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When Apoquel® was introduced, I was not a big supporter. The medication used such an unnatural way to manipulate normal dog physiology. But as time went by, I saw that Apoquel was very helpful for some dogs and didn’t cause the major side effects of steroids. Still, it’s not a panacea without side effects and it’s not right for every dog.
When clients ask me for an alternative to Apoquel, I have a standard list of recommendations. Some are alternative drugs and others are lifestyle tweaks. Which ones we use depends on the severity of the dog’s symptoms, the dog’s tolerance and the owner’s budget.
Alternatives to Apoquel:
Drug-based alternatives to Apoquel include Cytopoint® injections, Atopica®, Temaril-P® and other corticosteroids. Immunotherapy injections, allergen avoidance and frequent bathing are effective non-drug alternatives. An upgraded diet and lifestyle modification to decrease stress can also help.
In addition to working with hundreds of client-owned dogs with allergies, I also happen to have two dogs with seasonal allergies. It seems like I’ve tried just about everything on them, including Apoquel. Read on and I’ll tell you what I think works and what might not be worth trying.
What Is Apoquel for Dogs?
Apoquel is a dog medication manufactured by Zoetis. It was approved by the FDA in 2013 to control atopic dermatitis (skin allergy) and pruritus (itch) in dogs.
Oclacitinib, the active ingredient in Apoquel tablets, decreases the production of cell-signaling proteins called cytokines. Cytokines are the cause of the itching sensation in the skin of allergic dogs.
Apoquel doesn’t cure allergies, it just blocks a dog’s itch sensation. That means your dog can still have redness, scabs and sores even if he’s taking Apoquel, but the itching probably won’t be as severe.
Apoquel is not an antibiotic. It’s very important that skin infections be treated prior to or concurrently to starting Apoquel.
Side Effects of Apoquel
The most common side effects of Apoquel are vomiting and diarrhea. It may increase the risk of bacterial, fungal and viral infections. Demodectic mange flare-ups can occur in dogs taking Apoquel. Probably the most concerning side effect is the possible worsening of cancer in treated dogs.
Other facts about Apoquel:
- There is no generic form of Apoquel as of May 2021.
- Apoquel is not a steroid but does affect the immune system.
- In May 2021, the cost of a month’s supply of Apoquel for my 50-pound dog was about $75 when ordered from a discount online pet pharmacy (not including shipping costs). It will probably cost more if you purchase it in a vet clinic.
- It’s not approved for use in dogs less than 12 months of age.
- It’s not approved for use in cats.
- It can be used intermittently or long-term.
- It is not necessary to taper down/wean off the drug before stopping its use.
- Apoquel does not cause drug dependence, but of course symptoms may return if you stop giving it.
Apoquel is not right for every dog or every situation. Fortunately, there are many alternatives-some are drugs and some aren’t. Let’s look at the most common alternate allergy medication prescribed by vets.
- Great at reducing itching sensation
- No steroid side effects
- Can be used long-term
- Can be used with many other medications including NSAIDs
- Not for use in dogs under 12 months old
- Causes vomiting and diarrhea in some dogs
- Newer technology-don’t know long-term effects
- Not for use in dogs with cancer
- Relatively expensive, especially for large dogs who have to take it year-round
- Animals who can’t take steroids
- Dogs with a long allergy season
Drug Apoquel Alternatives
Most people just call this class of drugs “steroids.” It includes prednisone, methylprednisolone, dexamethasone and several brand-name medications like Temaril-P. We’ve been using steroids to treat allergies in dogs for decades and they work pretty well when used short-term.
They do cause side effects in many dogs like increased drinking, urination, and appetite. When used long-term, they affect every body system including the liver and endocrine system. Having a pup on long-term steroids is no fun and should be avoided whenever possible.
As much as steroids get a bad rap, I don’t mind having a dog take steroids for skin allergies for a couple of weeks once or twice a year. They’re inexpensive and unlikely to cause long-term problems when used judiciously.
But dogs who take incompatible medications like NSAIDs (Rimadyl, Metacam, Previcox, etc.) can’t safely take steroids. Dogs with other health conditions like diabetes and congestive heart failure also don’t do well taking systemic steroids.
And dogs who need allergy relief for more than a few weeks per year need a different treatment without the long-term bad effects of steroids.
- Effective for most dogs with skin allergies
- Long track record
- Works fast
- Side effects like increased drinking and urination
- Long-term adverse effects on all body systems
- Can’t be given with NSAIDs
- Dogs with a short allergy season
- Dogs not taking conflicting meds like NSAIDs or congestive heart failure meds
- Dog owners on a very restricted budget
Apoquel Alternative Injection: Cytopoint
Cytopoint, or lokivetmab, is an injectable anti-itch treatment for canine atopic dermatitis. It is an antibody that works by destroying certain cytokines that cause the itching sensation. So, it has a similar end effect to Apoquel, but it accomplishes it in a different way.
Cytopoint injections are available only from your vet and the cost might be slightly higher or lower than a month’s supply of Apoquel for the same dog. It’s supposed to work for 4 to 8 weeks, but in my experience, many super itchy dogs start itching again after only 3 or 4 weeks.
- No pills to give
- Usually works within 24 hours
- No caution needed in dogs with cancer
- Safe to use in dogs of all ages
- Reduces skin allergy symptoms within 24 hours
- Requires vet clinic visit
- Allergic reaction–rare but possible
- May stop working for some dogs after a few months
- Newer technology-don’t know long-term effects
- Dogs with a short allergy season
- Dogs who can’t tolerate Apoquel, Atopica or steroids
Cyclosporine is a natural substance that was isolated from a fungus in 1971. Today, it’s widely used as an immunosuppressive drug in humans and animals. Atopica is a brand name of cyclosporine made for dogs and cats.
Atopica can be used to treat an allergic dog’s skin and works pretty well, in my experience. The reasons it’s not used more are, first, it’s more costly than Cytopoint and Apoquel, and second, it causes stomach upset for more than a few dogs.
- Effective at reducing skin allergy symptoms
- OK to use long-term & with other allergy meds
- Cost is higher than other allergy medicine
- Causes nausea in some dogs
- May cause gingival hyperplasia
- Suppresses immune system-use killed virus vaccines
- Caution in dogs with cancer
- Caution in dogs with diabetes or kidney disease
- Dogs who did not respond well to Apoquel or Cytopoint
- Animals who can’t take steroids due to health reasons or conflicting medication
An antihistamine is rarely a viable alternative to Apoquel but it might help decrease the amount needed.
Over-the-counter medications like Benadryl, Zyrtec and Allegra are great because they’re cheap and easy to get without a prescription. What’s not so great is that they don’t actually help itching dogs very much.
I only recommend antihistamines for dogs with very mild symptoms. They can be used in addition to (and may decrease the need for) other stronger medications.
- No prescription required
- Can be used with many other medications including NSAIDs like Rimadyl
- Not very effective in all but mild cases
- May cause drowsiness
- Dogs with mildly itchy skin
- Dogs who take other medication to treat allergic dermatitis as an adjunctive treatment
Non-Drug Allergy Treatments
These are the treatments with the best proof and track record for decreasing allergic skin symptoms in dogs. Veterinarians will want to treat a secondary skin infection first.
This should be a no-brainer, but I think a lot of dog lovers skip over this cheap and easy technique to minimize a dog’s allergies.
During your dog’s worst allergy season, keep windows and doors closed and use a good indoor air purifier. Schedule your longer dog walks for days when pollen levels are lower. You can check Pollen.com to get ideas.
Grass allergies are common in some areas. If you can’t remove your lawn, at least keep it cut short to prevent it from flowering and producing pollen.
Another tip that might seem obvious but it often goes overlooked. We now understand that the pollen on a dog’s skin causes as many, probably more, symptoms than inhaled pollen.
As soon as your dog comes inside from a walk or spending time outdoors, give him a good rinse. If your dog mainly has itchy feet from allergies, I found a great tool to easily wash just the feet.
Do this religiously during your dog’s worst allergy season and you should see improvements in symptoms. Hopefully, you won’t have to give your dog as many pills!
Clean Your House More
Many dogs are sensitive to indoor allergens, too. Dust mites are a common provoker of allergies in dogs.
Wash your dog’s bedding in hot, soapy water at least once a week to minimize the presence of dust mites. You should also vacuum, dust and sweep your house frequently to improve the environment for your itchy dog.
Immunotherapy is the technical name for allergy shots. Your vet or veterinary dermatologist will run blood or skin tests to see what your dog is most allergic to. Then microscopic amounts of those allergens are put into an injection given to your dog.
The amount of allergen in the injection is slowly increased over a period of weeks to months to train the dog’s immune system not to overreact to it. Injections start out at several per week but eventually, many dogs only need an injection about once a month.
Some veterinarians are even having good luck with sublingual allergy desensitization which doesn’t require shots at all.
I recommend immunotherapy for dogs who have more than a few weeks of serious allergy symptoms every year. It’s also good for dogs who don’t respond well to allergy control medications or can’t take them for health reasons.
Impeccable Flea Control
Many geographical areas of the U.S. have a big problem with fleas. Flea bites make all dogs itch but some dogs have an immune system that is overly sensitive and have a massive skin reaction to even one flea bite. This is also called flea allergy.
When I was a youngster in Indiana, I had a dog with flea bite hypersensitivity. It was in the days before we had effective and safe flea control products. I couldn’t figure out why my poor dog lost all the fur from her mid-back to her back feet. She only had a couple of fleas. Oops!
Later I learned that dogs with flea bite hypersensitivity as well as dogs with atopic dermatitis need to have super strict flea control. One flea bite can cause a flare-up that’s hard to get under control without strong drugs.
The flea control products I tend to feel the best about are the spot-on kind like Frontline Plus. It’s been out for a long time and has a pretty low rate of adverse reactions.
You can do natural flea control, but it’s going to take more time and effort to do it well.
Read my article on natural flea control methods for tips.
When dogs get allergic dermatitis, their outer layer of skin fails to keep allergens from penetrating. In the last decade or so, a couple of interesting products were developed to enhance the skin barrier function of allergic dogs.
The ones I’ve used the most are made by Douxo. Their product called Douxo Calm Mousse is a convenient foam you apply to your dog’s skin. At least one scientific study found it to be effective at reducing skin inflammation (3). And veterinary dermatologists frequently prescribe Douxo products for allergic dogs I’ve referred to them.
Fish Oil/Omega-3 Fatty Acids
Unless you’ve been living under a rock for the past 15 years, you’ve heard fish oil is good for your health. It’s good for dogs for the same reasons–they get too much omega-6 fatty acids and not enough omega-3 fatty acids in their diets. An improper balance between the two types favors increased inflammation.
Check out my article on fish oil. You can give your dog a nutritional dosage of fish oil every day even if he doesn’t have a skin problem. For allergic dogs, check with your veterinarian to see if your dog could benefit from a higher therapeutic dosage of fish oil. It can help dogs with itchy skin have fewer symptoms and require fewer strong medications to control atopic dermatitis.
Some studies in humans suggest that an allergic skin condition can worsen when stress levels are higher. We don’t have scientific evidence to prove this is true in dogs, but decreasing stress could improve the overall quality of life, including allergies.
Sources of stress for dogs might surprise you. Boredom and inability to express their natural behaviors is probably the biggest culprit for modern house dogs.
Concentrate on providing adequate exercise, socialization and time for free expression of dog behaviors like barking and digging.
Improve Your Dog’s Diet
It seems like the idea of food allergies as a cause of itchy dog symptoms has just exploded in the last ten years. While it’s true that some dogs are sensitive or even allergic to food ingredients, food allergies account for far fewer cases of allergic dermatitis than pollens and other indoor allergens.
Still, feeding a higher quality diet that has fresher fats and antioxidants certainly seems like a step in the right direction. I personally believe that upgrading your dog’s diet is the one thing every owner of an allergic dog should do.
If you and your veterinarian believe your dog might have a food allergy, do a food allergy trial with a strict hypoallergenic diet for at least two months. If you don’t see a big improvement after that, you don’t have to continue.
Natural Options Instead of Apoquel
I’d put any natural remedy in the category of “might help but probably won’t work as a single treatment for significant allergies.” That doesn’t stop every pet product site from raving about their miracle cure for dog allergies. Be ready to use these in conjunction with conventional medicine because, in my experience, most of them are not very effective on their own for treating serious symptoms.
We don’t have much scientific evidence to support the use of any of these. However, a lot of people report that these treatments help allergic dogs. Get help from a holistic veterinarian if you’d like to explore an Apoquel alternative mentioned here.
- Beta-sitosterol– a naturally occurring plant hormone that may decrease skin allergy symptoms in humans (1).
- Stinging nettles– available as a tea or dried herb in capsules, this is a traditional remedy for allergies in humans. We don’t have any evidence to support its use in allergic dogs.
- Local bee pollen-anecdotal reports of decreased allergies when small amounts of local bee pollen are ingested regularly.
- Homeopathic remedies-some dog owners have good luck with mild doses of homeopathic remedies such as Rhus tox. 6C for their itchy dogs.
- Acupuncture-there are specific points and treatments meant to quell the imbalance in the body that leads to itchiness. Again, we have anecdotal reports of efficacy but not much in the way of scientific evidence.
- Chinese herbs-combination formulas like San Ren Tang contain Coix, or Job’s Tears, which has an anti-inflammatory effect (4).
My Own Dog’s Experience with Apoquel
A few years ago, one of my allergic dogs had a real explosion of symptoms. I was doing everything I knew how to do to avoid giving him drugs but it just wasn’t enough.
I’d given him prednisone or dexamethasone in previous years to control the worst of the symptoms, but since he was now taking Rimadyl, prednisone was not an option. I decided to try Apoquel since so many of my patients took it with great success.
What I saw was an almost immediate improvement in his itching. The redness disappeared and his hair grew back over a couple of weeks.
When I decreased his dosing from twice to once a day, he still did well.
I probably had my dog take Apoquel for about 4 or 5 weeks in total. I felt like it was a success but I have to wonder if it messed up his digestive tract. He had previously had guts of steel and after taking Apoquel, he seemed more sensitive to diet changes, vomited occasionally and had a few mild bouts of diarrhea.
I can’t prove it was the Apoquel. It could have been the Rimadyl or who knows what. But he continues to take Rimadyl without problems even now.
Overall, I think Apoquel is a miraculous drug that quiets the infuriating itching seen in canine atopic dermatitis. I would use it again for appropriate cases in the clinic as well as for my own dog in certain circumstances.
But it’s not a miracle medication that cures dog allergies! It should be used sparingly to control the itch in allergic dogs while you implement other therapies.
- Han, N. R., Kim, H. M., & Jeong, H. J. (2014). The β-sitosterol attenuates atopic dermatitis-like skin lesions through down-regulation of TSLP. Experimental biology and medicine (Maywood, N.J.), 239(4), 454–464. https://doi.org/10.1177/1535370213520111
- Olivry, T., DeBoer, D. J., Favrot, C., Jackson, H. A., Mueller, R. S., Nuttall, T., & Prélaud, P. (2015). Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC veterinary research, 11(1), 1-15.
- Pin, D., Bekrich, M., Fantini, O., Noel, G., & Vidémont, E. (2014). An emulsion restores the skin barrier by decreasing the skin pH and inflammation in a canine experimental model. Journal of comparative pathology, 151(2-3), 244-254.
- Seo, W. G., Pae, H. O., Chai, K. Y., Yun, Y. G., Kwon, T. H., & Chung, H. T. (2000). Inhibitory effects of methanol extract of seeds of job’s tears (Coix Lachryma-Jobi L Var. Ma-Yuen) on nitric oxide and superoxide production in raw 264.7 macrophages. Immunopharmacology and immunotoxicology, 22(3), 545-554.
Last update on 2021-10-17 / Affiliate links / Images from Amazon Product Advertising API