AAHA publishes allergic skin disease guidelines for dogs, cats

Sometimes an itch is more than just an itch, and owners of pets with allergic skin diseases are familiar with the sometimes time-consuming and frustrating diagnostic process. Patients with allergic skin disease often require lifelong management of their condition.

On October 31, the American Animal Hospital Association (AAHA) announced the publication of the 2023 AAHA Management of Allergic Skin Diseases in Dogs and Cats Guidelines intended to provide a systematic approach to identifying and treating allergic skin diseases in these animals.

The guidelines describe detailed diagnostic and treatment plans for flea allergy, food allergy, and atopy in dogs and for flea allergy, food allergy, and feline atopic skin syndrome in cats.

Designed to simplify the path to diagnosis and management, the guidelines emphasize a multimodal approach for the patient with allergic skin disease. Acute and chronic conditions are separated accordingly.

Dr. Julia Miller, co-chair of the AAHA Management of Allergic Skin Diseases in Dogs and Cats Guidelines Task Force, acknowledged that allergy cases can be especially difficult to get a consensus on because there are many ways to manage them.

“A lot of people get bogged down on that and can’t see the light at the end of the tunnel,” she said. “But what the guidelines did nicely is distill into a user-friendly way how to start your approach. They give concrete recommendations and step-by-step workups for allergic patients so practitioners can feel confident they are not missing something along the way.”

Doing it the right way

Dr. Jessica Vogelsang, chief medical officer at AAHA, agrees.

“When you have these complicated, long-term diseases as a primary care provider, it’s so overwhelming to try to figure out how to prioritize these things,” she said. Her own dog, Ollie, was the inspiration behind the guideline’s mascot, designed by Lili Chin.

At various points in his journey, Ollie has been prescribed shampoos, medicated foot rubs, injections, allergy shots, antibiotics, antifungals, and ear medications.

“When you come in, you just want your pet to stop itching as soon as possible,” Dr. Vogelsang said. Most recently for Ollie, that meant twice-weekly foot baths to manage his atopy. 

However, skin allergy treatments don’t have a “one and done” solution. Desperate clients may sign their pets up for food trials or mail-order blood or saliva allergy tests, but the guidelines are clear that those are not conclusive diagnostic tools.

“Being purposeful in your choices of diagnostics and treatments will end up saving money in the long term,” Dr. Vogelsang said.

According to the guidelines, a detailed history must be taken, including response to previous treatment, and a physical examination must be performed with particular attention to ears, skin folds, and paws. A minimum dermatologic database should be collected, including cytology of skin and ears. The guidelines describe key questions to ask when presented with allergic canine and feline patients.

Veterinary staff should prepare clients for the fact that these cases require lifelong maintenance and treatment, and to expect the occasional flare up even in the most well-managed patients.

While the emergence of flea prevention and “fantastic medication options” make treatment easier, Dr. Vogelsang stressed that allergic skin disease is a lifelong condition.  

“It is a very compelling message to say, ‘Do this one thing and things will be fine.’ Unfortunately, it’s not reality,” she said. “It's about managing expectations. Giving people realistic expectations helps.”

Considerations for the care team

In addition to straightforward diagnostic algorithms, the guidelines incorporate spectrum of care considerations and veterinary technician utilization recommendations, which may result in more efficient intake, management, and follow up of cases.

Adding language around spectrum of care was something task force members wanted in the guidelines, Dr. Miller said, to recognize the reality of the patients’ and clients’ situations. This includes emphasizing that these options do not mean the pet is getting substandard care.

“We wanted to make sure to incorporate options so it’s not that you just have to treat this condition this way every time. There are pivot points where there are opportunities for different interventions in cases that can work best with clients’ finances and other factors,” she said.

Veterinary technicians, too, can play an important role when it comes to itchy pets, Dr. Miller said, who is a board-certified veterinary dermatologist at the Animal Dermatology Clinic in Louisville, Kentucky. A big part of the guidelines’ diagnostic portion is about asking specific history questions, which veterinary technicians can do, as well as collect and interpret cytology results.

“Technicians are so important when it comes to client communication as well. That’s a huge aspect of being successful with allergic pets and dermatology,” she said. “How are you making sure the client understands this is long term and that rechecks are essential? That this will take an investment?

“That’s where you can use a veterinary technician to reiterate the things you recommend. If they hear from multiple people, it drives it home for them.”

To improve client satisfaction and optimize patient outcomes, the guidelines offer charts and algorithms to walk providers and clients through treatment options and realistic ways to help their pets. Also included are recommendations for when a referral to a veterinary dermatologist should be considered.

A version of this story appears in the January 2024 print issue of JAVMA