Dr. Charli Dong, DACVD, joins the podcast to tackle one of the most frustrating and common cases in practice: the itchy dog that just will not get better. If you have ever had a client convinced it is “just a food allergy” while their dog continues to suffer, this episode is your playbook. Dr. Dong breaks down canine atopic dermatitis in a way that actually makes sense, from puppies presenting earlier than expected to the messy overlap between food allergies and environmental triggers. You will walk away with a clearer approach to multimodal management, including when to use diet trials, how to set realistic expectations, and why the skin barrier and nutrition matter more than ever. This is practical, real-world dermatology that helps you feel more confident the next time an allergic dog walks through your door.

This episode is brought to you ad-free by Hill's Pet Nutrition!

Hill's Therapeutic Derm: https://www.hillsvet.comxpet-nutrition/derm

Hill's Veterinary Academy: https://na.hillsvna.com/en_US/dashboard

Dr. Charli Dong is a board-certified veterinary dermatologist with extensive experiencing diagnosing and managing canine allergic skin disease, including canine atopic dermatitis. Her clinical and research interests focus on improving the lives of itchy dogs through better long-term management strategies, skin barrier support and evidence-based therapeutics – a holistic approach. Education is central to Dr. Dong’s passion. She has served as Exam Chair for the American College of Veterinary Dermatology, is actively involved in training dermatology residents and teach veterinary students, and is a frequent national and international speaker. She has authored numerous scientific publications, with an emphasis on translating emerging research into practical, real-world guidance for both veterinarians and pet owners.

Welcome everybody to the Cone of Shame Veterinary podcast.

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I am your host, Dr.

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Randy Rokey.

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I am here with Dr.

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Charlie Dong and , we're

talking vet dermatology.

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We are talking about allergic dermatitis.

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, guys, I've got.

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I make a confession this episode.

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I, I am the owner of a goldendoodle.

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I have a golden doodle.

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I don't wanna talk about it.

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, he, we have a, anyway, I, I

don't wanna talk about it.

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I have a golden dole.

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We have a thing that works for us.

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He's my boy and he is what he is.

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, and he has, , he has allergic

dermatitis because of course he does.

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So anyway, I have been

wrestling with that.

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It's actually kind of the thing that

came up in like the last six months, and

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he's been a bit of a challenging case.

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And so I wanted to talk

to Charlie about that.

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And we jump in and, and get into it.

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We talk a lot about, allergen,

, immunotherapy, and we get

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in into a lot of nutritional

management of allergic dermatitis.

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We talk a lot about, , the Hills Derm

Complete Diet, , derm, complete Puppy.

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So there's a lot of stuff about

those diets in this episode, but

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it's, it's, it's really good stuff.

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So anyway, I really

enjoy talking to Charlie.

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If you are a Derm fan, if you are

a fan of atopic dermatitis or, and

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a fan of Goldendoodles, this is

gonna be a great episode for you.

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This episode is made possible add free

from our friends at Hills Pet Nutrition.

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Let's get into it.

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Kelsey Beth Carpenter: This is your show.

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We're glad you're here.

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We want to help you in

your veterinary career.

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Welcome to the Cone of Shame with Dr.

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Andy Roark.

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Andy: Welcome to the podcast, Dr.

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Charlie Dong.

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How are you, my friend?

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Charli: Doing well.

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Thanks for having me.

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I'm excited to be here.

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Andy: It's an honor to have

you, you are such a neat person.

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So you are a boarded

veterinary dermatologist.

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You are an international

lecturer, speaker, researcher.

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, you train.

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Derm residents.

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you are a clinical preceptor

for senior veterinary students.

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You just, you just do a lot of stuff.

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And, , I had to ask you what Dermoscopy

was because that's a big interest of

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yours and you're doing this really wild

stuff with imaging and dermatology.

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It's just, you've just got.

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I don't know.

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You've just, you're doing a lot of really

fascinating stuff in, in the derm world,

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and so I'm really happy to have you here.

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I wanna talk to you today about

something that is so beneath you.

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You're gonna be like, Andy,

I can't believe you brought

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me here to talk about this.

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I, I wanna talk about atopic dermatitis.

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Because my dog is an AIP dog and I

wanna make sure that I'm doing what I

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can to manage this dog because my wife

is starting to give me a hard time.

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And I was looking at blood work with the

traveling internal medicine specialist.

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And I said, Hey, I have this, patient and

this is what is going on and everything.

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And I went a good five minutes

down the road before he said,

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well, show me the blood work.

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And then he looked and he

said, is this your dog?

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And I was like, yeah.

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And he said, do you have a golden doodle?

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And I was like, alright, look,

let me tell you the story.

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And, and so that I had to tell him

about, how I wanted a golden retriever

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and my wife wanted a golden doodle, and

we compromised and got a golden doodle.

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And so that's where we are.

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So anyway, long story short.

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I have a golden doodle with aey and

I wanna make sure that I'm doing

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what I'm supposed to be doing.

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And so anyway, I, I was

hoping that I could sort of

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talk to you about that today.

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And, , so just at a high level,

can we just sort of talk about,

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talk to me about, about prevalence

of canine aey, if you don't mind.

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Just because.

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I still see a ton of pet owners

who are convinced that this is a

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food problem, and they're like,

I think he's got food allergies.

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And I'm like, I don't think

you just have food allergies.

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Can you sort of start, start at that

high level and talk about sort of

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prevalence of like food allergies

versus atopic dermatitis and kind

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of how those things interact.

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Charli: Yeah.

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I'm so glad you brought up this topic,

Andy, because atopic dermatitis is.

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So prominent in the world now.

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, I see it a lot more often than I used to.

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I think in my residency we were taught

dogs less than one year of age and

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dogs older than seven of years of age.

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And I think that's still repeated in

veterinary schools today that they

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have food allergies until ruled out.

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And while that's true, in order to

figure out if a dog really has food

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allergies, we do have to, , perform

the diet trial, I would say.

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During my residency, I realized that

there's a lot more dogs with atopic

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dermatitis presenting at less than one

year of age, especially for french cheese,

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especially for doodle mixes as well.

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Andy: So, so I wanna unpack that

'cause I , you hit sort of run on it.

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I thought that one year

of age was extremely rare.

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And yet I am, you know, I'm

seeing more and more research that

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comes out to say that, that puppy

atopic dermatitis is a real thing.

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It's just, it's sort of contrary

to kind of what I was trained.

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Can you start to talk a little

bit about What are we, what is

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the prevalence , of sort of puppy

ape or puppy atopic dermatitis?

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What should we be looking for?

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I mean, it, it was, I almost

felt guilty talking to people

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about sort of allergies in their

1-year-old or nine month old puppy.

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But you, you sort of seem to think

that that's is becoming more common.

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Charli: So in the literature, it's

hard to say because there's anywhere

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between 10 to like 75% of cases

of dogs having food allergies.

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But realize this is in a research

setting and also these studies tend

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to be a little bit a while ago.

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I think there's been a paucity

in food allergy studies.

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But I think in the real world

it's actually much less than that,

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especially if we're like having

coffee and like chit-chatting with

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other veterinary dermatologists.

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I think our numbers are

actually much lower.

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So I think in reality it's

more to like 10 to 30% because

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realize for these dogs, not only.

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For true food allergies and only food

allergies and that you can diagnose them.

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So the actual percentage is much

lower because the people who can

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actually perform a DIA trial completely

and correctly is already a lower

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population than the general population.

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So you have to prove that the dog has

a food allergy and only a food allergy.

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Now, I do see a lot of atopic dogs who

also have a food allergy, or they have

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a food allergy trigger for their atopic

dermatitis, and that's really confusing.

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So it seems like there's.

130

A higher possibility of food allergies,

but they write, they might actually

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have a food triggered atopic dermatitis.

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However, it's very confusing because

we actually don't have proper tests to

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prove the difference between the two.

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And I think in reality you don't,

in the real world, you don't really

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need to prove the difference between

a true food allergic versus a food

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induced atopic dermatitis dog.

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Andy: Gotcha.

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So, so I mean, functionally from a

management standpoint, we're gonna, we're

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gonna handle them the same, correct.

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Charli: Yes.

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In real life, yes.

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Andy: what is your approach to these dogs?

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So say that you're, you're, you are

seeing, we've got, we've got a puppy.

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Let's, let's do a golden doodle.

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Uh, so we've got a goldendoodle.

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We've got a seven, eight month old

itchy, golden doula that's coming in.

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Charlie, how do you look at these cases?

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How do you start to frame up,

how you walk through them?

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Like what do you want to know

when you look at this dog?

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Charli: That's a very good

question and actually a question

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that come across a lot nowadays.

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So with With atopic dermatitis, I

like to think of it like gram soup.

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So there's a lot of little ingredients.

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You're constantly changing it.

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You're constantly adjusting the

palate, and that's the thing to

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understand about atopic dermatitis

is that it's not set in stone.

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It's not like one formula works for

everybody and one formula stays the same.

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You're constantly adding a little bit

of everything and seeing what sticks

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because it's different for everybody

and every pet parent, and every.

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Patient.

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So I like a multimodal approach,

and I think all clinicians should

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because you don't know the person

and you don't know the dog.

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, so as a dermatologist, we're trained,

, allergen immunotherapy is always the

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best because it is something to be

proactive with the immune system.

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Andy: Okay.

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Charli: And while that's true for

atopic dogs, I also think that

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nutrition is another way to be

proactive with the immune system.

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So with atopic PA patients,

we always think of like a

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brick and mortar appearance.

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So the brick are the corneocytes

and the mortar is made outta this.

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Fatty layer that sticks all the

bricks together and in the skin,

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it's made out of fatty free fatty

acids, cholesterols and ceramides.

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And while we can definitely do topically

to replenish that area, because dogs

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with atopic dermatitis, they actually

have gaps in holes in their skin.

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So they have a problem with that mortar.

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And so it allows all the allergens

and things that they're allergic

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to go through into their.

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Immune system and then there

is an overactive response

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with their immune system.

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So one way we can fix it is by

topically we can replenish oils using

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the right shampoo, things that are

really moisturizing, , but nutrition

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are the building blocks so we can

actually give those fatty acids.

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And one of the things I like to use

is the derm complete diet because it

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has those fatty acids that are the

building blocks that can actually

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replenish the skin in a natural way and

be proactive with the immune system.

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Andy: Okay, so let's, there's a number

of things here I want to sort of unpack.

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So looking at, sort of looking at the,

atopic dog and we talked, you started off

188

talking about, allergen immunotherapy,

, so talk to me a little bit about.

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what is your sort of diagnostic approach?

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when I start looking at, diet trial,

we have a lot of different options now.

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for atopic dogs.

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so we've got there, you know, there's the

hydrolyzed diets, you know, like ZD is,

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is a classic that we hear a lot about.

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And then there's the sort of the

derm complete diet, which is egg

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and rice based diet, I think.

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, yeah.

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And so, I'm looking at these things and

I'm looking at this dog and I'm going, I,

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which, I'm pretty sure this is an ay dog.

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, how do you choose your tools here?

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And so, so firstly I wanna talk

to you about that is, is like,

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what is your starting point?

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And then I wanna get more into

sort of the skin barrier that you

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were talking about in a moment.

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Charli: Okay.

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Yeah, that's a good question.

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So with diet trials in dogs less than one

year of age, a true and balanced one, we

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don't actually have that many choices.

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So as a specialist, a lot of times

they're already kind of doing a

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diet trial before they come to be.

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And I say kind of because.

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Usually it's not on the vet, but

it's on the person's understanding

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of how to do a diet trial.

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They're either like, oh, it's not getting

better, or We did it for a little bit.

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But it's a very critical time

period in a puppy's life because

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that's when you're doing training.

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If you don't have high value treats,

it's a little bit harder to train.

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, unless your dog is just like.

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Pure lab, then they're a

little bit more food motivated.

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But some of the doodle crosses, , they

may not be that interested in foods.

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And so I usually do tell owners like the

whole gamut on how to do a diet trial.

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There's two parts we need to do.

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The washout period, they can't have any

treats or chew toys, which is again,

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critical for less than one year of age.

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and then we challenge

with the previous diet.

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So there's two parts.

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so a lot of times I do want them to feed

just any diet or do all their training

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and then at one year of age, we have

a lot more options on balanced diets

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that you can perform as a diet trial.

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We also know it's not a forever diet,

but I feel a little bit more comfortable

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on choosing either like one protein, one

carb diet as a diet trial, or we have

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more options for commercial, , diets.

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Andy: talk to me a little bit

about, about hydrolyzed versus

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something like, derm Complete.

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, the interesting part to me in that diet is

really this emphasis on the skin barrier.

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Like, what are sort of the pros

and cons between those two pathways?

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If you start to kinda look at,

am I doing a hydrolyzed diet?

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Do you wanna wanna focus on

something, uh, on something different?

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Like, like derm complete?

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how do you make that choice?

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What are the key factors,

I guess, in your decision?

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, Charli: yeah, so I still wanna keep

, the pet parent and like the dog.

242

It, it can, it does matter, like

based on the dog's personality,

243

but, , to choose when to perform the

diet trial, I think is very critical.

244

And the timeframe, because of the

training, Aspects of having a puppy.

245

So I think that's the first

question you need answer.

246

And the second question is how much

the owner actually believes that

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a dog has a food allergy or not.

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If they do believe there's a food

allergy, then of course perform.

249

Or if there's any GI signs, , or

if you are suspicious of a food

250

allergy, then of course perform

the diet trial as soon as you can.

251

But if you both don't really believe that

there's a food allergy, you think there's

252

more of environmental allergies, I don't

think it's wrong to just skip that step.

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And a way you can kind of satisfy

both is to feed germ complete

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because that is built for a

dog with atopic dermatitis and.

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, it's an egg base, so less likely of the

allergens of a dog who is food allergic.

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Andy: Gotcha.

257

And then also you, there's a puppy

formulation, so I'm assuming that's

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sort of a, a higher protein, you know,

matching the needs of the growing dog.

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while we wait, un practice a

little bit for me because I, I

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think this is really interesting.

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So what you're saying is if I had a

case that came in and I had a puppy and

262

the puppy's kind of itchy puppy, and

I'm not really convinced it is a food

263

allergy, I just, it's sort of a general,

a general allergy to the world puppy.

264

Your idea would be, Hey, we're

going to do a food trial.

265

But right now, while we are doing

puppy classes and we're trying

266

to treat and reward and things,

it's not really the best, time.

267

And so maybe picking something

like derm Complete that you know

268

is egg-based and then also, has

a, you know, emphasis on, healthy

269

skin barrier, you maybe go to that.

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And then at one year of age after

we've had this Time to do the puppy

271

training and things like that.

272

You're saying sort of circle back

around at that time when we move to an

273

adult diet and then do a food trial,

then because also we've got a lot more

274

options when we get to adult diets.

275

Talk to me more about, the skin

barrier and the importance thereof.

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So you talked, at the beginning about the

bricks and mortar and, , and how that's,

277

you know, how sort of important that is.

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The skin barrier and the importance

in, maintaining that with allergic

279

dogs is something I feel like is

really getting a lot of attention

280

in the last six to 12 months.

281

I've really heard more and more about it.

282

Talk to me about sort of the

importance here and, and how

283

do you kind of factor that into

your sort of treatment decisions?

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Charli: Yeah, that's a good question.

285

I think more and more owners are even

bringing up that there is, like gut health

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is related to this overall skin health.

287

So more people are interested in nutrition

, and prebiotics and phytonutrients,

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and bioactive means, which.

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Derm Complete has all of those things,

which is really helpful because then

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you don't have to think, you have to

buy all these supplements that people

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just wanna add things to their food.

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You could just say, Hey, you can feed

this diet, because it provides all those

293

things already that can help build the gut

health, and it does translate to the skin.

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Okay.

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Andy: So when we start to look

at these, at our multitude of

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options for say, older dogs, right?

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so just adult dogs less than less than

seven, what do you think needs to be

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in the standard GPS toolbox when they

start to look at, atopic dermatitis?

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So you talked before about immunotherapy.

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We've talked a bit about diet.

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, what are the things that I should be

making sure I'm thinking about, or the

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tools that should be in my toolbox when

I look at, I don't know, skipper, Rourke,

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the golden Doodle who's six years old,

and seemingly allergic to the world.

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, what are the things that, that you

really think should be emphasized?

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And so the multimodal approach that

general practitioners would take.

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Charli: That's a good question and

it's a little bit of a loaded question

307

'cause I think it depends on , what

aspect you are meeting that patient.

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Is this a patient who has been a

long-term atopic patient who's been

309

already been on immunotherapy or is this

one of the ones that I would see as a

310

referral and it's the first time and

they have tried everything and they're

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coming in because it's a little bit

hard to say when I think we may see two.

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Different populations of

patients that come in.

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And so like when I have a patient

that first comes in to me, , and

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they've tried everything, it's

kind of like putting out the fires.

315

I want to do a multim mold approach,

and unfortunately that always includes

316

medicine or fortunately because medicine

always provides instant gratification.

317

, and they have like homework of

six to 10 things they need to do.

318

So I don't want to pile them up

with more and more things, but.

319

What's interesting is that after

that first day after I've had put out

320

the fires and they have, or they're

out of the shock phase and they feel

321

more comfortable, they can snuggle

up with their little one again.

322

, and they can, there's not

a stinky room anymore.

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Then they become more accepting and

they're looking out for alternatives

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and usually non-medication alternatives.

325

And that's when they're more accepting

for allergen immunotherapy because

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then they can cut down on medication.

327

They don't wanna overmedicate

or they feel it's very costly.

328

'cause while very effective medicine

is very expensive, , and then that's

329

when I do bring on nutrition or more,

actually, most of the time the clients.

330

Themselves will bring

on, Hey, what can I do?

331

Is there a change in diet?

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What can I feed to make this better?

333

And that's when I do say, , d then I

suggest different diets, , at that point.

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But they always want

instant gratification.

335

And so with.

336

With food.

337

It is while very effective, and

even for food allergic dogs, it

338

is never an instant gratification.

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Andy: what's your general timetable

on, on, on food and introduction?

340

So when I, bring people in and they say,

Hey, you know, we really wanna focus

341

on, on the diet here and starting to try

to relieve these symptoms and things.

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I really try hard to set expectations.

343

That are gonna be reasonable because

I think that they go and they, got

344

the new shiny bags and they're really,

you know, they're really excited.

345

I'm gonna take it and

this is gonna be magic.

346

And in their heart of hearts,

day three, they're looking

347

to say, is this working yet?

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Is it working yet?

349

And I don't want them

to become discouraged.

350

How do you set expectations for how long,

you know, bringing in diet and really

351

starting to manage these conditions is

going to take, before you say you're

352

going to see, you're going to see results.

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, Charli: a true diet trial.

354

As you know, there are two phases.

355

So there's the first phase, which is the

washout period, and there are studies

356

done before that said you can diagnose 90%

of dogs after an eight week diet trial.

357

If you wanna be by the book,

then at least 12 weeks of washout

358

period of that special diet.

359

But so people usually come to me and

they've been on the DIA trial and let's

360

say they are really doing it correctly.

361

Uh.

362

But it still is a washup here,

and they usually give up after

363

that one bag, like you said.

364

usually if it's a true food allergic dog

and there's no secondary infection, I

365

would say it takes even about at least

a month to see the symptoms die down.

366

Because usually by the time I see

they already have secondary infection.

367

That's what makes it a

little bit complicated too.

368

So when you treat the

secondary, it does seem better.

369

But a true like food

it, it does take about.

370

At least a month to see a difference,

but that's why we recheck.

371

Usually, I would recommend rechecking in a

month because that's when you check in and

372

to encourage them to buy that second bag

or to continue with a diet trial, because

373

you're right, sometimes they give up

after two week, two to three weeks because

374

they're like, this is really boring.

375

I can't feel any treats.

376

I can't do this, I can't

377

do that.

378

And it gets very frustrating.

379

So usually at least a month, but

remind them that it can take.

380

Longer to really C effects, but also

remind them that it's not a therapy.

381

While it can be, it's a test.

382

It's just a really long test

and they're doing all the work.

383

Andy: I think I really like that

about it's remind them it's a test.

384

I, I think that they look at nutrition

like a pharmaceutical sometimes.

385

They're like, well, I, you know, I

started doing, you know, I started doing

386

Apoquel and immediately saw results.

387

They go, well, that's, that's just

a different, that's stuff's great.

388

That's just a different, it's,

that's different than nutrition.

389

And, and trying to get them

to un uncouple those things.

390

You know, we've sort of been

talking through life stages today,

391

and so we started talking about.

392

Puppies early on in sort of management

of, of the, you know, allergic

393

dermatitis puppy, and then into sort

of the, adults and things like that.

394

Well, the last sort of thing I want

to talk to you about a little bit is,

395

is starting to manage comorbidities.

396

So we know you said, , less than

one year and over seven years, we

397

don't tend to, to see these things

as what we were sort of told.

398

And we, and we know now

that that's not true.

399

When I, when I.

400

Get that senior patient when I've

got a seven, eight, 9-year-old

401

dog and they're starting to,

to develop some comorbidities.

402

Let's say the SDMA is, is a little bit

elevated and, and my urine is, is a

403

little bit, uh, dilute on my urinalysis

and I'm worried about sort of early renal

404

disease or moving into renal disease.

405

And some of these senior dogs,

how do you manage those things?

406

Are you, picking priorities around

the severity of the condition or

407

are you trying to, to manage them?

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Both.

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There's other conditions like,

oh, we go back to chronic renal

410

disease where diet is kind of the

go-to, you know, staple of therapy.

411

but then I've also got this quality

of life issue around dermatitis.

412

Charlie, how do you look at those cases?

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Charli: Yeah, that's a very good question.

414

And it, it is tough because that's

when they've been doing very well on

415

their immunotherapy and diet and it's

been a long time coming, but they are

416

getting older and a lot of times we are

worried about renal disease, but all

417

the renal diets are generally chicken

based and so there's not really choice.

418

So you have to choose

between like, okay, my.

419

Food allergic dog, , with chicken

based diet or do I worry about it?

420

Skin?

421

But actually I believe hills is

coming up with a new diet, , that's a

422

derm complete with, , renal support.

423

So you won't have to choose, you can

choose that diet for your atopic and older

424

patient who is food allergic to chicken.

425

, Andy: that's fantastic.

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shifting away from renal diets just

to sort of more geriatric patients.

427

are there any, considerations that

you have around just generally

428

aging, dogs with atopic dermatitis?

429

I mean, are there modifications

that you sort of make or, or

430

start to look for when you have.

431

A patient that's just getting

older or do you kind of, if you

432

found something that's working, I

guess we just sort of stay with it.

433

Is there any reason that the therapeutic

plan or I might, , would change, or

434

that I would want to sort of adjust

the multimodal approach that I have

435

as, as my patients start to age?

436

Charli: Yeah, actually, , it does

come up a lot and most people are

437

looking for like decreasing medication

because they feel like it's getting

438

a little bit much, or if they do have

renal disease or liver complicated,

439

usually elevated liver enzymes.

440

And while they can't.

441

See that on the patient, they're told

that by their veterinarians, and that's

442

when they do wanna decrease medication.

443

And that's when we look for more

holistic approaches like allergen

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specific immunotherapy or uh, nutrition.

445

Andy: do you see increasing

compliance in senior patients?

446

Do, is, that kind of what you're saying?

447

Or, or do you think that pet owners

are more likely to say, let's get this

448

diet thing figured out because as my

pet is getting older, I want, to be

449

doing less of the pharmaceuticals.

450

Is that, kind of a trend

that you've noticed?

451

Charli: Yes, actually, I, it is,

, patients, they're looking, especially when

452

they're starting to worry about diabetes.

453

So then like steroids that used

to be working, they're now like,

454

ooh, maybe not, or heart disease

where again, they don't wanna use

455

as much steroids, or in their eyes.

456

Other medications like a or cyclosporine

are, too much medication and so

457

they now they want to cut it back.

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Andy: That makes sense.

459

Dr.

460

Charlie Dong, thank you so much for being

here and talking through this with me.

461

what are your favorite resources?

462

If there's some, , young.

463

Blossoming dermatology enthusiasts

out there who are like, I,

464

I think this is fascinating.

465

I wanna know more about this.

466

Where would you send them?

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Charli: you can always

use the Hills Academy for.

468

Nutrition based.

469

I've also written several articles,

we could check those out, or

470

especially one on atopic dermatitis.

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It's a very thorough article.

472

so that's one.

473

I'm, and it has nutrition and

top and it has some options

474

for topical therapies as well.

475

More holistic approaches.

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Andy: Well, I will link all

of that up in the show notes

477

including, , including your articles.

478

Thank you for peeing here guys.

479

Thanks for tuning and listen everybody

take care of yourselves, gang.

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Speaker 2: And that's our episode

guys, that's what I got for you.

481

Thanks for being here.

482

Thanks to, , Dr.

483

Charlie Dong for being here.

484

Thanks to Hill's Pet Nutrition

for making this episode possible.

485

Take care of yourselves, everybody.

486

Be well.

487

I'll talk to you later.

488

Bye.