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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 24410
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My 5 y.o. male Labrador has been getting short or breath

Customer Question

My 5 y.o. male Labrador has been getting short or breath with any physical activity, red bumps on his abdomen with scratching and licking as he would if flea infested,( but he isn't) for the last three weeks with symptoms worsening. He had his usual flea
pill changed last month and was given bravecto for the first time. Could this medicine be causing his symptoms? if so, is there an antihistamine I can give him?
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.

Here is the pertinent data concerning fluralaner (Bravecto) for you:

  • In Beagle puppies treated at 1x, 3x and 5x the maximum recommended dose (= 25 to ~60 mg/kg bw) three times with a 56 day interval, fluralaner was well tolerated. There was no evidence of product-related effects in food consumption, body weight, clinical parameters or physical examination variables, or clinical pathology findings.
  • In a pivotal reproductive study Beagle dogs were treated up to 3X the recommended dose 3 times at 8 weeks intervals starting 12 weeks (males) and 4 weeks (females) before expected mating. Treatment continued until the females had whelped (males) or the puppies were weaned (females). No adverse reactions were observed in adult dogs and no detrimental effect on reproductive functions, number of puppies and puppy survival was detected.
  • Safety data collected during field studies in Europe and the USA showed that the product was in general well tolerated. In the European field study mild and transient diarrhea, vomiting, lack of appetite and drooling were recorded in 1.6% of dogs in the first days after treatment.

According to that data, I wouldn't incriminate his skin condition nor his shortness of breath to Bravecto although I can't rule out an idiosyncratic (peculiar) reaction. The red bumps are likely to represent pustules of a superficial spreading pyoderma - bacterial skin infection - which is commonly seen secondary to an allergic dermatitis. His shortness of breath is a nonspecific symptom of systemic illness as well as both cardiovascular and lower respiratory disorders and should prompt having Kodiak's vet take a look at him. To answer you directly, yes, an over the counter antihistamine such as diphenhydramine (Benadryl) at a dose of 1-2 mg/lb every 8-12 hours (maximum dose of 50 mg at any one time) has been suggested for reducing the pruritis (itchiness) associated with allergic dermatitis. Studies have shown, however, that these antihistamines are effective in less than 10% of these dogs.

Please respond with further questions or concerns if you wish.

Customer: replied 1 year ago.
Thank you for the information. I will indeed take him for an evaluation. Is there a better tx than antihistamine for the itching, scratching for dogs?
Expert:  Dr. Michael Salkin replied 1 year ago.

You're quite welcome. Addressing the pruritis is best done by addressing the underlying etiology of the pruritis. That might be done with a systemic corticosteroid such as prednisone, the new cytokine antagonist oclacitinib, or a systemic antibiotic. Please take a look at my synopsis of the pruritic dog and you'll see that this might not be straight forward..!

Pruritic (itchy) dogs are suffering from an allergic dermatitis in the great majority of cases. Allergies to flea saliva, environmental allergens (atopic dermatitis) such as pollens, molds, dust and dust mites, and foods should be considered. (Paw and extremity licking indicates both atopy and a food intolerance and so it behooves vets to distinguish one from another.) In many instances, a concomitant pyoderma (bacterial skin infection), yeast infection (Malassezia), or mange mite (Demodex or Sarcoptes) might be contributory.

Kodiak's vet can check a sample of Kodiak's skin surface microscopically (a “cytology”) for abnormal numbers of bacteria and yeast and skin scrapings can be taken in an attempt to find mites. Pyoderma is treated with a minimum of 3-4 weeks of an antibiotic in the cephalosporin class such as cephalexin (Keflex) and yeast is addressed with ketoconazole for at least a month.

Our dermatologists tell us to apply an effective over the counter flea spot-on such as Advantage, a fipronil-containing product such as Frontline or one of the newer prescription products available from Kodiak's vet even if fleas aren’t seen. Dogs can be such effective groomers so as to eliminate all evidence of flea infestation. Dogs who remain primarily indoors can contract fleas because we walk them in on us and flea eggs and larva can remain viable in your home for months. As the weather warms at this time of year, egg hatches are common. In severe cases, an anti-allergenic prescription glucocorticoid such as prednisone will work wonders for dogs allergic to the saliva of the flea. If you have other pets they may have fleas too but may not be allergic to the flea’s saliva.

Environmental allergies are usually initially addressed with prednisone as well. In some dogs an over the counter antihistamine such as clemastine (Tavist) at a dose of 0.025 - 0.75mg/lb twice daily or diphenhydramine (Benadryl) dosed at 1-2mg/lb twice daily may be effective. Antihistamines, however, aren’t reliable. Adding fish oil to the diet at a dose of 20mg/lb daily of the EPA in the fish oil might synergize with antihistamines to provide better anti-pruritic action. The omega-3 fatty acids in fish oil are antiinflammatory but may take 8-12 weeks to kick in. The new cytokine antagonist oclacitinib (Apoquel) is likely to revolutionize how we address atopic dogs and should be discussed with his vet.

Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Kodiak's immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from his vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra. (I prefer the hydrolyzed protein diets.) A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time.

We need to consider seborrhea in such a patient as well. This is skin disorder of keratinization and maturation. It's a diagnosis of exclusion of the above mentioned skin disorders and can be suggested by skin biopsy.

Please continue our conversation if you wish.

Expert:  Dr. Michael Salkin replied 1 year ago.
Hi,
I'm just following up on our conversation about Kodiak. How is everything going?
Dr. Michael Salkin