Dr. Randall On Immunotherapy and Allergy Diagnosis and Treatment

Interview with Amy Randall, DVM, MS, Diplomate ACDV about veterinary immunotherapy and allergy diagnosis and treatment

  1. What is veterinary immunotherapy?

immunotherapy oral treatmentImmunotherapy is the use of FDA standardized allergens (pollens, house dust mites, molds) in a liquid formulation which is administered to the allergic patient to help desensitize her to those environmental allergens she has developed an allergy to. Immunotherapy is formulated from an intradermal test performed on the patient to identify what trees, weeds, grasses, molds and house dust mites she is allergic to. Once we know what she is allergic to we can then use the liquid allergens to make a specific serum for the patient. Immunotherapy can be administered as a liquid orally (top photo) or as an injection in the skin (bottom photo). We teach pet parents how to administer these at home to their pets. Over the course of months we try to desensitize the pet to these allergens so she is no longer licking, chewing, scratching or developing ear and skin yeast and bacterial infections.

  1. Why does your clinic treat allergies AND ears? i.e. How are the two linked?

Immunotherapy injectionsWe treat ears because ear infections (yeast and bacteria) are caused by allergies. Most clients do not know that when their pet continues to develop ear infections it is due to an underlying allergy. It is not normal for dogs or cats to have ear infections yearly or every few months. There must be an underlying cause. Ear infections are part of allergies and are a symptom of allergies. Without allergies most dogs and cats would not develop ear infections.

  1. What types of allergies do you treat at your clinic?

We treat allergies to grasses, trees, weeds, molds, house dust mites, feathers, wool, cat and dog dander. We test for these types of allergies and also identify contact allergies or irritants which come from topical products such as shampoos, ear medications and topical sprays.

We treat hearing loss when it is due to the use of an ear product. Some ear products have been known to cause temporary deafness just like in people. If we see the patient soon enough after the deafness has happened we can usually restore the hearing with an ear procedure and discontinuation of the products causing the deafness.

  1. What types of testing do you normally recommend to determine what your patient is allergic to?

We only recommend the use of intradermal testing which is like skin prick testing in people. We sedate the pet and then shave a small area on the side and administer up to 70 different allergens in the intradermal layer of the skin. Within 15 minutes we begin to see a red, inflamed small bump like a hive develop if the patient has an allergy to that specific allergen. We test for specific trees, weeds and grasses. They are all identified in a grid formation and numbered on our allergy test sheet. If the patient has developed antibodies to the allergen the injection will cause the release of histamine in the skin and you see a hive. This process is very specific and is the gold standard for identification of allergens. This test provides us with the fewest false positives unlike the blood allergy tests which are not standardized and provide a lot of false positives and false negatives.

  1. Do you use compounded or individually formulated medications in treating your patients and, if so, please tell us about the benefits of using compounded medications.

We only use compounding pharmacies for specific drugs when the patient is too small to take the prepared amount we have available from manufacturers. We also will use compounding pharmacies when we need to administer a liquid and the only form of medication we have is in tablet or capsule forms. We do not compound our own medications – we use pharmacies for this.

We do formulate the immunotherapy serum at my clinic from standardized supplies of allergen concentrates we purchase from a human manufacturing laboratory in North Carolina. The allergy serum formula is based on the results of the allergy test. I make up the formula based on the seasonality of the patient, their environment and what the parents can tell me about the patient’s environment and exposure to specific allergens.

  1. When you say that you offer “natural” immunotherapy, what does that mean and how is this different from how another veterinary dermatologist might treat the same patient?

The reason I specifically talk about natural immunotherapy is to educate the public because most people don’t realize that immunotherapy is a natural treatment modality. The allergens in the serum are the pollens which have been harvested from farmers’ fields growing these grasses, trees and weeds and which we then place into a sterile solution. The allergens in the serum can also be mold spores which have been grown and harvested and again placed into a solution to be administered to the patient as a liquid. This process applies to all the allergens. They are not synthetic – they are from nature. I do not think people realize that the serums are not medications and therefore won’t cause liver and kidney problems.  Another benefit to immunotherapy is that I do not have to perform bloodwork or worry about side effects.  So the bottom line is that immunotherapy is very safe and much safer than pharmaceutical medications.

  1. What can a pet parent do to try to prevent allergies from occurring?

cat in grassThey can’t prevent the development of allergies. We still do not understand the entire pathomechanism of how allergies develop and why. We tell parents of dogs with allergies to try not to breed them since we do know there is a genetic component. However, development of allergies is generally due to many factors, not just genetics. We do not know which dog, cat – or horse for that matter – is going to develop allergies until it happens.

  1. Is there a particular type of diet you would recommend to reduce the incidence of allergies and generally improve a pet’s health and welfare?

I would recommend trying to keep animals on limited ingredient diets with fewer preservatives and additives. By limited I mean do not feed a diet which has venison, chicken, beef and turkey all together. Try to stay with 1 or 2 protein sources. Don’t keep switching around to different proteins; try to stick to one type. Food allergies are typically associated with animal proteins and a much smaller percentage of animals have grain allergies. The media has produced too much hype revolving around grains. Most of my patients have allergies to chicken, beef, and soy. Try to stay with simple ingredients and know the company. Find out where the ingredients are being sourced and how the food is being manufactured. Follow the recall lists on companies and stay away from companies which seem to constantly have recalls. Try to stay away from companies using a lot of overseas (Asian) ingredients. Call the companies and start asking these questions. If a company gives you good answers and good information you can have some confidence that it is producing better food.


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