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OCTOBER 18, 2008 Need a Tissue? Why aging is putting more people at risk for developing allergies -- and what you can do about it By KELLY GREENE The Wall St. Journal Not everybody outgrows a stuffy nose... 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... 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. (snip) 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 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.
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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.
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Trying over-the-counter medications may seem like the simplest fix, but they can cause a number of disconcerting -- and sometimes hazardous -- side effects... 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 the allergen" triggers inflammation or irritation.
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http://online.wsj.com/article/SB122401049282033313.html (subscription)
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