Adult Allergies

First-time allergies in adults are on the rise -- and they often don't go away like the ones you get as a kid. Here, how to find sweet relief.


Allergies -- At Your Age?

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"Compared to 20 years ago, there's simply no doubt that we're seeing more adult patients seeking help for new allergies," says Peter Socrates Creticos, MD, medical director of Baltimore's Johns Hopkins Asthma and Allergy Center. Among the most common types: pollen, dust, mites, pets, mold, and food -- all of which you can have reactions to for the first time as a grown-up.

When you're allergic, your body responds to something it sees as an allergen by first making immunoglobin E (IgE) antibodies, proteins the immune system produces to recognize and fight specific body "invaders." An allergic reaction is what happens when the IgE antibodies that are now in your body trigger the release of histamines, leukotrienes, and other chemicals. These substances cause all allergy symptoms, from the sneezing sparked by a mild pollen allergy to breathing difficulties from a severe food reaction.

Adult Allergy Causes

Why can you suddenly become allergic to, say, cat dander? Because if you have a genetic predisposition to this allergy, it can take years of exposure before your body starts making IgE antibodies. Or these are triggered when moving exposes you to a new area's allergen (as in my situation). Viruses may contribute, too -- people are more liable to get an allergy after being sick. Then there's the "hygiene hypothesis": Smaller family size, improved sanitation, and personal cleanliness as well as frequent use of antibiotics limit exposure to infections from viruses and bacteria, resulting in fewer infections and prompting people's immune systems "to develop the tendency to overreact to routine things like dust mites or pollen," says Amin S. Kanani, MD, clinical instructor, division of Allergy and Clinical Immunology at the University of British Columbia, in Vancouver. In addition, air pollution may irritate airways, making us more allergy prone.

Whatever the causes, one thing is clear: Unlike children, who sometimes outgrow allergies, "if you develop one as an adult, chances are you will have it for the rest of your life," says Beth Corn, MD, chief of the Allergy/Asthma Clinic at New York City's Mount Sinai School of Medicine. No one knows why. We do know that left untreated, allergies can cause fatigue, sleep disturbances, and mental fogginess.

Environmental Allergies

Repeated colds or sinus infections may put you among the 36 million Americans with hay fever (allergic rhinitis), an allergy to tree, grass, and weed pollen; the 10 million allergic to cat dander; or those allergic to dog or rodent dander, cockroach droppings, Asian ladybugs, or mold or dust mites (tiny organisms that live in the fibers of pillows, mattresses, and carpets). Symptoms include coughing, sneezing, itchy and/or watery eyes, runny nose, and scratchy throat. See an allergist if your primary doctor can't find the cause.

You may be advised to give up your dog or cat -- or vacuum and dust at least weekly to remove dander, dust mites, or pollen. The irony? These avoidance tactics may not be terribly effective. In one study, encasing bedding in impermeable "dust-mite-proof" covers didn't reduce symptoms in those allergic to mites. And British researchers found that five high-end vacuums with fancy HEPA (high-efficiency particulate air) filters were no better at cutting exposure to cat dander or mites than a 10-year-old vacuum.

Luckily, many effective medications are available. Allergy shots are another option -- combined with medication they may cure about one-third of patients and reduce or control symptoms for another third, according to Dr. Creticos. The rest of us are out of luck, and it can take more than a year to know which group you're in. Another drawback? The standard regimen is one or two shots a week for four to six months, then shots once or twice a month for three to five years. Due in five years: a vaccine for ragweed.

Food and Drug Allergies

About 1 percent of adults are allergic to foods, especially peanuts, tree nuts (such as cashews, almonds, walnuts), eggs, shellfish, and other seafood. Allergies to milk, soy, wheat, and eggs are more common among kids. The most frequent drug allergies are to penicillin and other antibiotics. New evidence suggests that women may be more prone to food allergies than men are.

Symptoms can start within minutes to an hour of eating or swallowing the food or drug -- you may have trouble breathing or feel nauseated and experience diarrhea and/or vomiting. Itchy hives also start to surface in this short window of time -- during which you must immediately head for the emergency room and/or call 911. A food reaction can trigger anaphylaxis -- a life-threatening emergency that may begin with severe itching of eyes or face and progress within minutes to difficulty swallowing and breathing, mental confusion, dizziness and/or a quick drop in blood pressure. Treatment is an injection of adrenaline (epinephrine) to open airways and raise blood pressure. You may also need IV fluids, antihistamines, steroids, or other drugs.

There are no allergy shots or preventive medicines, but your doctor can prescribe an epinephrine self-injection pen (such as the EpiPen) -- a do-it-yourself shot to slow the onset of or prevent anaphylactic shock (still call 911 after using the pen). Since reactions are often worse the next time, always have the pen with you, keep an extra at home, and replace them each year. Also check the Food Allergy & Anaphylaxis Network's Web site (www.foodallergy.org) for unexpectedly dangerous foods, like steak sauce made with anchovies. Have all drug allergies recorded in your medical records and wear a medical-alert bracelet or necklace.

Outdoor Allergies

Poison Ivy, Poison Oak, or Poison Sumac
Approximately 85 percent of the population will develop an allergic reaction to urushiol, the chemical that causes the red, itchy rash you get from these plants, which often includes bumps and big, weepy blisters. If you think you've come into contact with it, either directly or indirectly (urushiol can hitchhike on garden tools, clothing, and pet fur), wash exposed skin with rubbing alcohol, then soap and water as soon as possible. If you're doomed to experience a rash, you'll know it 12 to 48 hours later. To control the itching and inflammation, try over-the-counter or prescription creams with cortisone. Wear gardening gloves and hike in long pants.

Insect Bite Allergy
More than 2 million Americans are allergic to the stings or bites of bees, yellow jackets, hornets, wasps, or fire ants. If you're allergic, the stung area swells and spreads dramatically, usually in minutes; you may have itchiness or hives away from the sting -- all over your body or just in your eyes and nose. A severe reaction can lead quickly to anaphylaxis, so go to the ER or call 911 if you're having one. After one serious reaction, the next is likely to be more dangerous. Always carry an epinephrine pen. Consider allergy shots, which can be almost 100 percent effective.

Allergy Relief

As flowers start to bloom, so do all the symptoms of pollen allergies -- runny nose, itchy eyes, and constant sneezing. Pets, of course, are always around. Happily, though, a broad range of new medications can help with these allergies. "We now have medicines that are not only safe, effective and easier to use with less-frequent dosing, but they also don't make you sleepy, so you don't have to sacrifice alertness to get rid of your sniffles," says Asriani Chiu, MD, assistant professor of allergy medicine at the Medical College of Wisconsin, in Milwaukee. Match the level of your symptoms with the most effective medicines.

If Your Symptoms Are Mild

You don't need tissues on hand 24-7; symptoms (which last as long as the offending plant allergens are in the air, usually two weeks or more) come and go, usually during spring or fall.

You may want to try...

Over-the-counter (OTC) loratadine, a nonsedating oral antihistamine (available as Claritin, Alavert, or as a generic). You can take it whenever symptoms start to kick up. Another option is a nasal spray called cromolyn sodium (NasalCrom): It helps prevent the release of chemicals that start allergic reactions. Doctors say it's most effective if used daily (up to four times a day) and it can be used along with loratadine, if necessary. For nasal congestion, try nasal spray decongestants with phenylephrine or oxymetolazone.

You should also know...

OTC remedies containing diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton) or clemastine (Tavist) are effective, but are likelier to cause drowsiness than loratadine. If you use nasal spray decongestants, doctors recommend you limit use to three to five days; longer use can cause what's known as "rebound congestion," abnormal swelling and enlargement of your nasal passageways.

If Your Symptoms Are Persistent But Moderate

You have sneezing, itching, and a runny nose and possibly congestion for weeks or months at a time.

You may want to try...

Desloratadine (Clarinex), fexofenadine (Allegra), or cetirizine HCl (Zyrtec) -- prescription antihistamines that you take on a daily basis as needed. Another option is the antihistamine nasal spray azelastine HCI (Astelin). If you have congestion along with your other symptoms a good choice is a combination nonsedating antihistamine/decongestant product (such as Claritin-D, Allegra-D, or Zyrtec-D) or a prescription nasal steroid, such as fluticasone propionate (Flonase) or triamcinolone acetonide (Nasacort AQ).

You should also know...

Oral decongestants can cause jumpiness and insomnia; they're not recommended for anyone with high blood pressure. Nasal steroids are most effective when used regularly, but sometimes cause cracking and minor bleeding in the nose; in rare cases long-term use may be associated with a slightly increased risk of diabetes, osteoporosis, and cataracts.

If Your Symptoms Are Severe

Your allergies interfere with your sleep as well as your daytime functioning.

You may want to try...

A nasal steroid combined with a nonsedating antihistamine (with or without a decongestant) to keep symptoms at bay. If one of your chief complaints is a constantly runny nose, ask your doctor about ipratropium inhalation (Atrovent), a prescription nasal spray that can slow the flow. In addition, you may want to try montelukast sodium (Singulair), a once-a-day medicine originally used for asthma that can help control nasal allergy symptoms, too.

You should also know...

A single injection of a large dose of steroids (100mg of prednisone) before the allergy season begins is very effective at relieving symptoms, but most doctors only turn to it as a last resort. That's because corticosteroids, especially when injected, can trigger a range of side effects, from throwing your menstrual cycle out of whack to harming your adrenal glands, which play a critical role in regulating blood pressure, heart rate, and hormone production.

If Your Symptoms Are Mostly Eye-Related

You have itchy or watery eyes, blurred vision, swollen eyelids, and/or redness in the white of the eye. Eye indications are the top indoor/outdoor allergy symptoms in about 4 percent of sufferers. A leading culprit? Allergic conjunctivitis, irritation of the conjunctiva (the membrane covering the white part of the eye).

You may want to try...

OTC eyedrops that contain ketotifen fumarate (Zaditor) or prescription eyedrops with cromolyn sodium (Opticrom or Crolom) or olopatadine hydrochloride (Patanol) all contain mast-cell stabilizers, agents that prevent the release of chemicals that cause inflammation.

You should also know...

Most allergy eyedrops cause stinging or burning when you first put them in (although chilling them in the fridge first can reduce this). OTC eyedrops that contain decongestants such as oxymetazoline (Visine LR) take the redness away (as advertised) by shrinking the blood vessels in the eye, but they don't help a lot with itching. Also, if you use them for more than a week, they can actually make your redness worse.

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