Allergic reactions to foods, medications, pollen and insects can develop later in life.
Fifty million Americans suffer from allergies, according to the American College of Allergy, Asthma and Immunology, and some expert groups estimate the number is even higher. According to the Asthma and Allergy Foundation of America, allergies are the sixth leading cause of chronic illness in the U.S.
While most allergic reactions develop in childhood or young adulthood, an estimated 5 to 10 percent of Americans over the age of 65 are either living with chronic allergic reactions or experiencing allergic reactions for the first time. As the population ages — by 2030, 20 percent of Americans will be over 65 — the number of older Americans with allergies should continue to increase.
What is an allergy?
An allergic reaction occurs when the immune system mistakenly identifies a typically harmless substance, or allergen, as an intruder. Those substances can include dust mites, pollen, mold, pet dander, insect stings, medicines or foods that don’t cause a reaction in most other people. The immune system responds to these allergens by trying to fight them off as it would a germ or virus. However, with most allergic reactions, it’s responding to a false alarm.
This can cause a host of aggravating symptoms, including coughing, sneezing, hives, rashes, itchy eyes and a runny nose. Sometimes symptoms can be more severe.
Because allergy symptoms are so common, your first stop for diagnosis should be your primary care physician. If your symptoms are chronic or intolerable, make an appointment with an allergist. Skin and blood tests are the most common tests used for diagnosis.
“As we age, our immune systems get weaker, putting older Americans at higher risk for disease, including allergic reactions,” says Tiffany Owens, M.D., an allergist at the Ohio State University Wexner Medical Center.
Here’s how to recognize and treat five types of allergies that can develop as we age.
1. Hay fever
During the spring, summer and fall, trees, weeds and grasses release pollen into the air. That pollen can get into your nose and throat and trigger an allergic reaction commonly known as hay fever (allergic rhinitis). Nearly 20 million American adults and more than 5 million children suffer from hay fever.
Symptoms: Sneezing; runny or stuffed nose; coughing; post-nasal drip; itchy eyes, nose and throat; red and watery eyes; dark circles under the eyes.
Treatment: The most effective treatment is a nasal steroid or anti-inflammatory medicine that you spray into your nose and can buy over the counter. You can also control your environment by spending more time indoors when pollen counts are high outside and using air purifiers and air conditioners. If you spend a lot of time outdoors, you should wash your hands and face often to get rid of pollen that may have collected there.
“Antihistamines or drugs used to treat symptoms of allergies can sometimes cause cognitive issues. When possible, rely on topical medications or second-generation antihistamines such as Claritin, Allegra or Zyrtec,” says Jennifer Namazy, M.D., an allergist and immunologist at the Scripps Clinic in La Jolla, California.
2. Insect allergies
Approximately 2 million Americans suffer from insect allergies. Allergic reactions occur when the immune system overreacts to the venom from an insect sting. They’re most often caused by yellow jackets, honeybees, paper wasps, hornets and fire ants. Although people don’t usually develop insect allergies as they age, it can happen.
Symptoms: Pain, redness and swelling at the site of the sting can be part of a normal reaction. A serious allergic reaction occurs when the immune system gets involved and overreacts to the venom. When this happens, you could experience some of the following symptoms: swelling of the face, throat or tongue; difficulty breathing; coughing; shortness of breath; dizziness; stomach cramps; nausea and diarrhea; and itchiness and hives on your body. Anaphylaxis, a severe and potentially life-threatening reaction, usually occurs within 5 to 30 minutes of being stung or bitten.
Treatment: If you have a serious adverse reaction, call 911 immediately so that emergency medical services can assess the situation and, if needed, administer epinephrine (also known as adrenaline), a medication that effectively manages anaphylaxis by relaxing the muscles in the airways and tightening the blood vessels.
Patients with a history of anaphylactic reactions to insect stings should carry an epinephrine auto-injector device to use, if needed, to treat reactions.
“If you haven’t had this kind of reaction and don’t carry an epinephrine auto-injector, you need to be evaluated immediately,” says John James, M.D., an allergist and spokesperson for the Asthma and Allergy Foundation of America. “And consultation with a board-certified allergy specialist is highly recommended.”
3. Skin allergies
A skin allergy (allergic contact dermatitis) occurs when the skin comes into direct contact with an allergen such as poison ivy, poison oak or poison sumac. Other substances, such as the nickel in jewelry or the chemicals in lotions and skin products, can cause similar reactions. Namazy says it is sometimes challenging to determine exactly what’s causing the allergic reaction. Patch testing, a diagnostic method that does not include blood or skin-prick testing, can often help determine which specific substances are causing the inflammation.
“Skin disorders become more prevalent as we age, because skin changes by becoming thinner and drier,” says Namazy.
Symptoms: Itching, redness, swelling.
Treatment: With most skin allergies, the more you scratch, the worse the condition becomes. You should use moisturizers and topical ointments and steroids that reduce inflammation. Antihistamines can be helpful in reducing itching. If you have a rash, that’s persistent or painful, spreads quickly over most of your body, causes a fever or is oozing yellow or green fluid, see a doctor.
4. Food allergies
As with insect allergies, reactions to certain foods can occur quickly and suddenly, and if not treated immediately, they can be life-threatening. When you’re allergic to a food, your immune system overreacts to a particular protein found in that food. Often it takes only a small amount of food to trigger the reaction, which usually occurs within a few minutes to two hours of the time you ate the food. The foods most often responsible for allergic reactions include cow’s milk, eggs, fish, peanuts, shellfish, soy, tree nuts and wheat.
“While food allergies are more common in the young, as we age and introduce new foods, the potential to develop new allergies increases,” says Namazy.
Symptoms: Food allergies can cause mild to serious reactions. These include hives, red and itchy skin, itchy or stuffy nose, sneezing, itchy and tearing eyes, vomiting, stomach cramps, diarrhea and swelling. Symptoms of anaphylaxis include wheezing; tightening in the chest; trouble breathing; tingling in the hands; vomiting; stomach cramps; diarrhea; and swelling in the feet, lips and scalp.
Treatment: If you know you have severe allergic reactions to food, you should carry an epinephrine auto-injector with you at all times, in case of an anaphylactic reaction. If you have a reaction for the first time, see a specialist who can determine which foods you are allergic to, so you can avoid them. When you shop, read food labels to make sure you don’t eat anything that contains the food triggers you’ve reacted to. To prevent adverse reactions, always ask about ingredients when you eat in a restaurant, or eat foods prepared by family or friends.
Since food allergies can be life-threatening, you must always be prepared by wearing a medical alert bracelet or necklace and carrying an auto-injectable device containing epinephrine.
5. Drug allergies
Because older people take three times as many medications as younger people, according to Namazy, they tend to have more frequent allergic reactions. The chances of developing an allergy to a medication are higher when you take it frequently or when a medication is rubbed onto the skin or given by injection rather than taken by mouth.
The most common allergy-causing drugs include antiseizure drugs, insulin, substances containing iodine (X-ray contrast dyes), antibiotics like penicillin, nonsteroidal anti-inflammatory drugs like ibuprofen, anticonvulsants and chemotherapy drugs.
“Allergic reactions to medications are sometimes difficult to identify, as they tend to recur with repeated exposure to the same medication and symptoms can be similar to other conditions,” says Owens.
Symptoms: Vomiting and hair loss with cancer chemotherapy drugs, upset stomach from aspirin or diarrhea from antibiotics, skin rashes (especially hives), itching, respiratory problems and facial swelling. As with insect and food allergies, anaphylactic shock symptoms can occur.
Treatment: If you have an allergic reaction to a medication, consult your doctor, but unless symptoms are life-threatening, don’t stop taking a medication without talking to a health professional. A doctor can determine whether you should temporarily or permanently cease taking your medication and should be able to offer an alternative. If you are allergic to a specific medication, that information should become part of your permanent medical record, and all your doctors should be informed.
Is It a Cold, the Flu or an Allergy?
How to tell the difference
Allergies, colds and the flu can all make you miserable. They all affect your respiratory system, making it difficult to breathe. People who suffer from airborne allergies often think they have a cold, and when symptoms are more severe, they may think they have the flu. The common cold and the flu are both caused by viruses, but an allergic reaction is caused by your immune system responding to a trigger.
“Usually, a cold will start with a sore throat, followed by a few days of sneezing and a runny nose,” says Gary J. Stadtmauer, M.D., an allergist and clinical immunologist in New York City. “The flu is more serious than a cold, with symptoms including fever, chills and coughing. Allergies do not cause fever.”
- Symptoms last as long as allergens are present
- Stuffy and runny nose
- Itchy, watery eyes
- Treat with antihistamines, decongestants, nasal steroids
- Symptoms last one to two weeks
- Aches, pains
- Exhaustion, weakness
- Chest discomfort and cough
- Treat with fluids, rest, over-the-counter medicine and prescription antiviral drugs
- Symptoms can last up to two weeks
- Stuffy and runny nose
- Sore throat and cough
- Treat with antihistamines, decongestants, nasal steroids
We hope this information is helpful to you in the important work you do as a family caregiver.
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