As Allergy Season Approaches, Think Twice Before Using This

Analysis by Dr. Karen Shaw Becker

anti itch meds for dogs

Story at-a-glance -

  • Warmer weather means seasonal allergies for countless canine companions, and many veterinarians will recommend a drug called Apoquel, which treats symptoms, but not the root cause
  • If your dog gets itchy this time of year, and you’re at your wit’s end, before you accept that prescription, please research this drug
  • Apoquel is an immune suppressant similar in some ways to prednisone and cyclosporine, but its side effects are especially troubling
  • Both short- and long-term use of Apoquel can create additional health problems in your dog, up to and including diseases that are ultimately fatal
  • For the health of your four-legged family member, it’s important to take a trial-and-error, step-by-step approach identifying and healing not only with his itchiness, but also its root cause

If you have a dog with seemingly uncontrollable environmental allergies, right about now you’re holding your breath as the weather begins to warm up, your furry BFF begins to scratch, and another season of misery kicks off.

Your poor dog will soon be nonstop scratching, licking, chewing, rubbing his body against the furniture and his muzzle and ears along the carpet. From now till the first frost, the only time he (and you) will get a respite from the torment is when he’s sound asleep.

If this sounds all too familiar to you, and you’ve tried a variety of things over the years to ease your dog’s seasonal allergies, you’re probably desperately searching for something that will finally work. If you share your concerns with your veterinarian, she or he may suggest a drug called Apoquel. It’s also possible you’ve seen a TV ad for this drug that is arguably one of the best ever produced to tug at the heartstrings of concerned dog lovers.

Conventional Veterinary Medicine’s Answer to Itching Is to ‘Mute’ Your Dog’s Immune System

Apoquel, manufactured by Zoetis Inc., has been on the market since 2014. As all of you who read here regularly know, I never recommend pharmaceuticals as the first and/or only response to a pet’s health problem except in very specific situations, including emergencies in which a drug will save the life of the animal.

My practice philosophy is one of the reasons I’ve never prescribed Apoquel, have never mentioned it here at Mercola Healthy Pets, and warn against its use when anyone asks me about it. Another reason I never recommend this drug is its adverse side effects, some of which are potentially devastating.

Dogs with seasonal allergies that typically take the form of itchy skin (pruritis), have what can be described as overactive immune systems that respond inappropriately to harmless substances such as grass and pollen. The drugs prescribed by (primarily) conventional veterinarians — typically prednisone, cyclosporine (Atopica), and now oclacitinib (Apoquel) — relieve allergic symptoms by suppressing the immune system.

These pharmaceutical “solutions” do not actually solve the root cause of the problem — they only provide temporary relief of symptoms by turning the immune system down or off. Now, this may seem like the answer you’ve been seeking for your desperately itchy dog, but it’s crucial that you understand that these drugs carry a long list of adverse side effects, and Apoquel’s are especially troubling.

Apoquel ‘Mutes’ Specific Disease-Fighting Immune System Enzymes

Apoquel is a class of drug called a Janus kinase inhibitor that acts on one or more of the Janus kinase family of enzymes (JAK1, JAK2, JAK3). As part of your dog’s immune system, Janus kinases play a major role in controlling growth and development, regulating the inflammatory response, forming both red and white blood cells, and supporting the body’s defense against disease.

JAK1 finds and destroys abnormal (cancerous) cells before they form tumors and plays a role in destroying foreign invaders such as bacteria, viruses, fungi, and parasites. JAK2 is crucial to the production of bone marrow stem cells that form red and white blood cells and platelets. JAK3 supports the function of antibody-producing B cells and tumor-policing T cells.

Apoquel interferes with these extremely important enzymes to calm your dog’s itching. As miserable as that itchiness is, I’m sure you’re beginning to see the potential danger of easing your pet’s symptoms in this manner. Again, Apoquel and other immunosuppressants don’t solve the problem — they only relieve the symptom(s) associated with the problem.

Apoquel Manufacturer Zoetis Conducts Its Own Study and Finds Its Own Drug Effective and Safe

As is unfortunately the status quo these days, the manufacturer of Apoquel, Zoetis, conducted its own studies of its drug. In a 2013 study published in Veterinary Dermatology, the Zoetis team conducted a 7-day trial of 216 dogs (plus 220 dogs who received a placebo).1

Abnormal clinical signs observed in the 216 Apoquel-treated dogs during the 7 days were diarrhea (5 dogs), vomiting (5), lethargy (4), anorexia (3) and excessive thirst (3). So, it appears 20 dogs out of 216 (9.3%) had adverse side effects within a week of starting the drug (unless, I suppose, some of the dogs developed more than one side effect, making the number less than 20).

The Zoetis researchers then conducted a “continuation study” after the 7 days, from day 8 to day 30. From the study:

“Six dogs (four oclacitinib and two placebo group) were withdrawn from the study during the continuation phase for abnormal health events. Abnormal health events were reported in 11 of 179 oclacitinib-treated dogs post-study.

These were as follows: diarrhea (four dogs; severe enough to warrant cessation of treatment in one dog); vomiting (four dogs); fever, lethargy and cystitis (one dog); an inflamed footpad and vomiting (one dog); and diarrhea, vomiting and lethargy (one dog).”

So, 4 dogs receiving Apoquel had to be pulled from the study during days 8 – 30 for abnormal health events, and 11 more developed abnormal health events after 30 days. The number of affected dogs may not seem significant — unless, of course, one of those dogs is yours and something you’ve given him for itching has created one or more additional health problems.

Another Study Resulting in 21 Euthanized Dogs Concludes Apoquel Is ‘Safe and Efficacious for Long‐Term Use’

In 2015, several of the same Zoetis researchers conducted another study of Apoquel titled: “Long‐term compassionate use of oclacitinib in dogs with atopic and allergic skin disease: safety, efficacy and quality of life.”2

I suspect in this context, the term “compassionate use” means (more or less) that the drug isn’t intended for long-term use except in dogs for whom no alternatives exist. From the study:

“Background. Oclacitinib is safe and effective for treating dogs with pruritus associated with allergic and atopic dermatitis, based on randomized clinical trials of up to 4 months duration.”

“Hypothesis/Objectives. This study assessed long‐term safety, efficacy and quality of life of oclacitinib‐treated dogs enrolled in a compassionate use programme.”

This means the longest study Zoetis has conducted on Apoquel in dogs is 4 months (perhaps for a reason?), at which time its continued administration falls into the category of “compassionate use” of what amounts to an investigational new drug, since its side effects haven’t been studied beyond 4 months. In their “conclusions and clinical importance” section, the researchers write:

“Results indicated that oclacitinib was safe and efficacious for long‐term use and improved the quality of life for dogs in this study.”

Let’s just say my interpretation of their study results differs significantly from the Zoetis team’s:

Of the 247 dogs in the study, 21 had to be euthanized — 10 for cancers that presumably weren’t present at the start of the study

The youngest to be euthanized was a 6-year-old French Bulldog who’d been on the drug for 141 days

The oldest was a 13-year-old Labrador Retriever who’d been given Apoquel for 175 days

The first casualty was a senior Labrador Retriever who was diagnosed with thoracic metastatic cancer at day 17 on the drug

Next were 11.5-year-old and 12-year-old Golden Retrievers who were given the drug for 49 and 52 days, respectively

Eight of the 21 dogs were euthanized as a result of conditions diagnosed prior to the start of the study, so it’s not possible to know how the Apoquel may have affected the progression of their diseases

The remaining 3 dogs were euthanized for a ruptured cruciate ligament, an undefined central nervous system disorder, and abdominal ascites with pleural effusion

The mean age of the euthanized dogs was 9.8 years; the mean number of days on Apoquel was 279

Even though we can’t know for sure that the 10 dogs who were diagnosed with cancer after starting Apoquel developed the disease as a result of the drug, it’s an established fact that drugs that suppress the immune system can and often do render it incapable of effectively protecting the body from disease. 

If Your Dog Has Seasonal Environmental Allergies

Take heart! There are many safe, nontoxic steps you can take to relieve your dog’s symptoms while simultaneously addressing the root cause(s) of his allergic condition. The key is to address allergy symptoms immediately, don’t wait for your dog’s minor scratching to blow up into a massive issue.

If you know your pet has seasonal allergies, begin a seasonal-support protocol prior to allergy season starting. Addressing seasonal allergies proactively is a much easier approach than trying to manage an inflammatory meltdown once it has occurred.

Strategically addressing an allergic pet’s overactive immune system takes time, planning and some patience when it comes to finding the right blend of supportive therapies and approaches for your specific animal. To get started, since there’s no time to waste, please read my most recent post on this topic, Get Ready for Seasonal Allergies – Take These Steps Now.

Most importantly, if Apoquel (or any other immunosuppressive drug) is the only thing that is saving your pet from a life of allergic misery or potential euthanasia, my suggestion is you use this drug for the shortest duration of time possible (consider “pulse therapy” to minimize potential side effects) while concurrently working on balancing your pet’s exaggerated immune response.

Integrative and functional medicine veterinarians are equipped with a variety of innovative “tools” (beyond aggressive pharmaceuticals) that can help next year’s allergy season be less overwhelming, but the time to begin working on your allergic pet’s immune system is now.