Therapies to get patients through a tough allergy season - DVM
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Therapies to get patients through a tough allergy season


DVM360 MAGAZINE


This allergy season in the Midwest appears to be one of the worst in memory.


Atopy in a 5-month-old Irish Wolfhound. The perception is that onset is occurring at an earlier age.
Patients that usually begin symptoms in April or May had already started them in March. A possible explanation might be that, because the Midwest had an extremely mild winter, some patients never had the winter break from allergic problems.

This article offers some ideas that might help your patients this year. Some are reminders; others may be new, and some are a combination of the two.

Bathing and topicals

If nothing else, frequent bathing mechanically removes pollen from the coat and skin. In human allergy there is evidence to show that percutaneous absorption of pollen occurs to get the allergic reaction started; therefore bathing may be even more important for allergic dogs and cats.

Because pets tend to absorb more substances through hairless parts of the body (i.e., footpads, groin, medial pinnae and perineum), it is a good idea to rinse those areas more often during pollen season. Rinsing – not soaking – is important because soaking causes maceration of the skin; substances are more readily absorbed through waterlogged skin.

Bathing reduces the number of skin bacteria, already higher in allergic dogs and in warm weather. Also, it reduces secondary seborrhea and odor. A general cleansing shampoo is helpful; so are oatmeal-based shampoos or those containing pramoxine.

Antibacterial bathing with benzyl peroxide or chlorhexidine, for pets with bacterial pyoderma, along with allergy or miconazole/chlorhexidine shampoos for patients with secondary yeast dermatitis, can help with pruritus.

Topicals containing low-dose steroids are helpful. Use them once or twice daily to skin folds such as the axillae, groin or ventral neck fold where so many atopics tend to flare.

The topical Resicort can be diluted 4 capfuls/1 C water and used as a spray daily or as an after-shampoo, leave-on rinse. I favor less-potent topical steroids such as Resicort because owners tend to overdo topicals and may overuse more potent triamcinolone-containing products. If these products are dispensed, do so with explicit instructions.

Leave-on antipruritic, non-steroid rinses (such as relief cream rinse) can be helpful. Oil-based products should be avoided because yeast favor oil for growth. For focal areas of pyoderma, mupirocin 2% ointment can be used twice daily.

Antibiotics

Because the skin of allergic dogs (and humans) tends to attract bacteria more than nonallergenic dogs, antibiotics are essential in treating the pyoderma that most often accompanies allergy.


Note the chronic skin changes in an atopic dog from constant foot licking. (Top); Yeast dermatitis can present in the muzzle folds of an atopic dog. (Center); An acral lick granuloma on the foreleg of an allergic Poodle. (Below)
Bacterial pyoderma by itself can be pruritic in some patients. It is always a good idea to treat with antibiotics alone or in combination with antihistamines, avoiding steroids. Even a small dose of steroid combined with antibiotics may immunosuppress the patient enough that the pyo derma will not resolve. Be sure to treat the pyoderma until it is totally resolved, then add an additional week.

If you find that the antibiotic helps with the pruritus yet the patient flares without it, consider pulse-dosing the antibiotic (i.e., one week on/one week off).

Recall also that antibiotics such as penicillin, ampicillin and tetracycline have little activity against Staph intermedius. As mentioned previously, bathing with antibacterial shampoos not only can be preventive but, along with the appropriate antibiotics, can bring about a more rapid reso lution of the pyoderma.


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Source: DVM360 MAGAZINE,
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