e5 Dog dander

Dogs have a global distribution and all dogs produce allergens. Allergic sensitization to dogs is considered to be a risk factor for asthma and rhinitis, and has increased significantly over recent decades for both children and adults. Dog allergen particles are tiny so they easily become airborne, disperse effectively, and can enter small bronchioles to reach lower airways. Dog hair and dander extracts contain many antigens, any of which can bind to IgE antibodies and trigger respiratory symptoms in sensitized individuals. Many of these compounds also cross-react with other mammalian allergens, which poses extended diagnostic and therapeutic challenges. Evaluating dog sensitization can be challenging, but the introduction of molecular-based diagnostics has been an important step forwards in the accurate diagnosis of dog allergy.

Worldwide distribution

A 2016 survey of more than 27,000 internet users from 22 countries reported that one-third (33%) of people have a dog living in their home (2). Allergy to dogs has been recognized for many years (3), but the prevalence of dog sensitization varies geographically due to cultural differences, environmental factors and pet ownership (4). In a large pan-European study of adults referred to allergy testing clinics, approximately 27% (range, 16.1–56.0%) were sensitized to dogs (5). In Korea, 20.4% of adults assessed for various allergic diseases were sensitized to dogs, and direct exposure to dogs was an independent risk factor for sensitization to dog allergens (6).

Allergic sensitization to dog dander was reported by nearly one in ten (9.7%) German children aged 3–17 years (7), and the prevalence of sensitization increased with the age of the child (7, 8). Two large population-based surveys have demonstrated how sensitization to dog allergens has increased significantly over time for both children (Brazil: 8.1% in 2004 to 40.3% in 2016; p<0.001) (9) and adults (Sweden: 13% in 1994 to 25% in 2009; p<0.001) (10), which may be due to the hygiene hypothesis, changes in the manufacturing of agricultural products, and increased urban living with sedentary indoor lifestyle behaviors (9, 10). Of note, adults are more likely than children to be mono-sensitized to animal allergen components (11, 12).

These recent surges in sensitization are of concern because allergic sensitization to dogs may be a risk factor for asthma and rhinitis (3, 9, 13). Regardless of dog ownership, a Japanese study reported that more children with asthma were sensitized to dog allergens before they developed respiratory symptoms than non-asthma children (13).

Worldwide distribution

Dogs have a global distribution and an estimated total population size of 700 million (14). Dogs have evolved a close relationship with humans and can be found as owned pets in households or as free-roaming strays in urban and rural environments (14). Concentrations of dog allergens are highest in indoor environments where these animals are kept, but can also be detected in other indoor or public places where dogs have never been kept because of passive transfer (3, 4).

Living environment

Dogs release allergens through secretions and on tiny particles of skin scales (dander) between 2–5 microns in size (1 micron = 1/25,000 inch) which are commonly found in household dust (4, 15, 16). These particles easily become airborne under normal ventilation so can disperse effectively, and their tiny size enables them to enter small bronchioles and reach lower airways to trigger respiratory symptoms in sensitized individuals (3, 4, 16, 17). Dog hair and dander extracts are complex mixtures of components with more than 28 antigens, any of which can bind to IgE antibodies with varying frequency and intensity in dog-sensitive patients (18).

All dogs produce allergens, however, there are differences between breeds and between individuals within breeds (17, 19-21). Certain breeds are more susceptible to eczema and oily seborrhea, while older dogs have drier skin and produce more dander than younger dogs (22). Seasonal variation can also affect the levels of dog IgE antibodies (22).

All homes with dogs have high levels of dog allergens (23, 24). In private homes, dog allergens have been measured at 1 to >10 micrograms per gram of dust (4, 16), and airborne Can f 1 can range from 0.3 to 99 nanograms per cubic meter of air (16). Levels in homes without dogs maybe 10–100 times lower, but are still detectable and can affect sensitized individuals (4, 16, 23, 24). The threshold level for sensitization to Can f 1 is >2 micrograms per gram, while the threshold level associated with asthma symptoms in sensitized individuals is >10 micrograms per gram (25). 

In both homes with and without pets, the highest levels of pet allergens in dust reservoirs and air are found in the living room and bedroom (16, 23, 24). Carpets and upholstery are major reservoirs for dog allergens, however, detectable levels are also present on bare floors and smooth surfaces such as walls and furniture (16, 26).

School

Apart from the home, school is the most important indoor environment for children (25, 27). Many studies have detected dog allergens in schools at levels exceeding those needed to induce sensitization (27-30). However, levels of dog allergens can vary extensively both within and between schools, depending on factors including the presence of open shelving with settled dust, the extent of carpeted or upholstered areas, and the number of pet owners visiting the school (4, 25, 27, 29).

Classroom fittings, particularly chairs, can act as both direct and indirect sources of different particles and compounds, and the concentration of animal dander allergens in school dust frequently exceeds the amount measured in homes with no furred pets (25, 27, 28, 30). This means that children with asthma and other allergic diseases can be exposed to dog allergens at school even if they have no dogs at home (29, 30). The main source of animal allergens brought into the school setting is the clothing of pet owners (31). It is possible to reduce the levels of animal allergens if students change into school uniforms which are stored and washed at school (31). A Swedish national position paper on asthma and allergies at school recommended that furred animals including dogs should not be allowed on school premises at any time, in order to decrease the allergen levels in favor of pet allergic pupils (32).

Other topics

Significant exposure to domestic allergens can occur outside homes (33). The particles that carry dog allergens are sticky (3), and passive transfer on clothing or human hair can easily transport them to places such as schools, offices, hospitals, automobiles, public transport, and other places where dogs are not usually present (25, 29, 34-36). In these areas, furnishings, textiles such as curtains, upholstery and dust can act as significant reservoirs of allergens and impact indoor air quality (27, 33, 35, 36) in levels which may be higher than those in homes without a dog (34). While levels of allergens may be relatively low in environments outside the home, this exposure could be important for sensitized individuals who do not have a pet at home (29, 35, 36).

For example, upholstered chairs in hospitals constitute a significant reservoir of dog allergen particles, which if inhaled by patients attending appointments could exacerbate asthma (33). Additionally, a public transport study in Helsinki found just over half (53%) of passengers with allergy or asthma had been inconvenienced by symptoms during travel, even though only 0.13% of passengers travelled with a pet (36). 

Environmental source

The dog allergens (Canis familiaris allergens, e.g. Can f 1, Can f 2, Can f 4, and Can f 6) are ubiquitous and found in dog hair, dander and saliva, (3, 53). Can f 3 is also present in serum and Can f 5 in non-neutered male urine (17).

Can f 1 levels are not affected by the number of dogs in the home, but are significantly related to the amount of time a dog is kept indoors (54). Dog gender and breed may affect shedding of allergens and endotoxins into the environment (49). For instance, Can f 5 is only present in significant quantities in intact male dogs (17), which may help explain why children exposed to female dogs have a lower risk of asthma compared to those exposed to male dogs (49). While certain breeds may be marketed as “hypoallergenic” due to reduced shedding or a compact coat, two separate studies failed to show any difference in allergen shedding between dog breed groups (50, 51). 

Asthma and allergic rhinitis

Sensitization to dog allergen in early life is a strong predictor of the development of childhood asthma (37). Furthermore, the probability of remission of childhood asthma in later adolescence is reduced if the individual is sensitized to furry animals such as dogs (38). Contact with an allergen source can cause not only immediate symptoms but also a prolonged period of bronchial hyperreactivity which can last for several weeks (28).

In the UK, dog-sensitized children aged three years who were exposed to high levels of dog allergen had significantly poorer lung function compared to sensitized children who were not exposed (p=0.005) (39). A large population-based survey in the US similarly reported an increased prevalence of asthma and emergency care visits among dog-sensitized individuals exposed to elevated levels of allergens, and attributed 44.2% of asthma attacks to high levels of dog allergen in the bedroom (37). Projection of these results to the entire US population indicated more than one million increased asthma attacks per year for dog-sensitive and exposed individuals (37).

Other topics

Interestingly, approximately half (51%) of patients with severe asthma in Germany, who were previously considered nonatopic on the basis of non-standardized allergy testing, demonstrated allergic sensitization when tested against an extended panel of aeroallergens including dog dander (40).

Skin prick tests

Diagnosis of dog allergy can be difficult: many patients are misclassified due to self-reporting and even structured allergy history assessments can produce high levels (i.e. 27%) of false-positive rates for dog allergy (41). Serum IgE to dog epithelium has a poor correlation to skin testing with only 52.2% agreement and a correlation coefficient r=0.37 (42). Academic studies utilizing component resolved diagnostics have reported only 64% of sensitized adults have IgE reactive to Can f 1, while only one-third (32%) of those individuals are mono-sensitized to Can f 1 (22, 43). This suggests clinicians relying on these tests may be falsely assuming these patients are not dog-sensitized (22).

Evaluating dog sensitization is significantly more challenging and complex than it is for cats, and there remains a great difficulty in using skin prick tests (SPT) for detecting dog-allergic patients (22). Commercially-available dog extracts used in skin testing are composed of multiple proteins which vary by up to 1,000-fold in potency (22). The amounts of identified allergens in each extract are unclear as crude dog extracts are not standardized, and considerable variation in SPT results can also depend on the source of the extract used (e.g. liver, serum, salivary gland or keratinocyte) (20, 22, 44). This extensive variation in the allergen composition of commercial SPT solutions results in a patient-dependent ability to activate basophils (20). Contamination of the extract by non-dog allergens can cause false positives during testing, which also severely limits the utility of crude dog extracts in SPT to accurately identify sensitized individuals (22). 

Prevention strategies

The effect of dog ownership on the development of asthma is inconclusive. Overall, dog ownership at an early age has either been demonstrated to reduce the risk of asthma at a later age (45), or increase the risk of asthma and wheezing (e.g. systematic reviews by (46) and (47)). However, ownership of two or more dogs during the first year of life has been specifically associated with reduced risks of atopy, seroatopy and asthma in children by the time they reached six or seven years of age, versus children who were exposed to no dogs or just one dog (48, 49). The true picture of the relationship between risk and dog ownership is complicated by differences in study design and selection bias, as well as age-related heterogeneity (46, 47).

While certain breeds may be marketed as “hypoallergenic” due to reduced shedding or a compact coat, studies have failed to show any difference in allergen shedding between dog breed groups (50, 51). Washing a dog at least twice a week significantly reduces recoverable Can f 1 in hair and dander samples, and moderately reduces airborne Can f 1 (52). Effective cleaning of floors and seats, as well as the use of uncovered versus covered seats, has been shown to lower the levels of animal allergens in public environments (26, 27, 33, 34, 36).

Author: RubyDuke Communications

Reviewer: Dr. Magnus Borres

Last reviewed: December 2020