Apoquel

An allergy is an exaggerated and inappropriate immune system response. Conventional medicine loves to suppress symptoms.

Suppressing symptoms means getting rid of them without addressing the illness or disease. Allergies are an improper immune system response.

So let’s look at the drugs veterinarians often use to suppress allergy symptoms.

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Prednisone was the first conventional medication vets used for allergies. Prednisone and other steroids work by suppressing the immune system. 

Then, when allergic dogs stopped responding to steroids, veterinarians started using Atopica (cyclosporine). 

Cyclosporine was initially developed to prevent organ transplant rejections in humans. It suppresses the immune system to prevent the body from rejecting the transplant.

Atopica has a devastating and destructive effect on the immune system.  You can read more about the Atopica and my concerns here.

Unfortunately, Atopica is still used today for some dogs. This is alarming … the FDA has 17 pages of adverse events for Atopica in dogs!

Here are just the top 12 from the first page:

• Vomiting 
• Diarrhea
• Depression/lethargy
• Anorexia
• Pruritis
• Elevated liver enzymes ALT & ALKP
• Drug interactions
• Rapid Panting
• Trembling
• Seizures

The number of cases reported is pretty shocking. What’s ironic is the fifth side effect on the list is pruritus (itching) – the very thing the drug is supposed to stop!

So what’s next?

Enter the latest scary allergy drug, Apoquel®.  It also suppresses your dog’s immune system also … but in a different way.

So … is it safer?

Apoquel affects the body’s kinases. Kinases are signaling compounds that cells use to communicate with each other.

In the 1980s, an Australian chemist discovered some new ones. They’re known as JAK1, JAK2, JAK3 and TKY2. JAK initially stood for Just Another Kinase but was later renamed Janus Kinase.

With the growing epidemic of dog allergies, pharmaceutical companies saw an opportunity. They developed a drug that would stop these JAKs in their tracks.

And they sure succeeded. Oclacitinib maleate, under the brand name Apoquel®, is a Janus kinase inhibitor.

That means it stops JAKs from doing their job.

JAKs are key elements in controlling both growth and development. These particular JAKs do the work of:

1. Policing the body against tumor formation
2. Controlling body growth and development
3. Forming white and red blood cells
4. Ensuring antibody-producing B cells, and “policing” T-cells are functioning well.
5. Regulating inflammatory response

Apoquel’s mechanism is to interrupt JAKs … and prevent them from working.

Without JAKs your dog’s immune system cannot function correctly.

JAK1 is vital for the constant surveillance within your dog’s body. Its job is to find and destroy abnormal cells that have become cancerous … before they form tumors.

JAK1 is a crucial messenger. It’s needed to destroy invading parasites, fungi, bacteria and viruses.

JAK2 is central to the production of bone marrow stem cells. These cells then become red and white blood cells and platelets.

Your dog’s antibody system (B cells) and its killer-cell system (T cells) need JAK3 in order to work properly. These JAKs all talk to each other and share information to keep your dog’s body healthy. 

So you can see that by preventing JAKs from working … Apoquel undermines your dog’s immune system.

Of course, there’s research showing how dogs react to these drugs. 

Here’s how it's done.

The pharmaceutical company does a very quiet study and notes when problems occur.

For example:

• Liver problems pop up 12 weeks into the trial
• Tumors start to form 16 weeks into the trial

They carefully record these findings in the study notes. Once they’ve gathered all of the data, they prepare their formal public study. 

Often they end the public study review before the problems show up. So if the problems appeared at 12 weeks … they publish a 10-week study!

Apoquel research is no different.

A study conducted by the manufacturer to test the drug’s safety and efficacy stated:

“There were no fatalities and no abnormal health events that necessitated hospitalization in either the study phase [day 0–7 (+3 days)] or the continuation phase [day 8–28 (±20 days)] of the study. Given that the majority of dogs in the placebo group withdrew after the completion of the study phase, the incidence of abnormal clinical signs was similar in both groups (Table 3).”

So, it seems from these comments and data in Table 3 that the drug is fairly safe …

… but did you notice the duration of the study? It was only 7 days!

There was a “continuation phase” after the 7 day study period, from 8 to 30 days. The researchers report:

“Six dogs (four oclacitinib and two placebo group) were withdrawn from the study during the continuation phase for abnormal health events. Abnormal health events were reported in 11 of 179 oclacitinib-treated dogs post-study. These were as follows: diarrhoea (four dogs; severe enough to warrant cessation of treatment in one dog); vomiting (four dogs); fever, lethargy and cystitis (one dog); an inflamed footpad and vomiting (one dog); and diarrhoea, vomiting and lethargy (one dog).”

So about 6% of dogs tested had abnormal health events. That doesn’t seem very high. But that was only for 30 days!

If your dog takes this drug, he could be on it for years! Years … while this drug compromises his immune system. That’s a very heavy price to pay.

The manufacturer quotes a study that says it is safe for long term use … but the study results say something different. Here are some of the serious side effects noted:

• One dog was euthanized after 450 days of Apoquel. The dog had developed abdominal ascites and pleural effusion of unknown etiology. This means that he had a fluid-filled abdomen and chest.
• Six dogs were euthanized because of suspected malignant neoplasms. Those are cancers that spread easily … but are undetected because of immune suppression.
• Two dogs each developed a Grade II mast cell tumor after 52 and 91 days.
• One dog developed low-grade B-cell lymphoma after 392 days.
• Two dogs each developed an apocrine gland adenocarcinoma. On was dermal, the other an anal sac. These problems happened after only 210 and 320 days on Apoquel.
• One dog developed a low-grade oral spindle cell sarcoma after 320 days. It’s a very painful oral cancer for dogs.

Is it worth the risk? I don’t certainly don’t think so.

The manufacturer has limited Apoquel for use only in dogs over 12 months old.

They conducted a margin of safety study on 6 and 12-month old dogs. The study on the 6-month old dogs ended quickly though. The younger group had developed bacterial pneumonia and demodectic mange infections!

Here’s the warning on the company’s website,

“IMPORTANT SAFETY INFORMATION Do not use APOQUEL in dogs less than 12 months of age or those with serious infections. APOQUEL may increase the chances of developing serious infections, and may cause existing parasitic skin infestations or pre-existing cancers to get worse.”

In the 12-month old dogs the symptoms likely to be related to Apoquel included:

• Papillomas (warts)
• Interdigital furunculosis (cysts) with related dermatitis symptoms including- local alopecia, erythema, abrasions, scabbing/crusts
• Edema of feet
• Pneumonia
• Lymphadenopathy (abnormal or swollen lymph nodes) in peripheral nodes

Yes, you read right. The side effects include various types of skin diseases.

The drug was also found to lower white and red blood cell count. And it impacted certain types of lymphatic tissue … lymph nodes as well as bone marrow.

You can read these details under Prescribing Information on the company’s website. If you’re considering giving your dog Apoquel … you and your vet must read them before you make a decision.

When cancer cases come to me, the dogs on Atopica or Apoquel have the same oncologist records. They always note that the oncologist recommends stopping Apoquel or Atopica treatment.

Of course, it’s too late for that to make any difference at all. But it is a good indication that the problems with these drugs are well known.

Dr Khalsa,

In 2013 I took my dog to a veterinarian in PA that does clinical trials for all kinds of diseases in dogs. I trusted this vet to guide me in the right direction for my dog. I work in the medical field as a trauma nurse so I’m not new to health care. When this vet recommended Apoquel, I was excited to hear that there may be hope for my dog.

I specifically asked the vet multiple times before giving my dog this medication how the clinical trials turned out: side-effects, long term use, adverse effects, etc? He assured over and over again that this drug was safe and wasn’t known to have any harmful effects in dogs.

I started giving my dog this medication and before you knew it I found a mass on my dog’s abdomen. Immediately I took my dog to the vet as soon as I noticed the mass and she was sent in for surgery the next day to have the mass removed and biopsied. I found out she had adenocarcinoma of the mammary glands. Long story short, I went through surgery and chemo with my dog and in the end the cancer spread to her lungs and I had to euthanize my dog. I was devastated!

After a few weeks I contacted the vet who ran the clinical trial only to be told that this medication was known to cause abdominal tumors. ANGER is the only word to describe how I feel. I strongly believe this drug should be taken off the market.

I don’t know how this pharmaceutical company is getting away with essentially killing dogs.

– April

This is heartbreaking and sad.  Unfortunately, April and her dog are not alone.

There is good news! There are better and safer alternatives to this dangerous allergy drug.

Allergies have become an epidemic. When we use the word “allergies” we often mean food sensitivities and intolerances. They’re not always true food or environmental allergies. 

Food sensitivities and intolerances are about 15 times more common than true allergies.

It’s exhausting for owners to continually read ingredients on bags of dog food. And it’s frustrating to try therapy after therapy.

Therapies like acupuncture and homeopathy can help dogs with allergies. However, acupuncture results tend to be short term and may need repeating every couple of weeks. 

Homeopathy also works well. Just know that it can be a slow process. Your homeopath will usually need to prescribe a series of remedies until you find one that does the trick.

I use homeopathy, but I use it alongside my tailored Allergy Elimination 4 Pets Program. It’s based on the original work in NAET (Nambudripad’s Allergy Elimination Technique). I find it works incredibly well for over 90% of the patients I treat.

A good analogy for this technique is doing a virus search with a disc or program on your computer. It helps to clean up the glitches in it. The system I use works to clean up and straighten out your pet’s “computer.”

Over my many years of experience with holistic modalities, that’s what I’ve found works best. It’s non-invasive, non-toxic … and helps create a stronger immune system. An immune system that can and will fight off cancer and disease.

Unlike Apoquel … which stops that intolerable itching at the high cost of:

• A low white cell count
• A low red cell count
• Stunted growth 
• Increasing your dog’s risk of cancer.

When I became a veterinarian I vowed to protect the health of our pets. I wanted to make them healthier and help them live longer and happier lives.

Sometimes, with all these new and confusing drugs that pet owners rush to, I feel like I’m swimming upstream.

Before you jump ahead into my top alternatives there are a few things you should do first.

Feed your dog a fresh, raw and organic diet daily with immune boosters. This ensures he has all the nutrients and support he needs for better immune function.

Ideally, you also want to feed him novel proteins. A novel protein is a protein that your dog has never had before. Consider trying rabbit as a novel protein if you haven't fed it before. It's naturally high in B vitamins that also support his immunity. 

Removing allergens from the air will reduce the number of allergen stressors. 

75% of dogs fed commercial food are D3 deficient. Vitamin D levels are very important when it comes to allergies.

Use a topical product that works to calm the source of the itch. Dogs have ten times more mast cells on their skin than people do. 

If we were built like a dog, we’d be scratching our behinds and inner thighs during ragweed season. And, just like with people, your dog’s scratching makes things worse. 

Scratching increases the intensity of the itching … because it activates more mast cells. When your mother told you that the more you scratched that mosquito bite, the more it would itch … she was spot on!

What I’m trying to say is this:

If you can nip the first itchy spot in the bud, you’re way ahead of the game. Itching begets scratching and if we can handle the first set of itches we may win the battle.

Here are some things you can use to help the itch.

Zhu Dan Tablets from Seven Forests can help with the itch. 

Dosing:

• ½ pill to 1 pill twice a day for a smaller dog
• 1 pill two to three times a day for a medium dog
• 2 pills two or three times a day for a large dog

I recommend giving these with a meal.

Histoplex is a blend of herbal extracts shown to help regulate the immune systems. I find it works well for our dogs also.

Dosing:

• A small dog can get ½ pill twice a day
• Medium dog 1 pill twice a day
• A large dog can have up to 3 pills twice a day while 2 pills twice a day usually suffices. 

Betathyme is a naturally formed steroid that can help to stop that itch. Follow the directions on the label.

This is a very nice product that helps to curb the itch. Like Betathyme, follow the directions on the label.

• Derma Drops by Spa Diggity Dog: Apply to itchy spots as soon as you can.
• Zymox: This comes in a spray-on or crème formula. It’s excellent for itchy hotspots. You can find it on Amazon.
• Baking Soda: You can make a poultice and slurry it on the area
• NuStock: A great dependable product to nip itching in the bud

Remember – many allergic dogs are allergic seasonally. You can give these products during the common allergy seasons in dogs, the spring and fall. Another important point is that it’s difficult to get dogs off of Apoquel, so you need something on hand.

While topical solutions win the battle, I feel my allergy elimination wins the war. That’s because it can correct the immune system’s perception of the item as an allergen. This turns the allergic dog into a non-allergic dog.

My 40 years of experience taught me that owners could do this program in the comfort of their own home.

Allergy elimination techniques reboot, harmonize and revitalize your pet’s immune system responses. It corrects the immune system … so it behaves properly and doesn’t overreact.

Some pets will need a direct consultation to assess and go over long term skin problems. For dogs with a less complicated history, they can often be helped with an at-home kit.

Sometimes I feel that the world of modern medicine has gone mad with one in two dogs getting cancer.

And yet here is a new anti-itch drug that not only opens up the door to cancer – but hangs up a welcome sign as well.

Apoquel looked like a miracle for dogs with allergies … and the owners watching them itch.  Unfortunately, it turned out to be anything but. The negative effects of this drug as well as other conventions drugs are now well known. 

Thankfully these Apoquel alternatives are safe things you can try to help your dog.

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Written By: Deva Khalsa VMD

Since beginning her holistically oriented veterinary practice over 25 years ago, Dr Deva Khalsa has been incorporating homeopathy, acupuncture, Chinese herbs and nutritional advice into her practice. She also offers her unique Allergy Elimination 4 Pet technique to naturally reboot your pet's inappropriate immune system responses. She's the author of Dr Khalsa's Natural Dog, now in its second edition. Visit her online at doctordeva.com