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Topical therapy and immunotherapy can save time and frustration with dermatology cases


Joya Griffin, DVM, DACVD, shares advice on managing the itchy dog

Content sponsored by Nextmune

Dermatology cases can be challenging and time-consuming for the general practitioner. Joya Griffin, DVM, DACVD, and star of Pop Goes the Vet on Nat Geo WILD, joined a recent episode of dvm360 Live!™ to share her approach with these patients.

Note: the conversation below has been lightly edited for brevity and clarity.

Adam Christman, DVM, MBA:How prevalent are allergies in dogs and cats?

Joya Griffin, DVM, DACVD: Skin disease and ear disease are probably 50% of what a general practitioner is going to see on a daily basis. Of those cases, around 25% will have allergic disease, and in my experience, it’s way higher than that.

Christman: We know about the dermatologic database, and we know how important that is, but how can we truly diagnose the allergic dog or cat?

Griffin: It’s a process, and I think that’s something that clinician and pet parent must be involved with together. Atopy or allergic disease is a diagnosis of exclusion, which means that we have to rule out parasitic conditions and food, and we have to deal with the secondary infections before we can get to the diagnosis of allergy. Then we create our multimodal approach so that we can figure out the best care for each patient.

Christman: Can you tell me a little about immunotherapy and how successful it can be?

Griffin: Immunotherapy is probably my go-to way to treat my allergic patients because it’s drug-free and it’s actually getting to the root of the cause. It’s working to decrease that allergic flare through the immune response, so I love it. Many of my patients are dogs that are the worst of the worst: They have already tried all of the anti-immunoglobulin E medications and they haven’t been successful. In my experience, immunotherapy is 70% to 75% effective in reducing a pet’s allergic symptoms, preventing that continuous flare up and making them better over time.

Christman:What about Nextmune’s serum allergy testing?

Griffin: Serum testing is great. You can also do intradermal testing. Once you identify those allergens, we use them to create the immunotherapy for that pet. It’s a personalized, individualized vaccine. No 2 vaccines are the same because every patient is different. That’s how it works so well, because it’s for that pet.

Christman:Can you tell us about testing for food allergies?

Griffin:It’s still fairly controversial. We are working to try to validate these tests, and the best thing to do right now is an elimination diet trial. You need to remove what the pet is currently eating from their diet and then put them on something new and see if the symptoms and itching improve over time.

Christman: It takes time, and then when we have patients that have otitis externa or media, for instance, and a lot of pet owners may not understand that it is related to allergies.

Griffin:Yes, I always say the ear is a glorified tube lined with skin. Anything that affects the skin can affect the ears. And in fact, ear disease is one of the first symptoms of early allergies. So if you have a dog that had otitis several times before the age of 1, that is a predisposing factor for developing environmental allergies down the road.

Christman:Talk to me a little bit about the importance of bathing.

Griffin:I think that a bathing routine with topical therapy for any allergic animal is so important. It’s about that barrier function of the skin, and we need to restore that. We need to remove allergens from the skin and prevent infection.

Christman: What is the contact time required for Clorexyderm (Nextmune) products containing 4% chlorhexidine?

Griffin: Five minutes. Bathing dogs is labor intensive, and that’s what is so nice about Nextmune’s product line. They have mousses and sprays, and I really choose what fits with each patient. A client may not be able to bathe their pet once or twice a week like I want, but maybe applying a mousse will be manageable.

Christman:That makes sense for certain clients, for instance, those with rheumatoid arthritis or pet owners with very large dogs.

Christman:How often do allergy patients have secondary skin problems?

Griffin:At some point, all of my allergic patients will have a bacterial infection, if they’re itching a lot and/or have a lot of inflammation on their skin. It’s really important to try to prevent that, and the bathing and topical therapy are paramount for helping with that.

Christman: What advice would you give to the general practitioner frustrated with their dermatology cases?

Griffin:Those cases are tough and they do take a lot of time. That’s where your friendly neighborhood dermatologist can come into play. However, it’s really a multimodal approach. You have to individualize it for each patient, reduce the allergic flare, and put the itch out. So if you have something that you can utilize to help make them more comfortable, of course, we always need to do that. Topical therapy is a big piece of the puzzle that I think sometimes is missed.

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