Roundworms, whipworms, hookworms, and tapeworms are the most common intestinal parasites that afflict dogs. To eliminate these worms, there are currently six drugs available for use in dogs in the United States, and a myriad of choices of products that offer these drugs alone and in varying combinations.

The best dewormer for your dog is one that addresses your dog’s individual risk for contracting intestinal parasites, that is convenient to administer, and that addresses any breed-specific risks (see “The MDR1 Mutation and Milbemycin and Moxidectin,” below). The only dewormers that are not routinely recommended are ones that contain piperazine. Dewormers that contain piperazine have limited effectiveness against roundworms and do not address any other intestinal parasites. Your veterinarian can help you determine which dewormer is best for your dog’s lifestyle and risk factors for contracting intestinal parasites, but here is information about each drug that will help inform your decision:

How to deworm your dog

The easiest way to deworm your dog is to use an effective heartworm preventative all year long. Heartworm preventatives do more than just prevent heartworm disease. They also treat your dog for intestinal parasites. Some heartworm preventatives also include an insect growth regulator for flea prevention. Others include a drug that quickly kills ticks that become attached to your dog.

Each heartworm preventative product – with its particular combination of drugs – has a different spectrum of activity against intestinal parasites. For example, some preventatives are effective against hookworm, roundworm, and whipworm but not tapeworm. Other preventatives are effective against only roundworm and hookworm while some preventatives are effective against roundworm, hookworm, whipworm, and tapeworm.

The Companion Animal Parasite Council (CAPC) recommends that puppies be treated with a dewormer effective against roundworm and hookworm at two, four, six, and eight weeks of age. Puppies should be started on a monthly heartworm preventative as soon as they are old enough and weigh enough to receive the preventative.

According to the CAPC, if a puppy receives his first dose of dewormer at 6 to 8 weeks old, then the following deworming schedule is recommended:

• Administer a dose of dewormer. Use a dewormer that contains pyrantel, fenbendazole, or a combination of pyrantel and febantel.
• In two weeks, administer your puppy’s first dose of heartworm preventative.
• In four weeks, administer a second dose of dewormer.
• In six weeks, administer the next dose of heartworm preventative. Continue heartworm prevention all year long.

If you do not want your puppy or dog to be on heartworm preventative, then you should deworm according to the following schedule recommended by CAPC:

• Puppies should be dewormed every two weeks starting at 2 weeks of age until they are 2 months old.
• Puppies between 2 and 6 months of age should be dewormed once a month.
• Adult dogs and puppies more than 6 months of age should be dewormed once every three months.

Use a broad-spectrum dewormer that is effective against roundworm, hookworm, and whipworm. If your dog is not on a flea or flea/tick preventative, then select a dewormer that is also effective against the tapeworm Dipylidium caninum.

You notice your dog keeps swallowing a lot, acting like something is stuck in his throat. He may have drool leaking out of his mouth, in addition to swallowing repeatedly.

If your dog will let you, start by gently examining your dog’s mouth to look for a cause of the swallowing. Check the roof of his mouth for something a like a bone shard or short stick stuck across the hard palate. That can be a quick and easy fix if your dog will let you remove it.

NOTE: If you notice a string or thread stuck under his tongue, do NOT try to pull on that. That discovery should lead to a visit to the veterinarian. Your dog need surgery for a linear foreign body, like a string extending from the tongue into the digestive system.

Irritation Causes Excess Saliva

Anything that has irritated the tissues in your dog’s mouth can make him swallow more than usual and is usually accompanied by lots of saliva. This could be tissue damage from chewing on an electric cord or lapping up something hot like coffee laced with sugar and cream. Sneaking a spicy pepper from the garden or chewing on a mildly toxic plant can have the same result.

A dog who is swallowing repeatedly but does not appear to have anything stuck in his mouth may be nauseous. This type of abnormal swallowing is often accompanied by copious saliva, a “hangdog” look, and often some retching.

If you cannot positively identify and correct what’s causing the excessive swallowing, a visit to the veterinary clinic is required to determine the reason.

Dangerous Esophageal Blockages

Excessive swallowing with large amounts of drool and some gagging could indicate something stuck in his esophagus. If you can safely do so, open your dog’s mouth wide and look for a foreign object. You can also palpate his neck from the outside, but many objects are hard to detect and, even if you can see it, you may not be able to remove it yourself. A blockage in the esophagus is nothing to mess around with, and an urgent trip to the veterinarian is in order.

Intestinal parasites – such as roundworms, whipworms, hookworms, and tapeworms – are common in dogs and puppies. Mango worms and cuterebra (pronounced cue-tuh-RE-bra) are fly larvae that infect the skin but are not common parasites.

Roundworms

Roundworms are thin, light tan-colored worms that are about one to two millimeters wide (about 1/16 of an inch) and anywhere from four to fifteen centimeters long (about 1 ½ to 6 inches). One end of the worm is shaped like a spear and the other end is lightly coiled. When alive, the entire roundworm will become tightly coiled like a snake.

Most adult dogs will not exhibit any symptoms when they are infected with roundworm. It’s rare, but some adult dogs may vomit live roundworms or may have roundworms in their poop.

Puppies infected with roundworm will often have a pot-bellied appearance and a dull haircoat. They may have diarrhea that contains mucus. Unlike adult dogs, infected puppies will often vomit live roundworms and have roundworms in their poop.

Whipworms

Whipworms are extremely thin, white worms that are about 4.5 to 7.5 centimeters long (about 2 to 3 inches). The worm resembles a leather whip (like the one used in the Indiana Jones movies). One end of the worm is thick like a whip’s handle and the other end is thin like a whip’s lash.

Dogs who have only a small number of whipworms in their small and large intestines do not typically show any symptoms of whipworm infection. Dogs who are infected with a large amount of whipworms will often exhibit weight loss and diarrhea.

Hookworms

Hookworms are off-white colored worms that are four to five millimeters wide (about ⅛ of an inch) and one to two centimeters long (about ½ to ¾ of an inch). These worms have a hook on one end that resembles a fish hook.

Dogs who have only a small number of hookworms in their small intestines do not typically show any symptoms of hookworm infection. Dogs who are infected with a large amount of hookworms may have dark, tarry stool. Left untreated, these dogs may become anemic, lethargic, and lose weight.

Puppies infected with hookworm will often have anemia that can become life-threatening. These puppies may also be thin and lethargic.

Hookworm can also cause pruritic pododermatitis. Hookworm is often thought of as being an intestinal parasite. But hookworm can also enter a dog’s body through penetration of the skin, typically the underside of the webbing between their toes. Hookworm causes an intense itching when it penetrates the skin.

Tapeworms

Tapeworms are off-white colored worms that are 15 to 70 centimeters long (about 6 inches to over two feet). The part of the tapeworm that most people see in a dog’s poop or on the skin around the anus is the proglottid – a segment of the mature worm that breaks off and is released into the dog’s poop. These proglottids, which resemble small grains of rice and may appear around the dog’s anus, or stuck to his fur near his anus, also contain tapeworm eggs.

Dogs rarely show any symptoms of tapeworm infection. The presence of tapeworm proglottids may cause irritation of the skin around the anus, resulting in a dog scooting his butt on the ground.

The most common symptom of allergies in dogs is itching. If your dog often licks, chews, or scratches at his skin, he very likely has allergies. There are many tools available to make our itchy dogs comfortable again. But there are many causes of itchy skin, and it takes time and a proper diagnosis to find the right solution.

Common allergens in dogs

Allergens in dogs can be divided into three groups: airborne and contact allergens, flea allergy dermatitis, and food allergens.

• Airborne and contact allergens include plant pollen (from trees, grasses, and weeds), mold spores, dust and dust mites, and skin dander. These allergens cause itchiness in allergic dogs when the allergens are breathed in, make contact with the dogs’ skin, and/or are licked off the dog’s feet and coat. These allergies often have a seasonal component (and are referred to as “seasonal allergies”). When a seasonal link is not observed (such as with an allergy to dust and/or dust mites), this may be called “environmental allergies.”
• Flea allergy dermatitis (FAD) – where an allergic response to the saliva of fleas, injected in the dog’s skin when the flea bites, causes inflammed, itchy skin – is a very common disorder in dogs.
• Food allergies are not common in dogs. For those dogs who do have a food allergy, the most common food allergens are chicken, beef, dairy, and eggs. Grains – including corn and wheat – are the least common food allergens in dogs.

Symptoms of allergies

Dogs with allergies can be itchy anywhere on their bodies. However, most dogs with allergies caused by pollen, mold spores, indoor allergens, and food will be itchy primarily on the underside of their chest and belly (including the armpits and groin), around the butt under the tail, paws, ears, and around the eyes and lips. Dogs with flea allergy dermatitis are primarily itchy on their back in front of their tail, and on their thighs, underside of the belly, neck, and ears.

An allergic dog may chew, lick, and scratch at his skin, damaging the skin’s protective barrier. The protective barrier is composed of oils and the bacterial skin flora. Damaging this barrier is like filling in the moat around a castle; it allows opportunistic bacteria and yeast to gain access to the deeper layers of skin.

A dog who is itchy and has red, irritated, or damaged skin and hair loss in those areas is said to have atopic dermatitis. This is an inflammatory condition characterized by an increased production of IgE antibodies in response to an allergen. Ectoparasites such as mites can also cause itchy skin but are not atopic dermatitis.

Allergy tests and allergy diagnosis

Allergies are a diagnosis of exclusion. There are a lot of conditions that look like atopic dermatitis (see “Seriously Itchy Paws,” WDJ November 2022), so these need to be diagnostically ruled out before concluding that allergies are causing your dog’s itching and irritated skin.

Observation of the timing and frequency of your dog’s itching can help diagnose allergies and help pinpoint the allergen that your dog is sensitive to. If your dog is itchy at the same time every year he has a seasonal allergy. Tree, grass, or weed pollen that is prevalent at a certain time of year will trigger your dog’s itching. His symptoms will fade when the pollen stops being released and has been washed away by rain or swept away by wind.

In contrast, dust and storage mites exist inside our homes and can cause itchiness all year long. This is a non-seasonal allergy. Mold spores can cause both seasonal and non-seasonal allergies depending on the source (outdoors or indoors).

Only two types of allergy testing have been shown to provide more information about what is causing a dog’s environmental allergies: an intradermal allergy test and a serum allergy panel.

An intradermal allergy test is performed by a veterinary dermatologist. An area of skin on one side of your dog is shaved and tiny blebs of different substances – potential allergens – are injected into your dog’s skin. These injections are mapped out in a grid format. After a few minutes, each spot where a substance was injected is examined for the presence of a wheal (raised red swelling of the skin). The appearance of a wheal indicates that your dog is allergic to the substance injected in that spot. Intradermal skin tests are considered the gold standard tests for identifying inhaled or contact allergens for an individual dog.

A serum allergy panel can be completed by any veterinarian. This involves taking a sample of your dog’s blood and submitting it to a laboratory that specializes in allergy testing. Levels of antibodies to airborne and contact allergens prevalent in your geographic region are measured. If the level of antibodies to a particular antigen is high, then your dog may be allergic to that allergen. These tests are useful for determining which allergens should go into a dog’s allergy hyposensitization therapy (a.k.a. “allergy shots”), but should not be considered as a diagnostic tool, as they often return false positive results.

There is no blood or saliva test that has been shown to accurately diagnose food allergies in dogs. The only proven method for diagnosing food allergies is a diet elimination trial, which is a long and time-consuming process.

In a diet elimination trial, your dog is fed a novel protein diet – one that contains only protein ingredients your dog has never previously been fed. The novel protein diet is the only food he is fed until his itchiness is completely resolved. Then, other individual food ingredients are added back into your dog’s diet, one at a time, while you observe your dog for the recurrence of any allergic reaction, which would indicate that your dog is allergic to that ingredient. If this happens, that ingredient is removed from the diet until your dog is completely without allergy symptoms; only then would another single ingredient be added to the diet for testing.

During the diet elimination trial, it is vitally important that your dog eat nothing except the prescribed novel protein diet. This means no treats, flavored dog chews, table scraps, and no flavored medications, including some oral flea/tick and heartworm preventatives. (This does not mean that your dog has to go without these important protections; there are flea/tick and heartworm preventatives that can be used during the diet elimination trial.)

How to treat canine allergies

There are several treatment options for dogs with allergies:

• A veterinarian may prescribe medications that interrupt a process in the body called the “itch cascade.” This is a series of reactions that begins when a dog is exposed to an allergen and ends with the dog feeling itchy. These treatment options – like Apoquel and Cytopoint – interrupt the itch cascade so the dog does not reach the stage of feeling itchy.
• Medications that modulate or dampen the immune system’s response to allergens – such as prednisone and Atopica (modified cyclosporine) – may be prescribed by a veterinarian. There are potential side effects for these medications, so baseline bloodwork and periodic monitoring may be necessary when using them.
• Dogs with known food allergies may benefit from a limited ingredient, novel protein diet. Hills, Royal Canin, and Purina all have specially formulated diets that meet these criteria. Unlike limited ingredient diets that are available to purchase without a prescription, these diets are produced separately from other diets to eliminate cross-contamination with proteins that may cause an allergic reaction. Again, if the offending food ingredient is known, a limited-ingredient diet that does not contain that ingredient may help a dog, but if cross-contamination occurs at the pet food manufacturing plant, the allergic dog may suffer symptoms (and the dog’s owner won’t know why!).
• Dogs who do not have known food allergies may benefit from a diet that promotes a healthy skin barrier and flora. This type of diet is available from both Hills and Royal Canin and can be ordered through your dog’s veterinarian.
• Immunotherapy is an effective but time-consuming treatment option for CAD. This involves exposing a dog to low doses of allergens to retrain how their immune system responds to exposure to those allergens. To begin, allergy testing is completed to determine what a dog is allergic to and how severe their response is to those allergens. An immunotherapy serum is created specifically for each individual dog and can be given by injection weekly or by mouth daily. Immunotherapy is continued for at least a year and sometimes longer to achieve a positive effect.
• Bathing your dog once or twice a week with a medicated shampoo prescribed by your veterinarian may help to promote a healthy skin barrier. Some medicated shampoos are formulated to address concurrent bacterial and yeast infections. A leave-in mousse can be applied after bathing to soothe irritated skin, reduce foul skin odor, and resolve infections.
• A supplement that contains the omega-3 fatty acids EPA and DHA can help promote a healthy skin barrier. EPA and DHA have also been shown to interfere with the production of chemicals in the skin that cause inflammation and itchiness. These fatty acids are found in fish oil, but not coconut or olive oils. High-quality omega-3 fatty acids can be found in the products Welactin and Eicosaderm.
• A nutraceutical called palmitoylethenolamide (PEA) may help to reduce the amount of histamine that is released by mast cells in the skin. Reducing the amount of histamine released in the skin can decrease the intensity of a dog’s itchiness. A product called Redonyl is available as a flavored chewable without a prescription.
• Using a high-quality flea preventative all year long is an extremely important part of the treatment plan for dogs with atopic dermatitis. Dogs with allergies are often reactive to several allergens, including flea saliva. Decreasing exposure to fleas is one simple thing we can do to help these dogs be less itchy.

Finding the source of your dog’s itch can be a long and frustrating process. But you do not need to navigate this process alone. Your veterinarian is the best resource for properly diagnosing and treating the cause of your dog’s itchy skin.