Dermatological allergies in horses are common and frustrating problems. The three main types of allergies are insect bite hypersensitivity (IBH), atopic dermatitis (AD), and chronic urticaria (CU), with some horses presenting with more than one allergy type at the same time. These diseases run the gamut of hypersensitivity reactions, with IBH due to type I (acute) and type IVb (chronic) reactions. Both AD and CU are also caused by type I hypersensitivity, with CU additionally mediated via type II and III hypersensitivities. Stress, physical stimuli, and exercise also complicate CU. Specific diagnostic tools are limited; therefore, allergens are often diagnosed based on clinical signs, history, and response to treatment. The key to treatment of equine dermatological disease is environmental management, however this may not be possible based on the horse’s lifestyle. Conventional medications have focused on antihistamine and immunosuppressive medications, which can have undesirable side effects. Integrating traditional Chinese veterinary medicine (TCVM) provides alternative or ancillary therapy for skin allergies in horses, and offers a variety of modalities (acupuncture, Chinese herbal medicine, food therapy) which can be targeted to patient need and temperament. Combining conventional and TCVM therapies through an integrated medicine approach provides improved management of this complex disease for equine clinicians. A review of the immune mechanisms associated with dermatological allergic disease in horses is presented along with conventional and TCVM treatment options. A case study provides an example of how to organize and institute an integrated protocol for optimal management of equine allergic skin disease.