eighteen months of chronic itching on our four year old french bulldog mix and we have now climbed the full ladder of vet recommendations without resolution, going to the dermatology specialist next month and trying to figure out what questions to walk in with

Biscuit is our 4 year old french bulldog mix (DNA test says 62% frenchie, 18% staffy, 20% small assorted things), 31lb, neutered male, adopted from our local shelter at 8 months. for the first 2.5 years he had perfectly normal skin and we had no idea allergies were going to become the defining variable of our lives. then around month 32 (so roughly 18 months ago) he started chewing his paws after walks. then it was scratching his ears every evening. then it was rubbing his face on the carpet for 20 minutes after eating. then it was the belly rash. now we are in a place where he has at least one active hot spot most weeks, his ears are chronically inflamed even with the medicated wipes, and his quality of life is genuinely affected.

the vet ladder we have already climbed. one, our regular vet started with the standard "rule out fleas first" protocol, monthly Bravecto for 6 months, no improvement, no fleas were ever found anyway. two, switched to a limited ingredient kibble (Hill's d/d salmon) for 12 weeks, mild improvement maybe 15% reduction in scratching at week 8 but came back to baseline by week 11. three, hydrolyzed protein diet (Royal Canin HP) for 10 weeks, this was where things got weird because he improved for the first 5 weeks then went back to scratching during weeks 6-10 even though we kept him strictly on the diet with no treats and no extras. four, allergy panel blood work (Heska panel through the regular vet, ran us about $380), came back showing moderate reactivity to dust mites, mild reactivity to several grass pollens, and zero food reactivity which the vet said was consistent with environmental atopy more than food allergy. five, Apoquel trial for 6 weeks, dramatic improvement (probably 85% reduction in scratching) but our regular vet was uncomfortable keeping him on it long term at 4 years old given the immune-modulation profile and we tapered off at week 6. six, Cytopoint injections every 4-6 weeks for the last 4 months, which are working at about 60% efficacy and which insurance is covering and which our regular vet says is a reasonable long-term plan.

where we are stuck. the Cytopoint is working but only partially, and the partial response means he still has 2-3 bad days per cycle where the scratching is bad enough that he keeps us up at night and the hot spots still form. our regular vet referred us to a board certified veterinary dermatologist 90 minutes away, initial consult is $450, and we have the appointment in 3 weeks. she said the next conversation is probably going to be about intradermal allergy testing (the gold standard skin test, not the blood panel) and potentially immunotherapy (allergy shots / SLIT drops) which is a multi-month commitment. before we go, i want to make sure i walk in with the right questions because this consult is expensive and we will not get the full hour back if i forget to ask something important.

questions for people who have been through this. one, what should i specifically ask the dermatologist that i might not think to ask, especially around the immunotherapy decision (intradermal testing followed by custom serum, vs blood-based ALK serum, vs SLIT drops, these are the three branches i think exist and i do not understand the tradeoffs well). two, has anyone gone through the full immunotherapy protocol with a frenchie or frenchie mix and what did the timeline and the cost actually look like (i am seeing wildly different numbers online from $80 a month to $400 a month). three, the Apoquel hesitation our regular vet had at 4 years old, was that warranted or did your derm have a different view, because i am tired of watching Biscuit suffer and i want to understand if Apoquel long term is genuinely off the table or if it was a conservative GP call. four, the dietary piece, the panel said no food allergy and the hydrolyzed trial was inconclusive, do i let the food question go entirely or is there a more rigorous food trial protocol the derm might run. five, anything else you wish someone had told you before your first dermatology appointment. thank you. it has been a long 18 months and i would really like to give him his life back