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.
My dog Toby has been itching ever since I rescued him. It’s an all season thing. In the beginning, he had open sores and elephant skin, the fur on his back legs was completely gone and he was so miserable. I brought him to the first vet, who was completely useless. She prescribed antibiotics and steroids that worked until I ran out and then the itching came back with a vengeance. I went to a second vet who again prescribed antibiotics and steroids and suggested that I change dog food. I bought food that cost 80 bucks a bag for months and no improvement whatsoever. I brought him to a third vet who prescribed Apoquel, which did work for a couple months but then he was back to square one. Then they tried Cytopoint which worked for exactly one month and then became ineffective. They said the next step was 500 dollars for allergy testing and then expensive serums to combat the allergy/allergies. At this point I have 1500-plus dollars in on this problem and have gotten nowhere, so I called yet a fourth vet and actually had a long conversation with the vet herself, surprisingly. She suggested over the counter Zyrtec. I did some research and found that Zyrtec is pretty safe and effective for dogs and doesn’t make them drowsy. After doing a little more research on dosage (he’s 70 pounds so he gets two pills a day) I added fish oil tablets, a B-complex vitamin, and vitamin C to his regimen for good measure. In the last month, his fur has all grown back, he does no more scratching than a normal dog, and his energy has improved ten-fold. He’s a happy, healthy dog again! So despite all the expensive treatments the vet recommends, if anyone else out there has a dog with incessant itching, try Zyrtec. It has been a life saver for my dog.
My boxer pit mix allergies have been bad these past couple of years. She got her cytopoint shot this month and I’ve been doing the anti fungal baths. Her skin is dry and flaky and she’s still gnawing and licking her paws or inner leg. They placed her on hydroxzine and said to take every 12 hrs but that didn’t help her. We started cooking her food towards the end of December and she’s been eating turkey with veggies etc with her Krill chewable. They have an allergy test package treatment that’s $750 which I would love to do but I don’t have that kind of $ right now. I feel horrible for her. Our old vet would give her apoquel and terbafine( I think that’s how it’s spelled lol) and she did well but so many pills idk. Would you recommend taking her to a dermatologist? The vet where she’s going now hasn’t mentioned it. Thank you!
I practice in south Florida where we have a lot of allergy dogs. When cytopoint or apoquel fail (if they have worked in the past) it typically means that there is a secondary infection, whether yeast or bacterial. Your vet can do a quick and easy check for this by doing skin cytology—either a scotch tape prep stained or taking a qtip swab and putting the tape or swab onto a slide and looking at it under the microscope. Terbinafine is probably the safest oral medication for a yeast infection. Sometimes topical therapy doesn’t quite do the job and we reach for systemic meds like terbinifine. I’ve never had seen an adverse effect to apoquel nor terbinifine. Going to a dermatologist is a great idea! $750 seems a bit steep for allergy testing, but I don’t know if they are doing the blood draw (less expensive) or intradermal testing (more expensive).
Apoquel is a more broad spectrum cytokine inhibitor than cytopoint. Of course if I can use cytopoint instead of apoquel I will as cytopoint has no known side effects.
Have your vet do skin cytology to see if she needs to go back on terbinifine or take a course of antibiotic if needed. Good job with the bathing. Chat with your doctor and good luck.
My dogs take apoquel in the morning and take Benadryl at night. They are still itching? My Vet is on vacation can you tell me is there anything else I can give them? They are miserable and making me that way also.
If your pet is miserable then seek another vet to give some relief—such as cytopoint or a brief course of steroid. You can also give your pet a bath! Often times if apoquel was working and suddenly is not, there may be a secondary infection at play. You’ll want skin cytology (which is simple and inexpensive) to see if there is an injection present (such as bacterial or yeast). As it is summer time, be sure to check for fleas.
We have a 2 year old shihtzu. He has been wearing his cone all day everyday for over 5 months now :(. He has been to 6 different vets and none of the treatments worked. We are in the Philippines, so there is no access to a vet dermatologist. He has been taking apoquel but it doesn’t work. We are also bathing him in prescription shampoo. Is there anything else we can do? He is so miserable and isn’t living his best life :(. I just feel so guilty
Apoquel works for most pets but not all. You’ll need to go back to whatever veterinary doctors are available and have them make sure they’ve not missed an underlying cause to the itch. It could be fleas or mites, a food allergy, a secondary infection (such as yeast or bacteria). Typically if apoquel doesn’t help it means there is an underlying or secondary issue that wasn’t sorted.
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.
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
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!
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.
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.
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!!
Pets can have both food allergy AND atopic dermatitis. Unfortunately, they are not mutually exclusive.
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.
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
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?
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?
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.
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.
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. 🙂
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.
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. 🙂
Hello from SC. How much Zyrtec do you give a 70-73 pound dog? Thanks.
A big dog can take 10 mg of cetirizine (Zyrtec) once or twice daily. Do chat with your vet.
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.
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 ?
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
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.
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.