>This vet wants to try Cytopoint instead of Apoquel.

I think that's a good idea. Cytopoint has much fewer safety concerns than Apoquel: https://vetspace.2ndchance.info/all-of-dr-hines-dog-health-articles/cytopoint-versus-apoquel-for-my-itchy-dog-which-is-safer/

I would only use Apoquel if I'd tried Cytopoint for 3 consecutive months and not seen any effect.

But really, the gold standard is to aim for immunotherapy via allergy testing. Because dogs with allergies often stop responding to meds which just treat symptoms (like Cytopoint and Apoquel) as they age. They can need higher doses, different meds, cocktails of things - all with side effects. They can also become allergic to more things which they previously weren't allergic to. This is a known common trajectory for allergy dogs.

The only way to change that pathway, is via immunotherapy. With immunotherapy, dogs can often completely stop Cytopoint/Apoquel and symptom-addressing meds because the immunotherapy helps their immune system deal with the allergens directly. Unfortunately from various internet forums and FB groups it seems that people either don't realise this or don't want the hassle of immunotherapy and/or don't realise how much better it is for the dog than lifelong symptom-addressing meds. So the poor dogs end up on Apoquel or Cytopoint forevermore, with allergies getting worse as they age. See: https://veterinary-practice.com/article/improving-management-with-immunotherapy

Ideally, owners should pursue allergy testing and immunotherapy for a 'true' cure (albeit ongoing) whilst using Cytopoint and Apoquel just for flare-ups or whilst the immunotherapy starts to work.

From what I can gather online, people go to the vet for Cytopoint injections but typically are allowed to give immunotherapy injections themselves.

furriefriends, perhaps the sublingual drops weren't around when you started immunotherapy?? I know they are a much newer thing than the injections. As we give supplements daily, I don't see this as being much harder than sticking Riaflex or fish oil or whatever in food. (I know they can't be given with food, needs 15mins either side of eating food.)

1234. The sublingual drops were available and we did discuss but decided that the injection was better for my situation  
Things may have moved on of course in the years we have been doing the injections and possibbly they arnt as time sensitive as they were .
I know my issues as weak as it sounds that I felt I couldn't guarantee for the rest of brookes life I would never forget to give them ever day if there was another option . Unless I have forgotten something else .looking back it does seem that I should have been able to .she does get fed ever morning and night lol
I also can't remember if there is any difference in efficacy between the 2.
I might ask the vet to remind me why I decided on injections now u mention it .
Excellent post 1234.
One point I would.like to add is that even immunotherapy is often not 100 % successful .in our case vast improvement but brooke still needs regular checks and some topical treatments too. I think people expect total results which sadly it isnt and for some if used in older dogs ,past 5 years I belive it isnt successful enough to continue

From my googling, it seems that the sublingual drops and the injections are equally effective but sometimes one works whether the other doesn't, for a particular dog. So if you try one and it doesn't work, they recommend you try the other.

One website I read said that because you give them every day, forgetting a dose one day isn't a huge deal - unlike forgetting a monthly injection would be.

I think it is about 50-75% effective, depending on which research you read.

Intersting .yes I've seen up to 70 % .goodness how u measure that but I would say we are nearer the 70%

I didn't update this thread to say that we've done the Dr Dodd's HemoPet Nutriscan test for food allergies - using saliva to look for antibodies - and it came back that there was nothing she was allergic to or needed to avoid.

I know that mainstream vets don't put much faith in this test, but for what it's worth, it supports our thoughts (and our vet's thoughts) about this being an environmental allergy and not a food allergy.

We are still avoiding dairy and chicken but I've reintroduced beef, because avoiding both chicken and beef was pretty difficult! Not noticed any results of that yet, but she is on Cytopoint.

In 2 weeks, we get the blood test and her 3rd Cytopoint. Then we are hoping to try sublingual immunotherapy, if the test comes back with anything. The blood test and immunotherapy will be Artuvet's.

Thanks for the update.  I know when I have spoken about hemopet most vets don't know who they are
Nice to have your thoughts confirmed again . U can always twiddle with beef and chicken if needed longerterm .
I just thanked lucky stars we are raw as it does make it easier to avoid food allergens although most of ours are environmental. I probably have a wider range of meat available where I am as well
One step at a time u are getting closer to a management plan to make her comfortable

Update: We just had bloods drawn for the Artuvet testing and are waiting for the results.

We also had the 3rd Cytopoint injection. As she has *just* gone over the 20kg mark, she was into the next dosage. The vet wanted to give the proper dosage (for 20kg+) whereas I was a bit like... well if the dosage below this worked when she was 19.7kg, it's not going to suddenly stop working because she is 0.3kg over 20kg. But we went with the vet's recommendation and she had the higher 20-30kg dose.

Pup was too wriggly even with gabapentin and trazodone pre-meds to help sedate her for the blood draw, so we opted for a full injectable/reversible sedation rather than risk creating bad associations with the vet by wrestling her to be still enough for a blood draw.

Thank u for keep us up to date. Fingers crossed u are getting somewhere

Ok, I finally have the long-awaited allergy results back.

She is allergic mainly to house dust mites That was the only 'red' item. And then in grey (not so concerning) farinae mites(?) which are apparently another type of house dust mites. Everything else was green. This explains why the allergies are not seasonal, cos house dust mites are always present.

We don't have any carpets or curtains anyway, but we do have a sofa the dogs are allowed on and their dog beds - which we wash. I can't see us upping the hoovering as a result of this  

But we are getting sublingual immunotherapy ordered for it so hopefully that will help. Alongside the Cytopoint.

Its a real pain when it is something u can't get rid of.same with brookes environmental allergens.
those 2 are very common allergens in many dogs.
Please keep us updated i will be very intersting to learn how she gets on with the sublingual immunotherapy.
Is the tent to do both or try just sublingual? I remember being told it takes a while for any immunity to show not as instant as cytopoint

We're just doing sublingual - it's either/or. If that doesn't work the same company also make shots and we could switch to those. But it can take up to a year to see a result so we won't be switching any time soon...

We'll use Cytopoint when we need it in the meantime. We were easily getting to 1 month between Cytopoint shots so we can probably go longer than that... and hopefully the immunotherapy will let us come off that.

Got u .yes it took that long with us too. We still do habe to use topical things as and when in her ears. Its not perfect but way better than what it was. I am just so grateful we have done this and how much it has helped.
Hopefully u will find the same

I read somewhere that humidity had an effect on Dust Mites, though can't remember if you need to increase or decrease, to reduce them.

Thanks, I'll check it out. We have two air purifiers running. But really you can't eliminate dust mites, you can perhaps reduce them but whether that will be enough to help a very allergic dog is debatable... So I think the way forwards is the Cytopoint and immunotherapy....

Not that this applies to you as u feed raw but it is suggested that kibble.is kept in the freezer to kill dust and farina mites .

Trouble is if u bring the mites down to  an acceptable level  at home u will still have the problem is pup goes anywhere else. That may be enough to set things off for a while
I have to agree it does seem the treatment u are heading for is probably the best

Yes exactly. Dust mites are in any upholstered material, including car seats etc. It's not really possible to avoid them. So I'm not going overtime hoovering the house or throwing out the sofa!

Yes, I feed raw so no mites in grain possible here. Although I think those are a different mite to the dust mites.

Its both types apparently the farina? Ones too . I really only added that incase anyone else was reading your story

Oh, the farinae mites are another type of dust mite. They are apparently American dust mites as compared to European dust mites...

Interesting.  I would have to check which ones affect brooke of any. Its  become a bit of a blurr after 5 years

could dust mites be killed by stream cleaning soft furnishings?  I use one a lot in house and it certainly leaves house clean but maybe would kill them too?

I think it would prob depend how deep the steam cleaning goes? I steam clean our floors but didn't know you could steam clean soft furnishings...?

I have a hand held one and do things like rugs, cushions, mattress, curtains etc when inclined (not often!!!) brings rugs and carpets up lovely .  I would say probably a good idea to test on a small hard to see area on a new item before blasting whole thing in case the material does not do well with it
hard floors I do a lot with it but when in the mood it does clean up soft stuff well

Oh, I have a hand held one as well but I've only used it to clean hard items. So I just blast the steam at the sofa? Doesn't it end up wet?!

a bit damp but secret is you do a section or one sofa and go sit in dry bit then tackle other end once that bit dry.  mattress we have is on slats- I do one side with the steamer - leave it to air all day then turn it so dampish side is on the slats- with mine stuff doesn't end up wet just slightly damp

Oh right, I'll have to give this a go... thx!

Actually vets have very little training in dogs nutrition. I feed my dogs raw, but there's no need to go that far. If it is an allergy, it's likely chicken or grains. You can try a limited ingredient diet for a while to see if it improves. I had a dog with severe allergies, I had him on a nature's variety limited ingredient formula, I think it was lamb and rice. He was so much better on that food. Worth a try! Find more tips on https://fello.pet/en/dog-breeds/fila-brasileiro/

Have you had her blood tested? That might give you a clue to what's going on as well...

Yes. Don't think you can have read all the above... She doesn't have food allergies, she is allergic to house dust mites.