The Itch Wars: STOP your dog scratching with the right allergy diagnosis (+ common mistakes)

Join veterinarian Dr. Alex as he dives into the often fraught world of itch and allergy diagnosis. In this episode, he is joined by the incredible Dr. Jeff Werber, an award-winning veterinarian with over 38 years of experience.

Together, in this sneak peek into The Dog Allergy Summit, they unravel the complexities of canine allergies and discuss how to make an accurate diagnosis, along with the common pitfalls to avoid.

If you've ever wondered why your furry friend is constantly scratching or suffering from skin-related issues, this episode is for you. Discover the common culprits behind allergic reactions in dogs, whether it's environmental triggers or food sensitivities. Dr. Jeff Werber breaks down the different diagnostic methods and explains how to differentiate between seasonal and year-round allergies.

But it doesn't stop there! Dr. Alex and Dr. Jeff also tackle the complications that can arise from secondary infections and discuss the importance of maintaining healthy skin for your dog's overall well-being.

Whether you're a dedicated pet owner seeking answers for your four-legged companion or simply curious about the world of veterinary medicine, this episode of "Call the Vet" is a must-listen. Tune in and empower yourself with the knowledge to better care for your furry family member.

Check out The Dog Allergy Summit today

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Transcript

The following is an AI generated transcript of the above podcast episode:

Dr. Alex:

Dr. Jeff Webber it's fantastic to be talking to you today and you've got so many expertise to be bringing to the discussion that we're going to be having before we dive into some of the diagnosis and treatment for our allergic dogs. I'd love to know just what allergy types there are and maybe how common each of those types are because I think there might be differences that people aren't aware of with that.

Dr Jeff Werber:

Well, certainly there are. Allergic to skin disease in general is one of the more common things. We're going to see a dog for it's, itching and scratching. Another very common one is vomiting and diarrhea. Okay, that covers a lot of them right there. Maybe some sort of injury, limping, stuff like that. But dog is typically going to come in, it's going to have one of those. So as we say, very scientifically. ADR just ain't doing right. As far as allergy, probably the most common are going to be environmental atophase called atopic dermatitis, which is sort of pollens, grasses, weeds, trees, kind of like our hay fever. Then we have actually the types of environmental allergens that might be around a house that could be cape, OC, wool, feathers, house dust, house dust mites, human epithelia. That's right. They could be allergic to us. And then any kind of irritant. And then the one that interestingly gets a lot of attention, though it's really not as common as people think is food allergy. One good thing about dogs when it comes to these is you can often tell by the nature of the allergy and the distribution of allergic disease and signs what the allergen might be. Okay. And of course, seasonal allergy you have to think of. And here we are in La. I mean, I'm in La. It's springtime and it's beautiful out. And yes, we are seeing fleas and ticks already. So where I am, so that is a huge one to contend with. Cats, on the other hand, are a little bit different because cats, regardless of what the allergen is, they can manifest in so many different ways. So you don't have that kind of luck. Head start you would in trying to diagnose dog allergies. So again, if you really were to simplify it, and I mean really simplify it, the rump above the tail, lower back, that's fleas. Now, mind you, the dogs didn't read the book, so they don't always know that this is the way it's supposed to be. In the belly ventrum, groin inguinal area, you think atopic dermatitis, you're thinking pollens, grasses, weeds, trees. Of course, if they're lying down on something and there's an irritant something from them around the house, then you'd see a ventral. Now, true food allergy, if it is really true food allergy, you got to think of chewing the feet and ears. But of course, ears are an overlap because ears can manifest any allergy, especially atopic dermatitis as well. We often see it in the ears as well, so it gives you a clue, but it's not a hard, fast rule.

Dr. Alex:

I love that. So, food, I guess, because there's a lot of focus on food, and you're right that it's often the first thing that's blamed. And that's not to say that food doesn't always play a role in treating and settling our atopic dogs. But true food allergies are perhaps not as common as people might expect.

Dr Jeff Werber:

Correct. They say maybe 15%, more likely 10% of all. Allergies are going to be food related. The bad news is about food is that it's really hard to diagnose the allergy. Testing. We can get that a little later when we talk about diagnosing. It doesn't work for food. So then the only way to do it is food elimination. And boy, it is one of the most challenging things to do. Right. Of all the things we have to do when it comes to allergies, is that really good food trial. And it's tough.

Dr. Alex:

Yeah, absolutely. It's easy to do, but not easy to do right. And you can undo all of your hard work.

Dr Jeff Werber:

Oh, my God, what a little mistake.

Dr. Alex:

When it comes to, I guess that presentation as well. So we've got our category of dog that they do have that very distinct pattern that clues you into that. But equally, I mean, I see fleas, I'm in New Zealand, and we have a pretty cold winter, but I'm still seeing fleas. I would hazard a guesser every week, at least once even throughout winter. So like you said, they don't always read that textbook, do they? And it can be quite challenging then to separate allergies from other skin conditions, right.

Dr Jeff Werber:

And not to mention that when you think of allergies, one of the most common secondary sequeli of allergy allergic dermatitis is bacterial pyoderma. And it's usually when we see bacterial pyoderma, it's often secondary to something. And most often that something is allergy, which also complicates our treatment because you could be doing the best allergy treatment possible. But if you don't take care of that secondary infection, they're still scratching, they're going to town on themselves, and you're going to get so frustrated, you're throwing hands like, oh my God, what I do all that for? It's because you have to really take note that you need to treat the entire dog and that includes secondary infection as well. If that is one of the complicators, yeah.

Dr. Alex:

So if you've got a dog that's coming to see you in the clinic, then Dr. Jeff and you're suspicious that they're allergic, what kind of steps are you taking? If we're thinking now about diagnosing and getting to the bottom of that problem as quickly as we can, first of.

Dr Jeff Werber:

All, again, the location of the lesions will tell me a lot, certainly fleas. When I kind of go against the grain, the hair by the rump of the tail, and I see either fleas or flea, dirt or just that allergy, just that area being showing signs of allergic dermatitis, it's almost to me, it's like that big sign on the moon that says, we were here, fleas were here. We just know. I just got to find them. And people say, no, they don't know fleas. And I'm looking, painstakingly looking and looking, and sure enough, I find them. I say, I told you it's great there, isn't it?

Dr. Alex:

When you bring that, you get that flea comb. I always say, actually, the flea comb is one of the most useful pieces of equipment I have in my concert room. It's pretty basic, but it does the job.

Dr Jeff Werber:

So that's one thing, obviously, is it seasonal or not? And I often say this, if the allergy goes away during the non seasonal months, then clearly it's a seasonal allergy if it's there the whole time. And I still suspect allergy. Now I'm looking for something around the house. I'm looking for some household allergen that's there. You don't take the carpets out during the winter, right? You don't change the bed, the blankets, or the wool or the feather pillows during the winter. So they're there all the time. So if the allergy is there all the time, now I'm taking something more home, environmental. Because again, during the winter here, we don't have a big flea problem. I mean, yes, you can get occasionally will, but it's not a big flea problem. And of course the pollens change. So just the history to me is one of the best techniques, forms of coming to an accurate diagnosis. Now, how about testing? So if I based on my history and the clinical presentation I am now suspicious of some sort of allergen out in the environment, whether it's home allergen or outside allergen, like the pollens and the grasses, weeds, trees, et cetera, then I might recommend allergy testing. And allergy testing used to be much more of a challenge for us general practitioners than it is now, because you had to do the scratch testing, still probably the gold standard, but you have to keep the allergens have a shelf life. We don't test that many, whereas the allergists do the dermatologists. So you end up throwing them out and you got to really get good at reading them. And the best way to get good at reading them is do a bunch of them. But if you don't do a bunch of them, you'll never get good at reading them. And then it's a wasted test. So now with the blood testing, where they're doing serum testing, we're told that it's not quite as specific or sensitive, but it's not bad and it's a lot easier to do. You do not have to have drug withdrawal before you test them like you would with the skin testing. So it's much more convenient. And clients like it because you draw the blood, you send it off and you get a really cool report with all the scores. And then you can make up the allergen, the antigen testing, I mean, the antigen treatment based on the results of that test. But here's one thing I always tell my clients. I let them know what the point of this test is. The point is that we are trying to identify the allergens so we can desensitize or hyposensitize more accurately. And if you are not willing to commit to those daily sublingual drops, those are drops under the tongue or the injections, which start fairly frequently and then spread out over time, then don't do it because, yeah, you might be able to identify something around the house. Oh, my God. You got to get rid of all the feathers. You got to get rid of all the house dust, all the house dust, mites, tobacco, stop smoking, maybe, and then it's worth it. But if you're not going to commit to the desensitization hyposensitization, it costs a lot of money as a test if you're not going to do anything about it. So I have that discussion with my clients if they are ready to go for it. We're doing it, Doc. We're doing it because we got to help Bowser, then I'll recommend that some dogs respond so well, especially to some of the newer treatments we have that are much safer and much more specific, that if I could give maybe two months of treatment during July and August, and that takes care of them for the whole year, then we're good. Why go through the craziness of everything else? So this is where the educating the pet parent and really having a discussion with them plays a major role in what decision they will make and what options I will offer.

Dr. Alex:

Yeah, it's important. I think that's a fantastic mantra and one that I live by with any test that I do is if it's not going to change what we're going to do, then why bother? Because I think especially with allergy testing and with the blood test or the intradermal tests, if we're going down that route with a dermatologist, it lets us know what the biggest allergy things in the environment are. And there's normally a number of them. It's not normally just one, is it? But also you will have dogs that actually do not have allergic skin disease who come up positive. So it's important that we've been through a lot of these other things that you've spoken about before. We just jump to itchy. Dog draw blood, right?

Dr Jeff Werber:

Exactly. Totally true. And that's how I feel. It's usually not my very first line of defense. Sometimes it's almost like getting the client to try some other things, especially if there's no success and we finally say, look, do you want to subject your poor dog? I mean, it's actually an easier sell, if you will. Now, it was easier then when the alternatives were Atopica, we talked about a little bit or Prednisone or Prednisone, which have side effects. They're not the best drugs to keep a dog on long term. So if you can teach them to do what your allergy doctor would do for you and that's hyposensitized, then it makes a huge difference. So that's kind of how I feel. Anything else we want to talk about as far as identifying making the diagnosis before we talk about treating?

Dr. Alex:

Well, I guess because when we think of some of those complications or some of the other things, I guess just mentioning what other tests we've got. So we've got like our tape prep skin scrapes looking great.

Dr Jeff Werber:

So the complicators, as I said, will be skin related problems secondary to the allergy. And for then to identify certain bacteria, if there are lesions, we could do impression smears we can see. Are there certain bacteria that we can identify? That also helps us choose the appropriate antibiotics based on are we seeing gram negative rods? Well, most cephal sporens are good, except nowadays, because of mistakes that we've all made over the years, I'm seeing grand negative rods that are resistant to everything except maybe amicasin. So it's really tough. We've created our own monster, really, when it comes to the inappropriate use of antibiotics over the years. Of course, that skin scrapings we want to rule out mange. A lot of dogs, for example, immunosuppressed dogs who might have demodectic mange, back when I graduated school, that's a long time ago, let's just leave it at that. We used to say about 50 60% of dogs had the demodectic mage mite in their skin. Now it's 100%. And when I tell people to really freak them out, that many people have that mite living in our eyebrows. It peacefully coexist that you don't even know it's there. And in most cases the same thing with demodectic veins. But in cases of inflammation, immunosuppression, stress, anxiety, having a dog going through heat, a mama dog having puppies, right then we can see demodectic veins flaring up. So of course we want to take that. If there's intense itching now we have to think of scabies. And again, especially we see it more in young dogs. And that one I always tell people, be careful because that one can live on you now. It pretty much can't reproduce on you. It might be a couple of weeks of irritation and annoyance, but it'll ultimately resolve. But I've gotten it once or twice. Ringworm fungal infection also a complicator and linked often to the immune system. Dogs that go inside playing in mud. Depending on where you live, you can have these fungal. In certain parts of the United States, we see a lot of fungal disease. So here are some of the other conditions that just complicate. What would otherwise one would think, oh, allergies, no problem, but here's a pill, let's treat them. Not so fast, not so fast. It's not that easy.

Dr. Alex:

It would be nice if it was though, wasn't it?