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Adult-OnSet Allergies

A one-two punch of genes plus environment can lead to developing allergies later in life.

You're 70, just retired, and heading out on a warm spring day to take your grandkids to the park. But your eyes won't stop running, your inner ears itch so badly you keep sticking your fingers in them, and you're sneezing so many times in a row, you can hardly see to drive.

You're Never Too Old
"This is crazy," you think. "It can't be seasonal allergies; I'm not a kid!" Unfortunately, allergies can strike at any age --- it's not as uncommon as you think. Nor are adult-onset allergies limited to allergic rhinitis from allergens in the air. Take the story of Robert Tutton, a blogger for The New York Times.1 A March 2013 blog post related Tutton's story:

It started about two years ago, when I resolved to be healthier and bought a juicer. A few months into my new lifestyle, I started to cough after drinking a tall glass of fresh carrot-apple juice. I coughed until I threw up. My skin tingled and itched; it turned beet red --- from my face down to my chest. Hives started creeping out from under my sleeves toward my hands. I consider myself fortunate that my symptoms didn't include my throat closing. Doctors diagnosed an allergy to carrots, even though they had never troubled me before.

"My adult patients are always so surprised to be diagnosed with allergies," said Maureen George, PhD, RN, AE-C, FAAN, an associate professor of nursing at Columbia University Medical Center and a member of the Asthma and Allergy Foundation of America's medical scientific council. "They think it's a risk they've outgrown."

While it is not rare to develop allergies at an advanced age, it is less common than childhood onset. "In most people, onset is much more prevalent in early childhood or early adulthood. As you age, the persistent immune response is attenuated, and allergies decrease over the years," George stated.

It Runs in the Family
Adults who develop allergies probably have at least one parent or close family member who carries the atopy gene. Atopy is the genetic tendency or predisposition toward developing certain allergic hypersensitivity reactions to various things, and to develop the classic allergic diseases: atopic dermatitis, allergic rhinitis (hay fever), and asthma. Atopy involves the body's capacity to produce IgE, one of the five subclasses of antibodies that are made by the immune system to attack antigens, such as bacteria, viruses and allergens. In an atopic person, the immune system can overreact to common environmental proteins, such as the house dustmite, grass pollen, and food allergens.

"Allergies are the perfect exemplar of genes plus environment," George noted. "If you have a predisposition, and you're exposed to the allergen, there is always a chance that an allergy might develop."

Also puzzling is that allergies sometimes still develop when neither parent has the atopy gene. "This happens in about 20% of cases," George commented.

What Flips the Switch?
But what makes the switch flip, so to speak, from non-allergic to allergic, seemingly overnight? "This is not a question science can answer yet," said Janna Tuck, MD, who specializes in allergy and immunology at Allergy Partners of Cape Girardeau, MO, and is a spokesperson for the American College of Allergy, Asthma and Immunology. "Medical researchers are just beginning to realize how complex the human immune system is."

Tuck went on to say that there are times when you think you can pinpoint what probably led to the onset of allergies. A person who's never lived with a pet, then gets a cat and begins sneezing, has probably never been exposed to large amounts of pet dander. Once exposed, the scale tips, and allergies begin.

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Often a move to a new location can trigger an adult's allergies. "Say, for example, you have a man who lived his entire life in Cripple Creek, CO," Tuck said. "It's a very high altitude and a dry climate; and there is a relatively low dust mite population in Colorado, because mites can only replicate in climates with 75% humidity. Suppose he moves to Missouri --- a state with totally different weather, flora and fauna, and a much higher population of dust mites. The scales could tip; he might develop allergies for the first time in his life."

Many Unsolved Mysteries
But what about the grandfather mentioned in the first paragraph of this article? He hadn't moved. What about Robert Tutton, the NY Times blogger who had eaten carrots his whole life and had never been allergic to them --- until the morning he suddenly was?

George reiterated what Tuck said earlier. "Science doesn't have all of the answers in this area of medicine; there's so much we don't know," she explained. "But we do know that since the 1980's, we've seen an increase in allergies across the board. And when you have an increase across the board, you will see more geriatric patients also presenting with symptoms."

George said that scientists do know one thing for certain. "The pollen season has increased by almost one full day each year for 20 years in a row, on average," she stated. She uses northern Minnesota as an example. The climate in this state has changed so dramatically over the last two decades, it is experiencing a much longer allergy season than it used to --- 16 full days longer than in the past-and is recording a much higher pollen count all season long than ever before. And, doctors in this state are experiencing the highest increases in allergy incidence."

The longer allergy season increases the chance of having a high pollen count coincide with a "high ozone" day, which, according to George, "drives the allergens deeper into a person's lungs."

Seek an Allergist's Help
What is the best advice for people who are entering their twilight years and suddenly find themselves sniffling and sneezing? "Don't just assume your runny nose is caused by allergies," Tuck instructed. She's seen her share of older patients that have made this assumption, and have tried every OTC allergy medication available, to no avail. When allergy skin tests are performed, nothing turns up --- because they have vasomotor rhinitis, which is more of an "irritant response" (to strong odors, such as cigarette smoke, perfumes or strong cleaners) than a true allergy.

"If a patient believes they've developed allergies, they should go and see a board-certified allergist to either confirm or rule out a suspected allergy," Tuck urged. "We can certainly help those patients who do have allergies; but we can also offer solutions to those who don't."

Reference
1. Tutton, R. The New York Times. The 6th Floor.  Available: http://6thfloor.blogs.nytimes.com/author/robert-tutton

Anne Collins is on staff at ADVANCE. Contact: acollins@advanceweb.com.


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