Allergies in older adults

In April 2017, the AARP Bulletin wrote about allergies, and since it’s an AARP publication, it focused on adults age 50 and over. Before the 1990s (like when Drs. Engler and Malick were training), it was taught that allergy was an ailment of the young and usually got better as one became older. Further, it was thought that older individuals didn’t suddenly “become allergic.” Since the 1980s, though, the prevalence of allergy has increased in all age groups. It is now known that one can develop allergies at any age.

Just as treatment is different in children than it is in adults, a great deal of caution goes into considering therapeutic options in older adults.

For instance, oral decongestants, such as Sudafed, are more likely to cause side effects in older adults (e.g., high blood pressure, insomnia, irritability, and/or rapid heart rate). Sudafed PE is much safer. It doesn’t contain any “Sudafed” (pseudoephedrine) at all; rather, it contains phenylephrine, a much milder decongestant. Antihistamines, such as Zyrtec, Benadryl and Xyzal, can make you sleepy. Claritin and Allegra are less likely to cause sedation. Of further concern about sedating antihistamines is that long-term use increases the risk of dementia. The only antihistamine NOT on that list is Allegra (even Claritin is sedating and with anti-cholinergic effects at higher doses). Generic Allegra (fexofenadine) is much less expensive and works just as well for about 95 percent of our patients. Costco sells it as “Aller-Fex,” and Walgreens as “Wal-Fex”.

Nasal steroids are usually tolerated better than any of the oral medications because a much smaller dose of medicine is required to be effective since the medicine is applied directly to the nose. But some nasal steroids cause nosebleeds; original Flonase is most likely to cause a bloody nose. Two other over-the-counter nasal steroids, Flonase Sensimist and Rhinocort Allergy, are less likely to cause a bloody nose.

One treatment that works well in younger and older patients is allergy shots. Once we identify what you are allergic to, we can use allergy shots, or immunotherapy (IT), to make you less allergic. As opposed to medications listed above, which just treat your symptoms, IT is disease modifying. IT teaches your body’s immune system to ignore the dust mites, cat dander or tree pollen that can cause “false alarms” in the allergic. A word of caution about IT, though: many so-called allergists are not board certified by the American Board of Allergy and Immunology, and don’t use optimal doses of allergens in their recipes. All three allergists at The Allergy Clinic and Houston Allergy and Asthma Clinic are not only board certified by ABAI, but maintain that certification on an annual basis.

No one nose allergies like we do.™

Note: Information contained in this article should not be considered a substitute for consultation with a board-certified allergist to address individual medical needs.

Author

David B. Engler, MD, FACAAI, FAAAAI Dr. Engler is a board-certified allergist and immunologist who hails from Houston, Texas. He was recently voted Best Allergist/Immunologist in Houston by H Texas Magazine, an honor based on peer and reader voting, as well as a Super Doctor by Texas Monthly Magazine.