four year old golden with year round paw licking and five ear infections in two years, twelve week elimination diet got us maybe sixty percent better but not fixed, and now the dermatologist wants me to choose between cytopoint, daily apoquel, or allergy testing plus immunotherapy and i cannot tell which parts are medicine and which parts are marketing

Cooper is our 4 year old neutered male golden, 71lb, and his skin has been a slow motion project since he turned 2. the pattern is year round paw licking (front paws mostly, theyre stained pink at this point), recurring belly redness, and five ear infections in the last two years at $180 to $250 a visit depending on whether cytology was involved. our regular vet ran an apoquel trial for 30 days last fall, it worked honestly great, and everything came back within a week of stopping, which is when she said the word dermatologist and we got on a 3 month waitlist.

the derm consult was $310 and i want to be fair, it was thorough. she scoped both ears, did skin cytology, and put us on a proper elimination diet, 12 weeks of royal canin ultamino ($128 a bag, works out to about $95 a month for a dog his size) with genuinely nothing else, no treats, no flavored heartworm chews (we switched to a topical), nothing off the counter, my kids got lectured about dropped food. we were strict, i would put money on it. the result is real but partial, the ear infections stopped completely, belly redness mostly gone, but the paw licking continues, worse in late summer. derm says this is textbook, theres a food component we are now controlling and a concurrent environmental atopy component we are not, and goldens are one of the poster breeds for this combination.

so now the menu. option one, daily apoquel for life, about $87 a month at his weight, works fast, needs baseline bloodwork and periodic monitoring. option two, cytopoint injections at $145 each every 4 to 8 weeks depending on how long each one holds. option three, intradermal allergy testing at $450 plus immunotherapy shots we mix and give at home, roughly $70 to $90 a month the first year, with her honest disclosure that about 60 to 70 percent of dogs respond meaningfully and it can take 6 to 12 months to know. she was not pushy about any of them but i left with a folder of glossy zoetis brochures which did not help the marketing feeling.

my questions for people who have actually run these roads. one, cytopoint vs apoquel long term, the internet is full of people swearing by each and people swearing each one stopped working, what does the real world wear off situation look like. two, is immunotherapy actually worth starting given a 60 to 70 percent response rate and a year long wait, or is that money better spent just buying the drugs that already work. three, the derm insists on intradermal testing over the blood panel our regular vet offered at $280, is that a real quality difference or specialist gatekeeping. four, the question i actually care about most, does anyone ever get OFF the drugs, or is every path here just lifelong stacking of prescriptions and im choosing the order i stack them in