.com/science/article/pii/S0165242701003488[/quote]

Had a quick read but am wary of cherry-picking....but, and as usual:

A complete remission of clinical was reported in 9 out of 16 dogs treated with ASIT and four out of five dogs treated with placebo.

But if you read on it sounds as if it was terribly vague and riddled with poor data collection.

It has been stated in textbooks that ASIT may still be effective if oral prednisone/prednisolone doses are kept as low as possible or if they are administered on an alternate day basis (Scott et al., 2001).

No further details of the duration of alternate day dosage whereas I have always advocated a single larger dose and only, as necessary, or just before....

All[?] of the negative stuff about steroids always involves a course, usually with a taper; not the same thing at all....

and then there's this:

Adverse reactions to ASIT are reported as uncommon to rare in dogs. One paper reported an incidence of 5% (Angarano and MacDonald, 1991). In another blinded placebo-controlled study, 3 of the 27 dogs treated with alum-precipitated allergens exhibited severe generalized pruritus while 2 of the 24 alum-containing placebo-treated dogs suffered from generalized pruritus, one of them associated with generalized urticaria (Willemse et al., 1984). In another study of 100 dogs undergoing ASIT, one suffered from anaphylaxis, five had facial angioedema, and seven other dogs had milder adverse reactions though another 25 had a perceived worsening of the pruritus (Rosser, 1998). In this study, 38% of 100 dogs that began ASIT had adverse reactions (13%) or increased pruritus (25%) that were considered severe enough to require a change or discontinuation of therapy.

Bloody 'ell, nobody mentioned that..... [read it right through....]

The other thing that hasn't been addressed is the possibility that the "success" is more because of the absence of allergic insult in that the "success" is because the allergic factor is absent, classically fleas or grass or pollens, so no treatment at all would give exactly the same results.

RE: Atopy vs Food allergy

Rob Loxley — Thu, 10 Mar 2016 23:29:59 GMT

[quote user="Tomás Basto"] elimination diet (after allergenic blood work)[/quote]

Quick question - are you basing your elimination diet on a blood test? My understanding is that the accuracy of such blood tests is not great

RE: Atopy vs Food allergy

Rob Loxley — Thu, 10 Mar 2016 23:24:51 GMT

[quote user="Anthony Todd"]What is your success rate with immunotherapy and, roughly,what is the cost?[/quote]

Some completely controlled, some still on other meds (various combinations of pred/apoquel/ciclosporin/bathing/EFAs/antihists etc.) and some no discernable improvement so discontinued. If you want a summary of the published data I suggest http://www.sciencedirect.com/science/article/pii/S0165242701003488

Costwise - I'd refer you to the IDEXX or Artu price lists for testing and immunotherapy. The fact we have a number of patients who remain on it for years suggests the clients find the cost acceptable, but clearly nothing beats preds for price!

RE: Atopy vs Food allergy

Tomas B — Thu, 10 Mar 2016 20:42:26 GMT

And we are at day 7 of elimination diet (after allergenic blood work) just do be sure its ot FAD..

RE: Atopy vs Food allergy

Tomas B — Thu, 10 Mar 2016 20:40:57 GMT

As promised here it is...the pruritus starts between the fingers and advance to the periocular área, then the axilar área...this pic was taken yeasterday,,,the dog did some vetacort 3 times, and then went home with moderin 1pill 4 mg a day for 7 days and then half a pill with the space of 2 days for another week,, this pic is now that he dog changed the dose of moderin for half a pill(2mg day) for 2 and 2 days, at the beginning of this phase..

RE: Atopy vs Food allergy

Anthony Todd — Thu, 10 Mar 2016 17:37:12 GMT

[quote user="robloxley"]No - once they have a easy fix in just piling in the steroids they don't put in the effort with doing a good diet trial, with remembering flea control, regular bathing of the dog and cleaning of the ears etc. and the control of the dog's problem suffers[/quote]

Well they did in my hands because, as I keep banging on about, what you list above still continued whilst the steroids gave relief only when necessary.

We'd only give them 20 or 30 preds so they'd come back and we could reinforce the message and check progress.

[ Er, apart from the 5000 Betsolan boxer which wasn't at my hand....]

What is your success rate with immunotherapy and, roughly,what is the cost?

RE: Atopy vs Food allergy

Anna Battek-Kosiorowska — Thu, 10 Mar 2016 16:40:28 GMT

[quote user="Bob Russell"]

Don't rely on Advocate to ensure absence of demodex. Do multiple skin scrapes if not done already.

Bayer are more convinced about the effectiveness of Advocate than I am

[/quote]

Indeed! Just scraped a French bulldog full of Advocate positive for Demodex! Positive is not a word here. Demodex party is more descriptive.

RE: Atopy vs Food allergy

Rob Loxley — Thu, 10 Mar 2016 14:34:55 GMT

[quote user="Anthony Todd"]Can I add that, as the dreaded 'roids make the dog or cat [temporarily?] better, the owners are far more receptive to explanation and advice when you follow-up.....[/quote]

No - once they have a easy fix in just piling in the steroids they don't put in the effort with doing a good diet trial, with remembering flea control, regular bathing of the dog and cleaning of the ears etc. and the control of the dog's problem suffers

I get the impression you saw a very different cohort of atopic dogs that 20 pred tablets over 5 months of summer will adequately control!

As for immunotherapy - if I could control your dog's itch completely with no side effects, no steroids/ciclosporin etc using just a once a month injection that you can do at home, is that not a goal worth exploring? Yes some won't respond and some will still need other - but less - adjunctive treatment.

RE: Atopy vs Food allergy

Anthony Todd — Thu, 10 Mar 2016 13:44:41 GMT

[quote user="Virginia Campbell"] We spent 45 sodding minutes [/quote]

Yes, my "I don't know how he caught it..." comes to mind.

Can I add that, as the dreaded 'roids make the dog or cat [temporarily?] better, the owners are far more receptive to explanation and advice when you follow-up.....

RE: Atopy vs Food allergy

Virginia Campbell — Thu, 10 Mar 2016 12:51:39 GMT

[quote user="Anthony Todd"] after a surprisingly short time owners [er, most...] recognise the early signs and give the pred pre-emptively..[/quote]

Yep, it's the few who consistently refuse to acknowledge and act on the fact that a pred in time saves nine(teen), plus 3 weeks of cephalexin, medicated ear drops, a whole load of Malaseb, a consult and a recheck and let their dog get into a miserable state and complain about the cost that drive me nuts.

Kind of like the ones with a dog with food intolerances or pancreatitis. Yes I know i/d low fat or James Wellbeloved or homecooked salmon, broccoli and rice whatever is more expensive and boring than whatever shite you fed your last dog. But it's a damn sight cheaper and less unpleasant for the dog than a flareup. I AM TRYING TO SAVE YOU MONEY AND YOUR DOG SUFFERING YOU NUMPTY. I explained, on multiple occasions, in words of one syllable, I wrote it down, I gave you websites to look at, I drew comparisons to human experience that you might have had, I drew pictures, anything to help you learn and make life as easy for you as I could. We spent 45 sodding minutes in the consult room last time - I might as well have spent the time bouncing my head off the wall.

Aaaah that feels better. Might go to the "things that cause you stress" thread and write it down there - this is probably the thing that annoys me most about clinical practice.

RE: Atopy vs Food allergy

Anthony Todd — Wed, 09 Mar 2016 23:09:33 GMT

[quote user="Virginia Campbell"]I do agree with this though and give owners a few pred tabs to have available at the first sign of trouble though, or even on the morning of a groomer visit if that's a trigger for them, for example. [/quote]

Yes, and after a surprisingly short time owners [er, most...] recognise the early signs and give the pred pre-emptively... I guess that almost all dogs got away with 20 5mg pred over the summer

I gave you the stars