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Scratching to distracation! Atopy (Atopic or Allergic Skin Disease)

All dogs and cats have the occasional scratch, but when it becomes constant there is often an underlying cause.  One of these underlying causes is a condition called Atopy.  We are seeing more and more cases of Atopic Skin Disease in dogs and, less commonly, in cats.  

What is Atopic Skin Disease?

Atopy is an allergic response to airborne (inhaled) allergens, such as pollens, types of grass or trees or house dust mites.  In humans, this type of allergy would commonly present as hay fever (e.g. sneezing, runny nose/eyes), but dogs and cats have a different response to us and this type of allergy causes them to develop skin problems.  Atopic skin disease cannot be cured – treatment is aimed at reducing the overall itchiness of the animal and reducing the number of ‘flare-ups’ experienced – these are periods where the animal becomes especially itchy.

What signs do we see in Atopy?

Atopic animals almost always itch.  The affected dog or cat will have at least one area of the body which is itchy, or pruritic; however, the affected regions are different in every case.  Common areas of the body to be affected are –

·         Feet

·         Ears

·         Armpits and groin

·         Tummy or ventrum

·         Areas of less well haired skin around genitals

·         Skin surrounding eyes or mouth

However, all areas of the body, including the trunk, can be involved.  The skin feels warm to the touch and becomes red and inflamed; there are often spots and scabby or flaky areas, and the skin becomes thickened and can also become hyperpigmented (black) in more chronic cases.  Sometimes the only sign shown are recurrent ear infections, causing head shaking or scratching at the ears.  These affected areas can become so itchy that they often cause the animal to traumatise their own skin by rubbing, scratching or chewing/licking; this behaviour can unfortunately lead to further problems such as skin infections, over and above the underlying allergic skin disease. 

Because Atopy involves airborne allergens, animals are often more severely affected at different times of the year – often ‘flare-ups’ occur in Spring or Summer when levels of pollen are at their highest.  However, there are individuals who break with tradition and are worst affected during Autumn or Winter – particularly if indoor allergens such as house dust mites are involved.

How do we diagnose Atopy?

This bit can be frustrating, both to the vet and you, the owner!  A thorough history taken by the vet can certainly flag up the suspicion that Atopy could be a problem, but, as mentioned above, the waters are often muddied by the fact that the animal has some secondary problems such as a skin infection.  Unfortunately, the secondary problems can also cause intense discomfort for the animal, and so often the vet will treat the skin infection first and then go on to investigate any possible Atopic disease once the infection has resolved.  There may also be other skin issues, such as infestation with fleas or other parasites, which need to be sorted before Atopy is considered.

Once other problems have been ruled out, there are various ways of attempting to diagnose Atopy.  Often, the vet will recommend skin biopsies which are sent away to be analysed by a histopathologist – these are helpful as they give the vet an indication of the types of abnormal cells that are present in the affected areas.  Different types of cells, particularly inflammatory or white blood cells, are present in different types of inflammatory skin disease, such as Atopy, and so finding out which particular cells are present can help to rule Atopy in or out as a problem.  Once Atopy is strongly suspected, blood can be taken and tested against various different common allergens (such as various types of pollen, grasses, trees and house dust mites) to show which particular allergens are most strongly reacted to.  The animal can also be referred to a dermatologist who can perform intradermal testing, again against a range of allergens, to see which give the strongest reaction.

How do we treat Atopy?

UNFORTUNATELY, WE CANNOT CURE ATOPY.  Treatment is aimed at controlling the signs shown by the animal e.g. reducing the amount the animal itches.  There are several ways that atopy can be treated –

·         Anti-inflammatory medications – these aims to relieve the itchiness caused by the inflamed skin and hence stop the animal from scratching or chewing.  Most animals with Atopy need these to some degree, whatever other treatment is used.  This hopefully improves quality of life and also prevents the secondary problems such as skin infections that the animal can develop if he or she is constantly scratching.  There are a few different types of anti-inflammatory medications used – unfortunately they all come with some side effects and so animals need to be monitored if they are on these types of medication long term

·         Immune modulating drugs – these can reduce the body’s reaction to the allergens, causing less signs of irritation, and hopefully lessening the signs of Atopy.  As with anti-inflammatory medications, these drugs also come with some side effects and so animals need to be monitored if they are on these types of medication long term

·         Antihistamines – these are used to reduce the allergic response mounted by the animal – however, they have varying degrees of effect in individuals and don’t always help

·         Desensitisation injections – if the animal has had blood or intradermal testing and is shown to have reactions to one or more allergens, a desensitisation vaccine can be made up specifically for that individual.  These are given every few weeks initially and then monthly on a long term basis and can greatly help reduce the signs of Atopy.  This treatment can greatly improve the degree of itching experienced by the animal; however, it should be pointed out that not all animals respond – it’s impossible to say who will and who won’t

·         Medications to control other skin problems – antibiotics are often used at the start of Atopic skin disease, and during subsequent flare-ups of the condition, to control the secondary problem of skin infection.  Regular antiparasitic control, such as flea control, is always recommended to prevent any other causes of itchy skin

·         Supplements such as fatty acids can help to improve the health of the skin and make it less likely to respond to allergens

·         In some cases, it is possible to reduce the contact that affected animals have with the allergen that causes the problem – however this is often not possible if an animal is allergic to many different allergens

The main point to make about Atopy is that any treatment is aimed at controlling the condition rather than curing it.  This can make it a frustrating, time consuming and expensive disease to treat, so it is important that you understand the implications of the disease at the start.  However, once animals are better controlled, owners often report that they are much happier and livelier individuals and can go on to lead relatively normal lives.

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