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Allergies on the rise: in a surprising twist, adults are discovering that allergies emerge at any time of life.

It came as a big surprise when Gittel Willner suffered her first bout of hay fever at the age of 47.

"I never had allergies before," said Mrs. Willner, now in her 50s and living in Brooklyn, New York. "I remember thinking, How could this happen?"

Two years later, she had a frightening allergic reaction to a nut.

[ILLUSTRATION OMITTED]

"One morning, I was cleaning up the counters. I found a filbert and popped it into my mouth," she said. "Within a minute, my chest started constricting; I couldn't breathe, and I thought I was dying."

In her panic, she did not think to dial 911, but she vomited and the symptoms eased. She has since had milder allergic reactions to nuts, to peeling potatoes, and to fresh fruit.

Often thought of as childhood afflictions, allergies can occur at any point in a person's life. And experts say that the prevalence of allergies in adults is rising.

Hay fever, also called allergic rhinitis, has been diagnosed in an estimated 14 percent of American adults, or nearly 30 million people, according to a large survey financed by Altana Pharma, a pharmaceutical company. Another 3.5 percent of the population have allergies to food. Experts believe that the number of allergy sufferers is even greater because many never seek a diagnosis.

Most people who develop allergies as adults probably experienced an allergic episode earlier in life, but do not recall it. In babies and toddlers, allergies tend to take the form of eczema, and children suffering from seasonal allergies tend to be less bothered by a runny nose than adults. In many children, the allergies fade during www.saturdayeveningpost.com the adolescent years, only to return later.

But in some cases, adult allergy sufferers have no history of allergic sensitivity.

Dr. Michael Blaiss, a past president of the American College of Allergy, Asthma and Immunology, said that 30 to 40 percent of the population inherits a genetic predisposition to allergies. "I don't think anyone knows what tips people over," Dr. Blaiss said.

Some experts suggest that people whose allergies begin in adulthood were not exposed to high levels of allergens as children or that their immune systems became sensitive over the years. Moving to a city, a different area, or a new house can set off allergies, as can acquiring a pet.

Being exposed to allergens when the immune system is weakened, as occurs after a viral infection or during pregnancy, can also set off an allergy. It is not uncommon for women to develop allergies after pregnancy.

The number of children who suffer from allergies has grown since the 1960s, although the rates seem to have hit a plateau. Allergies in adults have also increased, and the experts say they expect the prevalence to continue to rise as children with allergies mature.

The most widely accepted theory to explain the increase holds that in Western nations, the developing immune systems of babies are exposed to fewer challenges, largely because of the widespread use of antibiotics, vaccinations against diseases, cleaner food and water, and better living conditions.

Without these challenges, their immune systems do not develop in a balanced way. As a result, they become predisposed to allergies. The theory is based on the fact that the body produces T helper cells, white blood cells that are at the core of the immune response. Naive T cells develop into T helper 1 cells (TH1), which primarily respond to infection, or TH2 cells, which mediate the allergic response.

It is thought that when people are underexposed to bacteria, to some viruses and to other danger signals in the environment, the TH1 arm of the immune system does not develop appropriately. That tips the system toward a TH2 response, causing a hypersensitivity to allergic reactions.

"We're moving away from the idea that you were born with a genetic predisposition and that suddenly when you met with the right allergen, you became allergic," said Dr. Fernando Martinez, director of the Arizona Respiratory Center at the University of Arizona.

Until recently, pollution was considered the top reason for the increase, and many experts still believe it plays a role. Some pollutants, like diesel exhaust, activate certain allergens, increasing their potency. Carbon dioxide can increase the growth of ragweed plants and make them pollinate more, leading to more pollen in the air.

Dr. Andrea T. Borchers, at the rheumatology, allergy and clinical immunology division of the University of California, Davis, School of Medicine, believes that indoor pollution is a bigger factor.

"People in the U.S. and other developed countries spend more than 90 percent of their time inside," Dr. Borchers said in an e-mail message. "In indoor environments, which have become increasingly airtight, and in food and water, we are exposed to thousands of organic and inorganic substances such as volatile organic compounds, phthalates and pesticides, to name just a few."

Many of these compounds can affect the immune system and cause sensitization, and many are associated with respiratory symptoms.

Allergies are not just an annoyance. People with allergies have three times the risk of developing asthma as those who are allergy-free. Adult-onset asthma is also on the rise. And allergies can lead to ear infections and chronic sinusitis, which in turn can lead to continual antibiotic use and sinus surgery.

According to the allergy survey, 52 percent of sufferers said allergies impaired their ability to work, and most said they felt tired and miserable when their allergies hit.

The symptoms of allergies include nasal congestion, sneezing, runny nose, itchy throat and eyes, headache, sinus pain or ear pain.

When allergic people are exposed to an allergen, their immune system produces an antibody called immunoglobulin E (IgE). If exposed again, the IgE reacts with the allergen, setting off the release of histamine, leukotriene and other chemicals that create symptoms.

Many adult sufferers are undertreated, and many never see a physician for their allergies. Patients tend to live with symptoms because they believe there are no better treatments available, experts say.

Allergies in adults are treated by a three-prong approach, as they are in children: the avoidance of potential allergens; the use of medications like antihistamines that do not bring on drowsiness, antileukotrienes, and nasal corticosteroid, sprays to reduce the inflammation; and a series of allergy shots for those with allergies who do not respond to the first two treatments.

But some patients still have symptoms even with the use of drugs. And although nasal steroids are the most effective medication, many patients do not like using them because they can irritate the nose and make people hoarse.

Dr. John H. Krouse, director of rhinology and otolaryngic allergy at Wayne State University's School of Medicine in Detroit, said, "There's definitely a need for better treatments that work more rapidly and are better tolerated."

Managing Indoor Allergens

Americans spend about 90 percent of their time indoors, encountering a broad range and level of air pollutants that may be two to five times higher than outside.

The major sources of indoor allergens responsible for allergic illness in the United States are house dust mites, domestic pets (cats and dogs), cockroaches, and fungi. House dust mites are microscopic eight-legged arachnids that live in the dust, especially in bedding.

"There are about a dozen other types of mites that live in damp, indoor environments for which allergy testing is rarely conducted" said Jeffrey May, M.A., author and principal scientist of May Indoor Air Investigations LLC. "These include mold-eating mites, so people exposed to those mite-fecal pellets are exposed simultaneously to both mold and mite allergens."

May offers the following advice on what works to minimize the presence of allergens, and what doesn't work.

* Boric acid and benzyl benzoate kill mites, but do not eliminate residual allergens.

* Tannic acid destroys some protein allergens, but only affects a small percentage of the total amount of protein in a cushion.

* HEPA air purifiers help clean the air but cannot prevent mite allergens in a pilow or mattress from affecting a sleeper.

* A dehumidifier in a basement helps control mold growth when the relative humidity is kept under 50 percent. In a bedroom, however, a dehumidifier will not prevent body moisture under a sleeper from raising the relative humidity in a mattress to 80 percent, a level conducive to mite infestations (and even mold) if sustained.

* It is best to control allergens by eliminating their sources. For example, solid urethane-backed covers on mattresses and pillows eliminate primary bedroom exposures to mite allergens. As a result, the dust on curtains will no longer be allergenic.

* Pet dander or skin flakes, as well as saliva and urine, can cause an allergic reaction. Animal hair is not considered to be a very significant allergen. However, the hair or fur can collect pollen, dust, mold, and other allergens.

"Immunotherapy can provide modest relief of symptoms in cat-allergic individuals" said Dennis Ownby, M.D., professor of pediatrics at the Medical College of Georgia. "Air filters have not been shown to be consistently effective in reducing symptoms in cat-allergic individuals. The only consistently effective method of reducing symptoms from pet exposure is to remove the pets from the home"

--Jo Ann Faber, American College of Asthma, Allergy & Immunology

Illustrated by Fred Taylor
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Author:Tarkan, Laurie
Publication:Saturday Evening Post
Geographic Code:1USA
Date:May 1, 2008
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