Feline Allergy Relief: Treatment of Allergies in Cats
Is your cat constantly scratching, overgrooming, or suffering from red, irritated skin? Feline allergies are a common but frustrating condition for both cats and their owners. In this episode, Dr. Brittany Lancellotti, veterinary dermatologist, breaks down the best treatment of allergies in cats to help your allergic cat feel comfortable again.
Treatment of Allergies in Cats: A Guide for Feline Owners
Feline allergies can be frustrating for both cats and their owners. If your cat suffers from itching, skin irritation, or overgrooming, allergies may be to blame. In this guide, we’ll explore the best treatment options to help your feline friend feel more comfortable and live a happier life.
Understanding Allergies in Cats
Cats can develop allergies to a variety of environmental and food-based triggers. Common allergens include pollen, dust mites, certain proteins in food, and flea bites. Identifying the cause is the first step in effective treatment.
Options for Treatment of Allergies in Cats
1. Allergen Avoidance
- Flea Allergy Dermatitis (FAD): Year-round prescription flea prevention as recommended by your veterinarian is essential for allergic cats.
- Food Allergies: Switching to a prescription hydrolyzed or novel protein under the supervision of your veterinarian diet can help identify food triggers.
Environmental Allergies: Avoidance of dust mites, human dander, and pollens is not typically effective for reducing itch in allergic cats.
2. Medications for Symptom Relief
- Corticosteroids: Steroids such as prednisolone can provide rapid relief but should be used cautiously due to potential long-term side effects. Steroids can be prescribed as oral medication (liquid or tablets), topical medication, or an injection (which has the most risks).
- Cyclosporine (Atopica®, Modulis®): This immunosuppressive drug helps control allergic reactions long term with fewer side effects than steroids.
Oclacitinib (Apoquel®): This medication is not approved for use in cats, but some studies have shown that cats may benefit if other medications are not effective or tolerated.
3. Allergy Immunotherapy (Allergen-Specific Immunotherapy – ASIT)
Also known as allergy shots, ASIT is a long-term treatment that gradually desensitizes your cat to allergens.
Requires allergy testing to identify specific triggers. This is most effective when done by a veterinary dermatologist. Dr. Lancellotti specializes in allergy testing at Veterinary Skin and Ear in Los Angeles.
Can take several months to show full effects but is the only treatment that modifies the allergic response to reverse the underlying disease.
4. Topical and Supportive Therapies
Medicated Shampoos and Wipes: Help remove allergens from the skin and coat.
Omega-3 Fatty Acids: Support skin barrier health and reduce inflammation.
- Antihistamines: Antihistamines like cetirizine or chlorpheniramine may help decrease the dose of other medications needed to provide allergic cats relief. By themselves, antihistamines are unlikely to completely control signs of allergies in cats.
Dive Deeper into Treatment of Allergies in Cats
Treating feline allergies requires patience and a multi-faceted approach. Whether through allergen avoidance, medications, or immunotherapy, there are many ways to help your cat feel better. Work closely with your veterinarian to find the best solution for your feline companion.
Struggling to give your cat medications? Consider a Calm and Cozy Cat Wrap!
Keep scrolling for full episode transcript and additional images.
Table of Contents
Full Transcript
Welcome, everyone, to today’s episode of Your Vet Wants You To Know. I’m Dr. Brittany Lancellotti, board certified veterinary dermatology specialist at Veterinary Skin and Ear, in Los Angeles, California. I am excited to continue our three-part series on feline allergies. I’ve talked to you already about the signs of allergies in cats, as well as the tests that we use to diagnose them. But today, we’re going to be diving into the part that every cat owner wants to know about, and that’s treatment.
Evidence Based Treatment of Allergies in Cats
Managing allergic cats can be challenging, but with the right approach, we can really help to keep your feline friend as comfortable and happy as possible. As always, everything that we’re going to discuss is evidence-based, meaning that it is supported by veterinary research which has been peer reviewed and published. So for any of you veterinary professionals out there who are listening, much of this information is pulled from the February 2021 issue of Veterinary Dermatology, which has some fantastic articles on feline atopic syndrome. So let’s get talking about treatment. I’m sure that you are all very interested in knowing how Otto, our itchy cat who had groomed off all his pants, recovered from his allergies.
Steroids Provide Fast Relief for Treatment of Allergies in Cats
When we’re treating feline allergies, the first goal is to stop the intense itching and scratching that these cats are doing. They really need fast relief. The only treatment we have that truly provides rapid relief is going to be steroids. Steroids reduce inflammation and suppress an overactive immune system. They provide rapid relief, often within hours or a few days, making them very useful for severe flare-ups, but they do have risks. Longterm steroid use can lead to things like diabetes, urinary tract infections, weight gain, muscle loss, kidney disease, heart disease, and many other side effects.
How Are Steroids Used for Treatment of Allergies in Cats?
There’s a number of different ways that we can administer steroids. Sometimes, this can be orally, with a liquid or a tablet. Sometimes, it can be a topical medication, like an ointment, a spray, or a drop. Sometimes, we use steroids as an injection, particularly in cats that are really challenging, when it comes to giving oral medications (by mouth). But keep in mind, the injectable steroids are going to have the most risks, out of all the different types of steroids available, so I really try to hold off on using steroid shots unless I absolutely have to.
There’s a great episode all about steroids, earlier on in the podcast series, episode 6 with Dr. Curtis Plowgian, where he and I talk about the different uses of steroids, and things to be aware of when we’re using steroids to treat an animal’s disease. That’s a great resource if you want to go back and listen to that episode.
Steroids can be used for short term control, and I’m often reaching for steroids at the beginning of my allergy workup, so that I can give that animal fast relief, while I’m trying to figure out their triggers. That helps me to minimize the use of steroids throughout the cat’s lifetime.
When Long Term Relief is Needed for Treatment of Allergies in Cats
We talked all about of the different types of triggers in the last episode. When we’re figuring out their triggers, if that cat is still struggling with their allergies after we’ve gotten them on a really good flea prevention, and we’ve done an elimination diet trial to rule out any triggers coming from food, then we know that the animal has environmental allergies. And this is something that is going to need more longterm management of symptoms.
Even if we’re considering pursuing allergy immunotherapy, or allergy shots to desensitize the cat on a long term basis, that immunotherapy takes a while to start working. We’ll need something that’s going to keep the cat comfortable, while we’re waiting for those allergy shots, to reverse the underlying disease process. That’s when we’re going to consider a medication known as cyclosporine.
Cyclosporine for Treatment of Allergies in Cats
Cyclosporine modulates the immune system, to reduce allergic reactions without the side effects that we get from steroids. This is a completely different class of medications. As of right now, there are two different formulations of cyclosporine which have been FDA approved for cats; Atopica® and Modulus®. There are other formulations of modified cyclosporine available, which may not be specifically labeled for cats, but there are lots of different options, for formulations of this particular medication, at our disposal.
Benefits and Risks of Cyclosporine for Treatment of Allergies in Cats
The benefit to cyclosporine is that this is a great therapy for longterm control of allergies, with fewer risks, compared to steroids, in our allergic cats. There are going to be some risks associated with cyclosporine use, primarily related to tummy-upset, when first starting this medication. So most often, if an animal is going to experience vomiting, diarrhea, or loss of appetite, it’ll usually be within the first two weeks of starting this medication. I try to help minimize the risk of tummy-upset by starting this medication at low dose, for the first couple of weeks, and then gradually building up until we get to that full dose. That gives the animals’ tummies some time to adjust to that medication, so that they’re not experiencing severe side effects, from giving them that full dose, right at the beginning of treatment.
One of the other drawbacks of this medication is that it takes a while to start working. This is usually why I’m holding off on starting cyclosporine, if I haven’t ruled out things like flea allergies or food allergies (because it doesn’t take me that long to get flea allergies and food allergies well-controlled in my patients). Oftentimes, by the time I’ve managed flea allergies or food allergies, that’s just when the cyclosporine would start working. And by that point, maybe I don’t need it, if the animal does not have environmental allergies. But if I know that an animal has environmental allergies, and they’re going to need something to control their immune systems’ overreactions for a long period of time, cyclosporine is a much safer option, compared to steroids.
Using Cyclosporine for Long Term Treatment of Allergies in Cats
Cyclosporine takes about 4-6 weeks to start working, and after about 2-3 months, we see continued improvement, in terms of how well this medication controls the underlying disease process. So even if the animal isn’t completely controlled by about a month or so into treatment, give it a little bit more time (especially if they’re tolerating the medication well), to see if there is improved benefit, the longer they’re on that medication.
Once I have a cat’s allergies in remission, I’m going to work on finding the lowest effective dose or frequency of cyclosporine, which helps keep them in remission, while minimizing how often they have to take that medication. This minimizes things like cost and side effects, in terms of minimizing how much we’re suppressing the immune system with cyclosporine, as well as tolerance. Cats prefer to have something shoved down their throat as little as possible.
Usually when I’m making dose adjustments with this medication, I’ll give the cat about a month or so to adjust to the new frequency. Then, if they’re still doing great, and their allergies haven’t come out of remission, I’ll have the owner pull back even further on the medication. If we’re combining the use of cyclosporine with allergy immunotherapy to desensitize the cat, then we can be able to pull back on cyclosporine even further, and have an opportunity to potentially discontinue it altogether.
Another thing to consider, when using cyclosporine on a longterm basis, is doing some blood work, to monitor things like white blood cell counts, liver values, and kidney values. We rarely see changes, in terms of those values.
The other major risk associated with cyclosporine is the risk of having more severe signs, if exposed to toxoplasmosis. The organism that causes this particular disease is most often found in raw meat, particularly carried by rodents. So if I have an indoor-outdoor cat that the owner knows is hunting on a regular basis, or if the owner is feeding a raw food diet (which has significant risks of parasite and bacterial infection), I am not going to recommend the use of cyclosporine because I don’t want to put them at risk of severe toxoplasmosis. This is an important conversation to have with your family veterinarian, or your veterinary dermatologist, depending on your cat’s specific lifestyle.
Antihistamines for Treatment of Allergies in Cats
So what about antihistamines? Do they work for cats? Pet owners will frequently ask about antihistamines like Benadryl or Zyrtec. The reality is that antihistamines are much less effective, in dogs and cats, than they are in humans. And while some cats may benefit from antihistamines like cetirizine or chlorfeniramine, their success is highly inconsistent, and it will not be effective for animals who are extremely uncomfortable.
The data suggests that if antihistamines are going to be effective, they’re only going to be mildly effective, in the treatment of very mild allergies, and are much better used as a preventative than a treatment, for acute flare-ups or longterm management. This isn’t something that is likely able to control your cat’s allergies by itself, but maybe it has some benefit in reducing the dose of other medications, in addition to the antihistamines.
So don’t be discouraged if antihistamines don’t work. They likely will not, and there are better options that we can reach for, if you talk to your veterinarian.
Use of Apoquel for Treatment of Allergies in Cats
What about Apoquel? I get asked about this quite a bit. Is Apoquel safe and effective for the treatment of allergies in cats?
There have been a few studies and one case report, looking at Apoquel for cats with feline atopic skin syndrome or asthma, and of the 48 cats that were evaluated between all of these studies (which is a very small number) about 30-50 % of cats had a good response within one month of starting treatment. But there is no consensus on dosing. And the data suggests that effective dosing for cats needs to be higher and more frequent than it does for dogs with allergies.
One study in 2022 suggested that once-daily dosing could be used, after two weeks of twice-daily dosing, with the owner monitoring for relapse of clinical signs, and that it’s unclear which ones cats would need on a long term basis.
Zoetis, the makers of Apoquel, have indicated that it is not to be used in cats. There’s just not enough safety and efficacy data, at this time, to have FDA approval for use of Apoquel in cats, and there are no safety or efficacy studies that have been published with the use of Zenrelia, which is in the same class of medications as Apoquel.
Treatment of Allergies in Cats with Apoquel
In those studies that looked at Apoquel in cats, there were some blood work changes. So it’s important, if your veterinarian is prescribing this medication, that there is some baseline blood work (before starting medication), as well as blood work after a certain interval, in order to monitor the animal’s response, to make sure that they’re using it as safely as possible. This goes with all of the medications that we’re using, including steroids and cyclosporine, plus or minus Apoquel, if that’s something that your veterinarian recommends.
Off-label use of Apoquel appears to be somewhat effective for feline atopic skin syndrome, in the small numbers of cats that these studies looked at, but there are no longterm safety or efficacy studies for the use of Apoquel, in the treatment of cats with allergies.
For me, this particular drug does not come up very often in conversation with my clients. Oftentimes, I’m getting significant improvement with things that are FDA labeled for cats, like cyclosporine, with the use of good flea prevention, elimination diet trials, and focusing on allergy immunotherapy, to reverse the underlying allergy.
The other drawback with Apoquel that I have found, in the small number of patients that I’ve reached for it with, is that oftentimes, it does need to be given twice a day. And for many cat owners, giving pills twice a day is a big drawback. So I want to try and find something that I only need to give once a day, or a couple times per week, like I do when the cyclosporine is really effective. Then, I can minimize the amount of times that the cat and the owner are doing the cat-pilling dance, when you’re trying to get the medication into them on a regular basis.
Allergy Testing to Formulate Immunotherapy in Cats
In terms of long term management for environmental allergies, allergy immunotherapy is our gold-standard treatment. If you want to address your cat’s allergies at the root cause, rather than just managing their symptoms or their signs, allergy immunotherapy (shots or drops) is the best option.
There’s a great episode, earlier on in the podcast series, episode 8, which is all about immunotherapy testing and treatment options. I would highly encourage you to go back and listen to that full episode, if allergy shots are something that you are considering.
This is going to involve testing for specific allergens, things like pollens from grasses, weeds or trees, dust mites, molds, and dander (from humans or dogs). That can be done, either through blood testing or intradermal testing (skin). Once we have those test results, we custom formulate a treatment that gradually desensitizes your cat’s immune system to the allergens for which they came up positive.
Dermatologists are Experts at Allergy Testing
It’s really important that allergy testing and formulating immunotherapy be done with a veterinary dermatologist, whenever possible. There is published data to show that allergy immunotherapy formulated by a veterinary dermatologist has a significantly higher rate of success than allergy immunotherapy when formulated through the family veterinarian.
It’s worth doing the investment of going to see a dermatologist to have a therapy that works very effectively, and oftentimes, this is going to be helpful in minimizing the frequency and severity of allergy flares that the cat experiences. About 65-75 % of animals with environmental allergies will have a reduction in the recurrence and severity of their allergic signs, which allows us to reduce the amount of medications that they’re using over time.
Allergy Immunotherapy is a Holistic Treatment for Allergies in Cats
So with allergy immunotherapy, we are giving a very small, controlled dose of the things that the animal is allergic to, either through allergy shots (mixed with saline) or allergy drops (mixed with glycerin). It’s important to understand that immunotherapy is not a drug. This is a holistic approach to retraining the immune system. It is the only treatment that actually modifies the immune system, rather than just suppressing the clinical signs that the animal is experiencing. This allows us to reduce or eliminate the need for other medications, like steroids or cyclosporine, throughout the cat’s lifetime. Generally, immunotherapy is going to be well-tolerated, with very minimal risks or side effects, and that’s because it’s technically not a drug.
Should Your Cat Get Allergy Shots?
So who’s going to be a good candidate for allergy testing and immunotherapy? Cats that have year-round allergies, that don’t fully improve with medications, are great candidates, especially if they are young and have many allergy seasons ahead of them. We want to focus on reversing the underlying disease process, rather than just committing these animals to a lifetime of things like steroids.
Other good candidates are cats that experience side effects from medications like steroids or cyclosporine. If they’re not able to tolerate the medications that we commonly use for treatment of allergies, or they have some other underlying disease process which makes it very risky for us to use these medications, allergy immunotherapy is a great way to minimize our reliance and need for things like steroids and cyclosporine.
Any owner who is looking for a longterm drug-free approach should consider allergy immunotherapy. It is a great way to provide a holistic approach to reversing the underlying disease in these animals. And I’ve had some truly rewarding cases, where immunotherapy has transformed a cat’s life, like Otto, who went from bald to beautifully fluffy again.
Does Treatment with Allergy Immunotherapy Have Drawbacks?
The main drawback with allergy immunotherapy is that it takes a while to start working. So while most of our therapies are going to work within days (steroids), or within weeks to months (cyclosporine), immunotherapy takes about 6-12 months to start working. It feels like a while, especially in the beginning. And that doesn’t mean that, after 12 months, we’re done with immunotherapy. This typically winds up being a very longterm treatment. But if this is a young cat that has many allergy seasons ahead of them, 6-12 months is going to fly by.
The maintenance frequency for getting injections, depending on who formulates your immunotherapy, is often going to be once every 2-4 weeks. Those injections are most often going to be administered at home, after teaching owners how to give their cat shots.
While there is a cost associated with the allergy testing and formulation of allergens over time, that cost is going to be much more economical than the cost of managing a cat on symptomatic medications, including the blood work monitoring that is recommended with those symptomatic medications. Especially if your cat is on the younger side, allergy immunotherapy should be something that you consider, to help the animal throughout the course of its lifetime.
Can Omega-3 Fatty Acids be Used for Treatment of Allergies in Cats?
Omega 3 fatty acid supplementation may be a helpful adjunctive nutritional therapy for animals with environmental allergies. Just like antihistamines, omega 3 fatty acids are unlikely to be able to control moderate to severe disease by itself. But again, this is going to be something that may help, in reducing the amount of steroids that an animal has to take, if the omega 3 fatty acids are controlling at least some part of that inflammation.
There are lots of different formulations of omega 3 fatty acids out there. I typically recommend either Ecosa 3FF Snip Caps or Nordic Naturals. Both of these brands have some data to demonstrate their efficacy. There are a lot of different omega 3 fatty acid supplementations out there now, and I would talk to your family veterinarian about which one they recommend, on a regular basis, so that you can purchase something that has some veterinary recommendations behind it.
The risks associated with omega 3 fatty acid supplementations are minimal. Maybe some animals don’t like the taste of the supplement, or they have a little gastrointestinal upset, as a result. But most of the time, this is going to be very well-tolerated, with minimal risk associated with it. Overall, it can improve skin health. It reduces overall inflammation, but it is recommended to talk to your family veterinarian before starting an omega 3 fatty acid supplement.
Treating Infections from Allergies in Cats
Another part of our treatment plan should include managing secondary infections. I say “secondary” because the primary disease is the allergy. There’s a great series of episodes, 42 and 43, all about skin infections and topicals, as well as oral antibiotics and antifungal medications. Episodes 44 and 45 are all about infections in the ear, and how to diagnose and treat them. I would encourage you to go back and get some more information from those episodes, if your pet is suffering from infections on the skin or in the ear.
The allergy is going to disrupt the skin barrier, as well as the skin barrier within the ear canal. That allows normal microorganisms, like bacteria and yeast, that typically live in harmony, on the surface of the skin, to penetrate through that damaged skin barrier and cause those secondary infections. These are not infections that your cat picked up from somewhere. It’s their own normal bacteria and yeast, which usually don’t cause a problem, that are being allowed to overpopulate because of that primary allergy. But those secondary infections can make the allergy worse by worsening the inflammation on that damaged skin.
Treating these secondary infections is just as important as controlling the allergy itself. Cytology is a very simple, very helpful test that your family veterinarian can do, in order to identify if there are bacteria, yeast, or a combination of those things, on the pet’s skin. Topical treatments like medicated wipes or spray, as well as mousse, can be helpful. Episode 46 is all about cytology and what this helpful diagnostic tool can tell us, simply and easily, while the animal is in the vet’s office.
Bathing or Antibiotics for Treatment of Infections in Cats
I typically don’t prescribe bathing for my cat patients as often as I do for my dog patients, but every once in a while, I’ve got a cat owner who says that they love giving their cat a bath. We’ll implement some medicated bathing, as part of our overall treatment plan, for these animals. So if your cat doesn’t mind a bath, then that’s something that you can volunteer as an important piece of information, for whichever veterinarian you’re working with.
Oftentimes, we may reach for oral antibiotics, or oral antifungal medications, to help with deep infection, especially when we have those really thick eosinophilic plaques, which I discussed in previous episodes. Your veterinarian will determine if infections are present, and what type of treatment is best for your specific pet.
Can Environmental Allergies Be Avoided in Cats?
But what about environmental management? Are there simple changes at home that can help? Reducing allergen exposure can help minimize symptoms, in a very few cases, in particular. A lot of times, owners get really fixated on allergen avoidance, sometimes hyper-focusing on cleaning, using air purifiers, and just minimizing the animal’s exposure to things that are causing the reactions.
Unfortunately, there are no published studies on whether or not cats with feline atopic skin syndrome can be treated, by avoiding what the animal is allergic to. And that’s another good reason why we shouldn’t be performing allergy testing without implementing immunotherapy. So unless you’re going to do allergy shots or allergy drops, I would not recommend allergy testing, if you’re just seeing what the animal is allergic to.
There was one retrospective study that looked at 29 cats that had asthma (another allergy), and one cat had a human dander allergy. It got better by prohibiting access to the owner’s bedroom, which helped to minimize exposure to human dander.
There were three cats, in that study, that had storage mite allergies, whose asthma improved by switching them from a dry kibble diet to a wet food diet. Oftentimes, storage mites are found in that dust in the dry kibble. By implementing a wet food diet, that animal had no exposure to storage mites, moving forward. While this may be helpful for animals that have asthma, oftentimes, it’s going to be very impractical for many of the allergens that trigger skin allergies in our cat patients.
So it’s more important to focus on desensitization rather than installing multiple air purifiers or trying to deep clean the entire house every single day. You just want to focus on using the medications to control the symptoms, and to use the immunotherapy to help desensitize the cat to what they’re allergic to.
Individual Treatment for Allergies in Cats
I think it’s really important to understand that every allergic cat is unique, and what works for one, may not work for another. A good treatment plan considers the severity of the clinical signs that the animal is experiencing, the cat’s individual medical history, and the owner’s ability to administer medications, as well as cost concerns. How long are we going to need these medications for?
Partnering with your veterinarian, or a board certified veterinary dermatology specialist, will ensure that your cat gets the best possible care. And if your cat is struggling with allergies, don’t lose hope. There are multiple treatment options available. With the right approach, we can get your cat back to feeling comfortable.
Even our patient from the beginning of our series, Otto, had to go through multiple types of medications, in order to find a treatment plan that worked for him, on a long term basis. We started with flea control and an elimination diet trial to investigate the primary triggers, and when we discovered that his allergies were ongoing, despite controlling for flea and food allergies, then we started allergy immunotherapy, to work on desensitizing him to his environmental triggers. Along the way, we used steroids to provide short-term rapid relief, and then implemented a cyclosporine to minimize the steroid side effects, on a long term basis. Otto did have some adverse reactions to cyclosporine, so eventually we were able to taper him off of that medication while the allergy immunotherapy was starting to take effect. But at this point in time, he is well-controlled on allergy immunotherapy, year-round flea prevention, and some topical anti-itch medications, every once in a while, when his ears start to get a little bit itchy. But for the most part, he has completely regrown his pants. He’s got a wonderful fluffy hair coat.
If you are struggling with your cat’s allergies, you can click on the resources tab, for a link to find a board certified veterinary dermatology specialist near you. If you live in Southern California, and you’d like to consult with me or one of the other amazing dermatology specialists at Veterinary Skin and Ear, we would love to see you. We absolutely adore our cat patients.
Scratching the Itch - The EveryCat Health Foundation
I like to end each episode with a segment that is designed to provide relief or just make you feel good, Scratching the Itch. Today’s ‘Scratching the Itch’ is the Every Cat Health Foundation. Formerly known as the Wynn Feline Foundation, this is the world’s only nonprofit focused solely on feline health research.
They award grants for cutting edge research in feline medicine, ranging from clinically applicable proposals to long shot investigations with game-changing potential. They meticulously evaluate grants and administer funds that have a high impact on feline health and welfare. The Every Cat Health Foundation has done some amazing work, advancing medications and treatment options for cats with a wide range of diseases.
I would highly recommend that you check out their website, so that you can see some of the incredible work that they are doing, to change the way that we treat our feline patients. If you would like to support the Every Cat Health Foundation, you can donate on their website, as well. All of their donations go towards implementing that game changing research for cats. Thank you all so much for listening. I look forward to your next visit with Your Vet Wants You to Know.
References:
- Mueller, R.S., Nuttall, T., Prost, C., Schulz, B. and Bizikova, P. (2021), Treatment of the feline atopic syndrome – a systematic review. Vet Dermatol, 32: 43-e8. https://doi.org/10.1111/vde.12933
- , , et al. Retrospective survey of allergen immunotherapy in canine atopy. Vet Rec 1998; 143: 139–142.
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