Addressing allergy emergencies in dermatology

Christina Gentry, DVM, DACVM, assistant clinical professor at Texas A&M University’s College of Veterinary Medicine and Biological Sciences in College Station, presented a series of dermatology-focused lectures at the 2026 Veterinary Meeting & Expo (VMX) in Orlando, Florida; hosted by the North American Veterinary Community. In a dvm360 interview, Gentry discusses allergic reactions that lead to emergency situations as well as other dermatologic emergencies.

The following is a transcript of the video:

dvm360: When is an allergic reaction to a drug or any other dermatology therapy considered to be an emergency?

Christina Gentry, DVM, DACVD: For us, when we think about reactions, hypersensitivity reactions to insect stings can be emergencies, because there may be facial swelling, paw swelling and facial swelling could lead to difficulty breathing. You can also have anaphylactic type reactions. All of that goes outside the realm of dermatology, but the reactions that we are most interested in as dermatologist—what we're called in for—is specific allergic reactions that manifest as immune mediated skin diseases, so toxic epidermal neurolysis, Steven Johnson syndrome, and occasionally other presentations of immune membrane diseases such as pemphigus or crossover conditions of all the dermatology diseases, where the histopathology is kind of varied or confusing.

It's most likely to be a drug reaction, because it's like your body doesn't really know how it wanted to get upset. And so instead of just having one very concrete pattern that says it's definitively this, you may actually see crossover reactions of multiple immune diseases, and it'll clue you into that, because, you know, the dog was totally fine until recently, within usually a week or so, a new medication was added.

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dvm360: What are some other dermatology emergencies for veterinarians to consider?

Gentry: After drug reactions, the things that we also consider emergencies can be erythema multiforme. This is a disease that we actually once kind of put in the same group as toxic epidermal necrolysis (TN), but now we know it's separate. Unlike TN, where your body sends out signals where you should kill all your keratinocytes at once, erythema multiforme is a condition where your immune system decides to give individualized death hugs from your lymphocytes to your keratinocytes in the skin. So if you have enough death hugs, you're going to have enough keratinocyte death and have ulcerative skin disease.

This one is most often idiopathic, meaning it's not drug associated, just randomly occurs. It spans the spectrum. Some dog's disease goes very rapidly, meaning there must be lots of lymphocytes giving bad hugs. But in some patients, they come in [any] day to your practice, because they actually don't have that much skin affected, so that one kind of goes bell curve.

Another one to consider can be acute vasculitis. So if your vessels are not functioning properly or are clogged from an immunologic reason or a nonimmunologic reason, losing blood flow to body areas can certainly become an emergency.

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