Adult allergies: Q&A with Dr. David Corry

Human bodies change over time, and as the decades shift, so too can one's tolerance to allergens. Dr. David Corry, professor of immunology, allergy and rheumatology, answers a few frequently asked questions about adult allergies and what people should expect to change as they age.

Question: How do allergies evolve as we age? Is this common?

Answer: It is very hard to say (how or when allergies may change), and is a highly variable issue from patient to patient. Certainly, persistent exposure to an allergen already eliciting a mild allergy is likely to result in gradually worsening disease. For example, mild dog allergy is likely to worsen in dog owners who refuse to get rid of the dog even after notification that they are starting to become sensitized.

Worsening over time is not guaranteed however, and it is largely unknown why some folks will worsen while others will not.

Q: Can you be a little bit allergic to something?

A: Yes. Allergic reactivity, especially that as shown by an allergy test, exists along a continuum from low, barely detectable reactivity, where you may experience minor symptoms like mild runny nose and sneezing, to very high reactivity associated with life-threatening allergic reactions like anaphylaxis.

Q: Should I get an allergy test as an adult? Which one is the best?

A: The process of allergy testing as an adult is largely the same as with children. Typical testing consists of counting the level of allergen-specific immunoglobulin E (IgE), the antibody that causes many allergic reactions, through a variety of commercially available blood tests, like the ImmunoCap test and skin prick testing (SPT).

The ImmunoCap is a sensitive test that gives absolute quantification of specific and total IgE and can be used to monitor response to therapy. It poses no risk to the patient aside from the bruising and fainting sometimes associated with blood draw.

The most sensitive test for detecting specific allergic reactivity is via SPT in which (small) quantities of extracts from the potential allergens of interest, like pollens, molds, insects and many others, are injected into the skin and a visible reaction occurs in the skin after about 30 minutes. This test poses some patient risk (extremely remote chance of severe skin or systemic allergic reactions) and is not as reliable as the ImmunoCap in monitoring response to therapies. However, (SPT) is the most sensitive and useful in formulating an initial immunotherapy prescription.

By Aaron Nieto

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