From Flares to Everyday Care: Managing Allergic Dermatitis

This episode is sponsored by Ceva Animal Health.

Many allergic dogs that start off seasonal don't stay that way. Without effective intervention, a few itchy weeks each year can become a year-round problem, and how closely a patient's flares follow the calendar depends heavily on where that patient lives.

In this episode of The Vet Blast Podcast, Brittany Lancellotti, DVM, DACVD, of Veterinary Skin and Ear in Los Angeles, California, and host of the Your Vet Wants You to Know podcast, joins host Adam Christman, DVM, MBA, to discuss how general practitioners can prepare for allergy season. Topics include how allergy seasons vary by region, how to stock an owner's at-home topical toolbox before a flare, and why cytology is the clinical pearl that has most improved her patients' outcomes.

Below is a partial transcript, edited lightly for clarity.

Adam Christman, DVM, MBA: Do different areas of the country have different allergy seasons or no seasons at all? And how predictable is this for any given patient?

Brittany Lancellotti, DVM, DACVD: I love this question, and you and I are in very different parts of the country. In Los Angeles, we have plant allergens like grasses, weeds, and trees. They're blooming all year round. We're also loaded with dust mites here, so these allergens are going to cause problems regardless of the season. Now, I grew up outside of Philadelphia and lived in New Jersey for a few years, which…is where you are. I worked at The Animal Medical Center in New York, and so my colleagues in the Northeast US and other climates where there are dramatically different seasons will certainly be able to attest that they see a lot more flares in the spring and the summer when there's a significantly higher pollen burden, when plants start to bloom, and those grasses start to grow. But I think it's important to remember that each patient is an individual, so we shouldn't forget to look at a specific pet's allergy history to pick up on patterns, and then ask the owner for insights into their observations as well. I think those things—the history and that client communication—really allow us to be more proactive and successful in our management strategies.

Christman: I had clients who, when football season came, actually had it on their calendar that said, “Atopy season is coming.” I just love how pet owners are so much more proactive with this, because they really will stock up or get ready. What does that look like on your end?

Lancellotti: A lot of this goes back to their history, and that can help us to educate the owners on what to watch for. It's certainly going to depend on the individual, but it usually includes a lot of topical therapies, things like shampoo, mousse, wipes, [and] pipettes, that may or may not be antimicrobial but certainly focus on barrier repair. For dogs with allergic otitis, maintenance ear flushing can also help to adjust the pH of the ear canal or remove cerumen that is going to be a good medium for bacteria or yeast to grow in.

I oftentimes will ask owners how often they're going to be able to bathe their dog rather than telling them, “You have to bathe your dog X amount of times per month.” And that gives me an idea of what they're capable of. Most allergic dogs do very well with bathing every 1 to 2 weeks, but bathing frequency or other topical therapies can definitely be increased during seasonal flares. I think a lot of pet owners have this misconception that they shouldn't overbathe their pet. A lot of the products that we have nowadays are specifically designed to be moisturizing and restorative to that skin barrier, so we can increase the frequency of bathing as often as we would like to help physically remove allergens from the surface of the skin.

I'll also use a lot of topical anti-inflammatory therapies…most often soft steroids like hydrocortisone or mometasone, rather than the more potent topical steroids like betamethasone or triamcinolone, so that I can minimize some of those steroid [adverse] effects of the skin with longer-term use. And the owners get very specific instructions on how to utilize those tools during flares, so it's in their toolbox. They don't have to use it all the time, but it's there if they need to reach for it, so they don't wind up in the emergency [department] at 2 o'clock in the morning. That can help us get that inflammation under control quickly before it progresses to a secondary infection, which then requires us to potentially reach for antibiotics that we need to be a lot more judicious about.