Henry's allergy testing results in; grass and a question about Cytopoint

[Dolly Dykhouse]

Hello everyone,

Henry began chewing/digging at his paw pads a few months ago. I thought that it might be caused by the new cedar bark that they had placed at the dog park we go to several days a week. Over the last 10-12 weeks it has escalated to not only rooting around his paw pads like a pig looking for truffles but also licking the tops of them to the point that they are now that lovely shade of rust red in-between the toes as well as scratching his muzzle and armpits multiple times a day. I had allergy testing done last week and the vet called me last night with the results; Bermuda grass, crab grass, rye grass and Russian thistle had a high reaction. I was pretty surprised...our backyard is aggregate and concrete, no grass at all and he rarely steps foot on ANY grass as our outings are to our local lake and the dog park which also has NO grass just bark or sand. Now with that said, our house backs up to our local 5 acre park which is loaded with all of the above grasses I imagine and even though I don't take Henry there (no dogs in public parks in my city) we do use a whole house fan to cool our house off at night and I had a lightbulb moment of "gee, this is right around the time we started using the whole house fan that his itching started." My window screens show all the pollen, dust, etc that is being pulled into the house and Lord knows I have to clean off the plantation shutters every few days because they are coated with dust and pollen. Does this make sense? Does grass have pollens that are released like flowers and trees? If this is the case, even though his dog park is all cedar bark the entire 15 acres surrounding it are grasses and trees and I'm sure that if they are pollen producing it is getting into the dog area and coating the bark too. Gah! 

The vet offered a few solutions; allergy shots, Apoquel and Cytopoint. I'm not thrilled about Apoquel as it is an immune suppressing drug and Henry is only 18 months old; a lifetime which could be shortened with this drug. Does anyone have any experience with Cytopoint? Ive done some reading and another doodle owner in Australia swears by it and uses it in combination with Apoquel for her doodles severe allergies. I'm going with the allergy injections to start because as I have read on this board, and Karen's experiences with Jack, that this is the safest of the options. If anyone (Karen!!!!) has any other words of wisdom and advice I am all ears! 

Thanks from Henry and Dolly

[Dolly Dykhouse]

Stacy, doing the best that we can do with the knowledge we have and the time and dedication to caring for our beloved animals is all we can do! I have spent hours reading old posts about Atopy here on DK and it isn't just the facts that you see, it is the experiences of all these doodle owners/lovers sharing those experiences to help others (Thank God for Karen and her researching/sharing JD's journey).

I am praying that the immunotherapy works as well for Henry as it did for JD and Ava. Sitting here in the living room on another sleepless night watching my boy being miserable is heartbreaking. I know somewhere out there that there is another owner(s) going through this too and all I can do is pray that they find this amazing group of people to lean on and learn from.

[Karen, Jasper and Jackdoodle]

Dolly, it turns out that the Relief spray is back on the market and chewy.com has it in stock! 

https://www.chewy.com/relief-spray-itchy-skin-dogs-8-oz/dp/119255

It works really well for temporary relief of the itchy paws. Try it! 

[DonMarie and Picco]

There is also a shampoo from Davis with Pramoxine.  I use it on Picco's feet (letting it soak in) during his bath while I wash the rest of him with his regular shampoo.  It seems to work well.  As I am typing this I think I found out about this shampoo from you, Karen!  Maybe I should get the spray for in between baths because he'll go after his paws when it gets close to his next bath time.

[Karen, Jasper and Jackdoodle]

Chewy also sells the Relief shampoo, which is very similar to the spray, with praxomine and colloidal oatmeal. That would be a good choice.

But Douxo Calm is still the best shampoo for itchy dogs, IMO. 

[Dolly Dykhouse]

Awesome Karen thank you!

[Dolly Dykhouse]

Ok we just got back from Henry's vet appointment and have our allergy vials in hand to start his injections tomorrow. However, in having her look at Henry's paws and doing a stain for yeast/fungal infection it shows that Henry (of course he does) have a yeast/fungal infection from the constant licking.

Vet has given me a prescription for Ketoconazone 200mg tabs for 28 days. I looked up the side effects and I already don't like what  am seeing/reading. Has anyone had any experience with this medication? Has anyone used an alternative method to clear up the yeast/fungal infection? Vet is also recommending using Duoxo Chlorhexidine PS shampoo at least 3 times a week instead of the Douxo Calming as she wants more than just building up the fatty acid layer on his skin barrier. Sigh...this dog I swear, it just makes my heart ache.

She also increased Henry's Zyrtec to twice a day, one pill every 12 hours. I am giving him his EPO with his morning meal, 500mg dosage. Should I give it at both meals to increase the effectiveness of the Zyrtec?

Thanks for everyones help on this!

Dolly and Henry

[Karen, Jasper and Jackdoodle]

The Douxo Chlorehxadine shampoo is very good, and it will help more than the Douxo Calm if he has an active yeast infection. 

I would not increase the EPO right now with other new meds and with starting the immunotherapy; too many changes at once. 
Jack's dermatologist gave me some topical meds when his paws were infected; it was a combination of two, and it was kind of a monkey business, because I had to wear rubber gloves to apply it to his feet and it had to be applied 3 times a day. One of the lotions was ResiKetoChlor, which is a topical form of Ketoconazole, and the other one was a topical steroid called Genesis. If you don't want to give the oral meds, you might ask the derm vet about those. 

[Dolly Dykhouse]

Thanks Karen I will ask. Henry had a pretty bad reaction to the strong antibiotics Zobuxa (Enrofloxacin) he was on for his severe UTI in March; it tore his stomach up to the point of vomiting blood and he was only on it for 5 days. Ketoconazone has similar side effects with stomach distress and a course of 28 days tells me that he could be in distress quickly and then what? He had to go on anti-nausea meds and Pepcid to heal his stomach from the antibiotics. I want to avoid putting this poor guy through anything unnecessary especially with just starting the immunotherapy today. 

[Stacy]

Poor Henry. He's having a rough time, it sounds like. And you too. I was thinking about it and my concern would be that if they're treating the fungal infection, but he continues to itch and lick, how successful is the treatment going to be? I also wondered if a downside to a topical instead of an oral would be it is harder to control how much he actually ingests if he's licking it off his feet all the time. They told me that it could be a full year to see good results from the immunotherapy. And if he doesn't have good itch relief from the second dose of Zyrtec that's a long time to be itching like that. I know you don't want to give him Apoquel, but what about Cytopoint? I was looking at their website, and it sounds like it might be a good option. I'm totally just thinking out loud here, I wish Henry good things!

[Karen, Jasper and Jackdoodle]

Yes, sometimes they do need some extra help in the way of meds, whether that be Apoquel, Cytopoint, or plain old steroids, until the immunotherapy kicks in. We were told it typically takes 6-18 mnths to see the full effects. Since Jack's worst season was Fall, we started the immunotherapy in January. 

[Dolly Dykhouse]

Thanks Stacy! Yes, I am having a hard time with this, I hate seeing him miserable, the on/off licking and itchiness has had some effects on his normal nutty puppy personality; that is always a telling sign isn't it when you see your puppy almost depressed because they are physically miserable?

I think that I am going to have the vet send in an RX of Apoquel so I have it on hand just in case the immunotherapy is slow to take. The one advantage of the drug is there is no tapering off and you can start/stop with no bad effect. The issue with the Cytopoint is that it is a newer drug, and the jury is out on long term effects...I want to do everything I can that I know will have the least potential of harmful effects first and then move to stronger medication if necessary. I so badly want to see Henry live a long and healthy life and I look at everything Karen did for JD to get him to a long quality life and know that it's possible, not easy or inexpensive but possible. Keeping my fingers crossed!

[Karen, Jasper and Jackdoodle]

I would also ask about the topical form of Ketoconazole. From what I have read, there are way fewer side effects and no GI issues. 

If I remember correctly, (it was  almost 7 years ago), the topical lotion dried very quickly and I didn't have any issues with JD licking his feet after I had applied it. I did have to distract him for a few minutes, until it dried.