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Doc Sara
Doc Sara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 952
Experience:  I am a dog and cat veterinarian with a lifetime of experience in our family veterinary hospital.
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Itching and rubbing nose and muzzle. We have treated /mites,

Customer Question

Itching and rubbing nose and muzzle. We have treated for flee/mites, antibiotics for skin, lotion for yeast, many food trials and currently using a vet nutritionalist UCD diet 2 ingrediants with supplements and omega oils. Probiotics, bathing, allergy t
Blood tests....and still he itches. My vet says that we should either use temeral p or zylkene. I am soooo anti steroids and also hate to bandaid symptoms as the cause is not addressed. Any smoking gun you can suggest I try before a course of steroids?
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.

Has the new cytokine antagonist oclacitinib (Apoquel) been discussed with you? Such facial pruritis is pathognomonic (specifically indicative) of either atopy or food intolerance. Food trials appear to have ruled out food intolerance. Atopic allergy testing results weren't posted. Was anything found to which a desensitizing serum could be produced and you would then initiate either sublingual or injectable therapy ("allergy shots")?

Oclacitinib works as well as do corticosteroids but without their adverse side effects. It's a selective inhibitor of proteins important in signaling a pathway that results in itching and inflammation. By inhibiting these enzymes, cytokines that result in inflammation and itching active in allergy are halted. The drug is FDA-approved for canine allergic dermatitis including flea saliva allergy, food allergy, atopic dermatitis and contact dermatitis.

Please respond with additional information and further questions or concerns if you wish.

Expert:  Dr. Michael Salkin replied 1 year ago.
I'm just following up on our conversation about Jack. How is everything going?
Dr. Michael Salkin
Customer: replied 1 year ago.
I have heard of Apoquel. However I am looking for non steroid treatment and Apoquel has a steroid component.
Expert:  Dr. Michael Salkin replied 1 year ago.

No, oclacitinib (Apoquel) is neither a steroid nor an antihistamine. It's classified as a cyclohexylamino pyrrolopryimidine.

Customer: replied 1 year ago.
Understood, I appreciate your suggestions.i may look into after it's been used a few years. I have heard good and bad. I want to reduce his licking/ irritation on his mouth so that the eczema can calm down and heal. I am thinking very benign topical products like cocanut oil that will not hurt him if licked and ingested. Thanks for your feed back.
Expert:  Dr. Michael Salkin replied 1 year ago.

I'll opt out. Please don't leave a rating or respond to me - either of which will dissuade other experts from entering our conversation. Please edit your question to say "I'm looking for a naturopathic vet for my dog who is itching..."

Expert:  Doc Sara replied 1 year ago.

Good evening, I'm Dr. Sara. I'm a licensed veterinarian who works exclusively with dogs and cats and have extensive "real world" experience treating allergic disease in dogs.

I understand your reluctance to use steroids and applaud your efforts to learn as much as you can about your pet's condition before making a decision!

I will second the notion that Apoquel is not a steroid. Keep in mind that even though it is new to the commercial market, it has been used for many years (as far back as 2010) by veterinary dermatologists with great success and very few side effects.

You also didn't mention Atopica (modified cyclosporin) - which is another allergy maintenance medication. I have used this medication with quite good outcomes over the past 8 years, however I do see a fair bit of GI upset with it, especially in the first few weeks. It also is usually double the cost of the Apoquel, now that it is available, so I'm using less Atopica and more Apoquel lately.

Allergen specific immunotherapy can also decrease the symptoms of allergies over the long term, and it's not technically "medication" but rather a controlled and gradual introduction of allergens to the immune system in an attempt to dampen the allergic response. Typically a precise allergy vaccine is tailored to the individual pet using their intradermal (skin) or blood allergy test results, however there is a product called Respit that takes the most common allergens in a geographic area and puts them into the vaccine. This eliminates the need for allergy testing BUT it can decrease the effectiveness if the pet is allergic to something other than what's "common" that is included in the vaccine.

In discussing local treatment of any area, we could consider topical steroid creams or leave ons like Resicort, although they may lead to just as much systemic steroid absorption as giving the steroid by mouth because it's more likely to be ingested.

I'll also opt out here so that if we have an expert well versed in naturopathic treatments, they can add in their thoughts.

~Dr. Sara

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