# Long term steroid use for allergy control



## hubbub (Jun 28, 2011)

Although I'm not a vet and can't really answer "officially" about long term use, I wanted to let you know that I feel your pain and Ruby's too! 

The bottom line for me: Without the steroids, I would not have had the pleasure of my girl's company for the last 10 years. That benefit outweighs any risks in my mind. 

My decision to use steroids long term was a personal decision because her quality of life was so poor. For 5-6 months out of the year, she had to be aided to walk because the pads of her feet had pulled away from her feet swelling. Year round, she chewed and scratched to the point of creating skin infections, she was covered with pustules and had lumps like marbles under her skin in areas. I could not afford the oral cyclosporine (Atopica) and it has the same success rate as the allergy shots. Fortunately, she did respond to the allergy shots after a year or so (the foot swelling/pad peeling issue resolved to a couple of episodes a year). 

My girl is 10.5 and has had severe allergies since about 12 weeks. She has essentially been on different levels of a steroid (prednisone) dose for most of that time. At one point, I was able to spread the maintenance dose out to 1 dose (20 mg) a week for about 6 months. Until this year, the main problem that she's had (outside of allergies ) due to chronic steroid use has been urinary tract infections. Earlier this year she was diagnosed with cancer (soft tissue sarcoma) and more recently we've added in kidney and heart issues. In an effort to address everything at once, we've just started a new regime with the right to go back to prednisone if things don't improve. 

Our current regime includes: doxepin (an antidepressant that has a strong antihistamine), slowly increasing fish oils (very slowly as she has a sensitive tummy), off steroids and diphenhydramine, 2 medicated shampoos and a leave in rinse. We'll also be changing up her allergy shots slightly at the next appt. The main thing I've learned over the years is the importance of extreme discipline with her medication, baths, etc. If we're off by a bit, it throws her into a tailspin that takes a while to recover from. 

I tracked back through your previous threads to see if I could get a sense of where you are coming from and what you've tried already. I had a couple of questions I didn't see addressed in the other threads:

- Has your primary vet been managing Ruby's care or were you referred to a board certified dermatologist?

- Was Ruby's allergy tested based on intradermal (prick) testing or on a blood draw? (one can give false negatives and the other false positives, so it's possible her allergy shot solution could be adjusted a bit if you've seen some relief from them) Was she on steroids at the time of the testing?

- Aside from upset stomach, chewing her feet and the lumps you mentioned on her neck in a previous thread, are there any other symptoms? Pustules, lesions, pads pulling away from toes, etc?

- Are you having to use antibiotics at all?

- Is she still on the thyroid supplementation?

ETA - I commend you for working so hard in Ruby's best interest. I know it's very frustrating. The combination of food and environmental allergies is tough and a human dander allergy is one I'm glad we don't have to deal with.


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## A1Malinois (Oct 28, 2011)

Long term steriod use can cause many issues. Such as Cushings Disease. I would never use a steriod on a dog long term. 

Have you done any allergy testing like Dr.Dodds for the food allergies?


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## artbuc (Apr 12, 2009)

Lincoln_16 said:


> Long term steriod use can cause many issues. Such as Cushings Disease. I would never use a steriod on a dog long term.
> 
> Have you done any allergy testing like Dr.Dodds for the food allergies?


"never" is a long time. I understand your point but, imho, you have to weigh the benefits/risks of any treatment. In many cases, such as the one posted above, the choice is long term use of pred or euthanasia.


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## LibertyME (Jan 6, 2007)

For me (and my dogs) ....a shorter life with higher quality of life will always win out over a longer life of misery...


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## vrmueller (Jun 14, 2008)

- Has your primary vet been managing Ruby's care or were you referred to a board certified dermatologist?

Yes, Ruby's primary vet has been managing her care from the beginning.

- Was Ruby's allergy tested based on intradermal (prick) testing or on a blood draw? (one can give false negatives and the other false positives, so it's possible her allergy shot solution could be adjusted a bit if you've seen some relief from them) Was she on steroids at the time of the testing?

We did blood work back in May of 2010. No steroids at the time of testing.

- Aside from upset stomach, chewing her feet and the lumps you mentioned on her neck in a previous thread, are there any other symptoms? Pustules, lesions, pads pulling away from toes, etc?

It seems when she is at her worst, she attacks one area. Each attack has been treated with antibiotics. She will chew her feet until there is infection. No pads pulling away and oddly I have never seen open lesions. There is generally scabbing in the one area.

- Are you having to use antibiotics at all?

When she has caused an infection, antibiotics have been used.

- Is she still on the thyroid supplementation?

Ruby is on Soloxine 2 times a day. Her levels are checked regularly by Dr. Dodds.

ETA - I commend you for working so hard in Ruby's best interest. I know it's very frustrating. The combination of food and environmental allergies is tough and a human dander allergy is one I'm glad we don't have to deal with.

Thank you so much for your input. It was extremely helpful, especially the antidepressant. I have often thought that Ruby's extreme issues are anxiety related. When I met with the vet, I asked her if this just might be OCD and she said if the steroid doesn't help then we can discuss behavioral meds. I did a search on the Doxepin and unfortunately, the drug cannot be taken if the dog has a thyroid disorder. 

I believe I have exhausted every avenue regarding Ruby's health. I was against steroids from the very beginning (puppy). Our lab mix from years ago suffered from AIHA and she was on pred for a number of years. I saw what it did and I can't believe we are back in the same boat. It is a quality of life issue right now and am hoping that she can be comfortable on a low dose so the side effects don't injure her further.


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## A1Malinois (Oct 28, 2011)

artbuc said:


> "never" is a long time. I understand your point but, imho, you have to weigh the benefits/risks of any treatment. In many cases, such as the one posted above, the choice is long term use of pred or euthanasia.


No I agree but if they knew exactly what the dog was allergic to maybe they could take efforts to limit the dogs exposure. Like if the dog was allergic to chicken, rather then feed chicken and give steriods you could stop feeding chicken and the dog wouldnt need steriods?

I have had many vets tell me Lincoln needs steriods. I wont do it. He was miserable on steriods and I never want to see him that way again. I am not sure how severe he is compared to your guy though. Mine scratches a good majority but its not constant. 

I would want to make sure they know the dogs allergies before having him live on prednisone. Have you tried other avenues before such a harsh drug? Like special baths, less harmful drugs like Hydroxine etc.

Have you tried a (as much as I dont like them) prescription food?


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## bioteach (Nov 13, 2010)

Brewer was so miserable from allergies that he was literally mutilating himself because of the itching. We tried Atopica which is not a steriod. Atopica is essentially the same drug (Cyclosporine) that they give to people who have had transplant surgery. 

Needless to say, it was very expensive, but the good news is that Brewer was comfortable for the first time in years. His hair grew back (he rubbed his face bald) and he did not have the side effects usually observed from taking steriods.

Over time, however, (he was getting old) his kidneys were losing function and he grew ill and crossed the bridge. Our vet believes that there were underlying health issues that worsened with age (he had been anemic for many years) and that the Atopica was not a major factor in his death at age 13+

If I had it to do over again I would choose the Atopica over Brewer's horrendous suffering. 

I wish that we could breed allergies out of goldens!


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## Dallas Gold (Dec 22, 2007)

One other option that might possibly help is acupuncture. I don't know if there are any in your location, but it might be worth a few sessions to see if it helps. Our Barkley had terrible skin infections and allergies and spent a year on prednisone in rescue before we adopted him. We started taking him for acupuncture for his hip dysplasia and about six months later I noticed his allergies were greatly improved. The acupuncture vet had been treating him for that without me realizing. She said that all her hip dogs allergies improved. 

He lived to one month shy of his 13th birthday when we released him due to complicataions of hemangiosarcoma.


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## jealous1 (Dec 7, 2007)

My Joey is on long-term use of Temaril-P as it has been the only thing that has even touched his allergies. I started out w/ a higher dosage and we are now down to 1 pill in the a.m. w/ a zyrtec in the p.m., although I increased that to 1 pill in a.m. and 1 in p.m. for the past couple of weeks as his allergies kicked up w/ the fall weather. I've tried to go every other day w/o with no luck. Like you, I weighed the pros and cons of long-term use and Joey's quality of life outweighed the cons. Joey will be about 8 next year (he's a rescue, DOB unknown) and I plan on getting a full senior panel done and continue to monitor his bloodwork.


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## A1Malinois (Oct 28, 2011)

I heard Atopica was good but to put my dog on it would cost $300-$400 a month. Mines on the Optimmune for his eyes which is Cycloporine.


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## Sally's Mom (Sep 20, 2010)

When I refer itchy dogs to the board certified dermatologist, he puts them all on Temaril P. Among other things... it is an antithistamine with a steroid.


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## Sally's Mom (Sep 20, 2010)

Atopica is very expensive. Especially with a big dog.


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## Abbydabbydo (Jan 31, 2007)

We did allergy tests, shots and Atopica over Abby's 8+ year life (still rocking). We are now on Temiril-P for the rest of her life, it is the only thing that works. 

Enough said.


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## A1Malinois (Oct 28, 2011)

How bad is Termeril P in terms of Prednisone. Which of the two are easier on the dogs system? I have never tried Temeral P but if its not as bad as pred I may consider trying it with Lincoln. Does Temeril P make them pee 24/7? I know with prednisone Lincoln ate and gained so much weight as well as drank so much and he peed every 20 minutes inside the house because it just fell out of him


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## jealous1 (Dec 7, 2007)

Other than no itching, I have not seen any side effects in Joey. Normal drinking and peeing.

Agree with Abbydabbydo - "enough said".


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## Sally's Mom (Sep 20, 2010)

Temaril P has prednisone in it.


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## hubbub (Jun 28, 2011)

If there's a dermatologist near you, it might be worth it to have another set of eyes look at her issues, even if it puts your mind at ease that a steroid containing product is your only option. 

In our case, we were told there were a number of options aside from the oral cyclosporine (Atopica), but they hoped that the doxepin would bring about the best results. I'm not sure that it has so far, but I hope to discuss further options at our appt next week. I appreciate your comment about the doxepin and thyroid supplementation. Interestingly, we've just started thyroid supplementation at a low dose and I'd noticed the warning. Again, it's on my list of things to discuss next week. 

My girl's allergy shots were based on blood tests as well, but only because we could not get her off steroids long enough to do skin testing. Our current hope/plan is to keep her off steroids until spring and do skin testing then to try to marry the the two test results. Intradermal testing might be worth looking into as well, especially if you think there has been ANY improvement as a result of the current formulation. 

Boy do we know about feet/leg chewing! At times it looked like a cartoon character eating a corn cob. I asked about antibiotics because we reached a point with recurring skin infections (with no bacteria in any scrapings) and she's been on a maintenance antibiotic for some time. When things are really bad she'll have lesions between her toes. 

From your other threads, it looks like you all are dealing with a storm of problems. Although it's frustrating, I'd like to think that Ruby was sent to you specifically because you've dealt with similar issues before. Someone else might dump her or just euthanize her, but as you said, you have exhausted every avenue for her. I'm also hopeful that since Ruby seems to have "episodes" that you'll be able to get to a low maintenance dose for her. :crossfing

Please keep us posted! If I learn anything next week that I think might be of interest to you, I'll try to post it here too.


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## Rainheart (Nov 28, 2010)

I just wanted to add a little bit about my mom's chocolate lab. A few years back, she came down with a bunch of red bumps and was itching like crazy about this time of year. We put her on prednisone and that seemed to do the trick. My mom always has prednisone on hand and we use it when she seems to be itching non-stop. We use 1/2 a tablet of 20mg. We have checked her bloodwork at least yearly and all looks good. My mom hasn't looked into allergy testing or anything since it isn't a huge problem for us and very manageable with a very cheap drug.


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## artbuc (Apr 12, 2009)

Lincoln_16 said:


> How bad is Termeril P in terms of Prednisone. Which of the two are easier on the dogs system? I have never tried Temeral P but if its not as bad as pred I may consider trying it with Lincoln. Does Temeril P make them pee 24/7? I know with prednisone Lincoln ate and gained so much weight as well as drank so much and he peed every 20 minutes inside the house because it just fell out of him


This is an obvious suggestion which you have probably tried already. But, just in case, did you start with a low dose and increase slowly to make sure you were giving the smallest amount possible? Maybe just 5mg per day along with the right antihistamine would reduce scratching to an acceptable level. Efficacy of antihistamines in dogs is generally not too good and highly variable. What works in one dog may not do squat in another. Clemastine (Tavist) works for 30% and cetirizine (Zyrtec) for 18%. For reasons not understood, antihistamines in dogs chemically degrade quickly so you can give large doses. Talk to your vet or dermatologist to see how much you can safely give. Rocky's dermatologist said 1.34mg clemastine 2-3x per day was fine. According to a study in the Canadian Veterinary Journal, cetirizine protocols vary widely from 2.5-10mg/dog, q24h, up to 1.1 mg/kgBW, q12h. This particular study used 1mg/kgBW, q24h, which did make 2 of the 22 dogs mildly sick for the first day or two although it appears that the vomiting in one of those two dogs was caused by an unrelated condition. Hydroxyzine is available from your vet (Rx only). It did nothing for Rocky.

A quick Google search says Temeril P contains 2 mg pred and the recommended dosage is 3 tablets, 2x per day or 12mg pred. I would hope to give much less pred than that.


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## jealous1 (Dec 7, 2007)

artbuc--I think you have to start off high on the Temaril-P to get the itching under control and then start lowering the dose; at least that is the way my current vet did w/ Joey (one of the other vets in the clinic I go to actually started him on a lot lower dosage w/ no relief prior to my regular vet seeing him--as soon as she saw the low dosage she advised it wouldn't do anything and immediately upped the dosage). He started w/ the 3 tablets 2x per day and like I mentioned, we are now down to 1 tablet along w/ a p.m. tablet of cetirizine in the evenings.


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## artbuc (Apr 12, 2009)

jealous1 said:


> artbuc--I think you have to start off high on the Temaril-P to get the itching under control and then start lowering the dose; at least that is the way my current vet did w/ Joey (one of the other vets in the clinic I go to actually started him on a lot lower dosage w/ no relief prior to my regular vet seeing him--as soon as she saw the low dosage she advised it wouldn't do anything and immediately upped the dosage). He started w/ the 3 tablets 2x per day and like I mentioned, we are now down to 1 tablet along w/ a p.m. tablet of cetirizine in the evenings.


Thanks. I don't know anything about Temeril P and I didn't mean to imply it should be started on a low dose. I agree that if your dog has bad symptoms you need to start with a higher dose to stop scratching before you find yourself administering antibiotics for 4-6 weeks.


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## vrmueller (Jun 14, 2008)

I just want to thank all of you so much for your input and suggestions. As of today, Ruby has been on the Temaril-P for 3 weeks. The first 2 were 3 pills one time a day. Last Thursday we took it down to 3 pills one time a day, every other day. So it has been 1 week on the every other day. She is still doing well on this dose. She has been on it before with varying doses. The goal now is to see how low of a dose she can be on without the scratching. The only side effect I have really noticed is her extreme hunger. I guess I can deal with that verses the marathon scratch fest. Also, I have had to have her bathed once a week. She starts really smelling badly after the 6th day of her bath. Since she has not been biting, licking, chewing and scratching herself, there is no odor coming from her at all. It has been 2 weeks since her last bath. I may be able to spread this out now. I will post in the next week with an update. Thanks again!!


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## artbuc (Apr 12, 2009)

vrmueller said:


> I just want to thank all of you so much for your input and suggestions. As of today, Ruby has been on the Temaril-P for 3 weeks. The first 2 were 3 pills one time a day. Last Thursday we took it down to 3 pills one time a day, every other day. So it has been 1 week on the every other day. She is still doing well on this dose. She has been on it before with varying doses. The goal now is to see how low of a dose she can be on without the scratching. The only side effect I have really noticed is her extreme hunger. I guess I can deal with that verses the marathon scratch fest. Also, I have had to have her bathed once a week. She starts really smelling badly after the 6th day of her bath. Since she has not been biting, licking, chewing and scratching herself, there is no odor coming from her at all. It has been 2 weeks since her last bath. I may be able to spread this out now. I will post in the next week with an update. Thanks again!!


Rocky and I are so glad to hear this positive report. If you read this forum you already know about MicroTek shampoo. Just wanted to reinforce what others have said. It does wonders for Rocky. Minimizes itching and helps cure minor infection (small pimples/pustules). You can get a big bottle at your local tack supply.


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## hubbub (Jun 28, 2011)

We had a recheck with my girl's dermatologist today and it made me wonder...How's Ruby doing?


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