I hear a lot of claims from clients about the cause and treatment of their pets’ allergies that sound like myths or misunderstandings to me, and I expect that. Obviously, a huge part of my job is educating my clients. But it especially bothers me when clients with such claims bring “proof” for them in the form of recommendations or opinions from other veterinarians.
The Academy of Veterinary Dermatology does a pretty good job regularly reviewing the evidence for various allergy treatments, and this is helpful is advising clients on what is likely to be helpful for their pets. There is, of course, always some uncertainty and room for differences of opinion, but the principles of how allergies work and the information concerning the pros and cons of common treatments is pretty solid. The problem is that there are few cases in which allergies can be cured, and there are risks as well as benefits to most effective treatments. This reality creates an opportunity for those who wish to market supposedly risk-free therapies or purported cures without real supporting evidence.
I recently ran across an example of an “integrative” approach to allergy treatment, which essentially means that standard recommendations and a certain amount of truthful information about the causes and treatment of allergies is integrated with unfounded accusations about how conventional medicine causes or fails to help allergies and a skewed perspective of the balance between risks and benefits, combined with promotion of unproven and implausible alternative treatments. These are opinions presented as facts, without good quality evidence to support them.
For Treatment of Flea Allergy Dermatitis-
I avoid recommending any…chemically-laden spot-on pesticides for your pets.
I realize many people like to use spot-ons because they are convenient and effective. But as far as I’m concerned, there’s just too much evidence of potential unhealthy consequences for your pets…In my opinion, the risks of these products are simply too great to warrant their routine (monthly) use.
And what “evidence” is there for the health dangers of these products? The usual source cited is a document from the Environmental Protection Agency (EPA) which references reported adverse reactions associated with topical flea and tick products and announces some changes in labeling and reporting rules. The problem is that the adverse reactions studied are simply reports made to the manufacturers by pet owners and veterinarians, and as the report states, “The incidents have not been verified and may have causes other than exposure to the pesticide.” While the precautionary response of the EPA is entirely appropriate, the bottom line is that when a pet becomes ill about the time a topical flea or tick product has been used, the conclusion that the product is to blame is natural but not reliable. People, particularly those with exaggerated fears of “toxins” and “chemicals,” are likely to look for such things to blame for anything bad that happens. It requires controlled study to identify whether these products truly cause any of the problems blamed on them.
Instead of topical flea control, this “holistic” practitioner recommends “natural” alternatives:
A soothing bath will kill any fleas on your dog, help heal skin irritation, and make her feel more comfortable and less itchy. Also, clean animals aren’t as attractive to fleas. Pick a non-grain (no oatmeal) herbal shampoo.
Make liberal use of an all-natural pest repellent like Natural Flea and Tick Defense…
Here are the natural Brazilian oils and ingredients found in Natural Flea & Tick Defense spray …
Bathing may reduce the numbers of fleas temporarily, but it provides no lasting protection, and dogs with flea allergies will continue to suffer if they are not protected from flea exposure. There is, not surprisingly, no scientific evidence to show that the alternative product recommended is effective or safe.
For Treatment of Food Allergies-
If your dog is over a year old, consider using Dr. Jean Dodds’ Nutriscan saliva test to determine if your pet is allergic to beef, corn, wheat, soy, eggs and/or milk (the most common antigens for dogs).
If your pet has been eating the same food every day for months or years, there’s a good chance she’s developed an allergy to it…She might be sensitive to the single source of chemically-laced protein she’s been getting (chances are the meat is loaded with antibiotics and hormones causing immune system over-reaction). She’s also probably grown sensitive to certain allergenic ingredients in the food, typically grains and other carbohydrates.
Work with your holistic vet to develop an allergy elimination diet to help pinpoint the source of the problem. I recommend a three-month diet, which is longer than what many vets suggest. I like to give adequate time for an animal’s body to clear the allergenic substances, detoxify, and clean out cellular debris…
The diet I recommend is preferably raw, either homemade (again, as long as it’s balanced) or commercial. Rotating the protein sources your dog eats is extremely important, as is strictly limiting or eliminating grains…
Your holistic vet should also suggest natural supplements to help with detoxification, allergy relief and immune system support during and after the elimination diet.
There is no research to suggest that the saliva testing is useful for identifying food allergies. It is sold based on questionable theory and anecdotes, which have little evidentiary value. And as far as uncontrolled testing, at least one dermatologist has run the test in dogs with confirmed food allergies responsive to diet change, and the test results were highly inaccurate.
There is absolutely no evidence for the implication that allergies to meat proteins is associated with mysterious chemicals or hormones in the meat. These notions, the references to “detoxification: and “cellular debris,” and the faddish obsession with grains are all part of an ideology which respects belief more than facts. If something sounds “natural” it must be safe and effective, and if it sounds “unnatural” then it must be harmful.
Of course, I’ve written about the raw diet nonsense before, and there is, once again, no evidence that raw diets have any benefit in terms of preventing or treating allergies. As for supplements, apart from limited evidence that fish oils can reduce the dosage of other drugs needed to control allergy symptoms, there is no solid data to support supplement recommendations. Overall, this section makes erroneous and misleading implications about the causes of food allergies, recommends a dubious diagnostic test, and then suggests treatments that have not been demonstrated to help.
Treatment of Environmental Allergies-
Make sure your dog’s drinking water is high quality and doesn’t contain fluoride, heavy metals or other contaminants.
Don’t allow your dog to be over-vaccinated or over medicated. Vaccines rev up your pet’s immune system – too many vaccinations can send it into overdrive. An over-reactive immune system sets the stage for allergic conditions.
Honestly, are we still on about fluoride in the water?! This issue has been studied intensively for 60 years, and there is no reliable evidence to support significant health risks. Heavy metals are certainly potential toxins and should be avoided, but they are not a cause for atopy in dogs. Again, we see the vague and irrational fear of supposed contaminants, which bears a superficial resemblance to reasonable concern about known toxins at levels shown to be harmful, but which underneath is really more of an irrational extension of the emotion of disgust and the fear of contagion.
As for vaccines, while it is true that both allergies and vaccines have something to do with the immunes system, the notion of “over-vaccination” is a fuzzy ideological one with no clear meaning, and there is no consistent evidence that excessive vaccination, however that might be defined, has any causal role in pet allergies.
Allergies are a serious medical problem that causes a great deal of suffering for pets and their owners. Causes are complex and involve both genetic, developmental, and environmental factors, and symptoms tend to come and go unpredictably, which makes evaluating the effects of any particular intervention challenging. While there are many safe and effective therapies that can help manage allergy symptoms, there is no cure. Only complete avoidance of the antigens the individual is allergic to can eliminate symptoms entirely, and this is often not possible. No treatment that has any benefit is completely without risks, and the risks and benefits must always be carefully and rationally weighed.
The variability and chronicity of the symptoms and the complexity of the causation create fertile ground in which to sow myths and misconceptions about causes and treatments, as this article does vigorously. Providing treatments based on sound scientific understanding of the physiology of allergies and supported by reliable scientific evidence of safety and efficacy is the best way to help patients with this serious condition. Myths about allergy causes and treatments that are without a rational, scientific foundation or any real evidence of safety and efficacy are not legitimate “choices” or “options” to offer pet owners looking for real help. Integrating unproven methods and outright nonsense with established allergy therapies doesn’t add value or reduce risks, it diminishes our ability to help these patients and their human families.
Skeptvet, with all due respect, concerning the EPA report on spot-on flea/tick applications.
Please look into that report thoroughly and the factors that brought it about. Also remember the correlation between the NAPCC and the EPA in past decades, these aren’t the only reports that should be included (no, I am not suggesting there is a conspiracy, only that neither is doing enough to get stricter regulations and enforcements into play for the safety of pets). How many times has the EPA slapped manufacturers on the wrist only to suggest stronger wording on labeling (we know that repeatedly bigger, more graphic pictures on the package do not work). If you look deeply into the studies that EPA requires of manufacturers for these products, it is crystal clear that the requirements are minimal, lacking in a great deal of useful data, low number of subjects in a test, many reported reactions in the studies are overlooked, and no subsequent studies are required, despite the rising number of adverse events associated with old and new additives, “proprietary ingredients”, “inert ingredients”, and so on. The over-the-counter products are the worst and practically every vet in practice has encountered his/her fair share of these product’s shortcomings and dangers.
I’m sure there are instances where pet owners applied the product incorrectly, or applied a dog product to a cat. The web is ripe with pet-owner-wannabe-pros dishing out bad advice such as taking a large breed dog flea/tick application and dividing it for the use on cats, for just one example. But, also consider many manufacturers outright insisting repeated applications of a product over the life of the pet – some manufacturers go so far as to insist repeated applications of more than one type of product (flea bath, spot-on, powders, sprays, environmental sprays, I’m sure I don’t have to name the infamous culprits). We don’t even know what ingredients are being used and the EPA has taken far too long to require disclosure.
While you may not have intended to, you essentially dismissed the EPA report as badly as the EPA did. If you would spend some time “investigating” why that EPA report came about, you’d understand why the EPA has a tendency to state “not confirmed”. Nothing could convince the EPA to do something about this very real and dangerous problem.
What’s the rôle of breeding in allergies?
The issue I was addressing was whether there was good evidence for the claims that these products cause widespread and serious health problems. There is no such evidence. The EPA report is often cited as proof of such health harms, but it consists of manufacturer reports of spontaneous and unverified consumer complaints, so it is not scientific evidence of health problems. People who have a strong a priori belief that “chemicals” and “toxins” cause such problems will focus on these products whenever an unexplained illness arises, and those who do not have this fear will not, so individual experiences and impresssions are not a reliable indicator of whether or not the products really are dangerous. At this time, I am not aware of any robust evidence, and given the millions of doses given to tens of thousands of pets, I suspect the health problems they do cause are relatively uncommon since such evidence has not yet emerged.
That is an entirely separate question from whether or not the EPA does enough to regulate these products. I’m a strong proponent of vigorous regulation of healthcare products, and I have repeatedly called for greater and more vigorous oversight of all pet care products, from dietary supplements and foods to parasite control products such as these. I don’t at all disagree that we should have strong laws aggressively enforced and that manufacturers should be required to support transparant, comprehensive scientific sttudies to demonstarte the real safety and efficacy of theri products. I doubt, unfortunately, that this will happen in this rabidly and irrationaly anti-government political climate and given the paucity of resources and political will for meaningful oversight of veterinary medicine and the pet care industry in general. But I agree it should happen and that the current state of oversight is not adequate.
I just want to be clear that this does not allow us to assume, however, that there is a serious danger from these products. The evidence currently available is not as strong as it should be, but what there is does not support the allegations proponents of “natural” pet care make about these products. And the risks of inadequate parasite control are often ignored in such discussions, particularly since many people don’t remember what things were like before we had truly effective flea products. So I am open to being persuaded that these products may not be as safe as they seem to be, but I have yet to see any persuasive evidence, and my point in the original article was simply that this EPA report doesn’t amount to such evidence. If you have something more substantive I don’t know about, I’m absolutely willing to look at it.
I believe that when the EPA is nearing completion of the “inert/proprietary ingredients” disclosure discussions, you’ll have more evidence to ponder.
I’m referring mostly to OTC products, and the few repeat offenders who scoff at the EPA, and only serve to submit insufficient data, outdated studies, etc (all of which are available for your perusal on EPA’s site). Some of the EPA’s investigators haven’t a clue for example, what pyrethrins are (nor some of the pyrethroids), nor their dangers to cats. Yet when you provide them the evidence in discussion, they will simply deny it. To me, that’s scary.
This is an entirely different problem than that of alternative vets bashing (mostly safe and effective) flea and tick products or other chemicals. We know that alternative vets tend to bash anything that isn’t natural or alternative, it isn’t specific to flea and tick products.
I believe the claims for “natural” products for flea and tick control carry far worse dangers, since there is no evidence they work, much less evidence of safety. But I also believe that (mainly) OTC products deserve an equal amount of scrutiny.
There may not have been “enough” in the report to make clear conclusions, but the actual “reporting” was not exactly set up for clear and concise statistics . There was enough worry and concern for the EPA to act, to engage in discussion, and to call for the public’s comments. I personally feel that if anyone, including the NAPCC, is going to report, then they need to re-examine the way they keep records and submission of reports of adverse effects to reflect accuracy and specifics.
I’m curious, whom do you feel should provide scientific evidence of the safety and effectiveness of an OTC product? The EPA does little to require manufacturers to submit ongoing data, and very little followup data, unless it is a new product registration, request for review, complaint, etc. At least some of the veterinary products have a tad more oversight when they are considered drugs (FDA), they offer guarantees, they are more strict with quality control, etc.
There is certainly a higher incidence of allergies in certain breeds (some retrievers, some terriers such as west highland and scottish terriers, etc). Since the ability of the immune system to respond appropriately to different antigens is related to the individual’s MHC diversity, it would not be surprising if some breeds with limited MHC diversity (or just certain MHC genes that predispose to allergies) have allergy problems that are related to breeding. I wrote about this in relation to autoimmune disease and cancer recently (http://skeptivet.blogspot.com/2011/05/cancer-autoimmune-disease-and-mhc.html).
Once again, the “holistic” crowd is studiously ignoring kennel club practices that promote inbreeding and lots of health problems-probably because of all the money they can make treating these poor animals that are never likely to be very healthy.
There’s no perfect way to test medical products, OTC or prescription, before marketing or monitor them post-marketing. I think the cost should primarily be borne by the manufacturers as part of the R&D for new products. While I agree that this limits innovation to some extent, since a proper process is lengthy and expensive, and of course I would love to see more government funding of basic research to generate new medical product ideas, I think on balance the only way that adequate resources can be made available to do the kind of safety and efficacy studies needed is if industry pays for it.
The issue then becomes how we regulate the process so that industry bias is minimized. I think pre-registration of clinical trials, mandatory reporting of outcomes (both postive and negative), and aggressive oversight by government agencies and, ideally, independent boards contracted by these agencies with appropriate controls for conflict of interest and transparancy, is a good start. While the prescription drug approval process isn’t perfect, it is a damned site bettter than the fox-guarding-the-henhouse of voluntary monitoring for dietary supplements under DSHEA. I know less about the EPA process, but it does look pretty lax. I’m not sure I have an optimal solution, but I do think the model of prescription drug approval and monitoring is, while imperfect, better than the minimal oversight there seems to be in terms of OTC products.
Thanks for the breeding info.
You think flouride is just fine for people and animals? I don’t have time to look through all the studies, but I believe it has been shown to be toxic (a neurotoxin for one). AND, why is it even in our water supply? Do we really need it to prevent tooth decay? If we do, then, sadly it’s not been working, but it still gets pumped in our water for some reason.
It’s certainly nonsense that we need fluoride washed over our teeth through the mechanism of municipal tap water. My father is a dentist and he made a pretty good living taking care of lots of dental decay and other problems.
I’m betting you’re not a fan of Mercola, but here is a link which provides a lot of discussion and within those references to studies.
Would you consider doing a thorough look at GMOs found in pet foods? Now most any pet food that has corn or soy almost certainly contains genetically modified corn or soy (unless it’s organic, which it certainly isn’t in pet foods), and my sense is that there may be some connection to allergies (along with potentially other issues). Now, of course, there isn’t really definitive research to show this, but there hasn’t been a lot of good research on the whole topic anyway or it’s not been looked at – GMO food has been sort injected intro out food supply over the last 15 years. Is RoundUp Ready corn & soy and BT corn okay to feed to animals every day for years? Hmmmm? And then there is the labeling issue. Most people have no idea that they’re feeding GMO corn and soy to their pets when they use products with these ingredients. Europe has pretty much banned GMOs and many countries have labeling laws, even places like Russia, but not in the US. The FDA doesn’t think it’s important or necessary to let people know food (human or pet food) contain GMO ingredients. Another reason to avoid grains like corn and soy.
You’re right, Mercola is a completely unreliable source of information. The subject of the health effects of fluoridation has been intensively researched for decades, and there is absolutely no legitimate basis to think that water fluoridation presents a health risk. And it is unquestionably effective in reducing the risk of dental diseases, so I have to disagree with you here.
Here are some resources on the subject:
Sure, I will add GMO to my list of subjects to look into.
We have a dog with long term itching so tried the Nutriscan Saliva test . What a waste of money that was. When I tried to ask someone to explain why the tests were negative when we are sure the foods are the problem we were given the run around. Spend $$ and no better off. Food elimination is the best way to go.
The salive test might work for some dogs, but not for ours.
I was desperate to help an itchy dog and tried the Nutriscan. To my surprise the results were negative.. The dog has to be eating the food for at least 6 months without a break and the results may still not be accurate. This should be on the web site so people can be better informed.
An elimination diet has worked much better for us and a lot less money.
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My lord, what evidence do you need?
Wouldn’t it be fair to say that if the dogs immune is low, there’s are more risks of an adverse reaction?
And would’t it be fair to say that the problem is the dog as a whole, everything you mentioned.
If you’re after “evidence”, what “evidence” do you want?
This is almost like reading an amateurs post, no offence, I’m no vet and I’m sure you’re great one, but at least cover all perspectives and include what “evidence” there is if you’re going to write about it, otherwise you’re wasting your time. Some of your posts are great.. not this one
TO have confidence in a particular therapy, we need pre-clinical data showing why it should work AND good-quality clinical trials showing it does work. What is needed is not complicated, the problem is imaging we can safely do without it.
This doesn’t really make any sense in terms of how the immune system works, so the question can’t be answered because it isn’t coherent. What does a “low” immune system mean? What kind of reaction? to what? The problem with much defense of alternative aproaches is that it relies on vague and ultimately meaningless statements, so there’s no way to know if we agree or disagree or what the evidence actually is until we are specific.