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

By Dr . Joi Sutton|2017-04-19T15:02:30-04:00Updated: May 4th, 2017|Pet Care, Pet Newsletter|23 Comments
  • Itchy Dog on Sidewalk

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 [email protected]. 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

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.


  1. Daleana Taylor August 25, 2021 at 9:12 am - Reply

    Hello. I have an 8 y/o miniature dachshund. She does have diabetes that was diagnosed 3 years ago and is treated with vetsulin. When she was a year old our vet was giving her steroid shots for the allergies, but we stopped those because they weren’t working for her. She has been diagnosed with skin yeast infections and ear yeast infections. The Apoquel we have given her for a few years now has stopped working. We have been giving her a Zyrtec am and a Benadryl pm along with fish oil once a day. We have cut out chicken but has seen no improvement. Our vet gave us some spray called Yeasty Beatty that does nothing to alleviate the itching. We did try the new allergy shot and unfortunately it didn’t help either. I know she is miserable. We have been bathing her weekly. Nothing is helping. We are considering a new vet, but money is tight. We just want to give our baby girl relief. Any advice would be very much appreciated.

    • Dr . Joi Sutton August 29, 2021 at 5:53 pm - Reply

      Typically when apoquel works initially then stops working, there is a secondary infection. Have you ruled out a secondary infection by skin cytology? Also, regular bathing with a medicated shampoo would likely help. If you feel she is miserable you should consider seeing a vet dermatologist. Chat with you’re veterinarian. And consider a hypoallergenic diet such as ultamno or a hydrolyzed diet. Chat with your veterinarian. Best, Joi

  2. Susan June 4, 2021 at 11:36 am - Reply

    Good afternoon- I have an almost 1 year old cocker spaniel who has been itching almost since we brought her home at 8 weeks. We have seen our regular vet and now a dermatologist. She has been on both Apoquel and Cytopoint and neither of them appear to have worked, she is still itching. I have a call in to the dermatologist but wondering what our other options might be? We don’t feed her any chicken, just turkey or ground beef with Purina Pro Plan Sensitive skin with Salmon. Any suggestions? How accurate are blood tests for allergies? Any help would be appreciated!

    • Dr . Joi Sutton June 6, 2021 at 10:57 am - Reply

      You are already in the hands of a specialist. Good job! Allergy testing for pollens and grasses and environmental allergies are pretty good, but may be more effective once the pet is 2 years old. Food allergy testing is not to be trusted. I’m sure the dermatologist would have checked for secondary infections and mites. It could be a food allergy. Beef is the top food allergen for dogs, followed by dairy then chicken. Please chat with the dermatologist about the next step. Let the dermatologist know your pet is still itchy. It may take time. And there are hypoallergenic diets for a 2 to 3 month month diet trial.

  3. Taylor home December 2, 2020 at 1:54 pm - Reply

    Hello Dr. Joi,
    I have a 9y/o cm toy poodle/yorkie mx who has been through it all. Cytopoint, apoquel, hydroxyzine, benedryl, zyrtec, loratadine, medrol, prozac, nordic naturals, genesis spray,gentaved spray. Nothing helps. No active skin infection, skin scrape always negative was using nexgard for a while to compliment, now using frontline gold with heartgard plus, skin cytology negative, tape prep negative. No leisions because we apply a cone when he really goes at it. Hylte baths or malaseb with resicort cream after, every other week unless super rainy then weekly. Trizchlor4 spray or malecetic spray in between. He chews his front and rear paws, and forelimbs. Ears are good because I apply mometamax every so often. I feel so bad for him. If food drops, he is so fast to snatch it up we fear we couldn’t get a realistic food trail accomplished.
    It seems the blood test for allergies and treatments could be the next step? This hasn’t been offered by our vet yet..maybe I should just ask for it? Any advice you can offer, we are grateful. Thank you for your time and consideration.

    • Kimberly October 17, 2021 at 10:18 am - Reply

      I would do the allergy test the best thing I did I was feeding my dog a special diet but come to find out she was allergic to some ingredients in that also!!

      • Dr . Joi Sutton October 17, 2021 at 1:05 pm - Reply

        Pets can have both food allergy AND atopic dermatitis. Unfortunately, they are not mutually exclusive.

  4. Don Cary November 6, 2020 at 12:41 pm - Reply

    Dr. Joi, I have a 13 year old miniature poodle. She has developed many adenomas, and recently has been itching severely. This has been followed by patches of very sensitive pink skin. What would be the best way to reduce the itching with an over the counter solution? My vet gave her a shot of vetalog triamcinolone then a week of Temaril pills, but this did not work great and once completed the itching continued. Please help, I am getting the opinion of another vet next week, but really could use your advice.

    • Dr . Joi Sutton November 8, 2020 at 4:19 pm - Reply

      I’m glad you are seeking vet care as it’s not possible to evaluate an itchy pet without an examination. Be sure to have skin cytology. Be sure to cover for other things like fleas. Your vet will likely try some apoquel or cytopoint. If your pet is diabetic please avoid steroids (triamcinolone).
      As far as homeopathic over the counter options: nothing is as holistic as an oatmeal based shampoo. Zyrtec is another good option. Best, Joi

  5. Maggie November 5, 2020 at 1:56 am - Reply

    Hi! I have a Boston terrier. He is 3 years old. He has been on apoquil injections and I give him a bendaryl nightly. I don’t think the injection works that well when he gets one. Still itching! He pretty much lives with an ear infection. I treat it. Then it comes back a few weeks later. His eyes are always red. His skin is red. He itches non stop until he has scratches and blood. I feel terrible for him. It breaks my heart. He switched to grain free food about 6 months ago. Not sure if it is helping. Are there any other medications good for allergies besides the apoquil? I’ve also started giving him these zesty paws allergy bites. I haven’t seen much change. There has to be some kind of relief for him that doesn’t have to cost $80 a month. Do you know of anything magical?

    • Dr . Joi Sutton November 8, 2020 at 4:15 pm - Reply

      Apoquel is a pill. You might be referring to cytopoint asthe injection. Both are cytokines inhibitors. Apoquel is more broad spectrum than cytopoint ,but apoquel can cause immune suppression. Cytopoint is a monoclonal antibody and has no known side effects. Both are often thought of as miracle drugs, but they can fail. The most common causes failure is a secondary bacterial or yeast infection. Take your sweetie to your vet for cytology to best determine how to treat. Cytology is easily done in the vet clinic with tape or a q tip and a slide and stain and a microscope.
      Grains are not the most common food allergies for dogs. The meat source (beef, chicken, dairy) are the most common food allergens for dogs. They make hydrolyzed proteins for food trials. And food trials are typically 3 months. There are novel protein foods, hydrolyzed diets, and perhaps best yet would be Ultamino which is down to the a I o acid level.
      Your let can be tested for environmental allergens with a s8 ole blood draw. It’s not inexpensive.
      Have you considered visiting a vet dermatologist?

  6. Jasmine September 26, 2020 at 11:50 pm - Reply

    Hello Doctor, I’m having a similar problem. My dog is a chihuahua and shes 9 years old, shes never even itchy or lost so much hair before. She got fixed 2 weeks ago and I think that’s when her hair loss and itching started. I believe she has mites because shes scratching her stomach, biting her legs and feet and also her neck. She started scratching so hard that she started to bleed little bumps of blood. I went in for a skin scraping but the doctor said they couldn’t find any mites but that doesnt mean she doesnt have it, she also didnt reccomend a cytology cause she didnt think bella needed it. Bella was on benadryl but she still itched. Now shes on apoquel and it’s her first day, after 7 hours she started to scratch again. I’m nervous and worried because her hair keeps falling. I ordered some hypoallergenic shampoo off of amazon so I plan to bathe her after her nails are trimmed and her ears get cleaned. I’m hoping itll help her feel better. But if there anything else I can do ? I already made a nurse appointment so she can get the injection to stop itching. I know these medications are suppose to stop the nerves from feeling itching but it doesnt solve my problem since they dont work and seem like there only hiding the symptoms. I need a cure, something that will show improvement. Please help or give me ang advice. I even put her on justfoodfordogs, to help with her pancreatitis. I just want her to regain her health that way shes strong enough to fight of the mites or what ever she could possibly have.

  7. 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.

    • Dr . Joi Sutton September 27, 2020 at 9:14 pm - Reply

      Great job. Do stick with the hypoallergenic diet. If cytopoint failed and apoquel succeeded then a food allergy may be culprit. Of course pets can have food allergy and atop concurrently. And if apoquel ever fails you know that there can be secondary infections. 🙂

  8. 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. 🙂

  9. 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.

  10. 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.

  11. 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

  12. 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.

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