Hi Barb,

Thanks for your question.

I understand the scenario you’re in completely.

A common result of steroid use is an elevated Alkaline Phosphatase (ALP) from the liver. Be aware that other common ailments cause an increase in this enzyme as well such as Cushing’s disease, haptic diseases and others. I recommend you speak to your veterinarian about performing diagnostics for any other cause of an elevated ALP. It would be unfortunate if the assumption was made that this is purely due to steroid usage while another underlying disease is developing undetected. 

The switch to Apoquel is in the attempt to prevent further negative side effects of steroid usage. It is certainly expensive. This drug works at the skin level to prevent the itch that they experience due to allergies. So it basically relieves the irritation caused by allergies and improves quality of life. It doesn’t dampen the body’s allergic response like steroids do but given the side effects, it is greatly preferred for management of allergic skin disease in dogs.

I will make a note that allergies are often diagnosed without full diagnostics to investigate for contributing factors. I have seen bad recurrent bacterial infections that have been diagnosed as allergies and that could have been resolved with courses of antibiotics and using shampoo. This would eliminate the need for a lifetime of expensive medication. I do encourage you to review the diagnosis of allergies with your veterinarian until you’re confident that it is the right diagnosis. You could also go for a visit with a veterinary dermatologist to review the diagnosis but also look for other treatment options that might be cheaper and healthier. They would certainly have more ideas and might diagnose a concurrent condition that is exacerbating the allergic skin disease.

I hope this helps.

Dr. Clayton Greenway