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Occupational Deer Dander Allergy Presenting as Contact Urticaria, Rhinoconjunctivitis, and Asthma: A Rare Case

Case Studies 5 min 3

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Created On: 10/08/2026

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Poster abstract

Occupational allergy to cervid dander is an uncommon but important cause of IgE-mediated hypersensitivity that may be overlooked in wildlife professionals. A 36-year-old wildlife worker developed immediate contact urticaria, rhinoconjunctivitis, and asthma exacerbations following repeated deer exposure during culling, carcass handling, evisceration, and global positioning system (GPS) collaring. Symptoms were confined to work-related exposure and resolved upon leaving the exposure environment, while venison consumption remained well tolerated.

Diagnostic evaluation showed sensitization to multiple aeroallergens, with strongly positive prick-to-prick reactions to red deer, roe deer, and fallow deer dander. Multiplex specific immunoglobulin E (IgE) testing identified sensitization to several mammalian allergens, and elevated fractional exhaled nitric oxide (FeNO 58 ppb) indicated eosinophilic airway inflammation despite normal baseline spirometry. The patient was diagnosed with type I deer dander hypersensitivity manifesting as contact urticaria, rhinoconjunctivitis, and occupational asthma.

Management focused on exposure reduction, workplace modifications, personal protective equipment, oral antihistamines, inhaled budesonide/formoterol, and an epinephrine auto-injector. This case emphasizes the need for heightened awareness of rare occupational allergens and highlights prick-to-prick testing as a valuable diagnostic tool when standardized cervid allergen extracts are unavailable.

Complaints

Recurrent localized wheals developing within minutes of direct contact with cervid blood during evisceration.
Itchy, watery eyes during deer-related occupational activities.
Nasal congestion and rhinorrhea associated with cervid exposure.
Recurrent worsening of pre-existing asthma, with chest tightness and wheezing during and shortly after handling deer.

Anamnesis

Introduction

Occupational animal-dander allergy is an IgE-mediated hypersensitivity reaction caused by allergenic proteins, primarily lipocalins and serum albumins, present in animal hair, skin, dander, and secretions. While allergies to cats, dogs, and laboratory animals are well recognized, occupational allergy to cervid (deer) dander is extremely rare and has been described only in isolated cases. The absence of standardized deer allergen extracts can make diagnosis challenging.

This case is presented because it shows a rare occupational allergen producing a combined cutaneous and respiratory phenotype, and because it illustrates the diagnostic value of prick-to-prick testing with native material when standardized reagents are unavailable.

Occupational history

A 36-year-old man employed in wildlife management with routine occupational exposure during deer culling, carcass handling, evisceration, and GPS collaring of live cervids.

Dietary history

Regular consumption of venison without adverse reactions, including processed products (minced steaks, sausages, and dry-cured sausages) prepared from red deer (Cervus elaphus) and roe deer (Capreolus capreolus), as well as minimally processed preparations such as stews, seared fillet (tataki-style), very rare meat, previous red deer tartare, and a rare-to-medium-rare ground elk (Cervus canadensis) burger.

Other animal exposure

No allergic symptoms following exposure to other wild animals (wild boars, foxes, badgers, hedgehogs, and squirrels) or household pets (three dogs and a pet python).

Past medical history

Pre-existing asthma.
Childhood allergen immunotherapy for IgE-mediated hypersensitivity to horse, cat, and rabbit allergens.
No history of angioedema, generalized urticaria, anaphylaxis, or other systemic manifestations.

Examination

(a) Clinical examination

No baseline evidence of airflow obstruction on spirometry performed outside periods of occupational exposure.
FeNO: 58 ppb (reference value <25 ppb), consistent with eosinophilic airway inflammation.

(b) Skin prick test (SPT)

Routine testing using a standard inhalant and epithelial allergen panel demonstrated positive reactions to

Dermatophagoides pteronyssinus
Dermatophagoides farinae
Alternaria alternata
Cladosporium herbarum
Betula verrucosa
Phleum pratense
Fraxinus excelsior
Dog dander
Cat dander

Histamine (1 mg/mL) served as the positive control, producing a 6-mm wheal, while saline was used as the negative control and produced no palpable wheal.

(c) Prick-to-prick testing

Following European Academy of Allergy & Clinical Immunology (EAACI) recommendations, native cervid dander prepared from hair and dander samples was tested.

Positive wheal responses were noted for:

Red deer (Cervus elaphus): ≥10 mm
Roe deer (Capreolus capreolus): ≥7 mm
European fallow deer (Dama dama): ≥5 mm

To exclude irritant reactions, identical testing was performed in eight non-atopic hospital staff members, all of whom showed negative responses.

(d) Multiplex allergen-specific IgE testing (ALEX2)

The assay confirmed broad sensitization to aeroallergens and demonstrated specific IgE against mammalian allergenic proteins, including:

Cat lipocalin (Fel d 4)
Dog lipocalin (Can f 1)
Bovine lipocalin (Bos d 2)
Horse lipocalin (Equ c 1)
Dog serum albumin (Can f 3)
Cat uteroglobin (Fel d 1)

Diagnosis: Occupational cervid dander allergy manifesting as contact urticaria, rhinoconjunctivitis, and asthma.

Treatment

(a) Initial management
Once cervid dander allergy was identified as the trigger, the first step taken was minimizing further occupational exposure to cervid dander and blood, covering both live animals encountered during collaring activities and carcasses handled during culling and evisceration.

(b) Definitive treatment
The patient was advised to implement strict occupational avoidance of cervid exposure whenever feasible. During unavoidable professional activities involving cervids, consistent use of appropriate personal protective equipment, including gloves and face masks, was recommended to minimize allergen exposure.

(c) Medications and ongoing therapy
Oral antihistamines were prescribed to control cutaneous and rhinoconjunctival symptoms, while maintenance therapy with inhaled budesonide/formoterol was initiated for asthma management and continued during occupational exposure. In addition, the patient was provided with an emergency adrenaline (epinephrine) auto-injector and instructed to carry it at all times as a precaution against potential severe allergic reactions.

Results

With exposure reduction, personal protective equipment, and pharmacologic therapy in place, the patient's respiratory symptoms — chest tightness and wheezing — resolved completely once cervid exposure ceased.

Key learnings

Cervid dander is a rare but important occupational allergen that can cause contact urticaria, rhinoconjunctivitis, and occupational asthma.
Prick-to-prick testing with native cervid dander is a practical diagnostic tool when commercial extracts are unavailable.
Normal spirometry does not rule out occupational asthma; elevated FeNO and exposure history can support the diagnosis.
Cervid dander sensitization may occur despite continued tolerance to venison consumption.
Early diagnosis, workplace exposure reduction, appropriate personal protective equipment, and timely initiation of anti-allergic therapy are essential to prevent ongoing exposure, disease progression, and long-term occupational disability.