Help! My Dog is Still Itchy! | Ask Dr. Joi

By |2017-04-19T15:02:30-04:00Updated: May 4th, 2017|Pet Care, Pet Newsletter|10 Comments

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. Let’s jump right in and talk about helping this itchy puppy!

Question: My dog, Katie, is going through that yearly scratching and licking phase. She is now taking Apoquel as she has had steroid shots already. My vet doesn’t want to keep giving her the steroid shots, so we have her back on Apoquel. It’s been a couple of weeks now and we haven’t seen an improvement. Now she is starting to howl because of the itchiness. How long should I keep her on the medication and what is the absolute amount she can take daily?

Answer: I’m assuming your pet is NOT a diabetic. It would be very unlikely that your veterinarian would give a steroid injection to a diabetic pet. I point this out as most of our newsletter readers have diabetic pets. Steroids are a known cause of insulin resistance, so we try especially hard to avoid steroids in diabetic pets.

Now, if Apoquel worked in the past and suddenly is not, there may be a secondary infection. You should take her to the vet to rule out infection. Typically vets will do a swab of the skin or tape prep cytology to look for yeast and bacteria under the microscope. Infections cause itch despite great drugs like Apoquel and Cytopoint. Sometimes simply taking care of an infection can alleviate the itch.

If it really is a seasonal allergy, there is a good chance it is atopic dermatitis (aka hay fever). I won’t give dosing advice as I’ve never examined your pet, but there is a brand new product out that works similarly to Apoquel and can be used with Apoquel for hay fever. Apoquel works within cells to prevent cytokines (messenger proteins in the body) from causing itch. Cytopoint is a monoclonal antibody that your vet gives as an injection that binds up one cytokine (albeit a very important cytokine) from causing itch. Cytopoint latches onto the cytokine extracellularly. And it is quite safe.

When she is itchy, do give her a bath. Bathing is very holistic and can really cut the itch. Use a non-drying shampoo like an oatmeal shampoo.

Also, let’s not forget the beauty of antihistamines. I’m a fan of Zyrtec which comes in an over the counter generic, cetirizine. It causes minimal drowsiness. If she is howling, get her back to your vet promptly to search for infection and to re-evaluate the game plan. At night time, consider the antihistamine, Benadryl (aka diphenhydramine), as it is known to cause drowsiness and can help her to sleep through the night.

Is she on omega 3 fatty acids? Fish oils have a subtle effect in the short term, but are definitely an aid for long term allergy management. And of course allergy testing is another option. Allergy testing has come a long ways in the last few years. Your veterinarian can pull her blood and send it to the lab which can test her for antibodies to various pollens and grasses and trees in your geographic region.

If the seasonal allergy occurs in warmer months, then we have to consider flea allergy. Parasites happen! Part of a good physical exam is to look for fleas or other parasites that are too small to be seen with the naked eye such as mites.

Have a chat with your vet and keep me posted!

Have a question or comment? Post below or email me at joi.suttondvm@adwdiabetes.com. I always enjoy hearing from my readers!


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

About the Author:

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.

10 Comments

  1. Nadine Dowland August 26, 2019 at 12:15 pm - Reply

    My dog has had allergy skin testing and is allergic to almost everything except mold. He has been on allergy serum under his tongue since last March and clemastine 2.68 mg one and a half tablets twice a day. However he had an extreme flare-up of something at the beginning of August and he’s on apoquel 5.4 mg twice a day and I was wondering if I should still give the clemastine that my vet said to give him the apoquel PRN and continue the clemastine . Everything I have read about apoquel is contradictory to give it PRN.

    • Dr . Joi Sutton October 19, 2019 at 10:12 pm - Reply

      Antihistamines aren’t nearly as potent as apostle for allergies, but there is no contraindication to using Apoquel and antihistamines together. Antihistamines are inexpensive compared to Apoquel, and antihistamines are also generally quite safe drugs. Some vets forego antihistamines once starting Apoquel, but I do not. All the tricks we had in our arsenal in the past (bathing, omega 3 fatty acids, antihistamines, redonyl, products to repair skin barriers, etc) are still helpful despite using Apoquel. Has your vet mentioned Cytopoint to you yet? I love Cytopoint for atopic allergy dogs. It is a similar drug to Apoquel but is an injection that lasts one to 2 months and there are no known side effects to Cytopoint.

  2. Rebecca | RestyledHomes November 9, 2019 at 7:19 am - Reply

    So, I believe I have a worst-case scenario here. My puppy is now 2 1/2 years old and I live in Southeast Florida which is filled with fruit bearing trees. At four months old my dog would have red itchy eyes simply from his morning walk. We have tried every shot, pills and combo out there. We also checked for skin infections & parasites. Currently Apoquel helps a bit. We feed him raw food which greatly helped his skin and gave him some relief for a few months. In time his allergies won. The 3 Vets we have seen say it’s FLORIDA 😞

    • Dr . Joi Sutton November 9, 2019 at 3:28 pm - Reply

      Rebecca, I also live and practice in south Florida (the other coast than you). Do you bathe your pet weekly to wash away the allergens? Have you tried Cytopoint (which can be used in conjunction with Apoquel)? Cytopoint is extremely safe and effective if hay fever. Have you tried a hypoallergenic diet? Have you speaker with your vet about products that help repair the skin barrier? Have you ruled out secondary infections such as yeast and bacteria? Have you had your pet allergy tested? Have you ruled out demodex? Have you considered referral to a veterinary dermatologist? These would be my next steps. Good luck to you! Joi

  3. Liz March 20, 2020 at 5:45 am - Reply

    I’m hoping you can help me. My toy poodle is 8. He’s been on 1/2 tablet 5 mg prednisone for 4 years for itching everywhere and often biting , licking tops of toes till no hair. He literally wore a cone 4 years with episodes of bandages on feet mostly the paw would heal and cone off for a while then all repeated. But his hair got quite thin on his chest. December he started chewing feet again. Vet prescribed Aloqueli thought for a while it worked. He seemed relaxed. He actually started playing more with my other poodle. But Jasper is Silver. Since mid December he has become a dark grey poodle with silver head and front legs. This is the apoque. He also commenced biting chewing all different places as though bitten by a flea. He has no fleas The groomer has never found fleas on them and we’ve never found a single flea inside. This week he licked a spot on inside front leg. Now cone back on so it heals. I fear the apoquel is not working. His dose 1/2 x 5.4 mg tablet once a day. I tried giving 1/4 alternate days to see if his coat changed back to silver but that’s when he chewed his leg.
    To add more issues he’s just been diagnosed with a heart murmur and now on Vetmedin twice a day. I’m losing the plot 8 years off this.

  4. Wanda May 29, 2020 at 2:10 pm - Reply

    Hello from SC. How much Zyrtec do you give a 70-73 pound dog? Thanks.

    • Dr . Joi Sutton June 7, 2020 at 8:01 pm - Reply

      A big dog can take 10 mg of cetirizine (Zyrtec) once or twice daily. Do chat with your vet.

  5. Jeanne Knudson August 17, 2020 at 11:17 am - Reply

    My dog has been on Apoquel for several years due to undiagnosed seasonal allergies. The first year I was able to stop the Apoquel in the winter but since then he has had to be on it year round. Admittedly, we have been having milder winters with little snow so the grass hasn’t been dormant as much. He is not responding to the Apoquel any more which is a common thing apparently for dogs in it long term. I tried Zyrtec on my dog and he attacked me after several doses. I see that irritibility can be a side effect. Not a problem with my 10 pound dog but I would be cautious using on a large aggressive dog. I have stopped using it, he was slightly better after three days but not significantly.

    • Dr . Joi Sutton August 22, 2020 at 9:21 pm - Reply

      Allergies can start as seasonal and then progress to year round.
      When a pet stops responding to apoquel or cytopoint (both meds are cytokines inhibitors) there is a secondary infection (bacterial or yeast). And of course your vet will look for less common things such as démodex.
      You might consider allergy testing and hyposensitization. Or a food trial.
      Sounds like you need a visit with your veterinarian. 🙂

  6. Nikki Ross September 20, 2020 at 11:02 pm - Reply

    I have a Pomeranian x chihuahua who has ear inflammation that flares up to become ear infections. He is a tricky little boy because he won’t let anyone touch his ears to do regular cleaning or even put ear drops in. He has become very paranoid and protective of his ears, obviously because he can’t tell us his ears are sore but he does have little tell tale signs I can pick up on. The vet prescribed him prozac which has helped calm him down and I havent been bitten for over 2 years now. When he first got the eat infections the vet would prescribe steroids which was only a bandaid solution and after many trips to the vet we have now got him on Apoquel but still gets the eat infections. When we go to the vet Junior has to be given a general anesthetic so they can check his ears properly and clean them and put osernic ear gel treatment when needed. We recently tried Cytopoint injection but there was no noticeable improvement. We have now started the elimination diet and were trying him on biscuits only Royal Canine Anallergenic biscuits but i could not give him his tablets with this. During the transition of foods i started giving him Zyrtec which seemed to alleviate the itchining. We have also been feeding him Royal Canine hypoallergenic canned food but he stopped eating this after a few weeks and it was difficult to give him his regular medication. I have been giving him his tablets in melted cheese and this works sometimes but other times he is just super suspicious of any food i give him. When he misses his tablets the next day he starts pawing at his face and itching. He really is a tricky dog but we have gone 6 weeks without having a vet appointment for him which is actually really good since it has been between 3 & 4 weeks for many months now.

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