Definition and cause
Feline eosinophilic granuloma is an inflammatory disease that most commonly occurs in cats but can occur in dogs and other species. While the proven cause is not known, it is believed that the underlying cause is related to an allergic reaction (food, insect, environmental). Other suspected causes include genetic predisposition, infection, or an autoimmune response. The body’s inflammatory response involves infiltration by eosinophils.
Medical therapy rationale, drug(s) of choice, and nutritional recommendations
Treatment is usually with systemic, interlesional, and / or topical corticosteroids. More resistant or deeper lesions often require immunosuppressant medication such as Cyclophosphamide or immunomodulating therapy such as Levamisole. Omega-3 and -6 fatty acids have been shown to improve the condition and reduce the reliance on corticosteroids.
The prognosis depends upon determining the underlying cause. Allergically incited lesions often respond well so long as the underlying cause of the allergy is controlled. Often, however, control is achieved with ongoing medication, and recurrences are common.
Integrative veterinary therapies
Eosinphilic granuloma is chronic inflammation secondary to antigens, which may gain access to the body through a wide variety of portals. Direct injury as in insect bite hypersensitivity is a classical example. As a flea feeds on the host, it releases anticoagulants and other proteins, which are detected by the immune system as it performs its police function at the injury site. In its attempt to prevent further injury, the immune system codes for antibody against these foreign proteins. Immunoglobulins are produced and IgE binds to mast cells in the skin, creating a future hypersensitivity reaction. Chemotactic factors lead to the infiltration of the tissue by eosinophils and the appearance of a lesion. Further contact with the offending antigen can trigger the disease state. (For additional information on the immune system’s production of auto-antibodies and cellular immune processes inciting disease, see site for Gland Therapy and Free Radicals.)
Antigen can be presented by other methods as well. Direct contact, inhalation, and ingestion are all possible genesis points for the condition. The gastrointestinal (GI) and integumentary systems are intricately involved with the basic homeostasis of the organism. Lymphocytes and macrophages are active in both the skin and intestinal tract. Dendritic cells in the intestine communicate with lymphocytes and often encode a “tolerance” response on the part of the organism to antigens, which enter through the digestive system. If this system is imbalanced, then hyperactivity and proinflammatory reactions may occur.
Food allergy, adverse reactions to food, injury to the normal functions of digestion and absorption, and bacterial overgrowth, along with ingestion of toxic substances such as food additives, aflatoxins, and preservatives can all permit the presentation of antigen to the immune system, which can result in inflammatory reactions in several areas of the body. Holistic doctors have long recognized the connection of the intestinal system and allergic symptomology, and successful handling of many patients commonly involves honoring this relationship by beginning therapy with attention to bowel health and diet. This syndrome of pathology resulting from altered permeability and digestion is often described as “leaky gut.” Conventional medicine also recognizes the importance of food trials, and is beginning to appreciate the relationship of intestinal injury from other factors such as adverse reactions caused by drugs (i.e., corticosteroids and NSAIDs).
Psychoneuroendocrine and immune factors also affect the skin. Stress can cause increased intestinal permeability and a corresponding onset of inflammatory pathologies.
Phylogenetically, there is an association with the excretory system, and in Traditional Chinese Medicine the Skin is governed by functions of the Kidney Zang Fu organ. When confronting eosinphilic granuloma complex issues, the clinician must recall all these factors in the maintenance of homeostasis. As the body attempts to handle homotoxins, it is common to see involvement of skin as both a barrier and an excretory organ. Furthermore, inflammation frequently can be observed in the integument. Eosinophils are frequently involved in cats. (See Homotoxicology, in this section.)
The clinical approach to such lesions involves looking for obvious agents such as fleas, gnats, and mosquitoes. Simple steps should be taken to remove them from the patient and time should be provided to see if recovery occurs. Use of proper insecticide can be the difference between a need for large amounts of immunosuppressive drugs and no medication whatsoever. Many patients begin to improve within 2 weeks after application of an effective spot treatment insecticide. Gentle, natural methods of parasite control (borax powder, diatomaceous earth, etc.) can be used and may be helpful, but care should be used with essential oils because these can be very toxic to some individuals, and in particular feline patients. Some pets are chemically sensitive and can be made ill by insecticides. Some of these individuals may genetically lack appropriate detoxification systems.
Elimination diets — limited antigen or hydrolyzed diets — are useful in cases of food allergy or adverse reactions to food or food additives. Success is gained with both approaches and no single diet assures positive results, so several trials are indicated. Home-prepared diets can be used. Some animals worsen when placed on the correct diet as they undergo regressive vicariation to the Excretion Phase, so the development of diarrhea does not necessarily mean that the diet should be changed (See Homotoxicology in this section).
Other conditions such as pancreatitis can result as the body flushes homotoxins from the system. Blood testing for food allergy is notoriously inaccurate and should not be taken too seriously. Such tests may guide the clinician, but often lead to confusion on the part of the client and other doctors. The client should be informed before blood testing is done.
Searching out other toxins in the environment is frequently beyond the ability of a busy clinician, but many antigens and haptens may be involved. Perfumes, tobacco smoke, cleaners (particularly heavily scented products and those that contain pine oil), perfumed laundry detergent, perfumed fabric rinses, dryer clothing treatments, carpet deodorizers, disinfectants, cosmetics, hair sprays, incense, and aroma therapy units may be key causative agents. Chronic exposure to certain environmental toxins (petroleum distillates or tar) should be evaluated in difficult cases. Advise clients to remove all such items.
Contact antigens and inhaled antigens should be considered. Wool in carpets, clothes, or bedding should be removed. Pet beds that contain cedar chips have been associated in the author’s practice, as well. Tree saps and contact with outdoor plants may also aggravate these cases.
Reactions to prescription drugs, vaccinations, nutritional supplements, herbal products, or other medicants should be considered. In some cases, there is a suspicion that injury resulting from such agents can sensitize the patient so that eosinophilic disease manifests at a later date. This relationship is hard to demonstrate but has some support in cases where application of homoeopathic dilutions of therapeutic agents lead to rapid recovery.
General considerations / rationale
While medical therapy is focused locally upon the external lesion, the nutritional approach adds nutrients, antioxidants, and gland support for the organs of the immune system and to help control inflammation. Because eosinophilic granuloma can have multiple causes as well as an exaggerated immune response from multiple imbalanced organs, a medical and physiologically blood evaluation is recommended to assess glandular health. This information gives clinicians the ability to formulate therapeutic nutritional protocols that address the local lesions as well as underlying organ conditions that may be ultimately responsible for the surface condition (see site, nutritional blood testing, for more detailed information).
Nutritional / gland therapy: Glandular adrenal, thymus, spleen, and lymph provide intrinsic nutrients that nourish and help balance the immune response, neutralize cellular inflammation, and prevent degeneration (see Gland Therapy, site, for a more detailed explanation).
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 immune-mediated conditions.
Quercetin: Quercetin is a flavonoids that has antioxidant properties. It also functions like an antihistamine, and has been shown to inhibit cells from releasing histamines. Therefore, it is beneficial in the treatment of allergic skin conditions.
Essential fatty acids: Much research has been conducted on the importance of essential fatty acids in the daily diet, and on the clinical management of various degenerative diseases. Seabuckthorne oil can be used to treat burns and skin irritations. It is a clinically approved in Russia for use in reducing inflammation and protecting against radiation damage.
Chinese herbal medicine / acupuncture
General considerations / rationale
According to traditional Chinese medicine theory, eosinophilic granulomas are due to Wind, Heat, and Toxin invading the body. Lesions come and go and they spread. The term Wind is used to describe this behavior because wind has the properties of waning and gusting — coming and going. Additionally, Wind can blow the lesions from place to place, much as the wind blows leaves over the yard. Heat refers to the inflammation. Toxins are the inflammatory mediators and any secondary bacterial invaders that may contaminate the lesions secondary to the self-trauma from pruritis. An herbal supplement designed for eosinophilic granulomas must stop the pruritis, decrease the inflammation, and address any secondary infections.
In Traditional Chinese Medicine, the Skin and Mouth are under the control of separate organ systems. Therefore, lesions in the Mouth are treated differently than those on the Skin, necessitating different formulas. To the authors’ knowledge, no Western studies have been performed to investigate this belief so there is no discussion of this in the section on appropriate herbs.
Appropriate Chinese herbs
Angelica (Bai zhi): Has antiinflammatory properties.
Atractylodes (Cang zhu): Has demonstrated antiinflammatory effects in the laboratory. It was shown to prevent xylene-induced auricular swelling, carrageenin-induced foot swelling, and acetic-acid-induced increase in abdominal capillary permeability in 1 trial.
Bupleurum (Chai hu): Has antiinflammatory effects. In addition, it has demonstrated antibiotic activity against several bacteria including B-hemolytic streptococci.
Cicada slough (Chan tui): Was used in a trial of 30 human patients with chronic urticaria. In this investigation 23% of the patients had significant improvement while another 50% had moderate improvement.
Dandelion (Pu gong ying): Has shown evidence of antiinflammatory actions.
Earthworm (Di long): Has been shown to increase the rate of wound healing. In rabbits with experimentally induced skin wounds it promoted the growth of fibroblasts, capillaries, and collagen fibers.
Forsythia (Lian cao): Has antiinflammatory and analgesic effects. It can decrease inflammatory exudate and edema. In addition, it has demonstrated antibiotic effects against common skin bacteria such as Staphylococcus aureus and hemolytic streptococcus in vitro.
Honeysuckle (Jin yin hua): Has been shown experimentally to have antiinflammatory effects in rabbits and mice.
Licorice (Gan cao): Contains glycyrrhizin and glycyrrhetinic acid, which have antiinflammatory effects. They prolong the effect of cortisones in the body either by decreasing its metabolism in the liver or by increasing the plasma concentration by decreasing protein binding. They have approximately 10% of the corticosteroid activity of cortisone. They decrease edema by decreasing the permeability of blood vessels and interfering with histamine action.
Mouton (Mu dan pi): Has demonstrated antiinflammatory effects in several studies. The mechanism of action seems to be through the ability to inhibit prostaglandin synthesis and decrease the permeability of blood vessels. In addition, it may help control secondary bacterial infections.
Platycodon (Jie geng): Causes antiinflammatory effects by increasing the secretion of corticosterone. This effect has been proven in rats. It suppresses allergic reactions and decreases capillary permeability.
Polygonum (He shou wu): Enhances adrenocortical function. Experimentally, this herb has been shown to increase the size of mice’s adrenal glands. It also increases hormonal secretion by the adrenal gland. These effects can increase endogenous serum cortisol levels.
Prunella (Xia ku cao): Has immunosuppressive activity. When administered by abdominal injection it was shown to significantly raise the level of plasma cortisol.
Rehmannia (Sheng di huang): Increase the plasma levels of adrenocortical hormone. This may lead to increased endogenous cortisol levels. It reduces swelling and inflammation.
Scutellaria (Huang qin): Contains biacalin and biacalein, which suppress inflammation in mice. These can significantly inhibit histamine-induced increase in capillary permeability. In addition, biacalin has antibiotic activity against Stapylococcus aureus and may have synergistic effects with ampicillin, amoxicillin, methacillin, and cefotaxime. It can help overcome B lactam resistance.
Schizonepeta (Jing jie): Has been shown to help control rashes and itching.
Siegesbeckia (Xi xian cao): Has both antiinflammatory and immunosuppressive effects. It has been shown to decrease swelling in rats. It also decreases both humoral and cellular immunity in mice.
Siler (Fang feng): Has demonstrated antibiotic efficacy against common skin pathogens such as Staphylococcus aureus.
White mustard seed (Bai jie zi): Has antiinflammatory effects. One of the components, sinapine, seems to be responsible for this effect. It also has antifungal and antibacterial effects.
White peony (Bai shao): Contains paeoniflorin, which is a strong antiinflammatory.
Xanthium (Cang er zi): Decreases inflammatory swelling. It inhibits the effect of histamine on the capillaries, thereby preventing an increase in capillary permeability.
Zedoaria (E zhu): Was used in 48 people with neurodermatits, a chronic dermatological disorder in which the skin is pruritic. It may thicken the way an eosinophilic granuloma does in animals. In this experiment, 21 of the 48 patients experienced excellent results, and 9 more had moderate improvement in their signs after injections of E zhu and Sal leng into acupuncture points.
General considerations / rationale
Eosinophilic granuloma marks a chronic inflammation reaction to particular antigens, which may gain access to the body through a wide variety of portals. This represents Impregnation Phase disease as the body responds to homotoxins that have bound to other elements and damaged the body’s ability to eliminate the offending substances. The body responds through a chronic inflammatory reaction in the attempt to remove damaged elements and repair these affected tissues.
In the authors’ practices, we frequently diagnose veterinary homotoxicoses related to flea collars. The most common signs are depression following application of the collar, but patients may have inappetance, seizures, anxiety, depression, vomiting, diarrhea, and upper respiratory signs, which vanish rapidly after removal of the collar. Careful questioning of humans residing in the home may reveal similar symptoms and especially chronic, recurring pharyngitis, rhinitis, tonsillitis, and headaches in people sleeping with these pets. When this is noted the people involved should be referred to appropriate medical care and the collar removed until accurate diagnosis can occur. Palmquist is especially sensitive to many chemical poison flea collars and develops a headache and sore throat within a few minutes of exposure. Many other people and animals seem to be so affected. Considering that most flea collars are ineffective in flea control, their use should not be promoted in most situations.
As with all Impregnation Phase disorders, eosinophilic granuloma complex may be recurrent and frustrating to treat; however, if the clinician integrates antihomotoxic medicines over long periods of time, a substantial percentage of patients will show improvement and reduced exacerbation in successive seasons, and some patients will exhibit remarkable responses. Because such treatment is without dangerous side effects, clients often opt for biological therapy instead of chronic use of immunosuppressive agents.
Appropriate homotoxicology formulas
Due to the wide variety of possible treatments needed in these patients, the reader is referred to the list of remedies at the end of the gastrointestinal chapter, as well as those in the allergies protocol. Pharmaceuticals may be needed for symptom control and can be safely used while integrating antihomotoxic agents.
Coenzytne compositum: The ingredient Citricum acidum is useful for dental problems and gingivitis. This remedy also is useful for scurvy; blackening of teeth; heavy deposits of dental plaque; painful, and herpetic vesicles around the lips; as well as nausea, painful cramping in the umbilical area, and distension.
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. Contains Cutis suis, Hepar suis, Splen suis, Placenta suis, Glandula suprarena-lis suis, and Funiculus ubilicalis suis to support regeneration and repair of organs involved in skin health. Contains Sulfur for repair of blocked enzyme systems and Cortisonum aceticum for repair of damage from prior corticoste-roid exposure. Aesculus hipposcastanum supports circulation and drainage.
Echinacea compositum: Used to bacterial infection control and immune normalization. It is a phase remedy for the Inflammation Phase.
Engystol N: Used for viral origin gastroenteritis and allergic dermatitis. It contains Sulphur in a higher potency, which is helpful for many chronic diseases and skin conditions. In some cases this agent by itself causes marked improvement. It combines readily with Cutis compositum and Ubichinon compositum to resolve difficult cases.
Galium-Heel: Indicated in most allergic cases. It is a phase remedy for Deposition to Dedifferentiation phases. Galium aparine, Sempervivum tectorum, Ononis spinosa, Juniperus communis, Betula alba, Saponaria officinali, and Acidum nitricum give it a diuretic effect, and Galium mullugo provides a detoxifying effect. Phosphorus supports parenchyma (lung, liver, kidney, and heart), and Apis mellifica helps with itching. Pyrogenium-Nosode helps with infectious Inflammatory Phases, and Urtica urens treats eczema and dermatosis. It is also a cellular drainage and repair agent and it is used for edema and to create drainage through connective tissue.
Hepar compositum: Used for detoxification and drainage of hepatic tissues, organ support, and metabolic support. It is useful in most hepatic and gall bladder pathologies. It is also an important part of the deep detoxification formula. Hepar compositum is used to treat duodenitis, pancreatitis, cystic hepatic ducts, cholelithiasis, cholangitis, cholecystitis, vomiting, and diarrhea. This combination contains Natrum oxalaceticum (also found in Coenzytne compositum, Ubichinon compositum, and Mucosa compositum) for changes in appetite and stomach distension due to air. Chelidonium has proapototic characteristics.
Hepeel: Provides liver drainage and detoxification. It is used in a wide variety of conditions including cancer of the liver, where Hepeel was found to be antiproliferative, hepatoprotective, and an antioxidant when tested in human HepG2 cells.
Lamioflur. Used for ulcerations of mucocutaneous areas, diseases of the skin, and mucous membranes. Contains Hepar sulphuris for skin ulcerations and pustular eczema; Acidum nitricum for lesions on mucocutaneous junctions; and Kreosotum for eczema of the hands and mucosa margins.
Lymphomyosot: Used for lymph drainage and endocrine support, and to treat edema.
Mezereum homaccord: Treats herpes, dermatitis, ulcerative eczema, and pruritus.
Mucosa compositum: Broadly supports repair of mucosal elements. Used in cellular cases and in recovery periods following active disease. This remedy contains Kali bichromicum, which is indicated for ulcers found on the gums, the tongue, the lips, and even on the gastric mucosa (gastric or duodenal ulcer). The tongue may have a thick, yellow, mucous coating, or, in ulcerative stomatitis or tonsillitis, it may be dry, smooth, shiny, or fissured. Kali has been used effectively in acute gastroenteritis associated with vomiting of clear, light-colored fluid or quantities of mucous bile, and in cases with hematemesis, flatulent colics, and dysenteric stools with tenesmus.
It also contains Hydrastis for mucosal support of oral problems such as stomatitis; mucosal suppuration accompanied by ulceration, inflammations, and colic of the hepatobiliary system and the gastrointestinal tract; and polyp formation. The Kreosotum component is for chronic gastritis with gastric hemorrhages and vomiting of brown masses. It also has a dental implication in cases with spongy gums and carious teeth and neuralgias proceeding from them, causing a burning toothache with deep caries, black patches, on the teeth and fetid discharges. The single remedy Phosphorus is broadly useful for dyspepsia and for jaw problems in dental disease. Phosphorus is found in many other remedies including Echinacea compositum, Leptandra homaccord, and several others. It is rich in suis organ preparations for mucosal support, plus a large variety of remedies with indications in the gastrointestinal sphere.
Also contained in this broad remedy is Argentum nitricum, (also in Atropinum compositum, Diarrheel, Duode-noheel, Gastricumeel, Momordica compositum, BHI-Nausea, and several other combinations). It is for distension in the upper abdomen, gastro-cardiac symptom-complex, amelioration from eructations, and gastric crises.
Psorinoheel: An exudation and cellular phase remedy. It treats itching, precancerous conditions, chronic skin conditions, acne, seborrhea, eczema, and pruritus.
Pulsatilla compositum: Used for regulation rigidity. If signs suddenly shift to inflammatory regressive vicaria-tion, shift to Traumeel. This remedy contains homeopathically diluted Cortisonum for repair of prior therapeutic damage, which may block recovery, it stimulates the mesenchymal tissues strongly toward healing. Patients frequently develop respiratory Excretion Phase discharges of mucus. The ingredient Sulfur is a reagent in allchronic diseases.
Schwef-Heel: Used for chronic diseases of skin and liver. This remedy should be interposed in most skin and liver cases. Patients that need this remedy may look dirty and have scruffy skin conditions, red lips, a white tongue with red tip, itching and burning of the rectal area with morning diarrhea, and prolapsed rectum. Sulfur is contained in this and several other antihomotoxic formulas including Coenzyme compositum, Echinacea compositum, Engystol, Ginseng compositum, Hepar compositum, Molybdan compositum, Mucosa compositum, Paeonia Heel, Proctheel, Psorinoheel, Sulfur-Heel, Thyroidea compositum, and Ubichinon compositum.
Solidago compositum: Supports the kidney and urinary system. It is part of the deep detoxification formula. The ingredient Berberis is antihistaminic and anticholinergic.
Thyroidea compositum: Provides drainage of matrix and support of the endocrine system. It is a phase remedy for Impregnation Phases and it is part of the deep detoxification formula.
Traumeel: A nonsteroidal antiinflammatory that is useful in all phases. It is helpful for regulation rigidity cases. It activates blocked enzymes in chronic disease states.
Ubichinon compositum: Provides support of energy-producing components.
Authors’ suggested protocols
Immune and lymph support formulas: 1 tablet for every 25 pounds of body weight BID.
Skin support formula: One-half tablet for every 25 pounds of body weight BID.
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 SID.
Beyond essential fats: One-half teaspoon for every 35 pounds of body weight with food (maximum, 2 teaspoons).
Chinese herbal medicine / acupuncture
For lesions on the skin, Formulas H52 ImmunoDerm and H67 DermGuard given at a dose of 1 capsule of each for every 10 to 20 pounds twice daily.
For oral lesions formula, H33 Eosinophilic granuloma is used at a dose of 1 capsule for every 10 to 20 pounds twice daily.
The ingredients of each formula follow. They contain herbs not mentioned above, but which increase the efficacy and minimize the side effects of the respective formulas.
H33 Eosinophilic granuloma: Angelica radix (Dang gui), burreed tuber (San leng), cicata (Chan tui), dahurian angelica root (Bai zhi), dittany bark (Bai xian pi), forsythia (lian qiao), fritillaria (Bei mu), kochia (Di fu zi), licorice (Gan cao), oyster shell (Mu li), prunella (Xia ku cao), red peony (Chi shao), siler (Fang feng), white mustard seed (Bai jie zi), and zedoaria (E zhu).
H52 ImmunoDerm: Angelica radix (Dang gui), atractylodes (Cang zhu), buffalo horn shavings (Sui niu jiao), bupleurum (Chai hu), dandelion (Pu gong ying), earthworm ((Di long), fleece flower root (He shou wu), honeysuckle (Jin yin hua), kochia (Di fu zi), licorice (Gan cao), moutan (Mu dan pi), oldenlandia (Bai hua she cao), poria (Fu ling), rehmannia (Sheng di huang), scutellaria (Huang qin), siegesbeckia (Xi xian cao), tokoro (Bi xie), white peony (Bai shao), and xantium fruit (Cang er zi).
H67 DermGuard: Angelica radix (Dang gui), aurantium fruit (Zhi qiao), bupleurum (Chai hu), cicada (Chan tui), cnidium (Chauan xiong), dahurian angelica (Bai zhi), honeysuckle (Jin yin hua), licorice (Gan cao), mint (Bo he), moutan (Mud an pi), platycodon (Jie geng), poria (Fu ling), schizonepeta (Jing jie), scutellaria (Huang qin), siegesbeckia (Xi xian cao), siler (Fang feng), silkworm (Jiang can), and xanthium fruit (Cang er zi).
(Dose: 10 drops PO for 50-pound dog; 5 drops PO small dog or cat) Treatment must be individualized, but the following represent good starting therapies, which can be readily adapted based upon clinical response.
Simple oral protocol: Engystol N, Lamioflur, and Traumeel S mixed together and given BID orally. Also deeper detoxification formula consisting of Galium-Heel, Coenzyme compositum, Ubichinon compositum, Solidago compositum, Hepar compositum, and Thyroidea compositum mixed together and given orally every 3 days. In addition, Cutis compositum given twice weekly to every other week. In difficult cases, Pulsatilla compositum may move the case toward regressive vicariation. Control of allergens is critical to success.
Autosanguis and oral combination therapy per Broadfoot (best option): Perform autosanguis therapy as follows:
Stage 1: Traumeel S IV
Stage 2: Tonsilla compositum or Pulsatilla compositum (consider Tonsilla compositum for first run and use Pulsatilla compositum as an alternative if no or poor response)
Stage 3: Engystol N and Galium-Heel combined
Stage 4: Cutis compositum
Stage 5: Coenzyme compositum
For each step above (2 through 5), inject half of this mixture into the patient subcutaneously (in cases involving one large lesion, consider injecting small amounts around the periphery of the lesion, a technique known as “circling the dragon” in Chinese medicine), and add the remaining half to an oral cocktail of the following ingredients: Psorinoheel, Lamioflur (contains Mezereum), and Echinacea compositum Forte tablets. Mix together and succuss it 10 times. Give 5 to 7 drops of this resulting final mixture orally BID to TID. Also treat the lesion topically with Euphorbium compositum BID. Broadfoot reports best results are when this is combined with oral blue-green algae and Gluta-DMG
Immune and lymph support formulas: Animal Nutrition Technologies. Alternative: Immune system support — Standard Process Veterinary Formulas; Immungen — Thorne Veterinary Products;
Betathyme — Best for Your Pet. Alternative: Modu-care — Thorne Veterinary Products.
Quercetin: Source Naturals; Quercitone — Thorne Veterinary Products.
Beyond essential fats: Natura Health Products. Alternatives: Oil of Evening Primrose — Jarrow Formulas.
Chinese herbal medicine
Derm Guard, Immunoderm, and Eosinophilic granuloma:
Natural Solutions Inc.
BHI / Heel Corporation