“Oh, my allergies are acting up.”
“I think I might be allergic to dairy.”
“My allergies have been really bad this year.”
If it seems like everyone around you is talking about their allergies or uncovering some new allergy later in life, you wouldn’t be wrong in thinking that people — specifically adults — just have more allergies than they used to.
According to allergyasthmanetwork.org, over 80 million people in the United States have been diagnosed with some type of an allergy.
“Pretty much all allergic disorders have been increasing across the board,” says Dr. Faoud Ishmael, with Mount Nittany Health’s allergy department. “At this point, there are some really big population studies where people look at certain groups and they follow people. For years, the prevalence was about 40%, so almost half of the [world’s] population had some kind of allergy. … As we’ve looked every decade
in terms of [allergy] prevalence, the past three or four times, every time someone does a new study, the prevalence is actually doubled. So not only are all [allergies] increasing, they’re actually increasing at a pretty dramatic rate. It’s an exponential increase.”
Ishmael explains that allergies can be broken down into a few different categories. Allergic rhinitis might be what you commonly think of as hay fever; it comes with sneezing, a runny nose, itchy eyes, etc. Then there are food allergies and allergic skin disorders.
So why does it seem like allergies are everywhere these days — and why is the data backing it up?
To start, it’s just easier to get tested for allergies today, which means more people who are concerned about symptoms can receive a proper diagnosis. Then, while some allergies are genetically influenced, there are also environmental factors at play.
“When you look at allergies across the world, pretty much all Western countries are seeing a pretty dramatic increase,” Ishmael says. “So the thought is that there’s something that we’re all being exposed to, in Western society, which people in developing nations don’t really have, or they have a different set of exposures, and that may be what’s driving it.”
However, he notes, no one is 100% sure what those exposures are. One hypothesis is that, in developing countries, individuals’ immune systems are exposed to threats that someone in a Western society doesn’t often deal with — like parasitic infections, for example. As a result, the immune system of that latter individual develops differently, doesn’t encounter an issue it’s designed to target, and becomes overactive, resulting in an allergy.
“There are certain risks depending a little bit on where you live,” Ishmael further adds. “For people who live in inner cities, for example, things like pollution and diesel exhaust particles will increase their risk of things like asthma. In other populations, exposure to certain pesticides might increase risk — in Amish populations, for example. There’s also questions about, if you go to a supermarket and you buy something and you look at the back of the package and there are 30 different ingredients in there, some of those things do affect your immune system.”
Dr. Timothy Craig, an allergist-immunologist at Penn State Health, points to similar research and theories
“Research suggests that higher exposure to PM2.5 air pollutants is associated with an increased risk of developing allergies. Additionally, a shift toward Western-style living — including less time spent on farms and reduced exposure to animals and natural environments — appears to play a significant role. Studies indicate that growing up on a farm and having regular contact with animals may help reduce the risk of allergies,” he says. “Diet also seems to be important. As more regions adopt a Western-style diet, there is a corresponding rise in allergy rates, likely linked to changes in the gut microbiome.”
Even climate change could be at fault, to a degree.
Ishmael notes, “Pollen seasons are starting earlier every year. They’re lasting longer, and then the peak [pollen] levels are getting higher. When you put all those three things together in a typical spring, we’re all being exposed to more of the allergen. So, you might have someone that had mild symptoms [in the past], but now when you factor in worse allergy seasons, it’s more pronounced and they’re more miserable than they were before.”
In other words, there’s a lot at play and, as such, it’s difficult to pinpoint just one factor that’s causing an increase in adult allergies across the board.
Then, you add in the simple fact that allergies can often be confused with other issues.
Geisinger’s Dr. Neil Baman is a board certified physician specializing in allergy and immunology, working out of Geisinger’s Scenery Park location in State College. “Oftentimes allergies get confused with intolerances,” he explains.
Rather than a food allergy, someone might experience a food intolerance, for example. Whereas a food allergy might lead to hives, itching, lip and tongue swelling, and difficulty breathing, a food intolerance may present as more gastrointestinal distress.
An allergy has a very specific definition. As Dr. Nathaniel Hare, allergist-immunologist at UPMC in Williamsport, explains, “Allergies occur when the immune system mistakenly identifies harmless substances, such as food, pollen, animal dander, dust mites, or medications, as threats. Once this happens, the body reacts every time it encounters that allergen.”
He also mentions a handful of other conditions that may be confused with allergies.
“Headaches and sinus [or] facial pressure may get confused with environmental allergies. … Nasal symptoms can overlap with allergic rhinitis but may also be caused by irritants [like] odors, perfumes, smoke [or] weather changes; nerve reflexes, such as reactions to spicy foods; or certain medications. Common colds, viral infections, and other respiratory illnesses can also resemble allergic reactions,” he says.
However, this confusion is typically on the patient side, and working first with a primary care provider and then a specialist can usually clear things up — and luckily, formally diagnosing and then treating an allergy is a bit simpler than actually determining why so many people have allergies nowadays in the first place.
For one, it helps that, out of the broad spectrum of allergies that one might have, adults are more likely to develop some allergies than others. For example, out of the various major food allergies, Baman says, a shellfish allergy is definitely the most likely to suddenly present in adults. Craig also notes that allergies to stinging insects, including bees and fire ants, are more likely to present in adulthood.
Additionally, allergies may or may not be something you need to seek treatment for right away.
Baman describes the approach one might take if they think they’re experiencing symptoms of an allergic reaction: “If it’s a gradual thing, [the patient] could take time to try to map it out and figure out what’s going on their own. If it’s an acute issue, where they have signs or symptoms of some sort of allergic reaction within seconds or minutes, and they’re in the urgent care or the emergency department locally, that would be something that’s discussed with their primary care practitioner, and [an allergist] could get them in relatively quickly.”
For gradual symptoms that may be affecting your life, but not to an extreme degree, there are a few things you can do before seeing a specialist that could be helpful in, as Baman put it, mapping things out.
Pay attention to symptoms and their timing, and potential triggers. Do you only experience symptoms during certain seasons? Or do symptoms appear episodically, when you encounter particular situations?
From there, if you and your care team do decide that allergy testing is a good idea, the process is pretty painless and the testing is very reliably accurate.
According to Ishmael, there are two primary ways that doctors go about allergy testing, blood testing including panels for environmental and food allergies, and skin-prick testing.
For the latter, he explains, “You basically put a little bit of allergen on the skin. We have a plastic applicator that makes a scratch and you expose the allergen to allergic immune cells in the skin.
Those same allergic immune cells also live in the nose, eyes, and other parts of the body, so putting it on the skin mimics what happens if you breathe in or ingest the allergen.”
From there, if you’re allergic to whatever allergen was applied, you’ll develop a small, itchy bump, similar to a mosquito bite. The application process only takes a few minutes and then patients wait 15 to 20 minutes for results to develop and then, often, you have your answer.
Once you’ve determined what exactly it is you’re allergic to, Baman says, there are multiple methods of treating those allergies: avoidance of the allergen, medications such as nasal steroid sprays or antihistamines, and allergen immunotherapy.
He sums up, “If an adult comes in with suspected environmental allergies, keep in mind that it could be nonallergic issues as well. That’s where seeing an allergist-immunologist would be helpful to differentiate that — but there are always ways to treat those other types of patients, in general, and [they should] seek help, especially if [symptoms are] affecting their normal activities. T&G
Holly Riddle is a freelance writer for Town&Gown.
