Mayo Clinic Q and A: Reasons for developing allergies later in life not always clear

• By

  Liza Torborg

  July 21, 2015

DEAR MAYO CLINIC: I didn’t have allergies when I was younger. But now in my 40s, I seem to get allergy symptoms during the spring and summer. Is it possible to develop allergies as an adult? Should I get tested? If so, what do allergy tests involve?

ANSWER: You can develop allergies later in life, and there is definitely value in getting tested to see if your symptoms are due to allergies. If they are, the test results will give you information about what you’re allergic to and help guide you as you decide on treatment. Allergy tests usually involve a skin test, a blood test or both.

Allergy development typically has two phases. During the first phase, called sensitization, you come in contact with a harmless substance, and your body mistakenly starts making allergic antibodies, called IgE antibodies, to fight that substance. Those antibodies don’t do anything until you are exposed to the substance, or allergen, again. At that time, the second phase starts. The allergen binds to the IgE antibodies. That sets off a cascade of immune reactions in your body, such as itchy or watery eyes, nasal congestion and sneezing, among others.

Common triggers for seasonal allergies include tree and grass pollen, which are prevalent in the spring and summer; ragweed pollen or other weed pollen, which are common in the fall; and spores from molds and fungi, which tend to be widespread in warm-weather months. This is in contrast with house dust mite allergen, which is considered perennial (present all year long) but has also shown seasonal variations based on ambient humidity.

It’s not always clear why some people develop allergies later in life when they didn’t have them before. A common reason for developing new seasonal allergies is moving from one geographic region to another. If you grew up in an area that has certain plants and trees, then moved to another area that has a different mix of vegetation you’ve never been exposed to, you may develop allergies to those new plants.

If, as in your situation, allergy symptoms develop but you aren’t sure what you might be allergic to, or even if your symptoms really are allergies, it is worthwhile to go through allergy testing. The tests can show what you are sensitive to, and knowing that can go a long way to customizing treatment to your specific situation.

A procedure called a skin prick test can be very helpful in diagnosing allergies. During the test, small amounts of material that can trigger allergies are pricked into the skin of your arm or upper back. Your doctor then watches for signs of an allergic reaction in those areas. If you’re allergic to a certain substance, you will develop a raised itchy bump at the test location on your skin.

In some cases, your doctor also may recommend a blood test to measure the presence of allergen-specific IgE in your bloodstream. A blood sample is sent to a medical laboratory, where it’s tested for evidence of sensitivity to possible allergens.

Once you know what you are allergic to, your doctor can help you decide on treatment. A wide variety of effective treatment is available for seasonal allergies. Some allergy treatments, like certain antihistamines, nasal corticosteroid sprays, saline sprays and washes, are available without a prescription at most drugstores and pharmacies. Other oral medications and some nasal corticosteroids require a prescription from your doctor.

To most effectively control your symptoms, talk to your doctor about getting tested for allergies. Then work with him or her to find the therapies that are best for your situation. — Rohit Divekar, MBBS, Ph.D., Allergic Diseases, Mayo Clinic, Rochester, Minn.

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Yes, Adults Can Develop Allergies Later in Life: Here’s How

Did you eat a meal you used to eat with no problem, and suddenly it made you break out in hives? Or did you go on a walk on a lovely sunny day, and you left sneezing and sniffling? If you’ve never had these problems before, you might be in disbelief and ask yourself, “can allergies and even anaphylaxis develop later in life?” You’re experiencing adult-onset allergies, and yes, adults can develop allergies later in life.

In this article, we’ll explain how allergies develop, why allergies develop in adulthood, and tips for treating your flare-ups.

What Are Adult-Onset Allergies?

Adult-onset allergies are allergies that manifest later in life. Allergies can develop from young adulthood to senior years. Typically, if you lived through your 20s without any new allergies or allergy symptoms, the chances of developing a new allergy are low.

How Allergies Develop in Adulthood

Most people typically develop allergy symptoms at a young age, outgrow their allergies, and become tolerant around their 20s or 30s. But it’s possible to develop an allergy or become allergic to something at any point in your lifetime. There isn’t clear reasoning as to why or how allergies develop in adulthood. Still, researchers believe that having one severe allergic reaction or symptoms during childhood can increase your chances of developing allergies as an adult.

Other possible triggers for adult-onset allergies include:

• If you had a skin condition, like eczema, as a child
• If you had a small exposure to an allergen as a child
• If you relocated to a new location or workplace with new allergens
• If you have a reduced immune system function and you come into contact with allergens
• If you have a pet for the first time

Possible Treatments for Allergies

Developing seasonal or pollen allergies later in life doesn’t have to be a complete game changer. But you should treat allergies of all severities. Here are some possible ways to treat your allergies, from seasonal allergies to severe food or contact allergies:

• Get a skin prick test: This test can help you see what specific allergens trigger your reactions
• Tell people around you about your allergies: Just in case you come into contact with a possible trigger, tell the people around you so that they know how to treat you
• Keep an EpiPen nearby: Having an EpiPen is essential if you interact with an allergy trigger
• Take antihistamines: Zyrtec or Benadryl can reduce your symptoms or keep them under control
• Consider allergy shots: Immunotherapy can gradually build your immunity within a few years of regularly getting shots

Yes, adults can develop allergies later in life. Some allergy symptoms are mild and require simple treatment, such as taking medication, while some symptoms are life-threatening.

If you’re dealing with new allergy symptoms or persistent allergy symptoms, we encourage you to reach out to Allergy & ENT Associates. Our allergy clinic near Houston provides professional treatment in allergies, asthma, and other severe allergies requiring special care. Book an appointment with us today!

Get rid of allergies! Myth or reality?

Interview with allergist-immunologist Sarida Nurievna Medjidova, who has been receiving patients at the PARACELS Allergy and Asthma Center for more than 12 years.

According to the World Health Organization, about 40% of the population is allergic to one or another substance. The accelerated rhythm of life, nutritional errors, environmental features, genetics – all these are factors that affect the development of allergic reactions. Is it possible to get rid of allergies? We talked about this with Sarida Nurievna Medzhidova, an allergist-immunologist at Paracelsus Medical Center.

Sarida Nurievna, please tell us, is it possible to cure allergies today?

It all depends solely on the type of allergy and the duration of the allergic process. Of course, it is almost impossible to completely cure an allergy, but it is possible to bring a person into a stage of long-term remission.

What are the most common allergies and which can be cured?

The most common allergy is to dust, animals, plant pollen. About 80% of my patients react to these allergens.

Using the method of allergen-specific immunotherapy (ASIT), we treat allergies to plant pollen, trees, meadow grasses, house dust mites.

Which allergy symptoms should I look out for and when should I seek medical help?

The most common allergic symptoms are: runny nose, nasal congestion, sneezing, itchy mouth, conjunctivitis/watery eyes, red and itchy eyes. Of the more severe ones, these are shortness of breath, heaviness in the chest, causeless cough, skin rashes. Allergy symptoms often appear suddenly and do not depend on colds and time of day. Such symptoms pass very well, for example, on vacation by the sea, and when you return home everything returns again.

How is allergic disease treated?

Treatment of allergic diseases occurs in two stages. The first is diagnostics, the determination of a causally significant allergen. At the appointment, the doctor carefully finds out at what time of the year, where and how allergy symptoms appear in order to determine the most significant allergens for the patient. The second stage is treatment. Limitation of contact with the allergen, the use of pharmacotherapy, allergen-specific immunotherapy (ASIT). Pharmacotherapy has a fairly rapid effect on symptoms, however, as a rule, when it is stopped, all symptoms return. The only method that can currently change the body’s attitude to the allergen and prevent the further development of allergies is ASIT.

ASIT consists in the gradual introduction of doses of the allergen responsible for the onset of symptoms into the human body. Gradually “getting used” to the allergen, the body stops responding to it.

Why ASIT?

With ASIT therapy, we influence the triggering of an allergic reaction. It’s like getting “vaccinated” against a disease. The mechanism is the same.

During treatment, the patient’s symptoms decrease or completely stop, the consumption of symptomatic drugs decreases, helps to avoid the development of multiple allergies, and prevents the transition of allergic rhinitis to bronchial asthma. If this is a seasonal allergy, then the treatment takes place in semi-annual courses. The patient uses the drug for six months, rests for six months.

How long does the treatment take?

Treatment with the ASIT method is long and takes from three to five years. At the first (initial) stage of therapy, allergens are introduced into the body with a gradual increase in dose; at the maintenance stage, the maximum dose of the allergen is introduced. The patient will be able to feel the effectiveness of the treatment after two years. Thanks to the methods of molecular diagnostics, we can give the patient, if I may say so, a guarantee of the safety and effectiveness of treatment using ASIT therapy. With the right treatment, together with the patient, we achieve the effect of long-term allergen resistance after therapy is discontinued.

What happens if the allergy is not treated? Antihistamines are very good at relieving symptoms.

If left untreated, allergic symptoms can cause complications and make the illness worse. Allergy significantly reduces the quality of life of patients. From the constant use of antihistamines, a person feels constant drowsiness, fatigue. Efficiency and academic performance are significantly reduced. It is especially difficult in the spring for schoolchildren and students who are allergic to flowering. This is the time for tests, exams and tests, when it is especially necessary to be included in the learning process.

What are the dangers of antihistamines. It seems that allergies are so easy to deal with. I took a pill – the symptoms disappeared.

The use of antiallergic drugs corticosteroids, bronchodilators is called symptomatic treatment. Due to their effect only on allergy symptoms. They do not eliminate the cause of the disease. With a new contact with the allergen, the symptoms return again. The effect of addiction is known, patients are often forced to change symptomatic drugs and increase the doses of medications taken.

How to evaluate the effect of ASIT therapy?

The patient will immediately feel an improvement in their well-being. Already in the second year after ASIT treatment, patients note a decrease in allergic symptoms, and at the same time, the need for the use of symptomatic medications sharply decreases, it is often possible to stop the progression of allergies (both the transition of rhinitis to asthma, and the expansion of the list of significant allergens, the tolerance of cross allergens, physical activity).

When should ASIT treatment be started?

With pollen allergy – in winter, with household allergies – during remission. Before starting ASIT, the attending allergist-immunologist instructs each patient, and if the patient is a child, then detailed training of parents. After the briefing, the patient signs an informed voluntary consent for ASIT and receives a passport of the patient receiving ASIT, the necessary written instructions. At our center, it is accepted that each patient receiving ASIT is assigned to his allergist, has the opportunity to contact him with any question that arises, and in the case of the temporary absence of “his” doctor, get advice from any other allergist on the day of treatment (by phone, e-mail, face-to-face). Our doctors, administrators and nurses affectionately refer to ASIT patients as “ASITs” and are always ready to help.

Allergies in children. Causes

According to some reports, 30-35% of children suffer from allergies, and in recent years these figures have been increasing.

Allergic reactions occur when the immune system reacts incorrectly, aggressively to certain substances that do not pose a danger to the body.

In this case, such substances are called allergens, and they are very different. The manifestations of allergies are also diverse: some of them cause only minor discomfort, while others are potentially life-threatening. The main measures to combat allergic diseases are avoidance of contact with allergens and antihistamines. In some cases, allergen-specific immunotherapy (ASIT) is used.

Allergies

Consider the main types of allergies in children.

Food allergy

According to the Union of Russian Pediatricians and the US Centers for Disease Control and Prevention (CDC), the prevalence of verified food allergies in children is 6-8% (1 out of 13-15), in adolescents – 2-4%, in adults – 2% . That is, we can say that it is predominantly a disease of younger age.

As the name suggests, food allergies are allergic reactions that occur after eating certain foods. But not every undesirable reaction to food is an allergy. There is such a thing as “adverse reactions to food”, and they are of two types:

• Non-immunological – food intolerance. This is a dose-dependent process, that is, the presence and severity of the reaction of the body will depend on the amount of the substance. It is most common and may be associated with a deficiency of certain digestive enzymes (the most common example is lactase deficiency, when the digestion of the “milk sugar” lactose is impaired), the toxic effects of certain substances in food, and microbial contamination.
• Immunological – food allergy. This process, on the contrary, does not depend on the amount of the allergen: both with a small dose of antigen and with a large dose, an allergic reaction will occur. These reactions are associated with an abnormal response of the immune system and are mediated through antibodies – immunoglobulins E (IgE).

What are the most common food allergens? 1.5% of young children are allergic to milk proteins. Moreover, in 15% of them, these allergic reactions persist in the second decade of life, and 30% are allergic to other products. Allergy to eggs occurs in 1.3% of children, to peanuts – in 0.5%. Other common food allergens include soy, cereal proteins, fish and seafood, and various dietary supplements.

Allergic rhinitis

According to the results of the International Study of Asthma and Allergy in Childhood (ISAAC), symptoms of allergic rhinitis occur in 8.5% of children aged 6–7 years and in 14.6% at the age of 13 years. -14 years old. The main symptom of pathology is congestion and watery discharge from the nose. The most common allergens are:

• wind pollen
• house dust mites
• proteins found on the skin and in dander of cats, dogs, horses, other animals
• molds
• cockroach excrement and other dust components

A child’s seasonal allergy to pollen is often fairly easy to detect: parents notice that symptoms appear at the same time during the year when certain plants begin to bloom. And if the allergen acts constantly, then allergic rhinitis is often mistaken for frequent colds, and it is not possible to understand the diagnosis right away.

Allergic conjunctivitis

This term refers to allergic reactions affecting the conjunctiva of the eyes. Usually they are combined with rhinitis – in this case, the term “rhinoconjunctivitis” is used.

Allergy to insect stings

Some insects inject poison under the skin during a bite. The body reacts to foreign substances, inflammation develops. But if a child is allergic to these compounds, the reaction can be much more severe. Usually, an allergic reaction does not occur after the first bite. It develops for the second or third time. Most often there is an allergy to the stings of bees, wasps, hornets, fire ants.

Contact allergy

Contact allergies develop when the skin comes into contact with certain chemicals. Most often these are various cosmetics, detergents, pesticides. A typical manifestation is urticaria.

Drug allergy

Drug allergies occur after taking certain medications. Any medication can cause it. For example, such reactions are common to antibiotics.

Atopic dermatitis

Atopic dermatitis is not pure allergy. It is referred to as multifactorial diseases, that is, those that develop under the influence of many factors. Not the last role is played by disturbances in the work of the immune system. Atopic dermatitis develops in 10% of children, usually in early infancy.

Symptoms

The manifestations of allergies are different. The main possible symptoms:

• nasal congestion and watery discharge
• sneezing
• blisters
• red spots, skin rash
• itching, burning of the skin
• itching and tingling sensation in the mouth
• nausea, vomiting
• diarrhea
• swelling of the face, tongue, lips
• cough, wheezing, wheezing
• suffocation due to laryngeal edema
• dizziness, presyncope, syncope
• redness and itching of the eyes, lacrimation

Usually, these symptoms occur after a short time – minutes – after contact with the allergen. Sometimes the connection is clear, for example, the child ate something, he was bitten by an insect, and almost immediately there were manifestations of an allergic reaction. And sometimes it is difficult to establish what causes the symptoms. What seemed like an allergy at first glance may turn out to be something completely different. An accurate diagnosis can be carried out by a doctor – an immunologist-allergist.

Severe allergies can manifest themselves in the form of such forms as:

• Angioedema – is an acutely developing tissue edema. It is most pronounced where loose subcutaneous tissue is well developed: in the area of ​​the lips, cheeks, eyelids, oral mucosa, tongue, scrotum in boys. The most dangerous swelling of the larynx: it manifests itself in the form of loss of voice, difficulty, wheezing breathing. Such a patient may die from suffocation. Sometimes, when the intestines are affected, symptoms of intestinal obstruction appear.

• Anaphylaxis is the most severe type of allergy. During it, blood pressure drops, blood circulation and respiration are disturbed. If you do not provide emergency assistance, it threatens the death of the patient. Anaphylaxis is very rare, most often allergic reactions occur in milder forms.

Acute allergic reactions

In case of a severe acute allergic reaction, immediately call an ambulance . Until the doctors arrive, you can take some measures:

• Do not panic and try to calm the child
• Stop child exposure to the allergen as soon as possible. Flush skin and mucous membranes with water
• Do not let the child drink or eat
• Give activated charcoal
• If a child is bitten by an insect, remove the stinger and apply ice to the bite site
• At the first sign of anaphylaxis, lay the child on his back and elevate his legs – this will help increase blood flow to the head
• If the child is unconscious or vomiting, place the child on its side to prevent inhalation of the vomit

For mild allergic reactions, you can give an antihistamine (taking into account age dosages!), But you still need to seek medical help.

Causes

The causes of allergies in children are not fully understood. Allergy sufferers produce immunoglobulins (antibodies) of class E more actively. They trigger an immune response. But why this happens in some people is not yet fully understood.

It is known that genetics and heredity play an important role. So, allergic diseases develop in 30–50% of children if one of the parents suffers from allergies, in 60–80% if both parents suffer, and only in 12% of children whose families did not have these pathologies.

Violations in the maturation of immunity in a child at the earliest stages of life are important. In turn, this can be influenced by exposure to strong allergens in infancy (including environmental pollution), early cessation of breastfeeding, frequent infections, the use of antibiotics (they destroy the microflora involved in the maturation of immunity), and other factors.

In 1989, scientists put forward the hygiene hypothesis when they noticed that members of large families are more likely to suffer from infections, but less often from allergic reactions. It has been suggested that “sterile” conditions contribute to the development of allergies. According to the hygiene theory, in order to “train” and work properly, the immune system needs to constantly come into contact with various bacteria and viruses, antigens. Subsequently, many studies have been carried out on this topic, but their results have been contradictory. There is no final clarity on this issue yet.

The immediate cause of an allergic reaction is the contact of a predisposed organism with an allergen. As we mentioned, allergens can enter the body in different ways, and depending on this, they are divided into three main groups:

• oral – swallowed
• respiratory – respiratory
• contact – skin contact

When should I see a doctor?

Any signs of an allergy in a child should be a reason to see a doctor. Usually, at first, parents visit a pediatrician, and already he sends an appointment to an immunologist-allergist. It is necessary to identify which allergens the immune system reacts to and prescribe antihistamines to prevent future episodes of allergic reactions.

In case of severe manifestations of allergy, an ambulance should be called immediately:

• swelling of the mucous membrane of the oral cavity, tongue
• swallowing disorder, speech disorder
• labored, wheezing, wheezing breathing
• abdominal pain, nausea, vomiting, diarrhea
• dizziness, loss of consciousness

Diagnostic methods

An allergy can be diagnosed in a child when they have symptoms and special tests have shown hypersensitivity to the relevant allergen. These two conditions must be met simultaneously.

There are two main methods for diagnosing allergic conditions:

• Skin test – prick test. During it, the doctor applies a small amount of the allergen in the form of a solution to the skin and makes scratches. The child is then observed for 15 minutes. The presence of an allergy is indicated by the appearance of a blister and redness – they are measured with a ruler. At the same time, discomfort, burning, itching can be felt on the skin. Symptoms resolve within 30 minutes or a few hours. Often during one procedure, sensitivity to several allergens is checked at once. Contraindications to skin testing include a history of anaphylactic reactions, acute allergies, dermatographic urticaria, and a child under 6 months of age.

• Blood tests for class E immunoglobulins to various allergens. At the same time, it makes no sense to measure their general level, because a huge variety of their varieties circulate in the blood, and each is directed against its own antigen. Measure only the levels of specific IgE directed against a particular substance.

These tests are enough to diagnose allergies, identify the allergen and give the child’s parents the right recommendations, prescribe effective treatment. With food allergies, an elimination diet can be prescribed, when certain foods are excluded from the diet, or, conversely, the inclusion of certain foods in the diet. At the same time, they observe how the symptoms have changed. Other studies may be ordered as indicated, for example, when there is doubt about the diagnosis and allergies need to be distinguished from other diseases.

Methods of treatment

The most effective method of dealing with allergies is to avoid contact with allergens. Recommendations depend on the type of allergen. For example, when reacting to certain foods, they simply need to be removed from the diet. Frequent wet cleaning helps to keep allergies to house dust components under control. With seasonal allergies to pollen, there is a whole list of recommendations during the flowering of “problem” plants:

• frequent wet cleaning
• do not go out during high concentrations of pollen in the air
• changing and washing immediately after walking
• close windows in windy and dry weather
• do not walk where allergenic plants bloom
• if possible, move to a region where there are no such plants

Unfortunately, it is not always possible to exclude contact with the allergen by 100%. To eliminate the symptoms of an allergic reaction, antihistamines are used. They do not affect the functioning of the immune system, but block the action of the main mediator of inflammation – histamine. Allergic adults and children use the latest generation of drugs – they have fewer side effects, and they do not have a sedative effect. According to indications, the doctor may prescribe other drugs, for example, glucocorticoids, leukotriene inhibitors, etc.

In some cases, the so-called antigen-specific immunotherapy (ASIT) can be carried out – it is also often called “allergy vaccination”. At the moment, this is the only treatment method that allows you to cope with allergies and achieve a lasting effect. It is allowed to be used from the age of five.

The essence of ASIT is that increasing doses of an allergen are introduced into the patient’s body – the immune system, as it were, is “accustomed” to responding to it correctly. Treatment lasts from 3 to 5 years and consists of two phases:

1. Basic . The allergen is started with a minimum dose and gradually brought to the maximum tolerated.

2. Supporting . At this time, the maximum tolerated dosage of allergens is used.

If a child suffers from seasonal allergies, then pre-season ASIT is carried out. The allergen begins to be introduced 3-4 months before the corresponding plants begin to bloom. By the beginning of flowering, the maximum tolerated doses are reached. After that, the treatment is interrupted and resumed the following year. Year-round ASIT is usually performed for household allergies, for example, to dust components. After reaching the maximum tolerated dose, it is continued periodically throughout the year.

ASIT is an effective and safe method of treatment , provided that the doctor carefully assesses the child’s condition and conducts the necessary examination.

Possible complications

If left untreated, allergies can lead to complications. Some of them:

• headaches due to persistent stuffy nose
• frequent respiratory infections , chronic sinusitis
• maldevelopment of dental arches and malocclusion – in allergic rhinitis
• increased fatigue and reduced school performance
• skin infections due to frequent scratching
• development of severe allergic reactions : anaphylaxis, angioedema

Forecast

The prognosis for food allergies depends on the type of allergen. In most cases, newborn allergies to milk, eggs, and soy disappear over time. Reactions to peanuts, tree nuts, fish and seafood often persist.

With allergic rhinitis, it is usually possible to keep the symptoms under control by following the doctor’s recommendations and taking prescribed medications. The condition often helps to significantly improve ASIT, but its result may become noticeable only after years.

What if my child has allergies?

Do not ignore the symptoms and let the disease take its course. The child must be examined by a doctor. He will figure out whether the manifestations are caused by an allergy or another disease, give recommendations, and prescribe treatment.

Main

• Allergic reactions in children are quite common and are now on the rise.
• Allergies can manifest themselves in different forms, and the symptoms may not always be immediately recognizable.
• The causes of the disease are not fully known.
• If a child develops allergy-like symptoms (even mild ones), they should be seen by a doctor.
• The most severe manifestations of allergy are Quincke’s edema and anaphylaxis. They are rare, but pose a threat to life and require emergency medical attention.
• Skin tests and blood tests for IgE are used to diagnose allergies. Other studies are carried out according to indications.
• The main methods of treatment of allergies: the exclusion of contact with the allergen, antihistamines (and others – according to indications) drugs, in some cases – antigen-specific immunotherapy (ASIT).