Summer of sneezing? How and why later life allergy happens

It can be confusing when respiratory and environmental allergies such as hay fever begin in our 50s. Alexa Baracaia explores why they happen and how to get diagnosis and treatment

Summer is on the way and your thoughts might be turning to pollen and other allergens..

Remember that stuffy nose? Your eyes are sore and itchy and you can’t shake that awful heavy-head feeling. Summer colds are the worst, huh?

Then you remember: didn’t this happen last year?

But it could be time to think again. Because these are classic symptoms of hay fever, and, just as with food allergies, respiratory allergies to pollen, pets or house dust mites, they can strike at any age.

“Allergies are not static,” says Hasan Arshad, clinical professor of allergy and immunology at Southampton University. “You can develop allergy to pollen at ten and people don’t ask why; at 50 people wonder what’s going on. But there is no difference.”

Allergies, hay fever and eczema at 50

Maureen Jenkins, clinical director of charity Allergy UK, agrees: “It can happen at any time. I know of a patient who was 84 when she developed hay fever due to birch pollen.”

And while these environmental allergies are often dismissed as minor, they can significantly impact upon your life. An estimated five to ten per cent of hay fever sufferers are affected so severely that they are unable to go to work.

Professor Gideon Lack, clinical lead in adult and paediatric allergy at King’s College London, says: “People with severe hay fever can feel like they have a chronic flu throughout the summer. And we all know how productive we are when we have a flu.”

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Someone may have not had any symptoms, and then suddenly at 30, 40, 50, something switches on the expression of the allergy

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The question, of course, for those who do develop allergies in later life is ‘why me?’

But the answer is only partly understood. Experts say 40 to 50 per cent of us are ‘atopic’, meaning that we are genetically prone to hypersensitivity conditions such as eczema, hay fever and asthma, even if we have never displayed symptoms.

Professor Lack says: “Someone may have made allergic antibodies to allergens for many years, yet not have any symptoms, and then suddenly at 30, 40, 50, something switches on the expression of the allergy.”

That ‘something’ could be repeated exposure to an allergen until it tips over a certain amount. Or it could be new exposure to large quantities of an allergen.

Other theories about why a person’s tolerance may break down include an insult to the immune system, such as a major infection; hormonal changes such as the menopause; and physical or mental stress.

Healthy living cannot guard against allergies

What it doesn’t signify is weakness in the immune system that can be ‘fixed’ by healthy living – or prevented.

“One can see it as an over-activity of the immune system, not an immune deficiency,” says Professor Lack.

“It’s very difficult to prevent. These events [that sensitise an individual to allergic disease] probably occur in early childhood.”

In the UK, one of the most common ‘aeroallergens’ (that is, airborne allergens that trigger a reaction) is the house dust mite. This is largely because, over the past 50 to 100 years, we have made the perfect breeding ground for the blighters.

Central heating has created the ideal ambient temperature and items such as carpets and soft furnishings have provided their favoured habitat.

Other common allergy triggers include dogs and cats, birch and grass pollen, and moulds found indoors in sheds, attics, fridges and window frames or outdoors among rotten leaves and plant litter.

Classic symptoms include sneezing, a runny or blocked nose, headaches and sleeplessness, itchy, red and watery eyes, coughing, a tight chest, wheezing, rashes and poor concentration.

What time of year do different allergies occur?

A key to diagnosis is the timing of symptoms.

Allergy to grass pollen will typically rear its head from May to July, whereas allergies to tree pollens can occur from February to June. Often if symptoms continue all year round they relate to indoor allergens such as house dust mites, pets and indoor moulds.

Lack says: “Identifying the allergens is important because that tells you when you are likely to experience symptoms and what period of year you should be treating yourself.”

If you cannot pinpoint the culprit, a GP can conduct blood or skin prick tests. Failing that you should ask for a referral to an allergy specialist.

Lack warns against high-street testing: “A lot of non-medical facilities that offer allergy testing, such as shops, health food stores and websites, use non-validated non-reproducible systems that lead to incorrect diagnosis. They are at best a waste of time and money and, at worst, dangerous.”

Allergy treatments and cures

Effective treatments range from antihistamines (“perfectly safe to take regularly”) to nasal steroid spray, eye drops and asthma medication.

Intensive immunotherapy is available in hospital for those with extreme symptoms and comprises injections or tablets to ‘desensitise’ sufferers.

Allergy UK also lists allergen avoidance steps that can be taken to minimise the effects. Bathing a cat twice a week can reduce cat allergens in the home by 90 per cent. Removing carpets where possible is recommended, as is regularly vacuuming with a high filtration (HEPA) cleaner. Most important is to follow advice to the letter.

Maureen Jenkins explains: “We had one gentleman in his 70s with a house dust mite allergy who had had years of misery because of it. We introduced him to a comprehensive avoidance programme and it changed his life.”

• Find an allergy specialist at the British Society for Allergy and Clinical Immunology