Hot Spot / Allergy Update - Immunotherapy?

[Moe]

So it has been a few weeks and I just got the results of the allergy test back. I seems like Charlie is allergic to a lot of things but the worst looks like Dust Mites. This was probably one of the worst allergies because it is not seasonal. I am reading up on how to control dust mites in the home. I have a carpet cleaning company coming next week to do all the carpets. I threw away her dog bed and am working on lowing mites in the home. 

Does anyone have any experience with Immunotherapy? The allergy testing company suggested drops or shots. Has anyone tried either one? The vet also mentioned the drug Apoquel to control allergies. She said it is hard to get right now but might be helpful. Anyone have any experience with treating allergies with that drug or have any other advice. 

There is no veterinary dermatologist in my area. I'm trying to work with my vet for now. I'm just looking for any experience you guys may have. I'm trying to learn everything I can so I can help my poor itchy baby.  

[Karen, Jasper and Jackdoodle]

First, please join the Atopic Dermatitis support group here on DK. This is a private group for owners whose dogs have been diagnosed with AD, otherwise known as environmental, seasonal, or inhalant allergies. Members of the group have experience with the various treatments for AD, and lots of us have used immunotherapy.

Jackdoodle has been on immunotherapy treatment since 2009, and it's been extremely successful. BUT, and this is a BIG "but", the success of the treatment depends on the accuracy of the testing. The antigens that are used in immunotherapy are custom formulated based on your dog's test results. The most accurate testing is skin scratch testing done by a veterinary dermatologist. Blood tests are nowhere near as accurate (saliva tests are basically a joke). It would be worth travelling to a veterinary dermatologist to get the testing right. The drops are also nowhere near as effective as the shots.

From what I've seen with JD and other dogs in the group, dust mite & storage mite allergies respond very well to immunotherapy, so I would encourage you to try it. 

Apoquel is a biologic drug similar to the human drug Xeljans. It suppresses the immune system, and it's got some serious side effects, including a greatly increased risk for cancer. The only advantage I can see to choosing Apoquel over Atopica (cyclosporine) is that it's cheaper. 25-30 % of dogs with AD don;t respond well enough to immunotherapy, and then you have to use immunosuppressant drugs. Dogs who test positive for a lot of molds are usually the ones for whom immunotherapy is least effective. But for a dog like yours whose main allergens are dust mites (assuming the testing is accurate), I would definitely give the immunotherapy a try. 

When trying to reduce dust mites in the home, it's important to use a high-allergen rated furnace filter and change it monthly. 

[Karen, Jasper and Jackdoodle]

I should also mention that JD tested high positive for both North American and European dust mites (allergies are very, very specific, so you need to know not just that your dog is allergic to dust mites, but also what kinds of dust mites, in order for immunotherapy to be effective) as well as storage mites and 12 other allergens, (mostly pollens, one type of mold, cat dander) and the immunotherapy has been very effective for him. Ten months of the year he has no symptoms at all. 

His dermatologist has tweaked his antigen formula once or twice over the years. 

[Moe]

These are the results. In the original post are the recommendations for immunotherapy. 

[Karen, Jasper and Jackdoodle]

LOL, I thought the recommendations were one of those DK ads that pops up. 

[Moe]

:)

[Karen, Jasper and Jackdoodle]

I have to say that the immunotherapy recommendations don't make sense to me. There are antigens included for which she scored lower than some that are not included. 

I really think you are better off going through a dermatologist. 

[Moe]

They did explain that in the report. They use your zip code to determine which alergins are common in your area. They don't bother treating for the ones that are not geographically relevant. 

[Karen, Jasper and Jackdoodle]

Which I'm guessing means they know their test is inaccurate. :)

Because otherwise, why would a dog test positive for so many things that aren't relevant to her environment? You can't have an antibody for something you've never been exposed to. 

Blood tests are so inaccurate that neither JD's dermatologist nor his internal medicine specialist will run them, even if you request it. 

Immunotherapy is a long process; it can take a year to see full results. It also involves giving your dog a shot every other day for a few weeks. I really think you should have skin testing done and do it right. 

[Moe]

Makes sense. I forgot mention that Charlie also tested positive for a tick borne illness called Anaplasmosis.  She does not have any symptoms so they are not treating it. I feel like this poor pup can't catch a break. 

Bugs of all kinds are the worst. 

[Karen, Jasper and Jackdoodle]

Also, has your vet discussed using antihistamines (NOT Benadryl) and fatty acid supplements (GLA, EPA, DHA) to help control the itching? Most GP vets are not well-versed in this, or other supplemental treatments to help keep atopic dogs comfortable, which is another reason it's so important to see a dermatology specialist. 

[Moe]

I'll join the Dermatitis group I didn't know there was one. The allergy test was a blood test. Right now charlie is still on the antihistamine/steroid and antibiotics from the last hot spot. She has also been taking a fish oil pill - EPA 230mg, DHA 170mg. I tried Zyrtec, it didn't do anything. The vet said that I could try Claritin but I have not done that yet because she is still on the prescription pills. She did not mention Atopica - we only spoke briefly because I told her I wanted to do some research before I commit to anything. We have hot water baseboard heat. I don't think there is a filter. I'll double check on that.  

The vet also suggested putting Charlie on a prescription food to rule out food allergies as well. How do you know if it is the food or the mites or the trees? I think I'm feeling like there are so many variables and things to try. I hate to give the dogs medication but the constant itching is so sad. We are renovating the house withing the next month so hopefully that will help with the dust mites. 

You're probably right, it may be worth it to drive the hour and a half to see a veterinary dermatologist. She has never been in a car for more than 15 minutes so I worry about 3 hours in a day also. 

This stinks. Thanks for listening to my vent. 

[Karen, Jasper and Jackdoodle]

I'd forget about food allergies, and I definitely wouldn't use an RX food, they are all garbage. Actual food allergies are rare and there is no accurate testing for them. To do a food trial, you need to choose an LID formula with a single protein source that she has never eaten before. The Food Group has recommendations. You will need to stick with that single protein source alone for 8-12 weeks, and that includes everything that she ever eats. Then if the symptoms go away, you know that there was a food allergy to something in the previous diet, but you still don;t know what. It's a tedious process. But since she's itching from the Atopy anyway, and on meds for it, there wouldn't be any way to tell if the diet was helping anyway. Let's tackle one thing at a time. 

Different antihistamines are more effective for individual dogs than others. Claritin worked better for JD than Zyrtec. Others have had the opposite results. Some dogs have responded better to Atarax or Chlor-Trimeton. It takes some experimenting. This is another reason I feel better having a specialist guiding the process. 

Yes, it stinks. It was very hard for me to accept that JD had an incurable disease that required ongoing lifelong treatment and caused him so much misery. Especially since I once had a foster GSD who ended up being PTS by his adoptive owner because of severe Atopy. Of course, now that JD's been diagnosed with two other conditions that are even harder to treat, and since he's done so well with the immunotherapy, the allergies look like a walk in the park, lol. So there is a light at the end of the tunnel.