Original Question: This message is directed to Clayton. My dogs are patients at your clinic I moved there because of you. I was disappointed when I found out that you have moved on but congratulations it was a well-deserved appointment and we still listen to you every Saturday on 1010. The reason for this question is that our 4-year-old Toy Poodle was so itchy that she was chewing large chunks of hair out. At your suggestion we agreed to do the Spectrum Labs Allergy. After reviewing the results you put her on Vanectyl-P tablets and 1/2 tablet of Benadryl in the evening. The combination worked well and her itchiness had gone down that could be expected for any dog. As you warned us she would put on weight and she went from 6 lbs. to 8.5 lbs. That was way too much weight for a little dog and affected her day-to-day activities. I met with another vet and she put her on a diet and changed her medication to 1/2 tablet of Apoquel. The diet worked and she is holding at 6.5 lbs and I weigh her weekly and she has her energy back. When she switched over to Apoquel she was on a full tablet once a day for 2 weeks. She wasn’t anymore itchy than she was on Vanectyl-P. Once we switched to 1/2 a tablet the itchiness came back not to the point of pulling hair out but it is constant. Another vet suggested that we take her off of the diet food and try a Potato and Duck. She put on 1/2 lb. in 2 weeks and continued to scratch. Needless to say we put her back on the diet food and she lost 2 oz. in the first week. Have there been enough studies on Apoquel to increase the dosage to a full pill (3.6 mg) each day? With all the travels to conferences you have been attending over the past year have you found another product that we can try? - Bruce
Thanks for your question.
I remember you well. Yes I have moved on from active practice in that capacity. It was prompted by some changes that occurred within my family, which was unexpected. It was and has been a difficult transition because I’ve always cared a great deal for the patients and clients that I was serving.
I try to avoid direct discussion on medication and dosage because of licensing regulations and the simple fact that I have not examined your dog recently. But I can share some general advice on allergy treatment.
Apoquel has good success but like any drug, some dogs will have a less than ideal response to it. You can keep them at the higher dose but it would be ideal to achieve control of the allergies on the lower dose, which is considered the ‘maintenance dose’. So in order to achieve that, we could consider the addition of another simple treatment that might lower the reaction intensity to allow that reduced dose to work.
You could start an antihistamine again and the clinic can provide you with dosages and instructions for use. Once she’s on it for at least 10-14 days, you can try again to reduce the Apoquel dose and see if the condition is controlled with that combination. Another option is to start using an antipruritic, antibacterial bacterial shampoo for dogs and bath her every other day for a week, then twice a week ongoing. I really like this idea because there’s a possibility she may not only have allergies, but also a secondary low-grade bacterial skin infection which is very common. It would also explain why the dose of Apoquel is not sufficient because some of the scratching could be due to infection which the Apoquel would not be able to treat and therefore explains the failure of it.
The diet change was a good idea as a trial but it is very difficult to confirm its value and determine which food would actually help. A diet change would only help if your dog has a food allergy, which I suspect it is because it sounds like it is year round. The choice of duck and potato was likely driven by the results of the allergy testing. Keep in mind that allergy testing is a good guide and can work incredibly well in a patient but then there are cases where you follow it and there seems to be no response. I likely discussed that fact to a degree if we spoke about the value of the allergy testing. So you could try another food but it could be hit or miss and it will be a trial, so you have to assess how well it works. Regardless of the allergy testing results, you could try a hydrolyzed protein diet for dogs, which is an anti-allergy food not because of the ingredients but because of the processing it goes through. This would likely be a good option if you wanted to try another diet change. I don’t want to name specific products in my answers so if you wanted to try it, you would ask your veterinarian for a ‘hydrolyzed diet’ and they’ll give you their recommended option.
These suggestions are likely a good start and I hope they achieve some success. I would recommend you also inquire about supplements for dogs with allergies which you could start administering that may help. These would be omega-3 fatty acid products that you give orally, or better yet, inquire about a topical one that I have often seen yield great results. If you ask about a topical omega-3 supplement that you administer directly onto the skin, your veterinarian will know the products to recommend.
Sorry I’m not able to be there taking care of this for you.
Dr. Clayton Greenway
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