What patient is the end stage allergic dog? For me, this is a dog 7 years of age or older, whose record reads "check skin, check skin, check ears, check skin, check ears" and presents with severe generalized erythema, concomitant alopecia, odor, crusting, lichenification and is still itching. Icing on the cake (or the dog) is concurrent iatrogenic Cushing's Syndrome with obesity, ligamentous laxity, continuous panting, lack of energy, and often bacterial cystitis. These patients are usually a breedat risk for primary allergic skin disease (atopic dermatitis) such as Lhasa apso, Shih Tzu, German shepherd, Golden retriever, West Highland white terrier, or other terrier breed. End stage allergic disease develops in response to low grade but persistent allergic reaction complicated by our therapeutic interventions.
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