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Has your dog been itching and licking themselves nonstop?

After being put on a 4-month waitlist, here’s part 1 on how board-certified dermatologists diagnose and treat allergies.

Weekly Bite

If you have a Belgian Malinois, Dutch Shepherd, or German Shepherd - pay attention.

According to Katarina Tengvall, PHD and Audrey Ruple, DVM, these breeds are highly susceptible to atopic dermatitis (environmental allergies) and adverse food reactions (food allergies or intolerances).

Symptoms usually surface between 6 months and 3 years of age, and they can be seasonal or year-round:

• Skin Issues: Itching and redness on the face, paws, legs, underside, and areas where skin folds like between toes

• Ear Issues: Ear inflammation, head shaking and wax buildup

• Gastrointestinal Issues: Vomiting, diarrhea, gas, and increased frequency of bowel movements

I consulted my vet multiple times. Each visit treated symptoms without finding the root cause.

My vet ended up referring me to a couple dermatologists since the root cause could be genetic and/or environmental.

When I called to book, they were vague about their process and required a deposit upfront for an appointment 4+ months away…

So I had two choices: sit on my hands, or learn the process myself while waitlisted.

I chose the latter.

If you've ever suspected your dog may have allergies or intolerances, this 4-part series is for you.

The Vet Allergy Playbook (Part 1/4)

Step 1: Physical Exam & Blood Test

Vets start with a physical exam and bloodwork to rule out conditions (like hypothyroidism or flea allergy dermatitis) that mimic allergy/intolerance symptoms.

Important Note: Blood tests cannot diagnose allergies directly. However, blood tests and intradermal skin tests can help identify specific allergens during elimination diet trials (step 4) or confirm environmental allergies (step 5).

Step 2: Cytology Test

Next, vets typically perform cytology tests to rule out additional conditions.

Conditions with similar clinical presentations:

1. Ectoparasite infestations (like scabies or demodex)

2. Bacterial skin infections (like bacterial folliculitis) 

3. Fungal overgrowths (like yeast dermatitis)

If the cytology test confirms a specific bacteria or fungi, then antimicrobial susceptibility testing can be performed to identify the best choice of antibiotic/anti-fungal.

In some cases, vets prescribe oral immunosuppressants for a short period to break the itch-scratch cycle.

Common treatments include:

• Topical antibacterial/anti-fungal solutions (like Chlorhexidine wipes)

• Topical antibiotics, anti-fungals, and steroid ointments (like Mometamax or Animax)

• Oral immune suppressants (like Apoquel)

But cytology tests are limited…

A negative result only confirms that parasites, bacteria, and fungi weren't present where the sample was taken. They can hide elsewhere…

Step 3: Anti-Parasitic Trial

As a result, vets typically pursue an anti-parasitic trial for 2-4 weeks to eliminate any parasites that might have been missed during the cytology test.

If symptoms persist or only partially improve, the next step is ruling out food allergies and intolerances through elimination diet trials.

In Part 2, I'll break down food allergies and intolerances.

TL;DR: Vets follow a 3-step diagnostic process: (1) Physical exam & bloodwork, (2) Cytology tests, and (3) Anti-parasitic trials.

Tail End

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Until next Thursday, ✌️

Sam