Uncovering Conventional Allergy Treatments for Pets: What are the Risks of Apoquel, CytoPoint & Steroids?

Preview: If you haven't read Part 1 yet, I highly suggest you do! In this segment, I'll walk you through the recommendations, risks and benefits of the most common allergy medications: Steroids, APOQUEL, Cytopoint, and Atopica. You'll learn about what the active ingredient is in each medication, how it works in the body, and the safety & risks behind these products! We are often told these drugs are safe but, are they really?! As I've said many times before, I want YOU to make informed decisions when it comes to your pet's care. Also included: different testing methods for allergies, alternative diets and remedies that may work to help alleviate the symptoms of allergies and balance the body... without the harmful side effects!

From a veterinary standpoint... allergies are generally treated with prescription foods/ hydrolyzed diets and usually medications such as steroids, APOQUEL, Cytopoint, Atopica, and maybe even some benedryl.

As I've mentioned earlier, it is generally not routine to actually test a dog or cat for food allergies through labwork, although the technology is available and some veterinarians do offer (and recommend) this service to be done.

Various testing methods are:

These tests can help identify the culprit of food related reactions, from a mild sensitivity to a full-blown hypersensitive reaction (allergy).

You'll often here veterinary professionals refer to the diet trial as the 'gold standard' and the only true way to identify a food allergy or sensitivity. Diet trials are very difficult to perform correctly. They are costly and time consuming. You MUST use a prescription hypoallergenic diet for 8 weeks, with absolutely nothing else given. Then slowly reintroduce different proteins and food items one at a time over the period of weeks to months.

Your vet may also refer your pet to a specialty clinic or local University for sample testing such as the skin prick, saliva or blood test. Some tests can cost thousands of dollars and only be done with a specialist. Others can be done in the clinic or even at home for a couple hundred dollars!

A few simple things to consider:

Simple, non-invasive tool to detect parasites, bacterial imbalances, leaky gut, inflammation markers, and more!

I prefer NutriScan, you can read more about their technology and product on their website. Grandma Lucy's (an amazing pet food company) offers it at a cheaper price and actually will give you a $50 credit back to their store to get your pet some high quality food! How cool is that?!

So, do medications work for food allergies?

The VCA states:

*Image is a screenshot from VCA website in an article about food allergies

Yep! Identify the source, and get to the true root of the problem.

Alright, so here we go! The most common medications that are prescribed for food (and environmental) allergies.

What is it?

Short for corticosteroids. Not to be confused with steroids that athletes might use.

Prednisolone, dexamethasone (40x stronger than prednisolone), methylprednisone, prednisone, triamcinolone... to name a few!

Can be an oral medication, injection, or a topical cream.

Mode of action:

Immunosuppressant. They resemble cortisol in the body (a hormone made in the adrenal glands). Generally they work to heavily decrease inflammation and reduce the overall activity of the immune system.

Safety:

Steroid use can be damaging to the body in many ways, but sometimes a short course may be needed. However, I have seen both human doctors and veterinarians jump at the chance to use steroids any chance they get. Whenever a flare up occurs; steroids to the rescue! Shut down the immune system! Shut it down, now!

I personally have experienced this merry-go-round. And let me tell you, it wasn't so merry!

Steroids knowingly cause severe Vitamin D deficiency! Which is needed for a healthy immune system and to decrease inflammation!

Common side effects include:

Some dogs may even develop Cushing's Disease from long-term steroid use.

*Note: steroids must be carefully monitored. When a pet (or human) is on steroids there is a process to weaning off of the medication that must be done in order to discontinue it's use. Abruptly stopping steroids is very dangerous.

"If your dog requires more than three to four months of corticosteroid usage, the condition should be re-evaluated or other treatment options should be pursued."

"Dogs on long-term corticosteroids should be monitored with quarterly examinations and with urine cultures and blood tests every six months."

-Source.

Since steroid use affects so many body systems, I always recommend full bloodwork prior to starting them. This way, a pet can be monitored more closely and changes can be made for an alternative treatment if needed.

Topical use of steroids in the ears, for example, causes systemic absorption of the medication. Some can heavily affect the adrenal and pets NEED to be monitored for adverse recations or development of other disease. Dogs that are susceptable to (or already have) renal dysfunction, lowered immune system, cortisol or adrenal issues should be closely monitored with (or not given) certain products.

Final word:

Steroids can be an option for short term use. But, the longer they are used, the more dangerous they become. They have their place, but I don't think food allergies is one of them.

What is it?

Oclacitinib maleate. Oral medication.

Mode of action:

This drug, simply put, turns off certain receptors and signaling compounds within the immune system.

These mechanisms are used to ward off invaders and threats to the body. They are a police force that help the immune system mount a response to tumors, infections, and inflammation. By turning these off, what could possibly go wrong?! To me, this is the most dangerous of them all. Even though the most common statement owners will here from their veterinarian is: "It's not a steroid, so there's no side effects!" *face palm*

Safety:

Safe for use in dogs 12 months of age or older.

Not for use in breeding, pregnant, or lactating dogs.

Has not been tested in combination with cyclosporine, glucocorticoids, or other systemic immunosuppressive drugs.

Side effects:

Plus more:

Dogs should be monitored closely for developing health conditions such as infections and cancer.

"APOQUEL may increase the chances of developing serious infections, and may cause existing parasitic skin infestations or pre-existing cancers to get worse. APOQUEL has not been tested in dogs receiving some medications including some commonly used to treat skin conditions such as corticosteroids and cyclosporine."

- Source.

*A note for humans!! The drug insert for APOQUEL specifically states:

"Wash hands immediately after handling the tablets."

Why is this?!

Well, because this drug is known to cause cancer! It is especially important that pregnant women know not to handle this medication!

Highlights from the insert:

Read the full drug insert

6/239 dogs in the study were euthanized for developing cancer.

6 different types of cancer.

Imagine those numbers throughout the nation.

That's about 1 in every 40 dogs on APOQUEL dying of cancer.

And those are just the numbers from the ones euthanized. There were multiple other dogs in the study that developed varying types of cancer and health issues.

Why happened to "Do no harm." .....????

Truthfully, I believe that most veterinary professionals are just very ill-informed and do not read the inserts, let alone available research. Not to mention, APOQUEL is a big money maker. One trial month of APOQUEL for a small dog can easily be over $100.

Final word:

This makes it to the top of my list of things I would never give to my dog. I don't believe that turning off the immune system to the extent of causing cancer is the answer. To me, the risk far outweighs the benefits. But, for some owners.. it's the only thing that has brought their pet relief. I would try every holistic option available before turning to this one.

What is it?

Lokivetmab. An injection of medication used to stop itching. A new product that came on the market in 2017. This injection does not contain preservatives.. so that's a plus.

Lasts for approximately 4-8 weeks. For relief of symptoms (itching, skin redness, etc.) of allergies (including environmental) and food intolerance. You may hear this diagnosis called atopic dermatitis.

Mode of action:

Cytopoint injection is an antibody protein that targets and deactivates another specific protein in the body that causes itching- Called Interleukin 31 (IL 31 is a cytokine). Cytopoint is not a drug. It is a monoclonal antibody therapy (synthetic protein substance created in a laboratory). It Said to be 65% (first dose), 85% (second dose), and 93% (third dose) effective in reducing clinical symptoms. It can begin working the very first day.

"CYTOPOINT is a biological therapy and not a drug, it is naturally broken down and recycled by the body. It is not eliminated from the body via the liver or kidneys like most pharmaceutical drug products. This is one of the reasons CYTOPOINT can be a safe choice for your dog."

- Source.

Safety:

Safe for use in all ages.

Though this is a relatively new treatment option, it seems fairly safe. I've only seen it used a handful of times as it is very expensive. A few hundred dollars for a large dog! The available information that I have found states that it is perfectly safe to use all other medications, and even parasite preventatives in combination with Cytopoint.

Side effects seem mild, and are generally:

But there have also been reports of:

Some forums, groups and other websites have been specifically dedicated to pets who have had severe reactions or even died after having Cytopoint injections. As with anything, reactions can occur. Remember, we are injecting a foreign protein into the body to shut off another protein...

"No long-term studies have been published to date to identify side effects."

-Source.

What I also don't like, is the constant yo-yo that happens. Injection, itch decreases. Injection wears off, itch returns. Another injection, itch decreases. And so-on. This is not ideal. What damage is this doing to the body?!

Final word:

I'm not sure I would personally use this. Instead of deactivating the bodily response (warning system), I'd prefer to eliminate the root cause of what is causing the reaction in the first place. That being said, some owners have exhausted all options before resorting to this treatment and found it greatly helped their pet. Quality of life is important in this case and I'd turn to this before other options based on mode of action and available safety data.

*Comparison: APOQUEL vs. Cytopoint.

What is it?

Cysclosporine. Oral medication.

A powerful, systemic immuno-suppressant that was originally used to prevent organ rejection in humans who had transplants. Cyclosporine is a mycotoxin (fungi) and is incredibly toxic to the body. It has a narrow therapeutic index, which leaves a large potential for toxicity to easily develop.

It has been around a long time, and not too commonly used anymore since we have many new options available, but it is still being used. It was approved by the FDA for use in dogs and cats in 2003.

Mode of action:

Inhibition of T-lymphocyte function causing a deactivated immune system.

It is metabolized by major organs such as the small intestine, kidneys and, liver.

Safety:

For use in animals over 4 pounds in weight and over 6 months of age.

Can cause decreased immune system response to vaccinations. Pets should not receive live vaccines if they are on this medication.

Most common side effects are mainly gastrointestinal such as:

Other adverse reactions include:

"Much less common adverse reactions include gingival hyperplasia, gingivitis/periodontitis, papillomatosis, hyperkeratosis of the footpads, coat shedding, hirsutism, lethargy, hepatotoxicity, anaphylactic reactions, angioedema, emergence of neoplasia (specifically lymphoma), nephropathy, and tremors."

-Source.

Cyclosporin is very powerful drug. So powerful, in fact, that it almost completely shuts down the immune system and makes the body much more susceptible to other ailments.

"Cyclosporine is a known human carcinogen; malignancy after transplant surgery has contributed to patient morbidity and mortality."

"The risk of developing skin cancer has been linked to cyclosporine treatment."

In transplant patients:

"Immunosuppression may contribute to the mortality rates, as it disrupts both antitumor and antiviral activities."

-Source.

Drug insert for dogs

Drug insert for cats

Final word:

I can't say that I would ever readily give this to my pet for food allergies. There are clearly way to many risks for my liking. I'm not sure how a drug like this was ever even considered in the first place for treatment of allergies.

Generally, imbalances and dysfunction occur from poor nutrition and a toxic environment.

By cleaning these up, we can help our pet's heal naturally. One of my clients has had great success with her itchy cat by switching to a higher quality food and eliminating environmental toxins!

First, it's important to know whether or not the symptoms your pet is experiencing are actually food related, even though environmental allergens can be related to a poor immune system from poor nutritional status.

For example: If your dog gets red, itchy feet only in the summer and is fine the rest of the year, make sure you eliminate lawn chemicals, clean their feet daily of any pollen, and boost their immune system via supplements to lessen the reaction.

Be sure that all aspects are evaluated and narrowed down. By continually switching food and using harsh medication trying to treat a food allergy, when it is actually environmental, obviously will not help the true root of the problem!

Moving to an alternative diet style can be a good starting point for most!

While grain-free and raw or homemade food may heavily frowned upon by many veterinarians, I've seen changes made like this that have worked tremendously time and time again. Pets who eat a less processed diet (such as gently cooked) are healthier. What?! How can that be?! Well, what does your doctor tell you about how you should eat? Less processed food!

Choose either a commercially available raw diet, or work with a qualified professional to formulate one with you.

*CAUTION I've seen homemade diets done very wrong, and your pet's health could worsen. Please, do your research! I love Perfectly Rawsome for meal plans and raw food education! She even has a few free recipes for dogs and cats!

Again, a less processed diet to promote overall health! Choose a brand that has a variety of products to rotate through.

Rotating foods (especially proteins) is very important to create a robust immune system and digestive tract. You can read more about that here!

This is a great option for those who want to stay clear of the toxic prescription diets we talked about in Part 1. You can talk to your veterinarian about trying this option first if they recommend their prescription foods, or you could DIY and see if you notice any results.

There are many herbal remedies and GI supplements that can assist in lessening reactions. Some contain probiotics, digestive enzymes and herbs all-in-one! Some herbs can even be brewed into a skin soothing spray to relieve the itch!

Remember when we talked about leaky gut and an over-burdened, over-reactive immune system? It's all related to the gut! Testing your pet's gut health should be the first step before any gut health support measure are taken. You need to know what's going on in there before making drastic changes, adding supplements, etc.

Even if the allergy is truly food related this can help. Using toxic chemicals on your pet such as flea, tick & heartworm medications only causes their body more stress and health issues.

Immunotherapy is a way to introduce allergens to the body in a low dose, less reactive way so the body can essentially relearn how respond to them in a healthy way (by not over-reacting). This can be very safe and quite effective in most pets. Though it is strictly for environmental allergies only.

I has personally stopped seeing certain veterinarians who not only recommended prescription foods for my dog, but also tried bullying me into feeding them. If this happens to you, look elsewhere for nutrition advice, especially if you are ever recommended a prescription hydrolyzed diet. In my opinion, they could cause more health problems than they solve.

*Side note: As mentioned in Part 1, these are USUALLY vets will recommend a food like this as a trial basis for allergy elimination. Something like this should most definitely NOT be fed long term.

Either way, I would address the pet's diet & health history as a whole to promote more balance within the body and suggest a more appropriate food.. Instead of stripping them of all nutrients.

When it comes to medication, it will be a hard decision. Ultimately, you must weight the pros and cons. Some medications may be needed to get things under control, even for a short time. Closely work with your veterinarian, express your concerns, and document your pet's health before, during and after any treatments.

Working with a holistic/ integrative veterinarian or a pet health consultant (like myself) can really better your chances at identifying and eliminating the root cause of the imbalance.

These hydrolyzed diets may work by eliminating the allergenic factor.... but they also work by virtually eliminating much needed nutrients from the body. They are the highest level of limited ingredient diet. No meat, no produce. It is hydrolyzed protein (usually plant-based) and a mix of synthetic vitamins.

You dog or cat is essentially eating a multivitamin... and being deprived vital nutrients from whole-food sources.

How is your brain feeling?! Loaded?!

GOOD!

I really hope this series has helped you get an in-depth look at allergy treatment protocols.

And remember,

Don't believe what I say. Research what I say!

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