I get some great questions from clients. They inspire me with article ideas and keep me in tune with diabetic pet owners. I enjoy interacting with our readers, and sometimes the questions are worthy of a newsletter. I bet if one person has this question and takes the time to write me, there are likely lots of folks with a similar question. Todays question is about a Diabetic sweetie and her allergy issues.

My sweet 10 year old miniature schnauzer has diabetes and severe allergies. Apoquel does not work, nor does the new shot Cytopoint. She is on a specialty diet and really likes it. I have tried changing her foods multiple times but she wouldn’t eat it. What other food should I try? She had food allergies before she was diabetic and changing her food really helped. Any suggestions would be greatly appreciated. Thank you!

How disappointing that neither Apoquel nor Cytopoint worked for your pet! Now as a refresher, the are 3 big categories of allergies for dogs and cats. There is atopic dermatitis, which is also referred to as atopy, environmental allergies or more simply “hay fever”. There is food allergy. And there are parasitic allergies, most commonly flea allergy. Flea allergy and atopy are the most common, particularly down where I live in tropical south Florida. Nonetheless, they must all be considered if you have an itchy pet!

Veterinarians usually try the holistic approach as much as possible when we have an allergic pet. This includes avoidance of the allergic trigger, weekly baths, omega 3 fatty acids, antihistamines and so on. Sometimes, despite these efforts we may yet still have a flare up of itch, a hot spot, or a secondary infection. Allergies can be extremely frustrating. At times we even run allergy tests on pets to determine what is triggering the itch. Allergy tests for environmental allergies have gotten pretty good, but testing for food allergy testing lapses behind. For food allergies we are usually left with an elimination diet. Yes, there are tests available for food allergies, but they aren’t as accurate as testing for environmental allergens.

I’ve been in the vet biz for a long time. For decades, we only had steroids as our rescue drugs when a pet had an allergy flare up. We still use steroids, but the use of steroids for allergic dermatitis has gone down in the last few years when a new drug, called Apoquel, came on the market. Apoquel is a cytokine inhibitor. Cytokines are proteins in our bodies that cause itch. I love Apoquel, and yet, I treat it with caution. Again, Apoquel has only been on the market a few years and we don’t yet know the long-term effects until we have a few more years worth of studies and reports of adverse effects, just as with any new drug. One fear is that it could increase the incidence of cancer over years of usage. I explain it like this: Our bodies have an amazing surveillance system. We make goofy cells all the time, but our immune system takes them out. If we suppress our immune system, for example with Apoquel, particularly if used over long spells of time, it might increase the risk of cancer cells in these pets. It’s a minor risk, but should be considered. I’d much rather have a pet on Apoquel than on steroids long-term. Or, we might use Apoquel on an alternating day dosage. And of course, since your sweetie is diabetic we should not reach for steroids.

What came next in the world of cytokine inhibition is fantastic – Cytopoint. Cytopoint came on the market earlier this year. I adore this drug! It is a monoclonal antibody that targets and takes out just one cytokine, but it is the most important cytokine for atopic dogs. I’ve had some atopic dog patients have phenomenal results on Cytopoint. I sometimes even use it as a diagnostic aid for itchy patients. If a pet become much less itchy after an injection of Cytopoint, then I know it has atopy. It might also have flea allergy or food allergy, but if it responds to Cytopoint, I know there is atopy involved. Cytopoint works only for atopy whereas Apoquel is broad spectrum and helps pets with food allergy, hay fever and parasitic allergy. Perhaps the best thing about Cytopoint is that it is a monoclonal antibody. Monoclonal antibodies are a very safe class of medication. Cytopoint can be used in puppies. It can be used in diabetics. It can be used if there is liver or kidney disease. We inject a dose into the dog at the vet clinic. The injection scavenges up the cytokine, and a single injection lasts for 4 to 8 weeks. I’m a huge fan.

Now, if your pet truly has allergies and yet did not respond to either Apoquel or Cytopoint, we need to consider reasons for treatment failure. Is there really an underlying allergy? Perhaps it is a parasite rather than an allergy. Are you certain there isn’t also a secondary skin infection as well such as a yeast or bacterial infection? Secondary infections can be intensely itchy and are a big cause of apparent failure of Apoquel or Cytopoint. Next, how often are you bathing her? A good oatmeal bath can help decrease the itch, and regular medicated baths may help decrease the incidence of secondary skin infections. Nonetheless, I’m guessing if she had food allergies in her past that food allergies may yet continue to play a role.

Diabetic dogs do well with a variety of diabetic foods. In general, since many diabetic pets became diabetic secondary to pancreatitis (schnauzers in particular are prone to pancreatitis), we usually suggest low-fat foods. I usually aim for a fat content less than 10 percent for most diabetic pets, for chubby pets and for pets with a history of pancreatitis. Lots of diabetic pets are also chubby as well. The low fat, high complex fiber nature is a good choice for diabetic dogs, but if she is itchy while eating we should consider a new diet!

Perhaps you should think back to what she was eating when her skin was in tip top shape! You said your vet diagnosed food allergy and that she improved on that food. How about feeding that food again? Or, if you know what the main protein and carbohydrate sources were of that successful diet you could make a home cooked diet with similar ingredients.

I think a chat with your veterinarian is in order. And perhaps a consult with a nutritionist or dermatologist.

Have a question or comment? Then post below! I always enjoy hearing from my readers!


NOTE: Consult your veterinarian first to make sure my recommendations fit your pets special health needs.

Dr . Joi Sutton

Dr . Joi Sutton

Dr. Joi Sutton is a 1993 graduate from Oregon State University. She has practiced both in emergency medicine and general practice. Dr. Sutton has done extensive international volunteer work though Veterinary Ventures, a nonprofit organization that takes teams of veterinarians to undeveloped countries for humane medical care. She also runs a small animal practice in South Florida.
Dr . Joi Sutton