9. January 2019
Advanced Age Is Not Protective Against Allergies

“Only children and young adults develop allergies.” That’s what many believe, but the reality is different: Nearly one in ten people over 65 will experience allergy symptoms for the first time.

Allergy studies have previously focused mainly on children and young adults. The elderly population was unjustly excluded, as this example shows:

“After two years of suffering from unexplained hives, it is a relief to finally know where these skin changes are coming from”, says Brunhilde Gösser from Hamburg, Germany. The sprightly 82-year-old pensioner was plagued every morning by itching on her entire trunk and underarms, and her skin was red and swollen. The medical term for these symptoms is urticaria. “It was unbearable and of course it looked terrible. The nightmare usually went on for three or four hours before I dared to leave the house again”, recalls the senior. She went to an allergy specialist for skin tests, which turned out positive for many foods and house dust mites.

Immune System and Skin Also Get Older

“Due to changes in the immune system, the elderly have an even higher risk of developing a food allergy than younger people do”, explains Larissa Brophy of Mount Carmel College in Columbus, the capital of the State of Ohio in the U.S. The reason for this, according to the nutritionist, is that the immune system changes over the course of one’s lifetime. The mast cells in particular, which help prevent allergies, no longer work as well in old age.
In addition, the stomach produces less acid. As a result, protein from food can move back into the body through the intestinal lining, whereas it would otherwise simply be excreted.

Not only do protective mechanisms lose their effectiveness, but the skin also becomes more permeable to toxins. The skin’s moisture level decreases and it becomes dry and cracked, allowing in toxins from ointments, cleansers and cosmetics. Nickel jewellery such as rings and earrings can then suddenly start causing problems.

Environment and eating habits change

Air pollution is an additional risk factor in the development of new allergies in later life. Fine dust, soot particles and nitrogen dioxide (NO2) bind to otherwise harmless pollen. The immune system perceives the changed pollen as a threat and creates antibodies.

Hay fever and other allergies can later lead to allergic asthma. Anahí Yánez and her team at the Research Center for Allergies and Respiratory Diseases in Buenos Aires, Argentina, discovered that one in ten new cases of allergic asthma only appears after age 60. In most of these cases, the patients also had allergic rhinitis (Yánez et al. 2018). For Yánez, a specialist in allergology and immunology, it is clear that asthma also needs to be taken into account as a potential cause of chronic throat irritation and shortness of breath in elderly patients.

Not only does the environment change over the course of a lifetime, but also our eating habits and the body’s reaction to certain ingredients. People of all ages try new fruits and vegetables or exotic spices from distant lands. This can also lead to food allergies, which are not rare in the elderly. A 2011 study revealed that one out of four people in a nursing home had IgE antibodies against food allergens (Bakos N et al. 2006).

The Right Diagnosis for Successful Treatment

Allergies in the elderly can be treated just as effectively as those in younger people. In addition to making a careful diagnosis, treating physicians also ask patients about existing conditions and medications. This is because the assumption from earlier studies that side effects from medications are not allergic reactions has been explicitly refuted by a more recent study. Nearly one in three side effects had an underlying allergic immune response (Ventura et al. 2018).

In Gösser’s case, an analysis of her current medications also led to the correct diagnosis. When the elimination of certain foods, changing the bed linens and ventilating the room failed to improve symptoms, her doctor asked about her medications. The pensioner was taking a small daily dose of acetylsalicylic acid (ASA, or aspirin) as protection against atherosclerosis. When Gösser stopped taking the medication, the skin changes disappeared. “I finally felt like a human being again. I’m surprised that such a useful drug can also be harmful.”

 

More information

Sources

Yánez A et al. Clinical characteristics and comorbidities of elderly asthmatics who attend allergy clinics. Asthma Res Pract. 2018 Apr 23;4:5.

Bakos N. et al. Risk assessment in elderly for sensitization to food and respiratory allergens. Immunol Lett. 2006;107(1):15-21. 

Ventura et al. Importance of hypersensitivity in adverse reactions to drugs in the elderly. Clin Mol Allergy. 2018;16:7.