Chesapeake Veterinary Dermatology Associates

My pet is on immunotherapy injections, how do I get them refilled?
For your convenience, we have an allergy hotline. Please call 410-828-0911 to leave a message to refill your pet’s immunotherapy injections. We recommend you call 2-3 weeks before you actually need the immunotherapy. Please note if you are ordering “induction”, “first maintenance refill”, or “maintenance refill” and if you need syringes. Also, please inform us if you will be picking them up at CVDA or you would want them mailed to you. Induction immunotherapy must be picked up at CVDA or may be shipped to your primary care veterinarian as you need to be instructed on how to give the injections (this usually takes 30 minutes).

What medications need to be discontinued prior to skin testing?
There are several medications prescribed for itchy skin that will inhibit reactions (wheals) on allergy skin testing. Review the drug withdrawal schedule below and discuss it with your primary care veterinarian. Please keep in mind that this is a rough guideline; individual cases can vary. Drugs should be withdrawn under the advice and discretion of your primary care veterinarian.

DRUG	WITHDRAWAL TIME
Topical steroids (eye, skin, or ears)	14-30 days (2-4 weeks)
Oral steroids	30-60 days (4-8 weeks)
Injectable steroids	70-84 days (10-12 weeks)
Topical or oral antihistamines	10-14 days (2 weeks)
Fatty acid supplementation (if possible)	14 days (2 weeks)
Tranquilizers	2-3 days (0.5 weeks)

What medications can I continue to give my pet prior to the appointment? Prior to skin testing?
Antibiotics, antifungals, flea preventative, heartworm preventative, thyroid supplementation, heart medications, anti-seizure medications, insulin, and ophthalmic cyclosporine for dry eye can be continued prior to any appointment or skin testing procedure. Cool water baths with oatmeal can be used to help soothe the skin and relieve itch up until 2 days before skin testing. Please have a discussion with your primary care veterinarian concerning which medications you need to continue to administer or begin before the CVDA appointment.

How can I schedule an appointment?
Since CVDA is a referral service, you and your primary care veterinarian must conclude that a dermatology referral is necessary for your pet. The veterinarian needs to fill out our referral form (see Forms tab) and send it to CVDA with your pet’s medical record (including any blood work, skin culture and/or skin biopsy reports). You may then call us for an appointment.

When are you open?
We accept appointments Monday, Tuesday, Thursday, and Friday. Our appointments are scheduled between 8:00 am and 4:00 pm.

How soon can I get an appointment?
Usually an appointment can be scheduled within a few days, but it can vary with each season.

Can my pet eat the day of the appointment?
Food should be withheld from the pet after 10:00 pm the night before the appointment. For appointments scheduled after 2:00 pm a small amount of food (no more than 1-2 measured tablespoons for a medium-sized dog and less for smaller pets) may be given before 8:00 am the day of the appointment. Water should not be withheld. Please discuss this with your primary care veterinarian to make sure your pet does not have any pre-existing medical conditions (eg, diabetes mellitus) hindering this practice.

What does an appointment cost?
The initial consultation with basic dermatologic procedures (skin scrapings and cytology) is up to $280. Cases requiring allergy skin testing can range from $600-900 which includes the office call, sedation, and initial itch-control therapy.

Do you bill or have a payment plan?
No, we do not bill. Full payment is expected at the time of your pet’s discharge from CVDA. If your pet needs to stay in the hospital for a procedure, a deposit of 50% of the estimate is needed at the time of admission. We provide estimates after the exam and prior to major procedures. Please feel free to ask about any fees before they are performed. Also, we offer Care Credit for those who wish to apply.

What is Care Credit?
Care Credit is a plan that uses a “special credit card”. Many veterinarians and some dentist accept this card. You will need to fill out an application and present it to us with a photo ID. We supply Care Credit with your information over the phone to determine if you are eligible. If accepted, a card will be mailed to you with information regarding your pre-set spending limit and repayment obligations. You will be able to use the card immediately if you chose to do so.

When should I arrive to a scheduled appointment and what should I bring?
We look forward to meeting you and your pet. Preparation on your part will help us take care of your pet's needs within the scheduled time.

How long does the appointment usually last?
The initial appointment usually lasts between 1-2 hours. Recheck appointments last about 1 hour depending on the severity of your pet’s condition. Drop-off recheck appointments can be arranged provided a phone number where you can be reached is available to us.

What happens during the appointment?
During the initial consultation, the dermatologist will review your pet’s medical history. Some of the history will be supplied by you on our dermatological history form. Although it is extensive, a complete dermatological history is crucial in understanding your pet’s skin disease. Subsequently, a complete physical and dermatological exam will be performed in order to prioritize a list of potential diseases. Typically skin scrapings and skin/ear cytology are performed to examine the skin’s microenvironment and look for complicating factors. Any additional testing procedures will be performed if deemed necessary and with your approval.

What is a skin scraping?
A skin scraping is a basic dermatological procedure. It is performed using a blade, a glass slide, and mineral oil. The skin is scraped either superficially or deep to search for parasitic mites. This procedure is not intended to cut the skin but to scrape the skin. Following skin scraping the area is abraded (similar to when you “skin” your knee). The sample is gathered on a slide and then examined with a microscope.

What is skin cytology?
Skin cytology is a basic dermatological procedure. It can be performed in several ways. One technique is to rub a glass slide on a lesion to obtain cells and potential micro-organisms (bacteria and yeast) that may be contributing to the skin condition. Another way is to repeatedly press clear acetate tape on a lesion which is then fixed onto a slide. Lastly, a cotton swab or blade may be used to smear skin contents on a slide. Regardless of the technique, each slide is stained and examined under a microscope.

Can animals get allergies? If so, how will I know?
Yes. Animals can develop allergies like humans, but animals typically show allergic signs on their skin and/or ears. For instance, people tend to sneeze and wheeze due to asthma and allergic rhinitis compared to animals that itch and scratch due to allergic dermatitis and/ or otitis which may occur seasonally or year-round. Inflamed skin and ears are then predisposed to secondary infection and water loss which compounds the level of itch the pet is experiencing. Dander, odor, whiteheads, blackheads, scabs, change in coloration, thickened skin, and hair loss are suggestive of infections which many times are the result of underlying allergies.

How do I know if my pet is itching too much?
Licking, chewing, biting, rubbing, and scratching are all potential signs of pruritus (itch). Many times animals are itchier during the night when they are not preoccupied with other events. Usually animals with an abnormal amount of itch focus their attention to a particular body region or regions. For example, dogs with allergic skin disease may frequently show signs of itch on the face, ears, paws, armpits, groin, and around the rump. It may be difficult to determine if a cat is itchy or just grooming. However, if the cat is vomiting hair balls, has excessive hair in its stool, has areas of hair loss, has obvious skin lesions, or seems itchy around the face/neck then the cat is probably itchy. It is important to remember that every pet has its own itch tolerance, which means the intensity and reason(s) for your pets pruritus may not be the same as a friend’s pet.

If my pet only seems itchy during a specific time of year, should I be concerned?
It depends. Mild itch that is accepted as tolerable by an owner may need no therapy other than an occasional bath. Itch that is more intense or becomes more intense each year warrants a discussion with your primary care veterinarian. Therapy in this circumstance may include a flea preventative, a medicated shampoo, antibiotics, antihistamines, a fatty acid supplementation, and/or a short course of oral or topical steroids. If this approach does not help alleviate signs, the pet does not tolerate it, or if the itchy season is lengthening then consultation with a dermatologist is an option. Regardless of who examines your pet it is important to start managing these pets earlier rather than later.

How soon can I expect for my pet’s allergic skin disease to get better?
With dermatology, there is no such thing as a “quick fix” because it takes time to understand the underlying cause of your pet’s skin condition. Often the skin condition has been present for many years prior to referral necessitating an ample period of time to improve and manage skin signs. First, we will need to eliminate the “absolutes” which are bacterial and/or fungal infections, fleas, mites, and secondary ear disease. Since therapy for allergies is tailored to the individual, other diagnostic tests and therapies are on a case by case basis. It is important to remember that allergies are managed, not necessarily cured!

What is skin testing?
Intradermal testing (IDT) or allergy skin testing is a tool that aids in selecting allergens for immunotherapy (aka allergen-specific allergy shots, hyposensitization, desensitization). This procedure with subsequent tailor made allergy shots is best performed after other possibilities for the skin condition have been excluded. Veterinary IDT is similar to human allergy skin testing; however, our patients need sedation and clipping. The side of the chest will be shaved in the shape of a rectangle and small black Sharpie pen dots will be put in a tandem array on the shaved skin

allowing us to know where to make the injections. A panel of pollens, molds, mites, insects, dander, and other environmental allergens are then injected into the skin. The size of any developing wheal is then recorded. The entire procedure lasts roughly 30 minutes.

Is there a benefit to allergy skin testing?
Yes. Skin testing allows us to select allergens to which the pet is allergic to for immunotherapy (allergen-specific injections). These injections are tailored to the specific pet and is the best long term management tool for environmental allergies. For most cases, it is important to exclude other causes of pruritus (itch) before performing and interpreting this test.

When is the best time to skin test?
Skin testing can usually be performed most times of the year; however, pets with seasonal allergies are best tested towards the end of their "allergy season" (within 2 months). Skin testing at other times for seasonally allergic pets may require a repeat skin test near the end of the allergic season with immunotherapy (allergen-specific injections) modified accordingly. Consequently, many pets will not be skin tested at the initial appointment until after the seasonal history of the pet is ascertained in order to get the best test possible.

What is blood (serum) allergy testing?
Blood allergy testing is usually reserved for those cases in which skin testing cannot be performed. This scenario occurs when an animal cannot be sedated due to another medical reason or when appropriate drug (eg, steroids) withdrawal cannot be accomplished. Most dermatologist would agree that skin testing gives a better reflection of what the skin is reacting to compared to blood testing alone. Many times skin testing and blood allergy testing are used together to get a better overall assessment of which allergens are bothersome to the pet. It is important that other causes of pruritus (itch) have been excluded before performing and interpreting the blood allergy test alone, specifically in nonseasonal allergic individuals.

How long does it take to see improvement with allergy injections?
Most pets will respond to immunotherapy (allergen-specific injections) within 6-9 months, but some will require up to a year before total benefits are appreciated. Roughly 70% of animals with environmental allergies (atopic dermatitis) respond to these injections; however, responses can vary. During the induction phase of immunotherapy, most all pets will need the benefits of other medications to make them feel comfortable (eg, antihistamines, steroids, shampoos, etc.). Once the injections take effect about a third of pets respond very well to injections without the need of many other medications, another third respond well but will require other medications during their worst time of the year, while the last third will require all other medications but hopefully at a reduced dose and frequency of administration. This means that about 30% of animals with environmental allergies alone do not respond to immunotherapy.

What should I do if I get skin lesions?
You should contact your physician.