Although I'm not a vet and can't really answer "officially" about long term use, I wanted to let you know that I feel your pain and Ruby's too!
The bottom line for me: Without the steroids, I would not have had the pleasure of my girl's company for the last 10 years. That benefit outweighs any risks in my mind.
My decision to use steroids long term was a personal decision because her quality of life was so poor. For 5-6 months out of the year, she had to be aided to walk because the pads of her feet had pulled away from her feet swelling. Year round, she chewed and scratched to the point of creating skin infections, she was covered with pustules and had lumps like marbles under her skin in areas. I could not afford the oral cyclosporine (Atopica) and it has the same success rate as the allergy shots. Fortunately, she did respond to the allergy shots after a year or so (the foot swelling/pad peeling issue resolved to a couple of episodes a year).
My girl is 10.5 and has had severe allergies since about 12 weeks. She has essentially been on different levels of a steroid (prednisone) dose for most of that time. At one point, I was able to spread the maintenance dose out to 1 dose (20 mg) a week for about 6 months. Until this year, the main problem that she's had (outside of allergies
) due to chronic steroid use has been urinary tract infections. Earlier this year she was diagnosed with cancer (soft tissue sarcoma) and more recently we've added in kidney and heart issues. In an effort to address everything at once, we've just started a new regime with the right to go back to prednisone if things don't improve.
Our current regime includes: doxepin (an antidepressant that has a strong antihistamine), slowly increasing fish oils (very slowly as she has a sensitive tummy), off steroids and diphenhydramine, 2 medicated shampoos and a leave in rinse. We'll also be changing up her allergy shots slightly at the next appt. The main thing I've learned over the years is the importance of extreme discipline with her medication, baths, etc. If we're off by a bit, it throws her into a tailspin that takes a while to recover from.
I tracked back through your previous threads to see if I could get a sense of where you are coming from and what you've tried already. I had a couple of questions I didn't see addressed in the other threads:
- Has your primary vet been managing Ruby's care or were you referred to a board certified dermatologist?
- Was Ruby's allergy tested based on intradermal (prick) testing or on a blood draw? (one can give false negatives and the other false positives, so it's possible her allergy shot solution could be adjusted a bit if you've seen some relief from them) Was she on steroids at the time of the testing?
- Aside from upset stomach, chewing her feet and the lumps you mentioned on her neck in a previous thread, are there any other symptoms? Pustules, lesions, pads pulling away from toes, etc?
- Are you having to use antibiotics at all?
- Is she still on the thyroid supplementation?
ETA - I commend you for working so hard in Ruby's best interest. I know it's very frustrating. The combination of food and environmental allergies is tough and a human dander allergy is one I'm glad we don't have to deal with.