Why aging is putting more people at risk for developing allergies

By Kelly Greene
Wall Street Journal

Not everybody outgrows a stuffy nose. Oren Cline, an 87-year-old retired accountant in Hickory, N.C., checks his computer every morning "to see what the pollen situation is for the next four days. When the pollen's bad, I don't go outdoors," he says. "My allergies have gotten worse as I've gotten older." The traditional view that allergies and asthma wane with age is falling to the wayside. Allergies affect 17% to 20% of the U.S. population, and that proportion doesn't decrease with age. In fact, symptoms in many cases worsen, or erupt for the first time in later life, says Karen Calhoun, chairman of the University of Missouri School of Medicine's otolaryngology department in Columbia, Mo. She is also president of the American Society of Geriatric Otolaryngology, a group formed two years ago, in part, to focus on the problem. "We have patients come in all the time and say, 'How can I have allergies? I'm 65 years old, and I've never had allergies before,' " Dr. Calhoun says. "They hit a threshold where they can't ignore the symptoms anymore."

At the other extreme, some older patients fail to get treatment, chalking up their symptoms to "aging," says James Pacala, a geriatrician and associate professor at the University of Minnesota Medical School in Minneapolis. "It won't even occur to them that allergies might be the problem," Dr. Pacala says. The reasons for an allergy flare-up in later life can include a move to a new part of the country, an accumulation of exposures in one location, changes in one's health, and genetics. "If you have one parent who's allergic, you have about a 40% chance of developing allergies; if you have two parents with allergies, there's a 60% chance," Dr. Calhoun says. Relocating to a mild climate -- where pollen is prevalent nearly year round -- is a common trigger. It can take a few years for the body to build up what are called reactive cells to an irritant, but once that happens, flare-ups can start.

"I saw a lady yesterday who moved here from upstate New York, and her first complaint was allergies," says Jeff Williamson, head of geriatric medicine at Wake Forest University School of Medicine in Winston-Salem, N.C. Sometimes, cutting back on travel can create a problem, too. Mr. Cline, the retired accountant in North Carolina, used to find relief for his allergies in Arizona, where he would head during the spring. But now he lives in an assisted-living apartment closer to family and relies instead on air filters and homeopathic remedies for relief.

Surprisingly, living amid a lifetime of possessions -- favorite books and furniture, for example -- can aggravate allergies to mold and dust. Doctors refer to it as the "lifetime load" theory. "With aging and allergies, one thought is that the sheer duration and breadth [of] stuff you get exposed to over life have a cumulative effect that winds up eventually sensitizing the body's immune system -- and creating an allergy you didn't have before," Dr. Pacala says.

Physiological changes in the body can unmask symptoms, too. The amount of water in the body generally decreases with age, which in turn decreases the action of tiny hairs, called cilia, in the nose that help wash it out. There's less blood flow to the nose as you get older, too, due to a variety of vascular conditions. "All of that ends up drying your passageways, producing more inflammation, and making you stuffy," Dr. Pacala says. Cumulative damage to the nose, including polyps and bent cartilage, contributes as well.

Scientists also are starting to look at the impact of menopause and hormone-replacement therapy. There's not much research yet, but a few studies point to hormone-replacement therapy as a factor in wheezing and asthma, in which the inflammation moves to the lungs. Hormone-replacement therapy was associated with asthma-like symptoms among women, particularly in those with a low body-mass index, according to study results published in the journal Allergy in January. A study two years ago of more than 2,000 Scandinavian women found that hormone-replacement therapy was associated with an increased risk for asthma, wheezing and hay fever.

Diagnosing allergies among older patients can be tricky. One problem has been the standard skin-prick test. "As people get older, their skin changes and is less reactive" to such testing, Dr. Calhoun says. She used a different form of testing -- an intradermal, or skin-puncture, test that goes deeper -- and found the incidence of allergies "almost exactly the same" among 100 people over age 60 as it was among 200 people under age 45. "The older folks tended to be a little more allergic to mold, maybe because of longer exposure and older household goods," she says. Another problem: Doctors simply don't think to ask older patients about allergies or postnasal drip, which could be chaining people to their homes and their tissues. To be fair, that's because physicians typically are busy treating acute health problems among older patients, such as heart disease. But treating allergies may have a bigger impact on a patient's lifestyle. "Rhinitis is something that's frequently lower on a doctor's list than a patient's," Dr. Pacala says. "My father's 82, and he has developed this constantly runny nose, and it drives him crazy. You go out into the world, and you're constantly having to wipe your nose. It's a drag."

Doctors also find it difficult, at times, to sort out allergy symptoms from those indicative of other medical problems. "Breathing difficulties can indicate allergies, an infection, emphysema or pulmonary fibrosis, and all the heart problems that can cause breathing difficulties, like cardiac asthma or heart failure," Dr. Pacala says. "When a person comes to me with breathing complaints, I'm going to rule out the really bad things first, then go down the list. It can be very difficult to disentangle" allergies from asthma, he adds.

Medications, too, can trigger side effects that include nasal symptoms, breathing problems or a cough. Ace inhibitors -- commonly used to treat coronary disease, diabetes and high blood pressure -- can lead to a dry cough, Dr. Pacala says. And beta blockers, which "do really good things for the heart and blood pressure, tend to constrict the airways in the lungs," he adds.

So, what's the best way to deal with allergies in later life? First, actually deal with them. "It's easy enough to find out if you are or are not allergic," Dr. Calhoun says. "If you have symptoms, find out and do what you need to get better. There's no need to suffer." Of course, that's easy to say and hard to do. One popular tool is a "neti pot," which "looks like an Aladdin lamp," Dr. Calhoun says. How it works: You pour saline in one side of the nose, and it comes out the other side. (YouTube has a number of entertaining videos that show how it's done.). "It's very effective," Dr. Calhoun says. "Let's say you're allergic to a particular mold. This one you're allergic to sticks to the mucus inside of the nose. If you can mechanically wash it away, it's not there anymore making your body react." Another basic fix that can bring great relief: a humidifier, particularly in the winter. "I have patients who come in with problems every October or November when the heat comes on," says Dr. Pacala, who practices in Minnesota.

Trying over-the-counter medications may seem like the simplest fix, but they can cause a number of disconcerting -- and sometimes hazardous -- side effects. At Wake Forest, Dr. Williamson's patient, for example, was taking Tylenol PM to deal with her allergies at night. "The morning after, she was dizzy, and she's really thin, which puts her at high risk for falling," he says. Watch out for first-generation antihistamines, such as diphenhydramine, the active ingredient in Benadryl, which can worsen memory conditions and cause confusion among people with mild Alzheimer's disease, as well as cause drowsiness, Dr. Pacala says. Alfa-adrenergic medications, such as Sudafed and Afrin nasal spray, shrink blood vessels to reduce stuffiness, but can exacerbate heart problems. The two types of medicine are often combined in cold preparations. In a man with an enlarged prostate, the combination can relax the bladder and cause the sphincter to clamp shut. "The next thing you know, he's in the emergency room with acute urinary retention," Dr. Pacala says.

Fortunately, newer drugs with less dire side effects can help alleviate symptoms. Second-generation antihistamines, including Zyrtec, Allegra, Clarinex and Claritin, "don't cause confusion or drowsiness as often," Dr. Pacala says. Nasal steroid sprays reduce inflammation, though they may take a while to start working. And there are other medications that "work at different spots of the process [in which] the allergen" triggers inflammation or irritation. Scientists are experimenting with anti-inflammatory drugs as they look for common links among allergic reactions, coronary disease and other health problems in which inflammation plays a role. Inhalers may work also, Dr. Pacala says, with nasal inhalers typically targeting seasonal allergies and oral inhalers targeting wheezing. "I've gotten burned a couple of times where I'm treating somebody for the wrong thing, and then I stick them on an inhaler and they get better."

Bonnie - once again, another allergy piece that completely omits food as an allergy/intolerant agitator. Unfortunately, Ms. Greene interviewed only conventional allergy professionals instead of delving a bit deeper.