Apoquel and Cytopoint, both manufactured by Zoetis, have been around for some time now – eight years and five years, respectively. They represent the newest and most effective drugs in the veterinary arsenal to stop itching in dogs with allergies – but their use is not without risk of side effects or contraindications. That said, these drugs have vastly improved the lives of many severely allergic dogs without any ill effects whatsoever.
Before I explain why these drugs are so ground-breaking, allow me to briefly explain why allergies are so hard to treat in some dogs, and how the veterinary medication predecessors to these drugs differ.
Dog Allergy Treatments
The hallmark of allergies in dogs is normal, healthy-looking skin that seems to itch. The offending allergen is either inhaled (atopy) or ingested (food allergy). Inhaled allergens frequently cause seasonal itching (only in the spring or only in the fall). Food allergy typically causes itching year-round.
The goal of allergy therapy is to eliminate the itch. If you don’t stop the underlying itch, your dog will scratch, chew, bite, and rub his way to secondary skin infections, which add a second layer of itch and discomfort.
There is a complex, biochemical cascade, with lots of different mediators, that occurs between the allergen first being recognized by the body and the result, which is skin inflammation and itch. In broad terms, treatments for managing the allergic itch block or interrupt this cascade at various points. The more complete the block or interruption, the better the allergy itch control.
It would be ideal if it was possible to completely prevent the dog from coming into contact with any of the substances that he’s allergic to, but in the case of atopy, this is pretty much impossible. It is possible in the case of food allergies – if you can identify the food or foods that your dog is allergic to by undertaking a diet trial. To properly rule out food allergy, you must feed either an extremely limited-ingredient diet containing only ingredients that are novel for the dog (he’s never eaten them before) or a hydrolyzed protein diet and nothing else for eight to 12 weeks, and see if the itch subsides. (If it doesn’t, atopy, not food, is likely the issue.)
Most of the medications used to relieve allergy-caused itching don’t manage food allergy itch very well, so if you skip this step, you may end up disappointed and frustrated.
In lieu of complete protection from contact between the dog and the substances he’s allergic to, the gold standard for managing allergies is still allergy testing and immunotherapy (allergy shots), just like those that humans get.
The goal of this therapy is to stimulate the dog’s body to create antibodies against his allergens, thereby blocking the inflammatory cascade right at the starting gate. Unfortunately, this is not the most popular approach to allergy management for pet owners, as it is expensive, labor intensive, not without risk, and comes with no guarantee.
So we move on to medications. Antihistamines are inexpensive, available over the counter, and safe. The problem is, they don’t work very well in dogs. They definitely won’t help in the face of a full-blown allergy inflammatory breakout. Blocking histamine at that stage is just too late.
Probably the most useful place for antihistamines would be leading up to your dog’s allergy season. If you know he has trouble in the fall, starting an antihistamine ahead of time might help dampen his initial reaction to his allergens. Or, if a prescription medication is helping but not giving 100% relief, sometimes adding an antihistamine will help. Discuss this with your veterinarian.
Steroids work well to stop allergic itching and their effect is immediate, but they come with a plethora of negative effects on the body, including immune suppression. I’ll still prescribe them for severe, acute cases, but only in the beginning, to get the inflammation under control. After that, we look for a safer, long-term solution.
Atopica (cyclosporine) was approved by the Food & Drug Administration in 2003. It’s a reasonable alternative to steroids for longer-term allergy management. But like steroids, it can cause immune suppression. It also takes too long to kick in. It can be as long as four to eight weeks before you see maximal response – way too long for the allergic dog and his owner to wait.
Newer Dog Allergy Medicine
The newest allergy treatment options are Apoquel and Cytopoint. These medications interrupt the inflammatory cascade at different points. They are both rapid-acting and have minimal side effects. There are pros and cons to each which we will discuss.
Apoquel
Apoquel (oclacitinib maleate) blocks the effects of cytokines, which are pro-inflammatory proteins heavily involved in the allergy cascade. It is an oral tablet administered twice daily for 14 days, then once daily. It takes effect quickly, within 24 hours, and works really well for many dogs. Side effects are not common, but vomiting, diarrhea, loss of appetite, and lethargy have been reported.
The results of safety testing done on Apoquel suggest the possibility of some immune suppression when using this drug. This is one of the potential downsides of Apoquel. Some dogs developed significant infections (pneumonia) and demodectic mange, which typically occurs in the face of immune suppression. This was especially true in puppies, which is why the drug is labeled for use only in dogs 12 months or older. It’s also not for use in breeding dogs or pregnant or nursing mothers.
Neither I nor my colleagues have had issues in our clinic with Apoquel causing immune suppression, and I do not hesitate to use it in appropriate patients. But the possibility makes careful monitoring of these patients prudent.
There is also a label warning – “Use with caution” – regarding the use of Apoquel in dogs with tumors. Cytopoint may be a better choice for these dogs, since it has no warnings or concerns regarding tumors.
Sometimes Apoquel works great when dosed twice a day, but not as well when the dose is reduced to the once-daily, long-term dose. I see this a lot in the clinic, and it’s so disappointing for the pet owner. A number of owners have asked me if they can just continue with twice-daily dosing. Unfortunately, long-term safety studies at this dose have not been done. Apoquel can be used this way off-label, but there is no way to know if it’s truly safe for your dog.
My preference for these dogs is to continue the Apoquel once a day (as labeled) and add Cytopoint. These two medications are perfectly safe to use together, and in my experience, this combination is often the magic bullet for those difficult-to-manage allergy dogs.
Cytopoint
Cytopoint (lokivetmab) is a monoclonal antibody against the cytokine interleukin 31 (IL-31), a big player in the allergy inflammatory cascade. It is an injectable medication, administered under the skin. It takes effect quickly, relieving itch within 24 hours, and typically lasts anywhere from four to eight weeks.
Side effects are rare, but once again, vomiting, diarrhea, loss of appetite, and lethargy have been reported. Pain or discomfort at the injection site occasionally happens, but typically is mild and short-lived if it occurs. Cytopoint is not immune-suppressive, and there are no warnings or concerns about tumors.
However, the one potential downfall of Cytopoint is that the dog can form antibodies against it. If this happens, then the medication will lose its effectiveness – forever. I haven’t seen this yet, but if your dog is responding well to Cytopoint at first, and then less and less so, this is likely what’s happening. I hope I never see it.
As a practicing veterinarian, I really like Cytopoint. If I had an allergic dog, I would choose Cytopoint first.
If you have an allergic dog, hopefully this information helps you as you navigate your journey. As always, the best advice for you and your dog comes from your veterinarian.
My dog had both of these,cytopoint worked with first injection ,less with 2nd and less there after. Same with Apoquil.
You need to look closer at both products. They both kill dogs! The side effects are not that rare. It’s true that you might see improvement once or twice and then it starts to wain.
Apoquel causes cancerous tumors and Cytopoint goes in there to attack where the allergy is originating. Unfortunately if your pancreas is a bit off because he’s diabetic or the kidneys are mildly compromised….
Watch out! I was told it was safe to use on my diabetic lab. It went after his pancreas and his blood glucose stayed in the 700’s for two weeks!! Fortunately he survived. I then starting researching and many dogs had awful side effects including death!
Lori is correct!!!! I am VERY disappointed with this article. Pushing more big PHARM is NOT the thing to do!!!!!!! I give this article a F rating. Please please, if you have a pet with allergies start with the holistic route, it may save your dog the agony of horrible consequences of big pharm shots. there are multiple opportunities to get your fur babies health back. I suggest looking into Vit C found in Mega C Plus, a wonderful supplement to help the immune system, it is a complete supplement too!!! Order is also found at the web store: OMS Love My Pet by Dr. Wendall Belfield, who spent his entire life working on these health issues for dogs and cats.
omslovemypet.com
I give your reply an “F.”
Vitamins for allergies! Really?
Get real
I , too, am extremely disappointed that WDJ would support this endorsement of these two products. There’s lots of information out there showing that the side effects are real for many unfortunate dogs. I have been subscribing to WDJ for many years, always trusted it for dog care information that leaned towards holistic , such as doing titers, avoiding additives in foods, force-free training, even articles on beneficial herbs. But recommending these drugs-WTH?? Seriously considering not renewing my subscription. Makes me sad.
I do so agree with you, and the other comments querying WDJ’s endorsing the use of these 2 Pet Big Pharma products for allergies. It’s very disappointing, and it seems to align with the constant, very frequent, email marketing that WDJ has resorted to in the last couple of years. It seems that there has been a noticeable change of philosophy at WDJ, and that making money now takes precedence over everything else. This article about allergies and their treatment has made my mind up for me, although I’ve been a very long term subscriber to the WDJ, I won’t renew my subscription.
Lori -I don’t think Apoquel “causes” tumor growth. It just doesn’t inhibit tumor formation.
Eddd- my understanding of how these drugs works is they are potent immune suppressors, many dog owners reported their dogs developed cancers after being on them for a period of time. Check out Dr Will Falconer and his Vital Animal blog- he explains this better than I.
Great job Lori! I’m finished with WDJ. I just signed up last month and I can see this is not a publication that I want to read or support.
I think I’ll stick with Dogsnaturally magazine.
I had to use Apoquel for one of my foster dogs. It ended up being given long term and then she developed high liver values. While liver issues are not officially listed as a side effect of Apoquel, I found enough anecdotal comments from various vets on the internet to support my concern. We discontinued the Apoquel and changed to Cytopoint which worked just as well.
Food allergies are more than just an itch – one of my dogs had one ear inflamed so badly that if I had not been referred to a new animal dermatologist that started practicing in my area; my dog would have likely had his ear drum removed. Other vet.’s tried numerous medications which did not correct the problem and food allergies were not even considered. One appointment with the specialist – the correct medication and within one month the ear inflammation cleared and I also started the dog on a restricted novel protein diet – problem solved!
I too am seriously considering cancelling my subscription to WDJ based on this zealous allopathic vet who clearly puts way too much stock in big Pharma!! What a travesty that WDJ published such poppycock!!! Look into Nutriscan, a test available from Hemolife. It saved our dog’s life. When we eliminated the foods to which he was sensitive, his and our life changed. Just got results for our pup. We now tailor her food to align with the test results for optimum health.
Did you read the article? She recommends assessing and eliminating food allergens before using either drug. She clearly states that the drugs are appropriate for controlling reactions to allergens that cannot be eliminated. I am happy that your dog is doing well after you eliminated his food allergens, but your anecdotal experience does not make this “poppycock”
Hi Patricia…I was reading an article in WDJ in which you commented about food allergy and inflamed ears. If you don’t mind me asking what medicine did you use and you also mentioned a special diet.
I have tried 3 vets…several liquid meds with oral meds as well as a grain free diet. My dog continues to have chronic ear infections and at times her skin is inflammed too. I have spent alot of money and time tending to her. I feel I’ve failed as a dog parent because I just can’t seem to nail it. Any iformation or advice would be appreciated. Thanks , Terri C. (casale@blaircon.net)
Agree! I lost a 5 yr old female Doberman due to being on Apoquel for 3 yrs – she had heart failure and after much research, discovered that can be a “side effect” from Apoquel. Please do NOT advocate for this product. There ARE holistic methods that help….I have had success with holistic.
So what are these holistic methods that you’ve had success with, please share.
Kim. There are several of course. Karen Becker DVM has a great many holistic and integrative suggestions for treatments for canine itchy paws, and other common conditions in her free, online videos and articles. They are very worth checking out. Personally, I had success with her suggestion for itchy paws using a shallow, foot bath of warm water and “Betadine,” a topical providone iodine available OTC in most drug stores. Mix the Betadine with the warm water until the solution is the color of tea, and have your dog stand in it for 3 to 5 minutes. Only the dog’s paws need to be covered.
I was quite surprised to see this article in Whole Dog Journal, thinking that “groundbreaking” meant something new on the holistic side of things, not a rundown of Apoquel and Cytopoint. One of my clients, who is a human doctor, read up on Apoquel and immediately stopped giving it to her dog due to how it works. She said it can cause tumors and pancreatitis, due to how it impedes lipid metabolism and is a JAK inhibitor.
I have had a rescue chihauhau mix since July. She chews on her feet. When I got her she was on an i ng for this itching/bit and also fungus under her tail. She weighs slightly under 9 lbs. I give her half of a 25 mg Benadryl daily, but it doesn’t help much. Any ideas (safe ones)?
E. Annette Baker Baker. I have a short haired, rescue, Chihuahua too. I’ve had him for more than 8 years now, from time to time he also wants to chew his paws. I believe it’s primarily seasonal with him.
I read about a harmless treatment in an online article by Karen Becker DVM, she’s an integrative vet who has a great many, free, online articles about various conditions and their holistic, or integrative, treatment. Her recommendation for the itchy paws was to make a shallow, foot bath of warm (not hot,) water and add an amount of topical, providone iodine, (“Betadine” – it’s available in most drug stores.) Until the water is the color of tea. Then have your dog stand in it, it need cover only his paws, for a few minutes, maybe 3 to 5 mins. This absolutely works for my boy! The other thing is, it’s worthwhile to invest in one of those soft sided cones (Elizabethan Collar,) for your dog to wear, as this will stop her access to chewing her feet, etc, and provide some time for the area to heal.
We tried EVERYTHING all summer long and nothing worked, just got worse and worse. I volunteer at a S/N clinic and a vet tech recommended Apoquel. She and others she knew had had a good experience. Called the vet for an Rx. 2nd week of med I went away for two days and boarded her. When I returned saw a complete positive turn around. Asked for ten more days meds and I consider her completely recovered and her personality is back to the very happy canine she was before summer.
Judy Van Fossen. I don’t believe there’s much doubt that Apoquel works, and works quickly, the question is, at what cost for the dog’s long term health?
Cytopoint was like a little miracle for our older dog, who is suffering from tumors on his liver and adrenals. He was so itchy all over, you couldn’t touch him without causing him to scratch. The vet wasn’t sure it would help, as she wasn’t convinced it was an allergy, but it stopped the itching within hours. It’s been about 4 months now, and he’s still fine, perhaps the substance he was allergic to isn’t around right now, I don’t know.
He had absolutely no ill effects. Thank goodness his final days will be comfortable ones.
My beautiful golden was given Apoquil when it first came out. Her dermatologist indicated it was safe. She died from cancer which I am convinced was caused by Apoquil. My current little girl has allergies and was injuring herself so I put her in a cone. When I took her to the vet I was offered Apoquil and Cytopoint. I gave a resounding NO to both of those options. While I was still concerned I did allow a steroid injection with the hope it would “reset” her itchiness. So far so good. This is not something I would do routinely but I had no option. She is raw fed, no chemicals on or in her so I was at a loss. I tried all of the natural remedies I could find. I continue to research but Apoquil is a killer as far as I am concerned.
My dog was suffering itchiness without ever finding the cause – whether food or environmental.
I had her on Apoquel for a good 2 years and it did work wonders. I moved to Cytopoint as I had read in Whole Dog Journal and other credible sources about potentially compromising the immune system.
She has been on it for a good 2 years. So far so good. One injection tends to last a good 3-4 months and we usually do not have to give it to her during summer and early fall.
Been very happy t how comfortable my dog is on it. She is a 10-11 year old GSD/Airedale mix.
You all have me scared. My Goldendoodle has been on Apoquel for several years now. I am wondering if I have been “killing” her. She just had a nodule removed from her lip that was a type of Melanoma but turned out to be benign, thank God. I have several Apoquel tablets left in her prescription bottle but think I will stop and see what happens. She also had a couple warts removed and researching warts, the indication was that dogs with a low immune system does develop warts. Aside from being contaminated by another dog.
I don’t think WDJ is necessarily indorsing the use of these medications but has provided and article as information for dog owners to understand their use in case their vet prescribes them for their dogs. WDJ also has provided this sight for owners to express their concerns and experiences.
I appreciate the feedback here because now I can approach my vet with more knowledge about my GDD’s Apoquel.
Sound approach. I added my 2 cents as I have had good results and sometimes I just feel the need to temper the handful of, sometimes vitriolic, responses on all social media feeds. Some saying they will unsubscribe because of an article that doesn’t follow their beliefs makes me chuckle. Only science should speak to all of us. And like any good pet owner, careful observations and consulting with your vet, and even a 2nd opinion is responsible pet ownership. Often there are so many underlying conditions or other influences that coincide with whatever is going on. Too easy for some to point at one thing and say with unscientific or no lab proof of whatever happened to their animal.
My dog is getting to be a senior. Tumours and fatty lumps will definitely happen at her age. I will monitor but keep her on her anti-itch regime.
Thank you
My puppy developed rashes at about 6 months on her belly, underarms & less obviously on her paws. We had her examined by 3 vets including a dermatologist that we had to wait 2 months to see and we did the intradermal skin testing and it’s confirmed she has atopic dermatitis. We waited until she was 1 year and started on 1/2 dose of Apoquel daily in addition to immunotherapy which could take up to 9 months to take effect. She went into heat just before the skin testing so her skin due to the hormones is still irritated but the Apoquel did appear to help alleviate the redness. Hopefully when we spay her it may help as well. She had a Cytopoint injection when it all began before we could see the derm specialist. Holistic treatments are not guaranteed and could take forever to work, if they do, and if you don’t get the intradermal skin testing done you are just conjecturing. While I agree big pharma should not be promoted, you need to consult your vet(s) and make the best decision you can with the evidence and research available. I don’t want my young dog to be on any medication long term but I can’t leave her suffering acutely in the meantime.
Thanks for your opinion, I agree, one-off statements of doom and gloom against medications that help relieve allergy issues are likened to the anti-vax scare that is sweeping the nation. We have an 8-year-old Boxer rescue we adopted at age 12 weeks, she came with the most outrageous itch, the cause of which could not be found. After a year of multiple food changes and topical shampoos, our Vet recommended we try Cytopoint, it worked immediately. she receives a shot every other 3 to 4 months and has never had a negative response. Thank you WDJ, for all of your timely information.
If I were you, I would research because what you are describing is what many pet owners have had happen to their dogs. Those same warts and many other immune / compromising issues! Please don’t allow your pet to become ill from these drugs! They suppress their immune systems and they can’t fight off anything! I just came home from the vet and refused cytopoint! I refuse to put my dog on allergy pills or shots without even knowing what he’s allergic to in the first place! This is ridiculous how they expect us to just trust them with these meds without even knowing what the allergy is in the first place! Whatever happened to allergy testing? I don’t understand why these doctors are doing this to people!
Very Sad to see this article in WDJ, it’s wrong on so many levels. It barely touches on all side affects these serious drugs cause. It was a “happy go lucky” infomercial for these drug companies, drugs that should be used as a LAST CHOICE, made to sound very safe. Again, Very Very disappointed in Whole Dog Journal.
There’s a really good article by a vet which explains how both Cytopoint and Apoquel actually work to stop pets from itching. The article explains the science behind how these two drugs actually work, and it’s very easy to understand. The vet’s name is Ron Hines. DVM. PhD.
You can find the article by Googling for “Vetspace.” Then when you’re on Vetspace click on articles about dogs’ conditions. Click again on the particular article about these two drugs to stop itching.
The article is entitled: “Cytopoint versus Apoquel.” Subtitled: For my itchy dog – which is safer? Which is more effective? Can I use both?
It’s well worth locating and reading this article by Dr. Ron Hines. DVM. PhD.
I so wish I could find something that would work for my golden. We have been doing Apoquel for just over a year and tried a few cytopoint injections at the same time. Like the article said, she did really well when it was the initial 2 doses a day. She’s still itchy EVERY day. I’ve tried stopping the apoquel, but she gets even worse. She’s also on the Purina HA prescription diet. As soon as we introduce anything different food wise, her itchiness increases immediately.
We had a veterinary dermatologist, but they closed their practice and now there aren’t any dermatologists within a 3 hour drive for us.
I understood when we started the apoquel that while long term side effects are not yet known, there are also potential negative impacts to their health if the dogs continue to be so itchy/inflamed their whole lives. Heartbreaking.
Anything with chicken, including treats? Eliminate that first.
My Ramses had a food allergy and my vet at the time said it was likely protein and chicken is the usual culprit in the U.S. He ate every chuck roast in my freezer, including a few pork roasts for two weeks and the itching stopped. I put him on a clean lamb food and he was fine. Then I tried fish and he was also fine. Unfortunately the beef kibble had chicken added to it. I read the labels just like for me and anything with any poultry product was eliminated. Original Milk Bones are fine. So take him off chicken.
Then try weekly baths with Douxo S3 PYO. You can get it from amazon. I also give Diana pawPrints Benedryl twice a day. One pill for every 25 pounds. She gets 4 in the morning and 4 at night at 105 lbs. For your Golden, maybe 3 pills twice daily. I will say the anticipated hot dogs really have improved her recall. If it’s chicken for your Golden, make sure you use pure beef Kosher hot dogs and read the label to make sure no chicken in them. If you cut the hot dogs into six pieces you can get quite a few doses out of one hot dog as the pills are small and you get fit 2-3 in one slice.
My French Bull dog Dante is literally the love of my life. I love him like a human. From the moment we got him, we realized he was smarter than any dog we had ever owned. My nickname is Mrs. Noah, so I can say that we have owned several types of dogs and well as every animal and reptile large and small. I am speaking from lots of experience. I am a total believer in going all natural for food as well as for health treatments. However, science has a place as well for us in the treatment for them. There is no reason to allow your pet to suffer or be uncomfortable due to allergies and skin disorders. I wouldn’t let my human children suffer so I treat my furry children the same. My other frenchie Saylor also tends to have allergies and both have been on Apoquel for years with zero side affects. So for the people that are entitled to their opinion, against Apoquel, it has been the answer to prayer for me. We were one of the first patients to get on it after many failed attempts to make my frenchie comfortable. I have not looked back and don’t mind the cost. It is a penny well spent. Owning animals is costly. As a responsible pet owner, you should want the absolute best for your dog . If your dog suffered from allergies, please put them on Apoquel. It will change their life and give them the quality of life they deserve.
I am very careful about what I give my dogs. For instance, no oral flea meds, only topical.
She developed atopic dermatitis and the vet thinks it’s environmental. I agree as I’ve been watching the pollen levels on my weather app. It’s either tree or grass pollen. I have been managing it with Benedryl twice a day and weekly baths with Douxo S3 PYO and she is doing marvelous. I will also use the Douxo wipes or spray in between baths if necessary. I rub her face every day to make sure she isn’t developing any little blisters. No licking or scratching either. Both of these are much safer for her so we will remain on this regimen as long as possible and I will be hyper vigilant. I don’t want her on steroids or any of these more powerful prescription drugs.
I thank the other commenters for their info on these two powerful drugs. Should my vet recommend either I will decline.