How we get an appointment of the Derm Vet skin and ear clinic?
You can come to the clinic either as a second opinion where all we have to do is contact your Vet to request the clinical history, or you can ask your Vet to refer your pet to us. Referral consultations are more expensive due to the more regular reports that have to be sent to the referring vet which can take considerable time to do . To arrange an appointment either phone the clinic on 0116326402, email enquiries @dermvet.co.uk or preferably fill in the form (best done on a PC or laptop) here
What is the purpose of allergy testing?
Allergy testing for environmental allergens is the last step in the investigation of a dog suffering with clinical signs consistent with Atopy , where parasites have been ruled out, and food allergy has been ruled out by the use of a properly conducted exclusion diet trial. The purpose of allergy testing is to choose which allergens could be responsible for the allergy (in case allergen avoidance is a possibility) and which allergens to include when making up individualised allergen-specific immunotherapy by injection or sublingually.
Do you do food allergy blood tests?
Food allergy blood tests are notorious for producing false positives and as such are usually a waste of money. I do not recommend doing them. The only possible purpose they may have is when, having already diagnosed food allergy by using an exclusion diet, you look at the negatives on a food allergy blood test with a view to trying those foodstuffs first when provocative testing and trying to get list of foods which can be accepted. The negatives on a food allergy blood test have an 80% predictive value.
What allergy tests to you do?
Here at Dermvet we do both intradermal skin testing (IDST) and serological IgE testing for environmental allergens. This maximises the possibility of including all the relevant allergens in allergen-specific immunotherapy. Neither test has been shown to produce positive reactions for a particular allergen every month of the year and we have seen several cases where the results of either test are the complete opposite of the other. One note of caution; despite having had a full diagnostic workup and making a provisional diagnosis of Atopy, between 10-20% of dogs will produce no reactions on IDST or positive results on serology… this is known as “atopic-like dermatitis” and is equivalent to the condition in human eczema patients, negative on prick tests, known as “intrinsic eczema”.
Are there any other allergy tests available?
Unscrupulous companies advertising on the Internet will offer allergy tests for a very cheap price where you send a sample of hair and saliva to them and you get a result with many different allergens supposedly being positive. These tests are an absolute waste of money and have no scientific data to support them. In fact, both in the UK and the USA these companies have been called out and fooled into giving positive results when distilled water and manmade fibres clipped off a cuddly toy have been sent to them.
How effective is allergen-specific immunotherapy and how long does it take to work?
Allergen-specific immunotherapy can start to work as early as 2 months into therapy or as long as 12 months. In fact, recent evidence from the USA suggests a very tiny minority of cases can actually take as long as 18 months to respond to therapy. Therapy is useful in 65 to 70% of dogs, half of which have an excellent response. Therapy usually has to continue indefinitely, as without it the immune system can slowly drift back to its previous state.
What are the risks of allergen-specific immunotherapy?
With injectable immunotherapy, there is a theoretical risk of anaphylaxis developing. This would normally occur during the dose buildup period In the first few weeks and this is the reason why the injections have to be performed at veterinary premises whilst the dose is being built up, so if anaphylaxis develops it can be dealt with promptly. Treatment for anaphylaxis would involve giving an adrenaline injection and intravenous steroids. I have never seen this side effect at all with the hundreds of dogs I have treated with Artuvetrin over the last 20+ years. A few dogs will itch more around the time of the injection for a day or so, and very few dogs may develop hives around the time of the injection. Both these scenarios usually respond to pre-dosing with antihistamines around the time of the injection. Sublingual immunotherapy, so far my experience, has not been associated with any of these signs.
What other treatments for Atopy exist?
As well as allergen-specific immunotherapy, which is the only treatment that actually tries to stop the immune system from reacting to allergens, other treatments which can be very effective include monoclonal antibodies against one of the primary itch-producing cytokines called interleukin-31 (Cytopoint injections), Janus kinase inhibitors inhibiting effects of interleukin-31 ( Apoquel), steroids, both topical and systemic, and immune inhibitors such as cyclosporin (Atopica). They all have their advantages and disadvantages, but Cytopoint and Apoquel are not very effective for the treatment of atopic otitis. As one of the major issues with Atopy is a defective skin barrier function, either supplementation with oral essential fatty acid preparations containing gamma-linolenic acid, or a spot-on containing essential oils applied weekly or every 2 weeks to the skin to improve skin barrier function, can also help as an adjunctive therapy. All Atopic dogs are more prone to bacterial and yeast infections and some cases will need topical therapy with medicated shampoos/mousses to keep infections at bay,
My dog used to respond to Cytopoint or Apoquel but it appears to have stopped working. Why?
This is a fairly common scenario and in the vast majority of cases, the reason is that the dog has developed a secondary infection with either yeasts or bacteria which also contribute to itching which is not responsive to those two drugs as the mechanisms of itch caused by infection are different. Cytology is usually done to establish if an infection is present and once treated with antimicrobials the allergic itch may once again respond to those drugs.
My dog is constantly suffering with ear infections and I cannot seem to get on top of it. What is going on?
Recurrent ear infections occur mainly because the primary causes have not been identified, and perpetuating factors such as persistent wax , discharge and debris, infection and pathological change within the ear canal have not been dealt with adequately. At the Derm Vet skin and ear clinic, we will deal with all of these issues to find a resolution to your dog’s ear problem.
Why does my dog have to have a general anaesthetic and video otoscopy to treat the ear condition?
In many cases of chronic otitis, there is a large buildup of debris within the ear canal, the tympanic membrane is not visible, being obscured by either debris or swollen tissue (did you know that all prescription eardrops are contraindicated if there is a ruptured tympanic membrane ?) and the ears are very painful. Resolution of chronic otitis is not possible whilst there is infected debris within the canal and the cleaning of the canal can only be achieved safely under general anaesthetic (although very occasionally it is possible under deep sedation ). If the ear drum is ruptured and the middle ear is infected, middle ear flushing can only be achieved safely under the high magnification offered by video otoscopy. Also, inflammatory lesions and small tumours can be treated via optical fibre, attached to a diode laser, passed down the video otoscope – This treatment is impossible to do with a handheld otoscope.
How many sessions of video otoscopy will be required to cure my dog’s otitis?
Every case is different. Some cases can resolve with just one session, but other cases, particularly the nasty pseudomonas-infected cases or those with severe hyperplastic lesions may have to have several sessions before all the pathology is resolved and the infection cleared. A lot of this depends on how easy it is for owners to apply medications between the video otoscopy sessions.
What is the average cost of a general anaesthetic and video otoscopy?
Excluding the initial and any subsequent consultation fees, the average cost of video otoscopy and follow-up treatment is around about £350-£600, depending on the degree of pathology and the number of ears affected. Some very difficult cases can be more costly than this. The cost of the procedure is dependent upon the time involved and the length of anaesthesia.
What is the cost of a second opinion consultation or referral?
Please see the current price list Dermvet Skin & Ear Clinic Fee List
My dog or cat needs surgery to remove the ear canal how expensive is the surgery and what are the risks?
Having performed over 320 total ear canal ablations ( TECAL-LBO – Total Ear Canal Ablation and Lateral Bulla Osteotomy) over the last 30 years I can say that this surgery can transform the lives of those animals with permanent changes to the ear canal which prevent resolution of the otitis and pain. It is very heartening to see how an animal previously dragged down by the persistent chronic pain of otitis can behave like an animal many years younger within as little as 2 weeks from having the surgery done. Surprisingly, the vast majority of pets recovering from surgery very quickly indeed without the need for bandages or elizabethan collars. The major risks are permanent facial nerve paralysis which I have not had in the last 80+ cases I have operated upon (previous estimates of incidence were around 3%) and draining tracts or abscesses coming from the middle ear – my last audit indicates an incidence of this of 3.8%). The cost of a total ear canal ablation surgery is around £2300 per ear
What other skin conditions do you deal with?
In addition to the common cases of allergy and otitis , I have experience in treating all manner of skin conditions dogs and cats including autoimmune diseases such as pemphigus and cutaneous lupus, scaling disorders such as sebaceous adenitis, various causes of both focal and generalised hair loss , infections caused by bacteria, fungi and yeasts and the many causes of pododermatitis.
My pet is insured. Do you do direct claims?
Depending on which insurance company you are insured with and reliant on pre-authorisation of a potential claim by your insurance company, we may allow direct claims for certain cases, but generally, we prefer payment at the time of consultation. We will then deal with your insurance claims rapidly so you will be reimbursed as soon as your insurance company can pay you back.
You will need to check with your insurance company about your level of cover, any exclusions you may have and what excess you will need to pay. Whilst we will try our best to help you with this, insurance companies generally will only deal with the policyholder. We may have to charge a fee for the admin work involved with this.
Do you do payment plans?
Unfortunately, due to the nature of the work we undertake and the administrative burden of setting up payment plans we do not offer this service currently.