Canine allergic dermatitis is a complex condition that can be influenced by environment, genetics, immune response, skin barrier function, and the cutaneous microbiome of the dog. Because of the complexity of this condition, what do the treatment options and plans look like for these canine patients?

Anti-Hero: A Variety of Inflammatory and Antipruritic Medications for Canine Allergic Dermatitis, 

Brittany Lancellotti, DVM, DACVD, shared a review of therapeutic options available to manage inflammations and pruritus. Throughout the lecture, Lancellotti shared multiple types of medications available to veterinary professionals, through slides and her own version of karaoke [Dermatology Version].

Glucocorticoids (GCs) bind to cytoplasmic glucocorticoid receptors, then translocate to the nucleus where they modulate gene transcription by binding to glucocorticoid response elements. This process upregulates anti-inflammatory proteins and downregulates pro-inflammatory genes. This process causes a few effects within the acute and chronic treatment of both inflammation and pruritus. There are some short-term adverse effects that are common, including behavior changes, diarrhea, panting, polyuria, polydipsia, polyphagia, and more.

Veterinary professionals prescribing these to patients should monitor the patient’s tolerance and reduce to lowest effective dose as well as frequency should be prioritized if GCs are being used in the long-term because of progressive adverse effects. These effects can include cardiovascular workload, immunosuppression, muscle and ligament atrophy, risk of diabetes and pancreatitis, and more. Lancellotti said that these medications are administered to patients by liquid or tablet at 0.5–1.0 mg/kg prednisone/prednisolone equivalent every 24 hours at first. The dose can then be lowered to lowest effective dose and frequency that is maintaining remission of clinical signs in the pet.

 Lancellotti also stated that these medications are not recommended for long term.

For the benefits of GCs, Lancellotti explained that it is rapid acting, effective against edema, can be an inexpensive option for clients, and has that variety of administration options. However, she mentioned some drawbacks for GCs is more frequent changes were observed during monitoring and it interferes with allergy and hormonal testing.

Cyclosporine inhibitors (Atopica; Elanco) leads to a decrease in activation of T cells, and a decrease in proinflammatory cytokines like interferon-α and is used in canines with atopic dermatitis who weigh at least 4lbs. This then leads to a decrease in pruritus and edema in treatment in chronic allergic dermatitis, not acute. When it comes to this treatment, the most common of the short-term adverse effects are gastrointestinal, with less common long-term risks including gingival hyperplasia, opportunistic fungal infections (which are less common at 5 mg/kg dosing), and papillomas.

This type of medication is administered by liquid or capsule at 5 mg/kg once daily for the first 4-6 weeks to determine if clinical sings improve, then the dosing frequency of administration can be reduced to either every other day or twice daily, and the daily dose itself can be decreased. Lancellotti cautioned attendees that when administering cyclosporine concurrently with medications that can affect the cytochrome p450 enzyme system in the liver, it will in result affect the concentration of cyclosporine circulating.

Right up until the end, Lancellotti engaged the room with her keyboard and voice. Her renditions of 'We Will Block You' and other remixed classics helped the audience understand that just like music in our lives, itchy dogs will be in the clinic. By understanding the different types of treatments, helping these patients get better will just be another song and dance.

Lancelloti B Anti-Hero: A Variety of Inflammatory and Antipruritic Medications for Canine Allergic Dermatitis. Presented at: WVC; Las Vegas, Nevada. March 2-5, 2025.

van den Broek A. Muller & Kirk’s Small Animal Dermatology. William Miller Jr, Craig Griffin, Karen Campbell. Saunders-Elsevier, St Louis; 7th Edition, 2013, 938 p; IBSN: 978-1-4160-0028-0, £113. 

. 2013;24(5):559-559. doi:https://doi.org/10.1111/vde.12055

Archer TM, Boothe DM, Langston VC, Fellman CL, Lunsford KV, Mackin AJ. Oral cyclosporine treatment in dogs: a review of the literature. J Vet Intern Med. 2014;28(1):1-20. doi:10.1111/jvim.12265

Articles

Brittany Lancellotti, DVM, DACVD, broke down the treatments for canine allergic dermatitis, including through song, in her lecture at WVC 2025

Medications for canine allergic dermatitis


A patient with cancer receives chemotherapy at a veterinarian visit.

Canine cancer occurs at about the human rate, and nearly half of all dogs older than 10 years develop the disease.

 Although less is known about the feline cancer rate, some types of the disease are more common in cats including lymphoma.

In an education session at the 2025 WVC conference in Las Vegas, Nevada, Rachel Venable, DVM, MS, DACVIM (Oncology), noted that the prevalence of cancer in dogs is what makes it so important that veterinary teams not only evaluate canine patients and know what to look for but also understand treatment options. In cases where clients decline a referral to a veterinary oncologist, the patient will need treatment from its’ primary practitioner.

There are various reasons why a patient with cancer may not be referred to an oncologist. According to Venable, reasons may be related to client finances or an inability to take time off from work to make an appointment. Lack of access to a specialist can also be an issue, especially for pet owners in certain areas of the US that require traveling a great distance for an appointment.

“Most oncologists are located in major metropolitan areas. So, if you live outside of that, there's actually multiple states that don't even have oncologist,” Venable said. “[And] sometimes it can be an issue when clients just clearly can't get in, or it's a long wait time.”

A barrier to care may also be because many oncologists are so booked up that the specialty clinic requires a definitive diagnosis of cancer to get in to have an appointment. Venable noted that referring clients to an oncologist that offers teleconsulting services may help bridge the gap in access to care.

Still, Venable said, in other cases, a client’s biases or past experiences drive their decision not to seek treatment with an oncologist.

A patient’s treatment plan will depend on a variety of factors. The type of malignant tumor, as well as its’ location, size, grade and stage all factor into treatment decisions.

Overall, Venable said, there are 4 pillars for treating patients with cancer. They include surgery, radiation, chemotherapy and immunotherapy. “Oral chemotherapy can include drugs such as cyclophosphamide, chlorambucil, lomustine and many others,” Venable said. “Oral chemotherapy does not require the same level of administration and handling in USP 800 because compounding of the medication is not required. This means you do not have as high a risk of exposure and only requires gloves for handling.”

Venable also discussed using targeted therapies such as toceranib phosphate (Palladia; Zoetis) and verdinexor tablets (Laverdia-CA1; Dechra) in general practice for treating patients with cancer. Furthermore, medications for pain as well as antibiotics can be administered to these patients.

“A lot of times these are older dogs,” Venable said. “People may not want to do one of those major treatments for various reasons, or it could be something where it's metastasizing everywhere. And so that's something to keep in mind.”

With palliative care, there is emphasis on quality of life and the patient’s comfort. A general practitioner can prescribe therapeutic drugs for helping a patient with nausea control, to stimulate appetite, and as an antidiarrheal, in cases of weight loss and gastrointestinal upset. Venable also suggested adjusting food to make it more bland and easier for the pet to digest.

“For pet owners who do not believe in euthanasia, high doses of morphine or morphine type drugs can be prescribed for their pet,” Venable said. “My experience with pet owners who do not believe in euthanasia, is that they are fine giving these medications to help calm their pets and make the passing more peaceful.”

How a cancer case is resolved depends on many factors including the cancer type, its’ location in the body and the extent of the disease. However, it is important that veterinarians are able to recognize cancer and have some familiarity with available treatment options.

Venable emphasized that there is no right or wrong way answer to managing cancer, and that should be communicated to clients. She noted that they will often feel pressure to make the best decision for their pet, and that a lot of emotion comes with a cancer diagnosis, so communication is key.

“A way to just kind of let them off the hook is to sit and tell them that there's no right or wrong. There's a lot of different options, and it's more important that they understand the expectations,” she said.

Cancer in pets. American Veterinary Medical Association. Accessed March 3, 2025. 

https://www.avma.org/resources/pet-owners/petcare/cancer-pets#:~:text=Approximately%201%20in%204%20dogs,rate%20of%20cancer%20in%20cats

Venable R. Cancer treatment options for primary practitioners. what to do when owners decline referral. Presented at: WVC conference; March 2-5, 2025. Las Vegas, NV.

Rachel Venable, DVM, MS, DACVIM (Oncology) discussed what primary doctors can do to treat their patients with cancer when clients decline specialty care during a WVC 2025 CE session 

Managing cancer in general practice

Integration output customized to an individual patient.

ScribbleVet and LifeLearn have integrated 2 digital services powered by artificial intelligence (AI). ScribbleVet’s veterinary scribe, which generates Subjective Objective Assessment and Plan (SOAP) notes quickly and accurately, and LifeLearn’s Sofie

 a decision support tool that provides immediate answers to pet health questions, will be working together to better assist veterinary teams with SOAP notes. The collaboration allows veterinary practices using ScribbleVet’s service to immediately access to Sofie's differential diagnostics for deep research within the SOAP.

Sofie delivers instant, reliable answers to veterinarians at the point of need, drawing from a vast, searchable library of trusted veterinary medical resources, according to ScribbleVet. While other AI search systems pull from open online sources, Sofie operates within a closed system—providing only evidence-based clinical information that veterinarians rely on daily and have trusted for years.

"The proprietary nature of Sofie's medical content is what sets Sofie apart and supports confidence in ScribbleVet," David Goodnight, DVM, executive vice president of Business Development at LifeLearn, said in the release.

 "Sofie ensures accuracy by sourcing exclusively from proven, authoritative references, setting it apart as a truly dependable AI tool for veterinary professionals."

With the integration, all ScribbleVet users will have access to Sofie's trusted veterinary medical content within their ScribbleVet application to make diagnostic and treatment decisions confidently and efficiently, according to the company.

 ScribbleVet users will be able to record the details of a patient exam, and have their SOAP note generated quickly, while the conversation is filtered to allow only medically relevant details to be included in the created record. In the assessment portion of the SOAP, there will be an option to view additional research compiled by Sofie that is specific for that patient's case.

"According to a recent [American Veterinary Medical Association] survey

, one of the most common concerns about AI adoption among veterinarians is the reliability and accuracy of AI systems," Rohan Relan, CEO of ScribbleVet, said in a news release.

 "We've addressed that concern with the LifeLearn-ScribbleVet partnership. Both companies share a passion for accuracy, so with this integration, we're not only improving speed and efficiency within veterinary practices, but we're also enhancing reliable analysis and better care."

The ScribbleVet-Sofie integration is featured in the exhibit hall at the WVC conference in Las Vegas, Nevada; March 2-5, 2025. Attendees visiting the ScribbleVet booth also have an opportunity to receive an AI-generated portrait of their pet.

ScribbleVet and LifeLearn announce integration between veterinary AI scribe and Sofie decision support tool. News release. February 25, 2025. Accessed March 3, 2025. 

https://prnmedia.prnewswire.com/news-releases/scribblevet-and-lifelearn-announce-integration-between-veterinary-ai-scribe-and-sofie-decision-support-tool-302385006.html

ScribbleVet. Scribblevet.com. Accessed March 3, 2025. 

Sofie. Lifelearn.com. Accessed March 3, 2025. 

https://www.lifelearn.com/products/sofie/

Gabor S, Danylenko G, Voegeli B. Familiarity with artificial intelligence drives optimism and adoption among veterinary professionals: 2024 survey. 

 February 11, 2025. Accessed March 3, 2025. 

A systems integration of ScribbleVet and LifeLearn's Sofie is being demonstrated at WVC 2025.

Two companies are integrating AI-based tools for enhanced SOAP notes

“So the first thing that we have to start off [with] is saying that a dedicated diet trial, today, is necessary for performing a correct diagnosis for a food-allergic dog,” began Galia Sheinberg, DVM, ESP, DLACVD, co-owner and founder of Dermatología Especializada Centro Veterinario Mexico, in Mexico City, in her lecture 

Practical aspects and innovations in diet trial for food allergy diagnosis

, presented at the 2025 WVC Conference in Las Vegas, Nevada. However, as Sheinberg explained, not all “itchy” patients should go on diet trials, and a detailed clinical history could help determine if the patient is a suitable candidate for this test. Among many points she presented in her lecture, Sheinberg shared some common errors that are made by veterinarians relating to diet trials.

According to Sheinberg, one common mistake veterinarians make when it comes to canine patients experiencing pruritus includes recommending a diet trial to each one of these patients, in every circumstance. “We have to understand when it’s really worth recommending a diet trial,” emphasized Sheinberg.

Oftentimes, the patient criteria for starting a diet trial are wrong, explained Sheinberg. “Maybe this dog was never itching before and it’s their first time they’re having issues, and somehow, automatically, they get prescribed or recommended a diet trial,” she continued. “So maybe [for] those dogs [it] was not necessary. …Maybe they had another diagnosis that wasn’t even related to their diet.”

“And most of the patients who are on a specific diet were never challenged, so they believe they’re on the right diet, but they’re still struggling,” said Sheinberg. To address this issue, she explained that taking a thorough clinical history is crucial. For veterinarians or clinics that may not have the time to go through a detailed clinical history with clients, developing a questionnaire or form for clients to fill out before the consultation may offer a solution.

When discussing feeding history with clients, it is important to know not only what the patient is currently eating, but what their diet has been like in the past. Information like whether the patient has been on a hydrolyzed or protein-selected diet, and if it was done correctly, should be discussed.

The fat fecal chart in the patient’s gastrointestinal (GI) history is also important. “Nowadays, as dermatologists, we understand that a lot of our patients have GI disturbances, and [clients] come in and… they don't tell us about it unless we ask. So, we need to know if [patients are] having any GI disturbances at all, how many bowel movements per day they're having, etc.,” explained Sheinberg.

If the patient has been on medication, and how they responded to it, needs to be discussed as well. As Sheinberg explained, some dogs have been on numerous medications, leading to the perception that they have failed every treatment. “But you really need to find out the timeline and the reasoning behind those failures and look at the skin and put everything together to see if the diet even had an opportunity to make a difference,” she emphasized.

Lastly, veterinarians should talk about the patient’s ears with clients, as many pet owners do not know there is a connection between the ear disease and the skin. However, it is important to “ask questions that are at the level of…clients so [that] they can identify the problems and understand what [is being asked].”

“…there's a lot of dogs that will have recurrent ear disease related to food allergies. It can be environmental, of course, but we can miss those if they come in for a skin problem or itching when they're not presenting with ear disease,” said Sheinberg.

Another mistake that Sheinberg has frequently witnessed is having patients undergo a diet trial for the wrong duration of time, whether it be too long or too short. “What I commonly see as a dermatologist…[in]…patients that have undergone a diet [trial] is that the duration of the diet [trial was] wrong,” said Sheinberg. “Maybe they didn't do the diet correctly, but a lot of patients believe they've done a diet trial, but they haven't done it in the right way.”

Because of this, factors relating to owner compliance should be taken into account. These factors include considering whether the home is suitable for the trial (ie., does the home have multiple pets, small children, elderly, owners with inconsistent feeding practices?); whether the owners are willing to change or restrict the dog’s diet; and whether the patient may have access to other food. In these cases, focusing on managing the patient’s symptoms and pursuing an environmental allergy diagnosis may be more appropriate, as a food trial is likely to have a higher failure rate and could result in wasted time, money, and the risk of losing the client.

 For patients who are undergoing a diet trial, careful monitoring throughout the process is essential.

Prior to even beginning a diet trial, veterinarians must carefully assess the patient’s clinical history to determine whether the patient is a suitable candidate for the trial. Moreover, ensuring proper duration of the trial and considering owner compliance can improve the success of diet trials and save time, money, and help keep the client.

To summarize, the following factors are indicators that a diet trial may be appropriate for a patient, according to Sheinberg

Non-seasonal canine atopic dermatitis (CAD) cases with skin issues triggered or aggravated by dietary factors

Young dogs (1 year or younger) presenting with non-seasonal itching, otitis, recurrent pyoderma, Malassezia infections, hot spots, or respiratory symptoms such as sneezing, conjunctivitis, and asthma linked to food consumption

Older dogs that show CAD symptoms later in life, independent of gastrointestinal factors

Patients with recurring otitis after other potential causes have been ruled out

Gastrointestinal markers may comprise recurrent, intermittent or ongoing diarrhea; more than 3 bowel movements per day; grass-eating; belching; borborygmi; vomiting; and gas.

A history of several diet changes in attempts to alleviate GI symptoms or find a diet the dog can tolerate

Sheinberg G. Practical aspects and innovations in diet trial for food allergy diagnosis. Presented at: 2025 WVC Annual Conference; Las Vegas, Nevada. March 2-5, 2025.

What makes a patient a suitable candidate for a diet trial?

Clinical history and patient selection for diet trials

For veterinary practices, online reviews can be an essential part of the clinic because reviews can bring in more clients or defer them based on what they see online. Because of this, managing them is a crucial job the clinic must take on in a way that creates trust and client retention, but also show the team and clinic to be humble, resilient, and think strategically.

, The Online Review Survival Kit: Thick Skin, Quick Wit, and a Dash of Humility

 at the 2025 WVC conference in Las Vegas, Nevada, Rhonda Bell, CVPM, PCM, CDMP, shared her survival guide that veterinary staff members can take back to their clinics to help them maneuver all reviews, the good, the bad, and maybe even the ugly. 

According to Bell, online reviews have become an important part of decision making by modern consumers because it provides social proof, which is the psychological tendency to look at other people’s experiences to decide for themselves. When it comes to the reviews, it also creates a peer consensus that can shape the clinic's perspective in their community and those online before they even step foot in the veterinary clinic. Bad reviews can even impact staff, where potential team members may not be interested in joining a practice after reading its reviews online or hurt the morale of the staff currently employed in the clinic.

“We can actually dissuade people from not leaving a review based on the fact that we respond. So remember how much fun we like conflict? A lot of people who leave reviews are also conflict averse. That's why they went online. They didn't call you. Right? So if they know that you are going to respond to all reviews, good and bad, they may not even leave you one because they're too afraid that you're going to continue that conversation. They know you're watching. So use that in your favor as well,” Bell explained.

“That's a good way to try to set up an environment of prevention. The other thing you can do when you're responding is you can say, ‘I'm sorry you had a bad experience. We'll be calling you to discuss this in person.’ So you're going to scare the pants off the guy who wrote the review and anyone else who's coming behind him who's reading it going, they call you and talk about it? Never mind,” she continued.

Bell also explained that although reviews are important, it’s not necessary to respond to all of them. There are certain reviews that can be left on Google, Yelp, Facebook, or other review sites that can be acknowledged without engagement, or even better off ignored. The key for practices is to know when to engage with reviews and when to not.

For bad reviews, they can be done in a way that does not have any intention of providing the clinic productive feedback based on their experience, rooted in a misunderstanding, or completely hostile. Bell explained that when it comes to these types of responses, it is more powerful to not respond than to engage.

: From genuinely concerned clients who may have had an unpleasant experience, a misunderstanding or unmet expectations. These reviews tend to be more specific or provide ways to improve the practice based on their experience. Normally, these reviews are worth addressing with empathy and can show the clinic areas they can improve in.

These kinds of reviews tend to be irrelevant or inflammatory in nature, often coming from people who have never actually been a client to the practice. In some cases, these types of reviewers can mobilize in groups and flood review platforms with negative comments. When it comes to these, it is best to not respond because it could escalate the impact of the trolls and packs.

 If the clinic is getting these types of reviews, it should be reported to the platform they are being left on. Many review sites will remove content that violates their terms of service.

If you respond to these kinds of reviews, it is possible to react emotionally, which can backfire, reinforce the initial complaint or invite further criticism. In these cases, it is best to take a moment to determine if the review warrants a response or can simply be noted. Responding to these types of reviews can create the negative impact of over engagement which can waste valuable time as well as emotional energy. Over-engagement can also potentially cause a situation to escalate, especially if the reviews are “troll”-like or pack attacks, which is when nonclients join in on bad reviews to create negativity. Bell believes in these scenarios; it is best to not respond. 

When it is time to respond to a review, once it has been deemed on that it is necessary, it should be crafted in a way that is professional and empathic to the reviewing, meaning it should contain 3 key components:

Acknowledge the clients experience by addressing the concerns without becoming overly explanatory or defensive. The responder should recognize the situation and the potential emotional toll it had on the client, patient, and the rest of the family.

Be empathetic. It can go a long way, especially when dealing with issues involving animal care, to show empathy. Teams can simply acknowledge the concerns the client has about the care their pet received to humanize the response.

Invite the responder to have a conversation offline instead of continuing it on a public platform. This can keep all the information regarding their incident confidential and demonstrate how the practice values the input of its clients to address it directly.

Bell encourages responders to not get into specifics in the response, especially if it involves pricing or a medical decision because it could lead to further criticism or a misinterpretation. She said if the review mentioned the name of the pet, it can be used in the response to be empathetic to the client and get back on the same page.

Before hitting send on that response, be sure to take a moment to step back and become emotionally grounded. If teams craft messages when they are emotional, it can lead to coming off more defensive or even unprofessional when it comes to the language. It is also important to make sure the responses are just not for the reviewer, but for anyone who could be reading the reviews of the practice, so be sure to keep the long-term reputation of the clinic in mind when crafting response.

Finally, staff wellbeing needs to be considered during responses, because that negative review can affect everyone’s morale. Owners or practice managers can have an open discussion about the review sin a supportive way to help foster a culture that sees the criticism as a possibility to grow.

“Don’t ignore positive reviews. There's a lot of power in responding to positive reviews. Remember social proofing, it tells people that you're paying attention, that you're watching closely. It also thanks the people who stopped and took the time to help you out. If you only respond to the negative ones, you're kind of alienating those guys who actually did something good for you because you never said thank you, right? And it doesn't have to be anything long. ‘Thanks so much for that 5 star review. We really appreciate it. Can't wait to see you guys again’ Don't do the same one every time. There's no copy and paste. Be a real person,” said Bell. 

Online reviews can have a great impact on the reputation of a veterinary practice, but they will all not be great ones. Learning how to deal with the bad with empathy can help turn the negatives into a positive, with opportunities to grow as a practice and as individuals, plus strengthening the ties and trust with the clinic’s community and clients.

She concluded her lecture by also suggesting that once resolving the reason the client left the bad review, asking if they would take it down and write a good one instead. Explain to them that the team works really hard to keep good reviews and that it would be unfair to them if the issue was resolved that was beneficial to both parties, but the bad review remained. Some people never think to ask, Bell concluded, but reminding them can help improve the clinic's online presence.

Bell R. The Online Review Survival Kit: Thick Skin, Quick Wit, and a Dash of Humility. Presented at: WVC; Las Vegas, Nevada. March 2-5, 2025.

Rhonda Bell, CVPM, PCM, CDMP, shares her guide for dealing with online reviews during her lecture at the 2025 WVC Conference 

Online reviews: To respond or not to respond 

Heartworm disease is not a new challenge for veterinary professionals, but according to Susan E. Little, DVM, PhD, DACVM (Parasitology), now is a great time for heartworms—and a bad time for dogs. The prevalence of heartworm is rising, making it more critical than ever for veterinary teams to take action.

“The challenges we’re facing with heartworm infection and the risk of heartworm infection in dogs in North America have never been higher. This is the worst it’s ever been for dogs because we’ve got the greatest risk of infection that we’ve ever faced. Thankfully, we also have some of the most powerful [preventives] we’ve ever had at our disposal,” Little said during her lecture.

At the 2025 WVC Annual Conference in Las Vegas, Nevada, Little presented "Heartworm Disease: Timely Updates on an Age-Old Problem," where she discussed the impact of rising mosquito populations on heartworm, plus the importance of additional testing. 

Just as it’s a great time for heartworm, it’s also an optimal time for mosquitoes. In recent years, mosquito populations have increased dramatically. Because heartworm transmission depends entirely on mosquitoes, this change has serious implications for veterinary medicine.

“There’s been really good data about the mosquito populations in North America over the last century, and from the 50-year period, the second 5 decades that they included [1996-2016]. It’s documented that there’s a 10-fold increase in the mosquito populations in North America. That is phenomenal, right?” Little said.

“There are a lot of theories about why that exists, and it’s not just [that] the...sheer number of mosquitoes [has] increased so much. There’s also a 2- to 4-fold increase in diversity of species. So, twice as many to 4 times as many species out there,” she continued.

Understanding internal parasite diagnostics

One factor believed to contribute to this rise is wetland restoration efforts in the United States. Because mosquitoes thrive in wet environments, these ecological restoration projects have inadvertently fueled an explosion in mosquito populations.

Because of this, Little emphasized the importance of year-round heartworm prevention. She urged veterinarians to discuss these changes with pet owners, ensuring dogs are protected every month, all year long. With mosquitoes actively transmitting heartworm and driving its geographic spread, veterinary teams must be diligent in their recommendations.

Little acknowledged that many veterinarians are frustrated by the challenges of heartworm testing, but she emphasized that early detection and treatment lead to better outcomes.

“We know that early detection and early treatment lead to better outcomes. That's true in most diseases, and it's certainly true in heartworm, but we also know that the antigen tests aren't perfect. False negatives occur,” she said.

“When I graduated vet school in [1993], I knew that early infections [and] all male infections—we were going to have a harder time picking those up, like only an antigen test. Antigen tests are sensitive, they're specific, they're phenomenal. But the sensitivity is usually 90% to 95%, which means you are missing 5% to 10% of the infections,” Little continued.

Because of this, it’s possible for a dog with heartworm to test negative on an antigen test. To improve detection rates, the Companion Animal Parasite Council and American Heartworm Society recommended 10 years ago that dogs undergo annual testing with both antigen and microfilaria tests.

Little explained that this 2-step testing approach increases diagnostic accuracy. For example, if a dog tests antigen negative but microfilaria positive, then heartworm infection is confirmed, and treatment can proceed. To simplify microfilaria testing in practice, she provided a step-by-step method:

“You collect that blood sample in practice, which you already have to do to run the antigen test. Many folks use a whole blood sample, which is what's necessary for a microfilaria test. And [it's] just a drop of blood on the slide, a drop of saline, cover slip, and examine. That's a microfilaria test,” she said.

Preventive care is the key to controlling heartworm disease, and client adherence is essential. Little suggested offering heartworm testing packages to ensure all necessary diagnostics are completed in 1 visit, minimizing the need for additional appointments and improving owner adherence.

By educating clients on rising mosquito populations, year-round prevention, and improved testing methods, veterinary teams can shift the balance—making it a bad time to be a heartworm and a great time to be a dog.

Little S. Integrating heartworm disease: timely updates on an age-old problem. Presented at: WVC Annual Conference; March 2-5, 2025; Las Vegas, NV.

Bad time for dogs, great time for heartworm.