Autoimmune, Allergies, or something else?

[RandyMan]

Hi everyone! I am new to these forums and am looking for moral support and advice for my dog, Randy, who probably either has allergies, an autoimmune disease, or both (our vet explained that these often work together).

Randy is a five year old chinese-crested/elkhound mix.  His beginning origins are unknown, as he was a rescue with no information, other than his age of six months at the time.  When we adopted him, he had horrible fleas and was very shy and timid.  Soon, he burst out of his shell and is an extremely loving and energetic dog who loves to bark at squirrels!  Compared to my other dog, Ralphie, who is the same age as Randy, Randy has been to the vet many times.  He went for ear infections two or three times as a young dog, and one summer, he was scratching his belly so badly that I took him to the ER vet in the middle of the night, where he was given a steroid shot.  (He is regularly groomed and bathed and an is an inside dog who is always monitored when we go outside.)

Last summer, I noticed one of his eyes starting to look crusty on the outside.  I took him to the vet, who tested for an ulcer.  Finding nothing, she prescribed a medication, which I gave to him.  It helped for a short time, and soon, his eye was inflamed again.  Along with that, he was doing a lot of scratching, especially on the lower part of his belly.  All of his eyelashes had fallen out, and the hair on the back of his legs was gone, too.  (I should note that he was taking flea preventative, too, and this persisted in the winter.)

I took him to a different vet in our neighborhood, who prescribed an antibiotic, as well as prednisone.  He also started on a duck-potato Z/D diet.  Further, he was tested for hypothyroidism and was found positive for that, so he's been taking levo-thyroxine since January.  While he was taking the Prednisone, his eyes cleared up, but as soon as the medication stopped, they became inflamed again, and he began scratching at his belly frequently.  Little red bumps appeared on his belly, too.  The doctor attributed those bumps to allergies and re-prescribed him more antibiotic and prednisone to clear everything up once more.  He also prescribed atopica (we get Cyclosporine from the pharmacy, since it's a little less expensive).

Randy has been taking the Cyclosporine without Prednisone for two months, and at first, it worked wonders.  His skin remained clear, and his eyes were so bright!  All of his lashes grew back, too.  In the last few weeks, I noticed one of his eyes beginning to look crusty again.  He is frequently scratching at it, and I'm afraid we're going to go through the same cycle all over again.  I think the "crusty" look of his eye is a result of his scratching, but I'm wondering why his eyes are itching so much.  Because this suddenly re-emerged two months into the Cyclosporine, I am wondering if this is more indicative of allergies than an autoimmune disease, but if so, I can't make sense of what he is allergic to.  If it persists, we will more than likely take him to an allergist to find out what specifically he is allergic to.  We've thought that maybe it is something outside since he is going on more walks with warmer weather, but even in the winter, he was having problems when he didn't get outside as much and most of the greenery was dead and not in bloom. Right now, we cannot afford a biopsy to see if he does have a specific autoimmune disease, but if there are no apparent allergies, we will be looking into doing that soon.

My questions are, based on your experiences, would you attribute this to an autoimmune condition, allergies, or both? 

If Atopica had suddenly stopped working for you, what was your next option?

Are there more affordable ways to test for allergies/autoimmune in dogs?  (I inquired about pet insurance, but we are not eligible since he has a preexisting condition.)  We can afford to give Randy all of the things he needs, as well as routine medical care, but in two months, his vet bills were over $2,000, and I cannot afford that in the long-term with his three medicines (Cyclosporine, Levo-Thyroxine, and Trifexis) and his prescription dog food.  Don't get me wrong, he is worth every penny!  I'm just wondering if you know of more affordable options or other types of pet insurance that will insure preexisting conditions not offered at the clinic.

Do you think we should get a second opinion at this point?  I trust our veterinarian, who specializes in dermatology, and explains the "why" because his decisions for Randy.  However, my husband thinks that the doctor isn't really invested in Randy's health and cares more about making money, as he often adds other things to our take-home bag, such as "fish oil" tablets, which are sitting as an up-sell item on the counter.  (I don't tend to think medical professionals are like that...)

Thank you so much; any help, ideas, suggestions, or information about similar experiences will be very helpful!

[Jo CIMDA]

Hi and welcome

I am sorry Randy is having all these problems.  It can be very difficult at times to differentiate between an allergic reaction and an AI skin disease.  Most AI skin diseases follow a typical pattern and even if the biopsy comes back as inconclusive there is enough evidence within the clinical signs to assume a diagnosis and start treatment.  As long as the treatment is correct and the skin starts to heal then you are probably on the right track and the presumptive diagnosis was correct.

The treatment for an AI skin disease is nearly the same - same drugs etc, but the dosage is different.  An AI skin disease will be treated with immunosuppressive doses of steroids or other immunosuppressive drugs, and the dose is higher than the treatment for a skin allergy, which is usually treated with an anti-inflammatory dose.

So the same treatment can address both AI skin disease and an allergic reaction to something.  If it is an allergic reaction and the cause is unidentified and therefore is possibly being reinforced, probably on a daily basis if it is in the local environment or something that is within the food, then once you lower the dose of the drugs it is likely that the problem will return because the dog is still allergic to the antigen/s it is exposed to. Also, with any skin lesions or broken skin there is the chance that fungal/bacterial/parasitic infection is present, and this has to be addressed at the same time.

If it is an AI skin disease and the lesions have healed because the treatment has suppressed the immune response and allowed the immune system to behave normally once again and achieve remission, then once in remission the dog will have to encounter a trigger factor  to start the disease process all over again.

I don't know if Randy has been on an immunosuppressive dose of medication or a dose appropriate for an allergic skin disease, but as you say it had good effect, and even his eyelashes grew back, then  if it was only a dose that would treat an allergic skin disease then I would assume it is an allergy you are dealing with and not an AI skin disease.  I doubt very much that you would have a good response to an AI skin disease unless the dose had been immunosuppressive.

If Randy were mine I think I would have his blood tested for all the things he may be allergic to. Idexx laboratories, has a very comprehensive blood test for many different allergens. This will save biopsies that may give an inconclusive result anyway.  If you know what Randy is allergic to then this is a good start, and with this knowledge you can avoid the specific allergens, whether it be certain grasses or food (although food test is not always 100% reliable) and there is a chance you may be able to get Randy off the Atopica and steroids and just manage his skin problem by diet and avoidance. Your regular vet can do this for you.

Below is the Idexx website:

https://www.idexx.com/small-animal-health/products-and-services/reference-laboratories/itchy-patient-tests.html

Good luck and let us know how you get on.
Jo