Can You Get Allergies Later In Life?

PlayPlay PodcastdownloadDownload Podcast
Here you are, loving life and enjoying the change of seasons when all of a sudden your skin is itchy, nose is running and eyes are burning. Just because you've been allergy-free your whole life doesn't mean you can't grow into one. For millions of Americans, this is the unfortunate truth.

Listen as Allergist Kenneth Johns talks us through late onset adult allergies and how to identify triggers that might aggravate your allergies.
Can You Get Allergies Later In Life?
Featured Speaker:
Kenneth Johns, MD, allergy and immunology
Dr. Kenneth Johns specializes in allergy and immunology and practices at Allina Health clinics in Cambridge, Coon Rapids and Maple Grove. His professional interests include child and adult asthma, seasonal allergies, hives and skin rashes.

Learn more about Kenneth Johns, MD
<< Full Podcast Library
Printable Version
Transcription:

Melanie Cole (Host): As you’re enjoying the change of seasons and all of a sudden, your skin starts to become itchy, and your nose is running, and your eyes are burning, just because you’ve been allergy-free your whole life, doesn’t mean you can’t grow into one. For millions of Americans, this is an unfortunate truth. My guest today is Dr. Kenneth Johns. He specializes in allergy and immunology at Allina Health Clinics in Cambridge, Coon Rapids, and Maple Grove. Welcome to the show, Dr. Johns. Why do some people develop allergies that haven’t had them before?

Dr. Kenneth Johns (Guest): Well, let’s start by saying there’s confusion here because allergy means different things to different people. To be clear, when we talk about allergic rhinitis, we’re talking about the nose, and eye, and maybe chest symptoms due to a hypersensitivity to something that blows around in the air like pollen, or mold spore, or dust mite, or what have you. That condition – allergic rhinitis, usually has developed most of the time by late teens or early twenties -- although everybody’s seen those children that seem to have them the day they were born -- but most of the time they’re acquired by the late teens and early twenties and plateau through the thirties, and then gradually fade away. There’s a very specific, natural history there.

When folks seem to develop allergic rhinitis late as an adult, sometimes it’s because they had them all along and they were just unmasked. For example, people that quit smoking can notice their allergy symptoms – maybe they were masked by the constant assault on the respiratory system from tobacco smoke. Other folks maybe become aware of their allergies because they’re all of a sudden exposed, so that’s a person that has always been allergic to cats but couldn’t really tell until they moved into an apartment with cats, and then they start to notice symptoms. Most of the time those allergies are acquired early, and adult-onset or late-onset allergies are maybe an unmasking.

Secondly, there are conditions that sound like allergic rhinitis, but really aren’t, and there’s quite a few of these conditions that are mistaken for allergic rhinitis. They follow a different natural history and have different treatment options and the symptoms are just subtly different. Sometimes it’s hard to tell them apart. An example there would be a person that has developed vasomotor rhinitis as an adult. Vasomotor rhinitis is a nose that runs and plugs up because of irritants as opposed to allergens. And again, different natural history, different treatment options.

Melanie: As we’re talking about allergic rhinitis, what about food allergies? Because I’ve heard before about some people who were not allergic to seafood or shellfish, and all of a sudden, in their 50s and 60s, they find that they are. Is this a common thing?

Dr. Johns: Again, to be clear, food allergy is almost always present at birth. It’s not really clear how or why. Later on in life, it’s possible – it’s very rare – it would be reportable that someone has a true food allergy that just suddenly developed as an adult. Most of those adult-onset or later-onset reactors are more of a food intolerance. Food-intolerance would be like a lactose-intolerance, which mostly develops as an adult. A lot of times when you hear this adult-onset food allergy, it’s really more of an intolerance. Again, treatment options are different, and symptoms are slightly different – and don’t get me wrong, some of those intolerances can be very serious, but they aren’t true food allergy, meaning they do not result in anaphylaxis.

Melanie: So what might someone notice if they’ve all of a sudden developed – or maybe not all of a sudden, but a little bit over time – an intolerance to something specific?

Dr. Johns: In terms of foods, again, it’s all about the story. People will tell you -- shrimp, for example, is a very common intolerance that we’re seeing these days. People will tell you that sometimes they can eat shrimp, and sometimes they can’t, or “I used to eat shrimp all the time and never had problems, and now I have reactions to shrimp –,” or some shrimp, or shrimp that is maybe prepared in a certain way. Intolerances can show up, and the symptoms are frequently more delayed than they are with allergy. It can sound like an allergic reaction. There can be a lot of itching and discomfort and swelling of the lips and face, but again, does not ultimately lead to anaphylaxis. A lot of it is the story that people tell that sounds more of an intolerance than an allergy. To be clear, a food allergy is very reproducible. It happens every time you eat the food, no matter how it’s prepared, in any amount, and the first time you eat the food and every time you eat the food. Those are usually very clear-cut. Intolerance is when people aren’t sure, that’s a good hint that it may be intolerance as opposed to allergy.

Melanie: Can anything be done whether it’s allergic rhinitis, whether you’re developing seasonal allergies that maybe you had all the time, but just didn’t realize, or these food intolerances, or even some kind of an intolerance to pet dander? Dr. Johns, is there anything to do about these? Are there some over-the-counter recommendations you’d like to make, or should they come and see an allergist?

Dr. Johns: All of those are possible. I think the first step is to figure out if you have an allergy or not, and that’s where the testing is very helpful. If you’re having nasal symptoms because of allergy to something, or if you’re having nasal symptoms because of irritants – more of an intolerance – our treatment options vary. We have good over-the-counter nasal steroid sprays that are very effective for allergic rhinitis. We have other treatments – also usually topical – that specifically work for the nonallergic nasal symptoms, those vasomotor rhinitis symptoms. Our medications are going to vary, but we do have good treatments for both. A lot of that stems from figuring out whether you have an allergy or not.

Melanie: And what about things like nasal lavage, or Neti Pots, or looking around your house for triggers? How does someone identify their triggers, Dr. Johns, and what would you – is there some prevention possible?

Dr. Johns: Much of that depends on what the specific sensitivity is. If you’re allergic to cats and you have cats in the house, that’s a tough one. There’s a lot of mythology about things that you can do to the cats, or do to the house, or do to the patient, but that’s a tough allergy to treat. Although, again, sometimes that is the culprit and that’s really our best option is to not have cats in the house. I’m not picking on cats in particular, but any indoor pets that are mammals have the potential to be allergens. I think a lot of that stems from knowing exactly what the sensitivity is.

Melanie: And do you sometimes recommend things like the nasal lavage to keep some of those things clear -- or air filters, or any of these things?

Dr. Johns: Air filters don’t have a lot of good data to support their use. Nasal lavage can be very helpful. Some folks with allergies find it helpful where you rinse out your nose with a good squirt of saline that’s hopefully clean and sterile, either with a Neti Pot or just a good squeeze bottle. Folks that are having infectious problems like sinusitis, or chronic sinusitis, they find lavage to be most helpful. My straight-forward allergy patients aren’t as impressed as the people that have other conditions that are more infectious, and they find the lavage to be extremely helpful. Sometimes they’re doing it as needed; sometimes they’re doing it regularly, twice a day. It’s one of those old treatments that’s been around for literally thousands of years, but can be extremely helpful.

Melanie: So then, in summary, wrap it up for us, Dr. Johns, with your best advice for people that may be suffering from seasonal allergies or late-onset intolerance, whether it’s to food or allergic rhinitis, or even to pets, what do you tell them every day about finding those triggers, identifying them, steering clear of them if possible, and when to see an allergist.

Dr. Johns: I think that’s exactly the case, try to sort out which condition you have because treatment options do vary depending on what condition you actually have. Sometimes there’s avoidance measures that we can do. For example, for dust mites sometimes there’s good medication that can be used such as that vasomotor rhinitis and sometimes there’s immunotherapy or allergy shots. Again, it really varies, and it really depends on exactly what the culprit is.

Melanie: Thank you, so much, Dr. Johns, for being with us today. You’re listening to The Well Cast with Allina Health, and for more information, you can go to AllinaHealth.org, that’s AllinaHealth.org. This is Melanie Cole. Thanks, so much for listening.