Allergies can increase with age
Brushing her teeth nearly cost Margaret Caley her life.
Caley, a lively 81-year-old and recent Volunteer of the Year in Kelowna, B.C., was in her mid-50s when it happened the first time. She had brushed with the same toothpaste she had been using for years. Within an hour, she was gasping for breath.
“My eyes ran, my nose ran, my mouth ran, and I couldn’t breath,” she remembers. Frantically, she signalled for her husband to get her puffer, the emergency medication she used for the mild case of asthma she had recently developed. That cleared her airways, but not long after, it happened again. This time, she made the connection. Caley discovered she had a severe allergy to the mint flavouring in the toothpaste. “That was the first serious allergy I’d ever had,” she says. “It almost killed me.”
While allergies and asthma are most often thought of as conditions affecting young people, senior Canadians are not immune. Statistics Canada figures for 1996 and 1997 showed that 16 per cent of people over the age of 64 had allergies to substances like pollen, dust mites and cat dander, only a little lower than the 22 per cent among adults and teens as a whole. About 5.7 perent of older people had food allergies, while close to 6 per cent suffered from asthma, a disease often closely associated with allergies.
But the actual number of senior adults with allergies and asthma may be higher, says Dr. Norman Epstein, director of the allergy clinic at St. Joseph’s Health Centre in Toronto. “Many healthcare workers are prejudiced against older people and won’t do the proper testing” for allergies and asthma, he says.
Allergies on the increase
According to the Allergy Asthma and Immunology Society of Ontario, an association of medical professionals, there’s evidence that allergic diseases are on the increase.
The good news is that if you haven’t developed an allergy by your mid 50s, you probably never will. In fact, most allergies show up for the first time in childhood, says Dr. Peter Warren, a respirologist and professor of medicine at the University of Manitoba. About 20 per cent of all allergy cases have their first onset when people are in their late 40s or early 50s, probably because of changes in the immune system that are a natural part of aging. “It’s very rare to develop an allergy for the first time at an older age,” Warren says.
That’s because of the nature of allergies themselves. In an allergic reaction, the body’s immune system mistakes a normally harmless substance, such as grass pollen, for a dangerous invader. The immune system produces an antibody called immunoglobulin E, or IgE, to fight off the invader. While everyone has some IgE, people with allergies are genetically predisposed to produce too much of it. Some of the IgE attacks the invader as well as cells in places like the skin, the nose and the airways called mast cells. The mast cells fight back by producing chemicals called histamines and it’s those that cause the swelling, itching and runny nose and eyes.
“The production of IgE tends to drop off as people get older,” says Dr. Susan Tarlo, a professor of medicine at the University of Toronto. “So it’s not uncommon for reactions to things like moulds to get less as you get older.”
Dormant allergies can still flare up
That doesn’t mean allergies that have long been dormant can’t flare up later in life. Retirees who move from one part of the country to settle in another can suddenly be surrounded by allergens they might rarely have encountered before. The result is allergies such as hay fever. Dr. George Luciuk, an immunologist in Richmond, B.C. sees it all the time among easterners who move to the west coast when they retire. “There’s a very high concentration of tree pollen like alder and birch that people are not so exposed to back east,” he says.
The season allergies make their appearance is often a clue to the type of allergy you have. In most parts of Canada, the season for tree pollen typically starts in March or April and goes until mid-June. Grass season is usually during the summer months, while in eastern and central Canada, ragweed causes itching and runny noses from about mid-August until the first frost.
Developing pollen allergies can sometimes lead to other misery in the form of reactions to fruits such as apples, nectarines and melons. The protein that causes the allergic reaction to pollen is very similar to proteins found in these fruits, making the immune system reject them as well. There are even stranger cross-reactions. For example, an allergy to latex rubber can cross-react with kiwi, banana and avocados.
Dust mites – tiny eight-legged creatures that live by the thousands wherever dust accumulates – can cause trouble in all parts of the country, but especially in the more humid coastal regions. They live in pillows, beds and drapes and feed off tiny flakes of dead human skin. It’s estimated that an unwashed pillow can be home to as many as 400,000 of the critters. Their excrement – politely called pellets – is one of the most common allergens known and the major trigger for asthma attacks. And as with pollen, mite allergies can cause unusual cross-reactions, making shrimp, crab and lobster impossible for some people to eat.
Treatment is available
Fortunately, sensitivities to pollen, mites and many other allergens can be treated. Antihistamines can relieve watery eyes and itchy noses. More troublesome cases can often be treated successfully with a process call desensitization, or immunotherapy, where specialists inject patients with extracts of the same proteins that cause the allergic reaction. Over time, the constant exposure resets the body’s defence mechanism and the allergic reaction stops. “Senior adults are excellent candidates for immunotherapy,” Dr. Luciuk says.
That type of therapy doesn’t work for another common allergy, reactions to food. The most common problem foods are peanuts, shellfish, nuts and sulphites, an additive commonly found in wine and some jams.
Signs of an allergic reaction to food include nausea, bloating, vomiting and hives. In more extreme cases, people might have a sense of doom or even experience anaphylaxis, the medical term for an allergic reaction so severe it can cause unconsciousness or even death. And while the only treatment for most food allergies is avoidance, they will, with luck, sometimes disappear on their own.
Not all reactions to food are allergies, says Monika Gibson, Ontario coordinator for the Allergy and Asthma Information Association. For example, some senior adults develop problems with chocolate and coffee. but allergies to both are quite rare. In most cases, it’s just an increased sensitivity. However, the symptoms are very similar, so it’s best to check with your doctor to be sure.
While the senior years provide a chance to finally get away from your job, the workplace can sometimes follow you into retirement in the form of allergies and asthma. A lifetime of exposure to particular chemicals can result in allergic reactions. For example, people who spent their lives in the medical profession will sometimes develop an allergy to the latex used in hospital gloves. However, if you’ve made it through your working years without developing an occupational allergy, there’s little chance one will show up after you retire.
Some allergies pose greater threat with age
Many allergies become less severe with age, but there’s one that can pose a greater threat – a reaction to insect venom, such as bee stings. “Insect venom can pose an additional risk if a person has cardiac problems,” says Dr. Eric Leith, President of the Canadian Society of Allergy and Clinical Immunology. Reaction to a sting can put additional strain on the heart.
In the case of an anaphylactic reaction, the treatment must be used with caution (anaphylaxis is treated with an injection of adrenalin, often using a device such as the EpiPen). Unfortunately, adrenalin also speeds up the heart rate and can result in a heart attack in less healthy individuals. If you have heart problems and carry an EpiPen or similar device for allergies, it’s vital that you use it only in truly life threatening situations, Dr. Leith says. Make sure your doctor gives you clear instructions about when and how to use it.
Age can also complicate the diagnosis and treatment of allergic diseases. Allergic asthma, for example, can be mistaken for bronchitis, emphysema or lung congestion caused by heart problems. A thorough exam, usually including a chest X-ray, can sort it out.
But senior patients may not always respond to treatment as well as younger ones. Some asthma and allergy medications don’t mix with medicines more commonly used by senior adults. And while the effects of asthma are usually reversible, patients who’ve had asthma all their lives and have not been properly treated – an all too common situation – can suffer long-term damage. There can be permanent obstructions caused by scarring from a lifetime of frequent inflammation. Senior adults might also feel the effects of asthma more acutely because the elastic recoil of the lungs – the springiness that holds the lungs open – drops off as people age, reducing lung capacity and making it even harder for people with asthma to breathe.
Despite some complications, the advice for living with allergies and asthma is largely the same for all age groups: take your medication, do your best to avoid the things that trigger your response, and be involved. Don’t leave it all up to the doctor.
“People know their own bodies,” says Monika Gibson. “It’s the people who learn about their condition and are most involved in their own treatment who do the best.”