Pet dander and perennial allergic rhinitis: therapeutic options.

Pet allergy may now be the most common perennial allergen in the United States based on recent skin-prick testing data. This trend corresponds with the rise (from 56 to 63%) in U.S. households having indoor pets over the past 10 years. Furthermore small, suspended, particulate animal allergens may be found in 90% of all homes and most public indoor areas. Although the most important cat and dog allergens are Fel d 1 and Can f 1, respectively, there are five well-described allergens for both cats and dogs. The effects of early life domestic pet and endotoxin exposure and subsequent clinical sensitivity remain controversial. Given that only the rare pet-allergic patient is willing to give away his/her pet, it is important to take an evidence-based approach to environmental control. Unfortunately, the benefits from changes in the environment that have been shown in research studies relate more to a reduction of allergens than symptoms. The pharmacotherapy for pet allergy will vary based on whether this is episodic or perennial allergic rhinitis (PAR) and on the severity of the symptoms. A stepwise approach for management, using both mono- and combination therapy, is proposed. Allergen immunotherapy, the only disease-modifying treatment available, may be the best therapeutic recommendation for patients with moderate to severe pet-induced PAR.