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– October 27, 2014: Douxo calm shampoo and relief shampoo sent home

– February 26, 2015: Pododermatitis, feet soaked in clinic. Prescribed: Mal-A-Ket wipes, Convenia, Temaril-P, Enrofloxacin

– March 13, 2015: ACTT drops refilled, Malaseb flush sent home

– March 26, 2015: Retested ACTT Comprehensive panel

– May 2015: Ordered new ACTT initial allergy drops 6-vial set, started new diet

Aerobic culture and sensitivity sent to lab on right front paw, fungal culture on left rear paw performed again; results pending at this time.

Current medications: Clindamyacin oral, Torbutrol for pain, epsom salt foot soaks, e-collar, and allergy drops

Lucky is a 6 Year Old, Neutered Male Maltese

To say that Lucky is a complicated case would be an understatement. Lucky was a new client in for a second opinion for dermatology. On his first presentation to me, Lucky’s owner reported chronic ear infections, chewing of all four feet, redness of skin, itching, and pustules on the skin multiple times during his life. The owner could not recall when the symptoms started. Since Lucky was coming to me for a dermatology consult and had already been on multiple medications, shampoos, and different diets, the owners were ready to allergy test at their first visit.

In March 2013, I diagnosed Lucky with allergic dermatitis. I suspected the cause was canine atopy, due to numerous environmental allergens, and otitis externa, most likely due to food allergies. Lucky was successfully treated with DVM Relief Shampoo and BNT transdermal gel from BCP Pharmacy. When we received the allergy test results, we started Lucky on ACTT allergy drops with a 6-vial, 22-allergen initial set. He was also started on Natural Balance Sweet Potato and Chicken Small Bites. Lucky had another very minor ear infection right after the diagnosis and a small skin infection during the same spring that was easily treated with Convenia and shampoo.

Lucky thrived with his allergy drops and limited ingredient diet. There were a few very small incidents or breakthroughs, but all in all, the owners were thrilled and so was I. That was until March of this year, Lucky started with a pododermatitis on his right front paw and his left rear paw. These were the only lesions on his whole body. There were absolutely (according to the owner) no food allergen insults knowingly being given to Lucky. On the rear paw, there was a very scaly and dry exudate and a mild pruritis. The front right paw was extremely swollen, discolored both red and purple, with moist exudate. This paw was extremely itchy to the point that Lucky had to wear an e-collar at all times or he would make the paw bleed.

This pododermatitis was bad from the start. It was aggressive, so I was aggressive. We started immediately with foot soaks in Malseb Flush, wiping in Mal-A-Ket Wipes twice daily, Convenia, Temaril-P, and Enrofloxacin. Fungal cultures were negative. The owner had just refilled her allergy drops, so I was hoping that these medications would work and I would not have to retest Lucky. One month later with little to no improvement, I retested Lucky with a ACTT Allergy Comprehensive Panel and Speciality Food panel. When the results came in, we changed Lucky’s food and had to reorder the allergy drops and start over with a new vial set. Lucky is a case that is continuing today. Not all dermatology cases are black and white or open and shut cases. Lucky is difficult not only because he is a very allergic dog, but also because he is also allergic to most medications and cannot metabolize them like normal dogs. I have a list of medications about 20 items long at my hospital that I cannot give Lucky. Most medications that I give him (only because I have to), need to start out at one-fourth of the regular dose. Lucky is a wonderful dog with great parents. Currently, we are waiting for his aerobic culture and sensitivity results. So far, we know that he has grown a resistant strep and staph species. I am waiting to do any kind of biopsy because the tissue is not stable enough at this time. Right now, I feel I would do more harm than good. Lucky is improving slowly, and my gut tells me that this foot infection will end up having nothing to do with his allergies in the end. His Dad stepped on his foot back in December, and radiographs turned up negative. Repeat radiographs in May said the same thing, but something else is definitely driving this, and I do not think that it is allergies of any kind.

Summary of History
– September 24, 2013: Pyoderma (Ulceration) for the first time at the age of 2 years old. Prescribed: Cephalexin and Quick Derm
– June 30, 2014: Skin infection, allergic dermatitis, chews feet, itching. Prescribed: Prednisone and Cephalexin. Talked to owner about allergy testing.
– July 29, 2014: Tested ACTT comprehensive panel and speciality food. Diet change: Iams Grain Free Naturals Chicken and Peas. Prescribed: Prednisone, Benadryl, and Douxo calming spray.
– August 26, 2014: ACTT Injections: 2 vial set
– March 5, 2015: Ear infection. Prescribed: EasOtic
– April, 2015: ACTT Injections: refill 2 vial

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Summary of History

– September 24, 2013: Pyoderma (Ulceration) for the first time at the age of 2 years old. Prescribed: Cephalexin and Quick Derm

– June 30, 2014: Skin infection, allergic dermatitis, chews feet, itching. Prescribed: Prednisone and Cephalexin. Talked to owner about allergy testing.

– July 29, 2014: Tested ACTT comprehensive panel and speciality food. Diet change: Iams Grain Free Naturals Chicken and Peas. Prescribed: Prednisone, Benadryl, and Douxo calming spray.

– August 26, 2014: ACTT Injections: 2 vial set

– March 5, 2015: Ear infection. Prescribed: EasOtic

– April, 2015: ACTT Injections: refill 2 vial set


He originally presented in the fall of 2013 with hyperemia and a superficial pyoderma in the fall of 2013. The diagnosis was allergic dermatitis and he was successfully treated with steroids and antibiotics for this first allergy insult.

In June 2014, Butch presented with severe pruritis, chewing his feet, and widespread redness over his ventral abdomen and inguinal areas. At this time, allergy testing was discussed with Butch’s owners. Butch was diagnosed with allergic dermatitis, a superficial pyoderma, atopy as well as suspected food allergy. Treatment consisted of prednisone and cephalexin. Eastern North Carolina has tremendous humidity and allergens, so it did not take long for these allergens to continue to plague Butch. His skin would get better while on the antibiotics and steroids; however, as soon as he came off of them, the itching and redness would return. Butch did not stop chewing his feet on any of the medications. This reconfirmed the suspicion of food allergy which can only be controlled by diet elimination and not medication.

Butch and his owners returned at the end of July ready to allergy test. An ACTT Allergy Comprehensive Panel with Specialty Food add-on was run. At that point, we added Douxo calming spray to his regimen and continued steroid treatment. When the results came in, the diagnosis was confirmed: Canine Atopy to multiple environmental allergens and food allergies.

In August 2014, Butch started his 6-vial, 8-allergen initial set of injectable Immunotherapy with ACTT. As of May 2015, he is well-regulated, receives only one injection a month, and has received no steroids since beginning treatment. Butch was changed to Iams Grain Free Naturals Chicken and Peas, and within 8 weeks all chewing of the feet stopped. Butch has only had one sick visit since starting IT. That was when the grandkids visited and there was an accidental food allergen insult (he was given table food by the children). Within days, Butch had an uncomplicated Otitis Externa which we were able to treat easily. Butch is a great example of the importance of early allergy testing. The owners’ compliance led to many stress free days for themselves, Butch, and his veterinary health care team.

Testimonial from Butch’s Owner:

When we first took Butch to Faithful Friends, his skin was a mess. It would be worse in the summer than the winter, but was bothering him most of the time. He would get red blotches all over his belly and would scratch almost constantly. He would also lick his paws a lot. His belly was always pink and around his mouth would be extremely pink, almost red. Since starting the shots, we have seen a great improvement in his color and he has almost totally stopped licking his paws and scratching. We also changed his diet to aid the shots. Butch is a different dog since he started to take these shots; his skin is so clear and he has no red spots or sores on his body. We are so happy with the results of the shots and his diet, and will start the second part of his treatment soon.

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– October 17, 2011: First ear infection at the age of 1 year.

– March 26, 2012: Ear infection. Suspect food allergy, diet changed to Iams IVF Skin and Coat Fish and Potato

– June 4, 2012: Pododermatitis Prescribed: Temaril-P

– November 29, 2012: Ear infection

– January 14, 2013: Changed diet to Natural Balance Sweet Potato and Fish

– July 15, 2013: ACTT Allergy Traditional and Speciality Food Panel

– July 26, 2013: Changed diet to Hills Z/D after ACTT allergy results

– July 30, 2013: Feet in bad shape. Prescribed: Genesis spray and Relief spray

– August 1, 2013: Skin Infection. Prescribed: Convenia, Mal-A-Ket wipes and relief spray

– September 30, 2013: Feet are bad again. Skin Scrape

– October 8, 2013: Idexx biopsy of feet, Diagnosed: Allergic dermatitis

– October 17, 2013: ACTT Allergy testing Combo 2. Prescribed: Temaril-P

– November 4, 2013: Talked about allergy results and owner wants to go the elimination route, especially with cotton.

– September 19, 2014: Ear infection (Accidental Food Insult)

– April, 2015: Doing great: healthy with no problems at this time, ears and skin are perfect. On Z/D, and elimination of environmental allergens and regular hypoallergenic baths.


who has been coming to me since his very first puppy visit. Ramsey’s first ear infection was diagnosed at the age of one. Cytology was performed and the infection successfully treated, but in five months another ear infection occurred.

Since Ramsey had upright ears, regular baths, and did not swim on a regular basis, I started to suspect a possible food allergy. At that time, my hospital did not regularly food test dogs, but did do food trials, which are time consuming. The majority of the time, we did not pick the right combination of novel proteins or novel carbohydrates on the first try. You can see in the timeline that we got it wrong several times. In June 2012, Ramsey received his first diagnosis of pododermatitis. This would become a very plaguing problem for Ramsey and his owner. Ramsey continued to have ear infections. Finally in July 2013, we tested Ramsey with ACTT food panels. When the results came in, we realized that Hill’s Z/D was the only food that Ramsey could eat without an allergic reaction.
However, just one week later, his feet were still very inflamed. Ramsey had to live in a cone during this time as he would chew his feet so badly they bled all over the house. We tried topical steroids, antibiotics (both topical and systemic), antifungals (topical), systemic steroids, and complete diagnostics (including: skin scrapes, biopsy with histopath, and cytologies). When our biopsy came back as allergic dermatitis, I then recommended to the owner that we perform an environmental allergy test. In November 2013, the results showed us that Ramsey had some very specific allergens in his environment.

After having a post-allergy testing discussion with the owner, we agreed that elimination was worth a try, since Ramsey was allergic to cotton which included all of his toys, blankets, and bedding. Today, Ramsey has all polyester toys or rubber and has not had any episodes of pododermatits since. The only ear infections that Ramsey has had since testing have been when there was known accidental food insult, which resulted in an ear infection within ten days of consumption.

Lessons Learned from Ramsey’s Case:

DO NOT WAIT TO TEST! If I would have tested Ramsey earlier and done complete testing, I could have saved my client a lot of money and Ramsey a lot of unneeded suffering. If you suspect food or environmental allergens, don’t wait, test the patient. Knowledge is power, and that power can truly give your clients and their pets a happier and healthier life.

A Note from Ivy Heath, DVM, Faithful Friends Veterinary Hospital, North Carolina, Ramsey’s Vet: 

We have trained our entire staff: receptionist, technician, veterinary assistant and everyone in between to look for the signs and symptoms of both canine atopy and food allergies in dogs and cats. By doing this, when an owner calls, we are able to start the conversation about allergy testing. This conversation is then repeated in the exam room when they are checked in, and again when the technician goes over the pet’s history and takes the pet’s vitals. This constant conversation about the benefits of allergy testing results in tremendous compliance with our owners. It is extremely rare that I, as a doctor, ever discuss allergy testing. Typically, when I enter the room to examine the patient, the blood has already been drawn for allergy testing.

Testimonial from Ramsey’s Owner:

Ramsey is a completely different dog since doing allergy testing on him. He was pitiful when he had to live in a cone, but it was the only guarantee I had that he would not hurt himself when I was not at home. Since allergy testing, he is now a happy, carefree, confident little man that never lives in a cone or has to battle an ear infection.