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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 32797
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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to start at the very beginning I rehomed a Cavalier King Charles

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to start at the very beginning I rehomed a Cavalier King Charles Spaniel just over a year ago and from the start she always had tummy which through trial and error we found out that she has quite a few allergies (one being chicken). We have now got past the tummy issue other than a few flare ups which are treated with Canikur paste. In the summer months she suffers with scratching of the tummy and the back and this has been treated with anti-histamines and also medicated shampoo - we thought this was also an allergy (although the vet has never checked as to what she is allergic too - grass, pollen???). Anyway we now have her on a raw food diet and as the weather has cooled I assume the scratching would stop but she still seems to scratch under her arms and her ears (I have flead her and have used ear mite drops to no avail)!!!! Her tummy was very pink in the summer but seems fine now so not sure if she is in a cycle of itch, scratch!!
I am at my wits end as I dont want her to be uncomfortable, although she is really happy in herself and is not in any pain other than the urge to scratch. Also just a note but when she is brushed her whole back shivers as though I am hitting a nerve?? Also she walks on her back toes and her whole body swings when she walks??
Sorry lots of info but my vets do not seem concerned
Aloha! You're speaking to Dr. Michael Salkin
Thank you for the thorough history you provided. I’m sorry to hear of this with Daisy. Pruritic (itchy) dogs are suffering from an allergic dermatitis the great majority of the time. Allergies to flea saliva, environmental allergens (atopic dermatitis) such as pollens, molds, dust and dust mites, and foods should be considered. (Paw licking indicates both atopy and a food intolerance and so it behooves vets to distinguish one from another.) In many instances, a concomitant pyoderma (bacterial skin infection), yeast infection (Malassezia), or mange mite (Demodex or Sarcoptes) might be responsible.
Daisy's vet can check a sample of Daisy's skin surface (a cytology) for abnormal numbers of bacteria and yeast and skin scrapings can be taken in an attempt to find mites. Pyoderma is treated with a minimum of 3-4 weeks of an antibiotic in the cephalosporin class such as cephalexin (Keflex) and yeast is addressed with ketoconazole for at least a month.
Our dermatologists tell us to apply an effective over the counter flea spot-on such as Advantage or a fipronil-containing product such as Frontline, FiproGuard or PetArmor even if fleas aren’t seen. Dogs can be such effective groomers so as to eliminate all evidence of flea infestation. Dogs who remain primarily indoors can contract fleas because we walk them in on us and flea eggs and larva can remain viable in your home for months. As the weather warms, egg hatches are common. In severe cases, an anti-allergenic prescription corticosteroid such as prednisone will work wonders for dogs allergic to the saliva of the flea. If you have other pets they may have fleas as well but may not be allergic to the flea’s saliva.
Environmental allergies (atopy) are usually initially addressed with prednisone as well. In some dogs an over the counter antihistamine such as clemastine (Tavist) at a dose of 0.025 - 0.75mg/lb twice daily or diphenhydramine dosed at 1-2mg/lb twice daily may be effective. Antihistamines, however, aren’t reliable. Adding fish oil to the diet at a dose of 20mg/lb daily of the EPA in the fish oil might synergize with antihistamines to provide better anti-pruritic action. The omega-3 fatty acids in fish oil are antiinflammatory but may take 8-12 weeks to kick in. The new cytokine antagonist oclacitinib (Apoquel) is likely to revolutionize how we address dogs such as Daisy but it’s currently unavailable due to the manufacturer’s mistaken assessment of its demand. Because her pruritis exacerbates in the summer, a seasonal atopy is likely but food intolerance can exist concomitantly. Please note that Daisy can be tested for atopy with a simple blood test rather than undergoing the more involved skin scratch testing. A hyposensitizing serum can then be manufactured with which you would give Daisy "allergy shots" or sublingual therapy. We see ~70% of dogs improving with either method of desensitization.
Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Daisy's immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from her vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra. A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time. Please note that a raw diet is not necessarily hypoallergenic.
Daisy's posture while walking is within normal limits unless you're seeing difficulty in jumping up or down, navigating steps, crying when lifted or approached or other evidence of pain. Her back shivering when brushed indicates hypersensitivity of her skin consistent with allergic dermatitis.
Please respond with further questions or concerns if you wish.
Customer: replied 3 years ago.

Wow that is an amazing amount of information so I am very grateful!!!! I have her on a raw food diet (Natures menu - which comes in blocks and has nothing else added to it and she only has natural fish treats. I also add a dash of Yumega oil plus to her morning food which is 'a unique blend of Omega 3 and 6 oils from natural plant sources specially selected to help maintain a healthy, soft & shiny coat, nourish the skin and help with moulting'. She has been having this for about 4 weeks.

My issue being that the vet has seen her 4 times and not once checked her skin or carried out any tests - he just said to give her anti-histamines to try and stop the itching.

I think I will take her back and ask that she be tested for Atopy so that we can start some sort of treatment to ease her scratching.

It definitely sounds like an allergy (I was starting to think it was neurological!!)

You're quite welcome. Yes, it sounds as if Daisy needs to see a vet more interested in properly working up such a common presentation. You also have the option of having Daisy see a specialist veterinary dermatologist as can be found here:
Unfortunately, antihistamines are the least likely class of drugs to be of value to Daisy. I'm going to check back with you in a few weeks for an update. Feel free to return to our conversation - even after rating - prior to my contacting you if you wish.
Dr. Michael Salkin and 3 other Dog Specialists are ready to help you
Thank you for your kind accept. I appreciate it.

I'll speak to you soon.

Please disregard the info request.