Spectrum of Care Considerations in Managing Allergic Skin Diseases

Allergic skin diseases are among the most common medical conditions in dogs and cats, with skin allergies, ear infections, and skin infections ranking in the top 10 claims submitted to pet insurance in 2021. Managing these conditions effectively requires a spectrum of care (SOC) approach, which provides a continuum of acceptable care based on evidence-based medicine while remaining responsive to client expectations and financial constraints. 

Step One: Clinical History¹ 

A thorough history is the foundation of SOC. Key considerations include: 

• Previous diagnostics and response to therapy 

• Seasonality of clinical signs 

• Signalment and breed predispositions 

• Realistic client compliance, considering: 

• Financial limitations 

• Ability to administer medications or topical therapies 

• Capacity to perform strict diet trials 

• Access for follow-up visits 

Practical tips: 

• Sending a dermatologic history form to clients ahead of appointments can improve efficiency. 

• Training staff in proper history-taking and client education enhances appointment quality. 

• Maintain an accessible record of treatment successes and failures to streamline planning. 

Step Two: Physical Examination¹ 

SOC relies on pattern recognition and probabilistic clinical reasoning to guide diagnosis: 

• Recognize common clinical presentations. 

• Use therapy trials when appropriate to confirm or exclude diagnoses. 

• Technicians can aid efficiency by collecting cytology, skin scrapings, and flea samples. 

Step Three: Treatment¹ 

Effective communication with clients is essential before implementing therapy: 

• Discuss the pros and cons of all treatment options. 

• Consider cost-effective therapies such as steroids, antihistamines, and limited-ingredient diets—these do not represent substandard care. 

• Explain adjustments to monitoring protocols for certain medications as part of financial planning. 

• Recognize treatment failures promptly and escalate to a standardized or more aggressive approach when needed. 

• Continuous conversations about SOC help remove stigma associated with meeting clients where they are financially or logistically. 

Step Four: When to Refer¹ 

Early referral can improve both clinical outcomes and client satisfaction: 

• Referral for chronic AOE or canine atopy in young patients can reduce recurrence and long-term costs. 

• American College of Veterinary Dermatologists survey highlights: 

• 82% of clients would have felt better if referred earlier 

• 73% reach frustration after three visits for a dermatologic issue 

• 15% may stop visiting their primary veterinarian for routine care if unresolved 

Step Five: Using Telehealth¹ 

Telehealth technologies can improve care efficiency and client communication: 

• Phone, email, or video follow-ups allow asynchronous monitoring. 

• Clients can send photos or videos for progress review; real-time platforms like FaceTime or Zoom facilitate interaction. 

• Telehealth has limitations: it cannot replace cytologic or otoscopic examination for infectious or occult conditions. 

• Teleconsulting with specialists improves access when distance, wait times, or finances are limiting factors. 

• Always adhere to regulations regarding the veterinarian-client-patient relationship. 

Conclusion 

Spectrum of care in allergic skin disease emphasizes balancing evidence-based medicine with client expectations and resources. Thorough history-taking, pattern recognition, and probabilistic reasoning guide diagnosis and therapy. Early recognition of the need for diagnostics or referral, combined with effective client communication and use of telehealth tools, improves outcomes, reduces long-term costs, and enhances client satisfaction. SOC is essential for providing flexible, high-quality care for dogs and cats with allergic skin conditions. 

Reference  

1. Miller J, Simpson A, Bloom P, Diesel A, Friedeck A, Paterson T, Wisecup M, Yu CM. 2023 AAHA management of allergic skin diseases in dogs and cats guidelines. Journal of the American Animal Hospital Association. 2023 Nov 1;59(6):255-84. https://www.aaha.org/wp-content/uploads/globalassets/02-guidelines/2023-aaha-management-of-allergic-skin-diseases-in-dogs-and-cats-guidelines/resources/2023-aaha-management-of-allergic-skin-diseases-guidelines.pdf.