Allergy mythbusters

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Common myths about dog and cat allergies can lead well-intentioned pet owners astray when it comes to getting relief for their itchy pet. In this episode, veterinary dermatologist Dr. Nellie Choi joins Dr. Brittany Lancellotti to dispel some common misconceptions they hear regarding allergic skin and ear disease in pets including:

  • Why antihistamines are not very helpful
  • Why ear infections don’t just happen in floppy ear dogs
  • Why fleas are still important to prevent even if your pet is indoor only and you’ve never seen a flea
  • Why there isn’t such a thing as hypoallergenic dog breeds
  • Why allergy immunotherapy should be an early treatment option and not a last resort

Plus, don’t miss rapid-fire mythbusters at the end of the episode regarding blood tests for food allergies, grain free diets, and coconut oil!

Welcome, Dr. Choi!

Dr. Lancellotti: Welcome everyone to today’s episode of Your Vet Wants You To Know. This is a really fun episode that we’re doing today- something a little bit different. A lot of the other episodes have focused on talking about specific diseases or medications, but this is a little bit of just a fun allergy MythBusters. With me, I have a special guest, Dr. Nellie Choi. She is a diplomat of the American College of Veterinary Dermatology and a registered specialist in veterinary dermatology. She’s worked in multiple private practices in California, in Perth, Australia, Singapore, and now Hong Kong. Prior to her veterinary dermatology career, she was working in general practice for five years in Australia which sparked her passion for dermatology. During her residency in Los Angeles, where she and I completed a residency together, she was presented with an award at the North American Veterinary Dermatology Forum for her clinical research in canine otitis externa, which  was later published in The Veterinary Dermatology Journal. She is a registered Fear Free practitioner and passionate about creating a pleasant experience for her pets during their clinic visits. Dr. Choi enjoys educating her clients (patients and owners alike), and we have the most adorable picture of her teaching a dog, writing on the whiteboard, and the dog sitting very attentively, looking at what Dr. Choi is writing. She’s going to be talking to me today and helping to educate you guys on some of the most common allergy myths that we hear as dermatologists. Welcome, Dr. Choi. 

[00:02:41] Dr. Choi: Hello. Thank you so much for having me.

Dr. Choi standing at a whiteboard teaching a dog about dog allergies
Dr. Nellie Choi teaches a patient about autoimmune skin disease.

[00:02:44] Dr. Lancellotti: I’m very excited about this, I think this should be a lot of fun. We’re going to have a couple myths that we go through. I think we have 5 total myths that we are going to work on busting today, providing our listeners with some evidence-based information, so that we can guide them on the right track. For any of you out there that are listening that are interested in allergies, Episodes 1-8 are everything you need to know about allergies. And if you’re looking for more information on how to do a diet trial, Dr. Meagan Painter did a really great episode on diet trials as well. There are a lot of good resources for you in the show, but it’ll be fun to talk about some things that we may not have touched on already. Dr. Choi… 

Myth #1: Antihistamines can control allergies in dogs and cats

[00:03:29] Myth #1. Very commonly, I hear pet owners say that they give Benadryl when they notice that their pet is itching. How helpful have anti-histamines been shown to be? 

[00:03:41] Dr. Choi: Honestly, I would say less than 10% success rate with controlling itch. Especially, when anti-histamines are used alone. Unfortunately, pet itch is not 100% driven by histamine alone, hence anti-histamine drugs that only target histamine rarely help. When they do seem to help, I suspect it is more likely the side effect of being drowsy, causing the reduced itch. The positive to anti-histamines though is that they’re over the counter, they’re inexpensive, and generally very safe. In my 10-plus years vet career, I have seen one dog develop an adverse reaction to anti-histamine, which also happened to be one of my best friend’s pug. On Christmas day, he developed a hyperexcitability reaction and was restless for hours. 

[00:04:35] Dr. Lancellotti: Oh, poor guy. Was it just him being hyper excited because it was Christmas day?

[00:04:39] Dr. Choi: I thought so, initially. I wish it was, but unfortunately he was getting more and more distressed as the anti-histamine was kicking in. Poor little thing. 

[00:04:51]Dr. Lancellotti: Okay, so anti-histamines may be helpful, but probably not. But they’re likely not going to do any harm to the animal. So if you want to try something for your pet, go ahead and give it a shot, but you will very likely have to see your family veterinarian or a veterinary dermatologist to really get those allergies under control. So let’s move on to Myth #2. This is something that I hear all of the time here in Southern California.

Myth #2 is that fleas don’t exist in indoor-only pets. So if a pet owner has never seen fleas on their pet, or if their pet is indoors only, how come we might still say to them that fleas are the issue? 

[00:05:35]Dr. Choi: Typically, adult fleas remain on the same host its entire life. However, the eggs laid by the female fleas, which can be 50 per day, are shaken off of the pet’s body in large numbers, like a salt shaker. These eggs then develop into larvae in the environment (which can be transported on your shoes, clothing, bags, etc.), and into your home. So even if your pet is 100% indoor, there’s still a risk of flea exposure. If your pet does not have fleas, and is already itchy from allergies, you never want to find out how much itchier they can be with fleas on them. So make sure you have year round flea prevention for all of your pets, whether they’re indoor or outdoor. 

[00:06:24]Dr. Lancellotti: Yeah, I think that’s great advice. If you want to hear a really fun story about me finding fleas on a cat that was indoor only, and those fleas jumping off onto an owner, then I would check out Episode 1 of the podcast. We go into lots of detail about fleas and flea allergies and why it’s so important to keep those animals on ‘preventative year-round’ if you want to control their itching.

Myth #3: Hypoallergenic Dog Breeds

[00:06:47]Myth #3- hypoallergenic dog breeds. What is that? Is there such a thing as a hypoallergenic dog breed?

[00:06:56] Dr. Choi: When a client tells me they had done a lot of research prior to purchasing a puppy, and was told by their breeder that their dog is hypoallergenic, I often wonder if they mean that particular breed is less likely to induce symptoms in allergic humans, or if the dogs are less likely to have allergies themselves. I’ve actually Google searched hypoallergenic dog breeds and apparently, West Highland Terriers and poodles did come up, as they are non shedding breeds. Unfortunately, humans with pet allergies are reacting to dander instead of fur, which means the only true hypoallergenic pet for an asthmatic human will be a pet fish or a reptile. The other unfortunate fact is Westies and poodles are typically atopic or allergic themselves. I see a large number of these breeds in the dermatology clinic for allergies. 

[00:07:51] Dr. Lancellotti: Yeah, and the owners always get very confused that their animal has allergies because they’ve been marketed as a hypoallergenic breed.

Myth #4: Floppy ears cause ear infections

Cocker spaniel with floppy ears. Image courtesy of Dr. Nellie Choi

Dr. Lancellotti: How about some other breeds in which we see a lot of allergies? Certainly, ear infections can be a major symptom of allergies. I have heard owners say, “My dog gets ear infections because they have floppy ears.” Is this true? Do all dogs with floppy ears like Cocker Spaniels develop ear infections? 

[00:08:21]Dr. Choi: This has been scientifically proven not to be the case because if that were true, only dogs with floppy ears would have ear infections and cute French Bulldogs wouldn’t have any at all. Both you and I know that’s not true. Allergies, such as food and environmental, are primary causes of ear infections. I have seen some dogs with mutilating surgery performed on them, called lateral ear canal resections, and this involves removing a section of the ear canal so that it ventilates or airs out to reduce rates of ear infections. Please do not have this done on your pets! Not only is it irreversible and disfiguring for life, it does not help reduce ear infections at all, as the surgeries only remove a section of the ear canal and the remaining part can still be infected. It also makes it incredibly difficult to put any ear medication into a mutilated ear as it just spills out.

[00:09:18] Dr. Lancellotti: Yeah, these ones are pretty sad because the underlying disease still isn’t addressed, the ear surgery doesn’t provide relief, and then the animal’s in a worse-off position. We do have a picture from a animal that had a lateral ear canal resection that we’ll put on the website, so that you can see what Dr. Choi is talking about there. But again, if that’s something that you’re considering doing, we would highly recommend finding a veterinary dermatologist and talking to them about other options for controlling the underlying disease, rather than performing this lateral ear canal resection.

Lateral ear canal resection in a dog. This surgery did not cure the ear infections. Photo courtesy of Dr. Nellie Choi.

How about allergy specific immunotherapy? We talk about this in Episode 8. Dr. Levinson and I go into detail about allergy testing and using allergy specific immunotherapy to reverse the underlying environmental allergy. As far as our allergy myth, there is this myth that allergen specific immunotherapy rarely works. Do you find that to be true? And would you consider this a first treatment option or a last resort? 

[00:10:22] Dr. Choi: I often get this question from referring vets as well, in terms of the success rates of immunotherapy and when a patient should be considered for allergy testing and desensitization. At my previous clinic in Perth, Australia, over about 90% of allergic patients go through allergy testing and desensitization, so culturally in our clinic, most clients preferred non-pharmaceutical treatment options for the chronically allergic pets. This is where allergen specific immunotherapy comes in. It’s the closest treatment we have to a cure for allergies, and if there’s a potential cure to a lifelong disease, why would you attempt it later in life as a last resort? It should be recommended at the start. Nothing makes me more sad at work than seeing a new patient that has suffered its entire life with skin allergies and are now out of options or no longer responding to drugs, looking for a miracle cure. Early intervention with immunotherapy should always be considered to improve the pet’s quality of life and give them the best chance of a drug-free life.

[00:11:29]Dr. Lancellotti: Amen. I absolutely agree. I just love when clients bring their allergic pet to me within those first few years of life. As we discuss on the ‘environmental allergies episode, it usually starts to appear between 1-3 years of age. That’s a great time to bring your pet in to see a veterinary dermatologist before your pet is completely overwhelmed by these secondary infections and chronic changes to their skin and ears, because young pets are the ideal candidates for desensitization using immunotherapy. We really want these patients to be comfortable over the many allergy seasons that they’re going to experience, so that we can work on minimizing the amount of other medications that they need throughout the course of their lifetime.

Myth #6: Pet will grow out of their allergies

Dr. Lancellotti: Dr. Choi, are there any other common misconceptions regarding skin allergies in pets that you would like to address? 

[00:12:22] Dr. Choi: Actually, yes. I hate to be a party pooper, but in my experience, pets do not grow out of their allergies. To keep them comfortable, we will either need to accept that they will need lifelong pharmaceuticals or to see a veterinary dermatologist for allergy testing for desensitization. I have seen clients try really hard avoidance techniques only for their itchy pets and it never works. In all the countries I’ve lived and practiced, there have been no seasonal allergies. The majority of the pets I treat have year-round-itch, which may have worse symptoms in spring and summer but generally, never asymptomatic in winter. 

[00:13:02]Dr. Lancellotti: So a good idea is to get over and see a veterinary dermatologist, establish a relationship, talk to your veterinarian about what options are available and what’s going on with your specific pet, so that you can figure out the best treatment plan over the course of that animal’s life, because they are not going to grow out of their allergies.

Rapid Fire MythBusters!

Dr. Lancellotti: Dr. Choi, I’m going to do a little bit of a rapid fire allergy MythBusters. Are you ready? 

[00:13:27] Dr. Choi: I’m ready. Super rapid fire. Shut it down. 

[00:13:34]Dr. Lancellotti: True or false. There is an excellent blood test available for testing for food allergies.

[00:13:40] Dr. Choi: A million percent false. 

[00:13:43] Dr. Lancellotti: Okay, next one. True or false. The most common food that dogs and cats are allergic to is grain. 

[00:13:50] Dr. Choi: Also false. Grain-free diets, to me, are a marketing gimmick that has been, unfortunately for us as dermatologists, very successful. But we do not believe in grain-free diets for food allergy elimination diet trials.

[00:14:09]Dr. Lancellotti: My last rapid-fire question- True or false; coconut oil is an excellent tool for dogs with allergies. 

[00:14:16]Dr. Choi: To season meat, I think it works quite well. I don’t know. I guess coconut oil is still a moisturizing Omega oil, which may help with reducing dryness in the skin. So if your itchy pet is itchy from dry skin, maybe it’ll help, but definitely not as a sole treatment for allergies.

[00:14:39]Dr. Lancellotti: I’ll take that as a rapid fire answer as well. 

[00:14:41] Dr. Choi: Yeah it’s a “no.”

Myths Busted!

[00:14:47] Dr. Lancellotti: Well, for those listeners who have pets with allergies, many family veterinarians are very comfortable managing pets with allergies, but the link to the American College of Veterinary Dermatologists to find a dermatologist near you is on the resources page of the website, if you would like to consult with a specialist. You can also view the references for today’s show in the show notes, as well as see some great pictures related to some of the allergy myths that were busted today. If your pet is allergic, I would strongly encourage you to join our Facebook group. Tell us what you’ve tried with your pets allergies. Was there a particular myth that we busted for you today? Are there any other myths that you’re curious about and want to know the answers to? Let us know. You can also follow us on Instagram as well. 

Scratching the Itch

[00:15:34]I like to end each episode with a segment called Scratching The Itch. This is a segment that is designed to highlight something, whether it’s a human interest story, a product or a website- just something that provides relief or makes you feel good. Dr. Choi, I’m wondering. Do you have a ‘scratching the itch’ for our listeners today? 

[00:15:53]Dr. Choi: I do, and I have a supporting photo for that as well. My husband and I moved to Hong Kong about 5 months ago and because of the pandemic, we had to go through quarantine and COVID testing. Initially, the process of moving to Hong Kong was pretty painful, so we had to wait at the airport for about 10 hours for our COVID test results. My fun-loving husband had bought an inflatable pool lollipop for us to rest on during the long wait. We got a lot of looks from people as I was taking short naps on this inflatable pool lollipop, and it was probably one of the most uncomfortable things you could take a nap on. But I did appreciate it very much, as the alternative was us just resting on a chair that they gave us, and that was not quite as nice. So, there’s a photo of this popular pool equipment that my husband also inflated by mouth, as we could not bring (obviously) any pumps and things onto the plane with us. I did appreciate all his efforts, but it was one of the funniest things that I think seen in an airport.

The inflatable popsicle pool lounger used for naps while awaiting COVID testing in the airport.

[00:17:18]Dr. Lancellotti: You’re not really interested in taking another nap on a pool lounger? 

[00:17:21]Dr. Choi: Not for many hours in a day. For little short naps under the sun by the pool is perfect, but not as an actual kind of mattress equivalent. 

[00:17:31]Dr. Lancellotti: Well, that was very nice of him for even trying to make things as enjoyable as possible in a tough situation. Thank you very much, Dr. Choi, for coming on today and doing this fun little episode about allergy MythBusters. I think that was really fun. Hopefully, we gave some people some information about something that maybe they had misconception about. Thank you. I appreciate it.

[00:17:54] Dr. Choi: Thank you, Dr. Lancellotti, for having me on. I had lots of fun and can’t wait to do this again. 

[00:18:00] Dr. Lancellotti: And for everyone out there listening, I look forward to your next visit with Your Vet Wants You To Know.


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