Definition and cause
The basic underlying cause for allergic dermatitis in dogs and cats is an exaggerated immune response to allergens such as pollen, dander, molds, dust mites and other environmental allergens and chemicals. The basic exaggerated immune response is believed to involve T-and B-lymphocytes, the production of IgE, and the stimulation of mast cells and eosinophils, causing the local, cutaneous reaction.
The result is that sensitized animals react in receptor sites in the skin, leading to pruritus and secondary issues. There is also an inherited component; many popular breeds such as Golden Retrievers, Irish Setters, and Old English Sheepdogs are more prone to the condition.
Medical therapy rationale, drug(s) of choice, and nutritional recommendations
The central focus of standard therapy is to identify and eliminate the causative agent in combination with antihis-tamines and oral and topical immune-suppressing drugs such as corticosteroids and cyclosporine. In addition, allergen desensitizing (immunotherapy) injections are favored by some dermatologists. Dietary recommendations include hypoallergenic diets in combination with omega-3-rich sources of fatty acids.
Most animals with allergic dermatitis respond well to topical and oral therapy in combination with avoidance of exposure to allergens. Allergic dermatitis is a progressive condition and most often requires ongoing medical therapy to control the allergic response.
Integrative veterinary therapies
Pollutants, preservatives, food additives, and a host of compounds can lead to tissue injury and activate the immune response. The mucosa is the primary barrier and location of many immune elements, and anything that injures the mucosal integrity can lead to immune dysfunction.
Once allergens gain access to these tissues, they can be removed and processed by macrophages in a wide variety of locations (especially the gut, liver, spleen, and lung). In cases in which the damage is rapidly repaired, there is a reduced likelihood of chronic allergies developing, but if a chronic defect in mucosal integrity occurs, then allergies can develop more easily. Genetic predisposition is a factor in this situation.
The liver is responsible for processing much of the material that originates from mucosal borders. The hepatic macrophage system of Kupfer cells is very efficient in removing and processing antigens. The liver can metabolize, conjugate, and excrete many homotoxins, and support of liver function and excretion is a critical portion of any allergic therapy.
Macrophages present the antigen components to lymphocytes and these dictate the development of immune response through the action of T-lymphocytes (TH-0, TH-1, and TH-2 cells). Alteration of the T-helper cell can determine the type of immune response by the organism. Homotoxins that are not removed by first passage through the liver can also be excreted by the kidney, skin, and lung. Homotoxins that have been eliminated by the liver but reabsorbed through the enterohepatic circulation also enter the system at this level.
Support of mucosal tissues is critical, and therefore one of the first areas requiring attention in allergic patients is the intestinal tract. The patient should be fed an easily digested ration which ideally lacks excessive amounts of allergens. This allows for improved intestinal function and reduces homotoxins presented to the liver. It also allows for improved mucosal integrity. In managing airborne allergens, it is advisable to reduce the level of homotoxins such as pollens, scented products and incenses, and toxic agents such as ozone and pollutants, which might damage mucosal integrity.
Adequate water consumption is also important in maintaining proper immune function and repairing damaged tissue. Probiotics may greatly assist in protecting the mucosal border and local immune system and are useful in most immune imbalance cases. Antioxidant agents such as vitamins and minerals, as well as other nutraceuticals, herbals, and whole foods, provide needed protection from oxidative damage and assist in repairing tissues.
Support of liver function assists greatly in handling allergic cases and in many clinical situations support of the enterohepatic system is the first action in preparing a case.
Providing attention to the renal system further assists detoxification, and is especially necessary in cases that are undergoing regressive vicariation from the Impregnation Phase to the Deposition and Inflammation phases. Providing adequate levels of fatty acids, especially omega-3 fatty acids, assists in repairing cell membranes and in decreasing levels of tissue inflammation.
Unnecessary or redundant vaccinations should be avoided in all patients, but this is particularly true in allergic pets. Risk for vaccination reaction is higher in atopic pets. In 1983, a study showed that allergies (such as atopic dermatitis) develop in dogs when vaccinated for distemper, hepatitis, and leptospirosis just prior to, but not after, exposure to pollen extracts. Dogs predisposed to atopy produce excess amounts of IgE antibodies in response to antigens, resulting in chronically irritating skin inflammations. Other organs may exhibit signs of hypersensitivity causing, for example, conjunctivitis or rhinitis, as exhibited in further studies by this group. A recent study demonstrated no increase in the rate of atopy in children receiving vaccinations. Good medical practice dictates caution in the use of any agent in patients that are known to be prone to allergic reactions.
Note: See Homotoxicology for the “4 Rs” approach to an allergic patient.
General considerations / rationale
While the target tissue is often the skin or intestinal tract, allergies are metabolically a systemic disease. They often involve multiple organs, particularly the liver, which shares the same detoxification enzyme systems. In addition, the elimination of toxins, allergens, and metabolic wastes often burdens the organs of detoxification, namely the bowel, kidney, lung, and skin. The use of immune-suppressing drugs such as cortisone, while often necessary because of self-trauma, actually exacerbate the condition by slowing elimination and covering up the inflammation. Because allergies are metabolically a multi-organ disease, a physiological evaluation of the blood is recommended to more closely address nutritional deficiencies and required gland support (see site, Nutritional Blood Testing, for additional information).
Nutritional / gland therapy: Glandular intestines, kidney, adrenal, thymus, liver, and pituitary supply intrinsic nutrients that improve organ function, reduce cellular inflammation, and promote and enhance detoxification (see Gland Therapy, site, for a more detailed explanation).
Probiotics: Administration of the proper combination of probiotics has been reported to have a positive impact on the intestines and the digestive process. Probiotics have been shown to improve and enhance the digestive process by secreting their own source of enzymes.
Sterols: Plant-derived sterols such as betasitosterol show antiinflammatory properties, which appear to be similar to corticosteriods. A cortisone-like effect without the associated immune-suppressing effects is beneficial in all allergic reactions. Bouic (1996) reports on the immune-enhancing and balancing effect of plant sterols, which are also beneficial to animals with allergic reactions or responses.
Evening primrose oil (EPO): Evening primrose oil has been proven to have both antiinflammatory and antipruritic effects. As part of a balanced nutritional program, evening primrose oil can exert a positive effect on animals with skin disease. Studies suggest that evening primrose oil is beneficial in people with atopic dermatitis and eczema.
Quercetin: Quercetin is a flavonoid and has potent antioxidant properties (see site, Phytonutrients). Quercetin also functions similar to an antihistamine in that it can inhibit cells from releasing histamines. This antihistamine attribute helps treat allergic conditions such as asthma, dermatitis, and eczema.
Chinese herbal medicine
General considerations / rationale
Practitioners of Traditional Chinese Medicine consider allergic dermatitis to be a combination of Wind, Heat, and Damp. Allergy generally is considered to be an immune disorder. Heat refers to the inflammation, which tends to be red and may be warm to the touch. Dampness describes the greasy nature of some allergic dermatitis patients. It can also apply to skin with serous discharge, i.e., “weepy” sores or purulent debris in pustules. Wind translates into itching, in modern terms.
Appropriate Chinese herbs and acupuncture
Angelica (Bai zhi): Has been shown to have antiinflammatory and antipruritic effects in mice.
Atractylodes (Cang zhu): Has activity against Staphy-lococcus aureus and dermatophytes.
Bupleurum (Chai hu): Decreases the effect of histamine release and has antibiotic effects against streptococci.
Cicada slough (Chan tui): Has been used successfully in humans to treat chronic urticaria.
Licorice (Gan cao): Inhibits the growth of Staphylococ-cus aureus. It contains glycyrrhi-zine and glycyrrhentinic acid, which have corticosteroid activity.
Lonicera flower (Jin yin hua): Has antibiotic effects against Staphylococcus aureus, E. coli, and Pseudomonas aeruginosa and is antiinflammatory.
Mint (Bo he): Relieves itching and has antiinflammatory effects.
Moutan (Mu dan pi): Demonstrates antiinflammatory actions via inhibition of prostaglandin synthesis and decreases vascular permeability. It inhibits the growth of Staphylococcus aureus, streptococci, and dermatophytes.
Platycodon (Jie geng): Decreases allergic reactions.
Poria (Fu ling): Has inhibitory effects on Staphylococcus aureus.
Rehmannia (Sheng di huang): Has shown antiinflammatory activity in mice.
Siegesbeckia (Xi xian cao): Inhibits the growth of Staphylococcus aureus (Phytochemistry).
White peony (Bai shao): Contains paeoniflorin, which is a strong antiinflammatory. It also has antibiotic effects against Staphylococcus aureus, some streptococci, E. coli, Pseudomonas aeruginosa and some dermatophytes.
Acupuncture has been used to treat skin allergies. By stimulating specific acupuncture points, it is possible to stimulate the pet’s immune system and reduce the itching and inflammation associated with allergic dermatitis.
The authors have used GV14, SP9, and SP10 to control inflammation (Clear Heat in traditional Chinese medicine terms). LI11 can be used to stop itching and HT7 can be used to calm the animal so it does not lick or scratch and irritate the skin further.
Local points can be used. These include LI4 for the front legs, GB34 for the back legs, and GB20 for the neck.
General considerations / rationale
The basic biophysiology of allergies is well described. Allergic reactions represent Impregnation Phase homo-toxicoses as IgE binds to mast cells and alters the response of the connective tissue to allergens. Numerous homotoxins are released as part of the allergic response; histamine is a major homotoxin that requires detoxification and elimination. Excessive amounts of histamine lead to tissue injury and progressive vicariation.
Understanding the elimination pathways for homotoxins is critical to properly handling allergic cases. Biological therapy for allergies involves decreasing the levels of homotoxins, improving detoxification pathways, increasing elimination of homotoxins, and supporting repair of injured tissues and organs.
4 Rs: This system for approaching allergic cases consists of:
Remove: Remove toxic materials, antigenic substances, pathogens, disease-causing stressors, and other factors that favor pathology. This allows for a cessation or reduction in tissue injury, and calming of the overtaxed immune response. Healing occurs best in a safe environment at a microscopic and macroscopic level. Avoidance of unnecessary vaccinations and unnecessary symptom-suppressive medicants, and use of limited-antigen and more natural diets, air filters, hygiene, endoparasite control, ectoparasite control, as well as an altered environment, are all examples of this step. In some cases, all that is needed for recovery is removal of the antigenic stimulation (flea allergy, mild pollen or food allergy). This is an important first step in handling all allergy patients. Detoxification therapy is useful in this step and it has been frequently observed that allergic pets do better clinically if they are given routine detoxification therapy at regular intervals (at least twice yearly). In mild cases, the easiest form of detoxification is the Detox Kit. In deeper homotoxicoses, the deep detoxification formula is recommended.
Repopulate / Revive: Provide adequate probiotic bacteria to repopulate a proper intestinal and mucosal flora, and revive function of chief excretory organs such as the liver and intestine. Probiotic bacteria also provide a means of reactivating damaged enzyme systems from earlier disease elements such as bacterial or fungal toxins and pharmaceutical agents such as cortisone, NSAIDs, and antibiotics.
Rebalance / Repair: Assist the natural bio-oscillation of inflammation and pH fluctuations, eliminate diseased tissue elements, clear the matrix of debris, promote collagen repair and replacement and provide improved circulation of hemic-lymphatic components, and provide adequate raw materials for enzyme production and tissue repair.
Reorganize: Cycles of repair continually improve the status of the diseased tissue and its relationship to the body as a whole. Hering’s Law of Cure manifests at this level as we see the body repair from inside to outside, from most important organ to least important organ, from the head down and in reverse order of present pathologic history. This is a useful tool for the clinician in determining whether a patient is undergoing regressive vicariation (in which case the clinician would simply continue therapy), or undergoing less desirable progressive vicariation (in which case the clinician would need to intervene and address the patient’s worsening condition).
In patients that are already on symptom-suppressing drugs such as corticosteroids, antihistamines, antibiotics, or cyclosporin, it is advisable to begin therapy gently and not to stop these medications initially. After the system has been sufficiently strengthened, the dosages can be gradually reduced until many patients no longer require as much medication to manage their cases. In some instances they may no longer need symptom-suppressing medications to maintain a healthy lifestyle. Not all allergic patients can be cured, but it is a worthwhile goal to simply improve their quality of life and when possible reduce their dependency on pharmaceutical agents.
Allergic patients can be greatly assisted by proper use of biological therapies and many make surprising recoveries if they are allowed to go through regressive vicariation and are not subjected to further suppression of their body’s natural healing responses. Homeopathy has been used for many years to treat allergies in human and veterinary patients. Clinicians should advise clients that this process might take from 1 to 3 years, and ascertain if the clients are dedicated to the process before embarking on such a program. It may be more expedient for some clients to simply suppress symptoms, but for those who desire maximizing the health of their pet, it is very rewarding and challenging work. Biological therapy options should be discussed with clients as part of the informed consent procedure as an option to administering potentially damaging pharmaceutical agents.
Appropriate homotoxicology formulas
A large number of antihomotoxic formulas may be needed to manage a case of allergic skin disease. Autosanguis therapy can be particularly useful. (Also see sections on Otitis externa and Otitis media; vomiting and diarrhea; coughing; and seborrhea, throughout this chapter). Careful attention to phase and phase shifting is needed to guide remedy selection. A list of commonly used agents follows:
Aesculus homaccord: Promotes improved circulation and lymph drainage.
Apis homaccord: Used for urticarial reactions (especially when combined with Lymphomyosot). Also used for pruritic dermatitis, pustular dermatitis, and bullous eczema.
Belladonna homaccord: Treats intensely red lesions, furunculosis, boils; the skin is dry, red, and hot; patients resent being touched. The ears may itch intensely, to the point that the pet drills things into the ears or rubs excessively. There is excessive head shaking.
Berberis homaccord: Part of Heel’s Detox Kit used for adrenal support and detoxification of the renal system and liver, in cases with pigmentation of the axillary area.
BHI-Allergy: Used for skin rashes and hives, and respiratory and ocular allergy symptoms. In the authors’ experience, this remedy is usually not sufficient to use as a single agent, except in mild, acute cases, and works best when combined with other remedies in management of allergy symptoms. Contains Sulphur 12X, which is useful in a wide variety of skin conditions and chronic illnesses.
BHI-Inflammation: Used for pyoderma, itching, inflammation, and atopy (especially when there is a tendency toward pyoderma with multiple small lesions). Can be used like an antihistamine in these cases, before other drugs are tried. Response can be seen within 1 week. Provides long-term control of itching in some patients as a simple nontoxic strategy.
BHI-Skin: Used for “eczema, blisters and cold sores, rashes and hives”.
Coenzyme compositum: Provides metabolic support.
Cutis compositum: A wide-reaching formula that stimulates nonspecific defenses in a variety of cutaneous conditions. Can be used in any phase homotoxicosis; opens skin to drainage and repair. Supports regeneration and repair of organs involved in skin health. Contains Cutis suis, Hepar suis, Splen suis, Placenta suis, Glandula supra-renalis suis, and Funiculus ubilicalis suis. Also contains Sulfur to repair blocked enzyme systems and Cortisonum aceticum to repair damage from prior corticosteroid exposure. The ingredient Aesculus hipposcastanum supports circulation and drainage.
Detox Kit: A combination of Lymphomyosot for lymph drainage, Nux vomica homaccord to support the gastro-hepatic system, and Berberis homaccord for adrenal, renal, and hepatic support that is used as a method of general detoxification.
Echinacea compositum: Used to control bacteria infections and for immune normalization.
Engystol N: Supports immunity. Through Sulphur, acts as a catalyst in chronic diseases. Useful in viral infections and allergic disorders.
Galium-Heel: This remedy is indicated in most allergic cases. It is a phase remedy for Deposition to Dedifferen-tiation phases. It has diuretic effects due to Galium aparine, Sempervivum tectorum, Ononis spinosa, Junipe-rus communis, Betula alba, Saponaria officinali, and Acidum nitricum, and detoxifying effects due to Galium mullugo. It supports parenchyma (lung, liver, kidney, and heart) through Phosphorus. Galium-Heel is used for edema and to create drainage through connective tissue. It also is used for itching (Apis mellifica), infectious Inflammatory phases (Pyrogenium-Nosode,), and eczema and dermatosis (Urtica urens). Finally, it is also a cellular drainage and repair agent.
Graphites homaccord: Used in obese patients with alopecia, oozing purple-colored lesions, and erosions that develop into suppurative sores.
Hepar compositum: Provides drainage and repair of the liver, support of metabolism, and reversal of prior corticosteroid therapeutic damage. It is critical as a first line of defense in skin repair, because it bears the brunt of detoxification.
Hepeel: Provides liver detoxification.
Histamin-Injeel: A homeopathically prepared histamine that assists in reversal of damages from histamine excess in allergic patients. When combined with BHI-Allergy vials it may produce a more potent Histaminum homaccord.
Lymphomyosot: Provides lymph drainage and support, as well as support of the thyroid function.
Mucosa compositum: Supports mucous membranes throughout the body. Used intermittently during repair stages.
Nux vomica homaccord: Provides detoxification of the liver and gastrointestinal tract; is part of the Detox Kit.
Psorinoheel: An exudation and cellular phase remedy that is used for itching, precancerous conditions, chronic skin conditions, acne, seborrhea, eczema, and pruritus.
Pusatilla compositum: Reverses the effects of prior cortisone therapy and regulates rigidity cases to move them toward inflammation and regressive vicariation.
Reneel: Provides kidney and urinary tract detoxification.
Schwef-Heel: Contains a homaccord of Sulphur, which is widely used in homeopathic practice. It is used for dermatosis with eczema, pyoderma, and red skin. It has great affinity for skin and adnexal tissues, and is known for working from the inside out on dirty and filthy animals prone to skin infections. Helps with redness and itching made worse by heat and red body orifices, and often is useful in concomitant use with other remedies in opening cases.
Solidago compositum: Provides renal support and is a phase remedy for Deposition Phase disorders.
Sulfur Heel: Used for eczema, pruritus, neuralgia with sensitivity to cold air (Daphne mezereum), urticaria with burning and itching skin (Arsenicum album), and irritating eczema (wood tar). It is also useful in scabies dermatitis.
Thyroidea compositum: Provides endocrine support and deep matrix cleansing. It is a phase remedy in Impregnation Phase disorders.
Traumeel S: Provides nonsteroidal antiinflammatory action, activates and regulates normal inflammatory responses, and unblocks enzyme systems.
Ubichinon compositum: Provides metabolic support.
Authors’ suggested protocols
Skin and immune support formulas: 1 tablet for every 25 pounds of body weight BID.
Intestinal and / or liver support formulas: One-half tablet for every 25 pounds of body weight BID. When required, kidney and pituitary support can be added.
Probiotic MPF: One-half capsule for every 25 pounds of body weight with food.
Oil of evening primrose: 1 capsule for every 25 pounds of body weight SID.
Betathyme: 1 capsule for every 35 pounds of body weight BID. (maximum 2 capsules BID)
Quercetin: 50 mg for every 10 pounds of body weight daily.
Chinese herbal medicine / acupuncture
The authors advise a combination of two herbal preparations: ImmunoDerm and Dermguard. In addition to the herbs discussed above, these preparations contains scutel-laria (Huang Qin), fleece flower root (He shou wu), siler (Fang feng), tokoro (Bi xie), schizonepeta (Jing jie), dandelion (Pu gong ying), oldenlandia (Bai hua she cao), kochia (Di fu zi), xanthium fruit (Cang Er zi), bitter orange (Zhi ke), angelica radix (Dang gui), buffalo horn shavings (Sui Niu jiao), earthworm (Di long), silkworm (Jiang can), and cnidium (Chuan xiong). The combination of these 2 formulas has antiinflammatory, antipruritic, and antibacterial effects.
Homotoxicology (Dose: 10 drops PO for 50-pound dog; 5 drops PO small dog or cat)
An autosanguis with Traumeel S, Engystol N, Hepar compositum, and Cutis compositum is quite useful in many allergy cases. Open the case as follows for 3-6 months, and use other antihomotoxic medications as listed above depending upon the patient’s specific symptom picture:
Traumeel S: Give orally once on Monday and Thursday.
Engystol N: Give orally once on Monday and Thursday.
Hepeel and Coenzyme compositum or BHI-Enzyme: Give each evening for 30 days.
Detox Kit (Lymphomysot, Nuv vomica homaccord, Berberis homaccord): Give orally twice daily.
Galium-Heel: Give orally twice daily. In the case of chronic or deep homotoxicoses, use:
Deep detoxification formula: Galium-Heel, Lymphomyosot, Hepar compositum, Thyroidea compositum, Solidago compositum, Coenzyme compositum, Ubichi-non compositum, given orally twice weekly for 60 to 120 days and then alternated with Detox Kit above. In the event of severe pruritus, give:
BHI-Allergy plus Histamin-Injeel, Cutis compositum, and Psorinoheel: Give as an injection; often gives sufficient relief so that biological therapy can continue. This can be repeated twice weekly as needed.
Skin, immune, intestinal, kidney, liver, and pituitary support formulas: Animal Nutrition Technologies.
Alternatives: Enteric Support — Standard Process Veterinary Formulas; NutriGest — Rx Vitamins for Pets; Derma Strength — Vetri Science Laboratories; Canine Dermal Support — Standard Process Veterinary Formulas.
Hepatic support: Standard Process Veterinary Formulas; Hepato Support — Rx Vitamins for Pets; Hepagen — Thorne Veterinary Products; Immune System Support Standard Process Veterinary Formulas; Immuno Support — Rx Vitamins for Pets; Immugen — Thorne Veterinary Products.
Probiotic MPF: Progressive Labs; Rx Biotic Rx Vitamins for Pets.
Oil of evening primrose: Jarrow Formulas.
Betathyme: Best for Your Pet — Alternative: Moducare Thorne Veterinary Products.
Quercetin: Source Naturals; Quercitone — Thorne Veterinary Products.
Chinese herbal medicine
ImmunoDerm and Derm Guard: Natural Solutions, Inc.
BHI / Heel Inc.