How Often Should a Dog with Chronic Skin Allergies be Re-evaluated by a Specialist or Advanced Practitioner

Excessive scratching, licking, rubbing and/or skin infections are signs that your dog is itchy. When our pets are suffering with chronic skin allergies it can cause a lot of worry and stress, especially at the beginning of treatment. Planning for reevaluation appointments, further treatment and testing can help you stay on top of your dog’s condition.

In this article we’ll cover:

• Why Do Dogs With Chronic Skin Allergies Need To See A Specialist Instead Of A Regular Vet?

• Signs A Dog's Skin Allergy Is Worsening And Needs A Visit to a Dermatologist

• How Many Times A Year Should A Dog With Chronic Skin Allergies See A Dermatologist?

• What To Expect During A Dog's Allergy Re-Evaluation Appointment

• Questions To Ask A Veterinary Dermatologist During An Allergy Follow-Up

• Long-Term Management Plans For Dogs With Chronic Skin Conditions

• General Veterinarian Vs Veterinary Dermatologist For Chronic Dog Allergy Management

• Frequently Asked Questions

Why Do Dogs With Chronic Skin Allergies Need To See A Specialist Instead Of A Regular Vet?

The decision whether to see a vet with additional training in dermatology, either an advanced practitioner or specialist, will often depend on how severe your dog’s allergy is, how frequently it flares up and how well managed your dog is.

If your dog’s symptoms are not controlled and it is licking, biting and scratching then you may well benefit from seeing a dermatologist.

It may be that your dog is getting recurrent infections relating to the allergies. Perhaps the feet continue to be a problem and it is biting or licking them. Perhaps the feet get recurrent infections or swellings, called ‘interdigital cysts’.

Very often recurrent ear disease is seen with allergies in dogs and this can be very hard to control and sometimes very nasty infections can take hold that need the help of a dermatologist.

Whatever the reason, allergy is a lifelong problem and successful management requires a thorough diagnostic work up and tailored treatment plan.

“Allergy in dogs is the most common problem we see. It’s the bread and butter of a veterinary dermatologist.” Dr Simon Want BVM&S CertVD MRCVS

Signs A Dog's Skin Allergy Is Worsening And Needs A Visit to a Dermatologist

If you notice the following signs it may mean your dog’s skin allergy is getting worse. You should consider visiting a vet dermatologist if they have:

• Recurrent ear infections

• Ear infections that won’t clear up

• Uncontrolled itchiness - biting, licking, scratching and/or rubbing

• Recurrent skin infections

• Recurrent or persistent foot disease

• Swellings between the toes that either won’t go or keep coming back - sometimes these cause pain and lameness

You can contact us to book an appointment. For skin allergy in dogs you don’t need a referral from your vet. We can evaluate your pet and then re-evaluate once treatment is underway.

How Many Times A Year Should A Dog With Chronic Skin Allergies See A Dermatologist?

How often your dog should see their dermatologist depends on how well controlled your dog’s allergy is, but also if your dog falls on the mild side of the spectrum or the more severe side. All dogs react differently to their allergy and some more severely than others.

Not all dogs respond to all medications. Initially you may need to be seen every few weeks during the investigative phase and this will gradually extend. If your dog receives monthly injections you may need to visit your own vet or consultant dermatologist monthly.

Eventually you may be seen every 3 to 6 months and this may be a combination of your own GP vet and your dermatologist. Even with very well controlled dogs they can get flare ups of the condition that may require unscheduled visits to your vet.

What To Expect During A Dog's Allergy Re-Evaluation Appointment

After the initial appointment and work up is over, you are then in the process of re-evaluation appointments and so the amount of work tends to decrease.

At each appointment you can expect a conversation to find out how your dog has been getting on and if there have been any flare ups. A full skin and ear examination will take place. If any areas of skin, feet or ears are affected your dermatologist will check samples under the microscope to check for infections.

The current treatment will then be evaluated to see if it is being effective enough at controlling the underlying allergies. If there is a flare up that requires specific short term management that will be dealt with at the same time.

Find out more about what to expect during a pet skin specialist appointment.

What is the Frequency of Blood Work and Diagnostic Testing During Allergy Re-Checks for Dogs?

Generally speaking you would not expect to repeat allergy blood tests. However, some medications may require periodic blood tests to make sure the medication is not causing any unforeseen complications. This may be between 6 monthly and yearly.

Questions To Ask A Veterinary Dermatologist During An Allergy Follow-Up

Pet owners should have good, honest conversations with their vet about how well they feel their dog’s allergies are being managed. Sometimes there can be a number of different dog skin allergies remedies and therapies involved and you should talk about whether you can manage all of the therapies, how well your dog is tolerating treatment and if a change of strategy is required.

Ask if you need to know how to use a certain medication. How long should you leave a medicated shampoo on before you rinse it off? Could someone show you how to effectively clean your dog's ears?

If your pet is still licking or scratching, does it have a secondary infection, a new parasite or do you need something else to settle the primary allergy? Has your dog developed a new allergy that maybe requires a repeat of a previous test? Perhaps a food allergy is now present that wasn’t there before. You may then need to repeat an elimination diet trial.

Make sure everything you need to do at home is written down.Repeat visits are an opportunity to fine tune treatment plans and are seldom wasted time.

Long-Term Management Plans For Dogs With Chronic Skin Conditions

During the initial phase of diagnosing allergies in dogs we would hope that your dog was placed on an elimination diet trial. This often requires a hypoallergenic diet for 4 to 6 weeks and then subsequent challenge. This important step is often overlooked, although it shouldn’t because:

• 10% of allergic dogs will have food allergy exclusively and this would mean no medication.

• 50% of allergic dogs have allergies to common things in their environment from house dust mites in the home, storage mites in their food and/or pollen and this would require long term medication. Environmental allergies are often known as atopy or atopic dermatitis.

• 40% of allergic dogs have both food allergy and environmental allergies.

Therefore, a special diet may make up a component or be the only treatment required to manage your dog’s skin allergies.

If environmental allergies are part of your dog’s problem then anti-allergy medication may be required long term. Once environmental allergies have been confirmed by ruling out other causes of your dog’s itchy skin disease then an allergy test may be performed. This will be in the form of a blood test and/or a prick test of the skin performed under sedation, known as an intradermal skin test.

This can lead to the production of immunotherapy, or ‘allergy shots’. These injections are administered under the skin usually every 4 weeks. If they work this may be required for the lifetime of your dog.

Other medications include tablets or oral liquids. Topical therapies such as shampoos, sprays, foams and wipes.

Your dog will require a tailored treatment plan dedicated to its allergies. It’s rare that any two dogs are treated the same.

General Veterinarian vs. Veterinary Dermatologist For Chronic Dog Allergy Management

More often than not your home GP vet is an excellent generalist, just like your own GP doctor. They may have many skills and interests but sometimes dermatology is not one of them. Time is often limited in GP practice and a referral dermatology appointment may take 1 to 2 hours and involve a detailed exam and allergy testing.

When a vet performs surgery they do all the work, but when it comes to treating chronic skin conditions, especially allergic dogs, it is the owner who is doing the most work. They are managing the dog at home and administering the treatment, washing the dog and applying ear drops or cleaning the ears. This takes time and additional expertise and training and is one of the key benefits of seeing an advanced practitioner or specialist in veterinary dermatology.

Next Steps for Your Dog With Skin Allergies

Excessive scratching, licking, rubbing and/or skin infections are signs that your dog is itchy. The commonest cause of this is allergic skin disease. This can be atopic dermatitis (environmental allergies), food allergy or both. Parasitic disease must be ruled out and skin infections treated.

If your dog’s skin condition is recurrent, uncontrolled or getting worse and you’re not seeing improvement after seeing your GP vet then a referral or second opinion from a consultant veterinary dermatologist could be right for you and your dog.

If you need help diagnosing or managing a dog with itchy skin disease then you can contact us.

Get in touch

Frequently Asked Questions

How To Manage The Cost Of Frequent Specialist Visits For A Dog's Skin Allergies

We always try to manage these problems as cost effectively as possible but allergy in dogs is usually a lifetime problem and requires lifelong management.

The best way is to have pet insurance but this only helps if your pet was insured prior to it first presenting with itchy skin or ear problems. Lifetime cover is best as annual policies are time-limited to one year. After that you will be unlikely to obtain cover for this condition.

If you do not have insurance, start saving early on to cover potential vet bills, but people often underestimate how much will be required.

Many vets have health plans that reduce the costs by around 10% and these can be useful.

If your pet is on long-term medication and you are not insured you can ask if a prescription would allow you to obtain the medication at a cheaper price. You would still have to pay for consultations and diagnostics but this can reduce the cost in some circumstances.

How Many Rounds Of Immunotherapy Does A Dog Usually Need For Allergies?

This is a very common question. The truth is that allergy is for life and if immunotherapy works then it will need to be given monthly for the lifetime of your pet.

It can take a year or more to be fully effective so other therapies and dog skin allergies remedies​ will be required, especially in the first few months.

Finally, no medication will work in all dogs and in around 20% of dogs immunotherapy will fail to help. 20% will require nothing else as it works so well. The remaining 60% will show improvement but require it as part of a combination of therapies.

How Accurate are Dog Allergy Tests?

It is accepted that 10% of dogs who are allergy tested will have a negative test. The tests are not 100% reliable and some dogs do not test well. Perhaps they are allergic to something that is not currently available to test for. Maybe they have an undiagnosed food allergy.

The best tests are for atopic dogs. That looks at house dust mites, storage mites, pollen and animal dandruff.

Tests are available for food allergy but are not recommended by dermatologists. They always come back positive but do not match the dog in real life. This is probably due to cross-reactivity of food proteins. If your dog has eaten chicken it will be positive to all poultry and fish! Beef will cross-react with lamb and dairy. Only an elimination diet trial can diagnose food allergy properly.

However, a positive allergy test to mites, animal skin or pollen is necessary to make immunotherapy vaccines, specific to your dog, and is the only treatment we know of that can safely alter your dog’s allergy.

Sources and References:

• Favrot, C., J. Steffan, W. Seewald and F. Picco (2010). "A prospective study on the clinical features of chronic canine atopic dermatitis and its diagnosis." Veterinary Dermatology 21(1): 23-31.

• Olivry, T., D. J. DeBoer, C. Favrot, H. A. Jackson, R. S. Mueller, T. Nuttall, P. Prélaud and f. t. I. T. F. o. C. A. Dermatitis (2010). "Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis." Veterinary Dermatology 21(3): 233-248.

  
  

Written and Approved by:

Dr Simon Want BVM&S CertVD MRCVS

RCVS Advanced Practitioner in Veterinary Dermatology

Director of Advanced Veterinary Dermatology Ltd