Atopy (Inhaled Allergies) and Hyposensitization

Atopy or inhaled allergies happens when your animal develops antibodies in response to environmental allergens. This condition tends to be seasonal but sometimes can affect your pet all year round. This results in itchiness (often directed to the face and feet) and recurrent skin problems such as bacterial infection (pyoderma), yeast infection, skin eruption (papules or miliary dermatitis), and ear infections (otitis). Sometimes, food allergies can also be suspected as a cause of itchiness. Unlike inhaled allergies, there is no good blood test for food allergies, and a hypoallergenic food trial (novel protein/carbohydrate) must be done to rule out this condition. Together, working with your veterinarian, the goal is to treat your pet's underlying allergic condition and help your pet be less itchy and more comfortable. If there are any problems or questions regarding your pet's treatment, please contact your veterinarian. Allergy testing Serum tests for allergies (allergy specific IgE serology) are useful to determine what elements in the environment are aggravating your pet's skin condition and to determine which elements your pet should avoid. The results of this test are used to formulate the allergens that are included in the hyposensitization kit. Skin tests (intradermal) are also quite sensitive but must be done with a dermatologist since this necessitates special equipment. This serum test, done through your veterinarian, is sent to an outside laboratory and includes many specific plants and elements for the northwest California area. Among those included on the test are: nonseasonal items such as house dust mites, insects, danders (from cats and humans) and molds as well as seasonal items- tree, grass and weed pollens and outdoor molds. Once the results of the test are obtained (this test takes 10-14 days), your veterinarian will review these with you and recommend formulation of the allergens used for hyposensitization. Usually, there are 10-12 allergens for which hyposensitization is done through the same lab. (this also takes 10-14 days). The hospital will contact you to schedule an appointment for a demonstration of how to give the injections and to review the protocol. Hyposensitization is the administration of gradually increasing quantities of allergen extracts to a dog or cat to diminish the adverse signs associated with exposure to that allergen. This is done by a series of subcutaneous injections given by you, the owner, at home on a regular basis. Often, this can be done just before a meal or treat is given so that there is a reward for the pet receiving its shot. The goal is to make your pet less sensitive to those items to which he/she is overly sensitive to now. Protocols The initial loading phase consists of low doses and small quantities given every 2-7 days with incremental increases to larger quantities given less frequently, every 1-3 weeks. You will receive a schedule but sometimes, the frequency and quantity of the injections must be varied. Some animals improve within a few weeks but most take many months. Concurrent treatment Although the goal is to treat the underlying problem with the allergies, sometimes, medical treatment aimed at controlling the signs is necessary. This is done with steroidal anti-inflammatory drugs (prednisone or prednisolone) or anti-histamines (such as benadryl, atarax, clemastine or chlorophenaramine) to help with itchiness. Essential fatty acids (omega 3, 6 fatty acids) in the form of Derm-caps or Lipiderm are helpful in treating allergic pets. Safety and adverse reactions Localized swelling, redness, itchiness or pain at the injection site, usually within an hour of administering the injection, can occur but this is not common. Pretreatment with anti-histamines and/or varying the amount of allergen can control these reactions. Anaphylaxis or complete collapse from a whole body adverse reaction to the injection is extremely rare. Nonetheless, it is a wise precaution to observe the pet for one hour after each injection. Recheck evaluations Rechecking with your veterinarian on a regular basis- every 3 months- throughout the first year of treatment is important in assessing the improvement and determining the frequency of injections since some animals will need injections more or less frequently than the schedule indicates. It is also important to control other problems such as yeast and bacterial skin and ear infections that may arise. Troubleshooting There is a schedule for injection amounts and frequencies for the hyposensitization protocol, but these are only general guidelines. According to your pet's response, there may need to be changes made, but these should be initiated by your veterinarian since there are many factors that contribute to itchiness. If itchiness decreases after each injection but then slowly increases again before the next injection is due, the allergy shots may not be lasting long enough. Your veterinarian may recommend that the injections be given more frequently and given when a flare up in itchiness is expected. If the itchiness increases after each injection and then the pet is less itchy before the next injection is due, the allergy shots may be dosed too high. Your veterinarian may recommend to decrease the dose by 25%. Items needed Your allergen kit has been specifically formulated for your pet. Initially, this consists of two vials- vial 1- a start-up vial half-full and more pale in color which is used in the initial phases of small, dilute amounts when first starting hyposensitization; vial 2- maintenance vial which is a darker color when the next phase of treatment is started. These allergens must be refrigerated. If these are accidentally kept at room temperature for a short period of time, this should not interfere with their efficacy. When you start to run low (below half a bottle), please contact the hospital to request a refill of the allergens. Please allow 10-14 days to order these. Refills will be only 1 vial. Needles and syringes You will be given tuberculin 1cc (1ml) syringes and 3 cc (3 mls) syringes as well as 22 gauge (blue cap) needles to draw up the solution and 25 gauge (red cap) needles for administering the injection. After using the needles and syringes, save them and return them to the hospital for disposal. Prognosis This is a long term treatment, not a "quick fix" and treatment is often life long. While most pets will show some degree of improvement on this treatment regime within the first 4-6 months, occasionally, it can take up to a year. It is recommended that hyposensitization be continued for at least one year before a response or lack of response can be evaluated. Remember that this isn't a "quick fix" but allows you to treat your pet's underlying problem unlike treatment with steroids and anti-histamines which just help the pet to cope with the symptoms of itchiness. The above is general veterinary information. Do not begin any course of treatment without consulting your regular veterinarian. All animals should be examined at least once every 12 months.