Delayed Reactions

Allergies can develop at any age, and some symptoms are nothing to sneeze at


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By Alexa Stanard

Sara Gleicher had a mean rash.

The Southfield resident returned from a 2013 trip to California with itchy, red bumps covering nearly her entire body. Gleicher, now 59, chalked it up to the hotel sheets. But the rash didn’t go away. Over the course of the next year, she saw five separate doctors, itching all the while.

“The first dermatologist did a bunch of blood tests and a biopsy and said it was dermatitis and that there was nothing we could do,” Gleicher says. “The second one said the same. The third suggested an allergy test but did a very selective test, which showed nothing.”

As a child, Gleicher had been allergic to tree nuts, poppy seeds, cat dander, grass, and pollen. She also had asthma and eczema. 

“Finally, in early 2014, I went back to my primary care doctor and said, I want a full allergy test,” Gleicher says. “He sent me to a doctor I love, who did the full panel — and voila.”

The test revealed Gleicher was allergic to dairy, soy, fish, eggs, oranges, lentils, black beans, and peas. Gleicher was “floored” by the results, she says. She eliminated all the offending foods, and her rash cleared up. 

In our allergy-anxious culture, most of the focus is (rightly) on kids. But adults can develop new allergies, too, both to foods and to things in their environment. 

 

What Are Allergies?

Allergies are a reaction by the body’s immune system to a substance that has been inhaled, ingested, or touched. 

Allergens — things like pet dander, pollen, and various foods — are typically harmless in themselves, but for the 20 percent of Americans who have allergies, they can cause reactions ranging from watery eyes to life-threatening anaphylaxis.

People with type 1 allergies produce an antibody called IgE in response to an offending substance. But an allergic reaction doesn’t happen typically upon first contact with the allergen, though. 

“People aren’t born with the antibody IgE,” says Dr. James Baldwin, division chief of allergy and clinical immunology at the University of Michigan. “You only make it if you’re genetically predisposed and have seen the allergen before — you typically don’t react the first time because the IgE hasn’t formed. It’s usually on subsequent exposures or after several exposures.” 

That delayed reaction is why a person can move to a new city and not have environmental allergies for the first season or two. Eventually, though, the antibodies cause the affected person’s blood cells to release histamine, which causes the physical symptoms we associate with allergies.

“Allergies can cause rash, difficulty breathing, swelling of the tongue and throat, often vomiting and diarrhea — it’s the body’s way of clearing the allergen out of the system,” says Dr. Elizabeth Secord, division chief for allergy, asthma, and immunology at Children’s Hospital of Michigan DMC. “Usually it’s not subtle. It’s important to seek medical attention because reactions can be life-threatening.”

 

Some Stick Around, Others Don’t

Allergies can come and go during a person’s life. Certain allergies, like that to wheat, are usually limited to children and outgrown by adulthood. Others, like those to seafood and tree nuts, are typically lifelong. 

“Food allergies in young kids are different,” Secord says. “There are some food allergies that children have that they usually outgrow; the big ones are milk, soy, wheat, and egg. Kids tend to have them more than adults and they usually outgrow them.  

“Then there are the big food allergies — fish, shellfish, tree nuts and peanut,” she adds. “If you have those, you tend to keep them. Some people do outgrow them, but usually if you’ve had an allergy to one of the big four, the advice is, there’s a lot of good foods in the world.”

It’s not clear why some allergies tend to stick around while others don’t. As we get older, our immune system weakens, making the body less able to muster a response to an invader.

“The good news is that as people age — late middle age to elderly — their allergies sometimes burn out,” Secord says. “The bad news is immune response reduces, too. The good responses are waning so the responses that make spring miserable are, too.” 

Nonetheless, adults, especially those who had childhood allergies, can suddenly begin reacting to familiar foods or to their environments. 

For Gleicher, most of the foods she has become allergic to are ones she ate often before her rash appeared; eliminating them caused her to lose 10 pounds. 

“Now when I get a reaction, usually from cross-contamination at a restaurant, I take an antihistamine,” she says. “It’s a magic pill, but it leaves you feeling drowsy. 

“The one fun thing is — I was always allergic to cats; I used to be so allergic I would just walk into a room where there were cats and my eyes would water up,” she adds. “But [recently] I went to D.C. and slept at a girlfriend’s place. Her two cats were all over me. [Now] I am not allergic at all.” 

Such shifts are not entirely understood by researchers. But Gleicher’s physician, Southfield allergist-immunologist Dr. Annie Arrey-Mensah, says medicine’s tendency to function in silos can mean that symptoms like Gleicher’s are overlooked or misdiagnosed.

Gleicher, she says, presented with a history of asthma and eczema. Her symptoms combined with her childhood history of allergies, Arrey-Mensah says, made her “easy to diagnose,” despite the fact that her condition had been missed by several other doctors. 

“We need to really focus more on the fact that skin conditions can be manifestations of systemic disease,” Arrey-Mensah says. “That’s where our field crosses with that of dermatology, and where we tend to miss the boat.”

 

Confusion Over Allergies

We now live in a culture increasingly concerned about chemicals in our air and water and additives in our food. That health consciousness is largely for the good, but when it comes to allergies, it can also create confusion.

Allergies are an immune-system reaction: If you eat dairy and, a few minutes later, your lips are swelling and you’re having trouble breathing, you’re probably allergic to dairy. If you eat dairy and it leaves you feeling gassy, you’re not. 

“The typical allergy to food happens within minutes of ingesting the food,” Secord says. “There are reports of up to a couple of hours, but something that happens a day later or two days later, that’s not an allergy.” 

Baldwin says he daily sees patients who mistakenly believe they are allergic to various foods.

“There are many different ways foods can disagree with people; we call those all reactions,” Baldwin says. “There are several different mechanisms by which they can disagree [besides allergic reactions.] You can have toxic reactions, metabolic reactions, idiosyncratic reactions. People say, ‘I’m allergic to this food and I want a skin test.’ But a skin test will only help with type 1 — nothing else. ”

The difference between an allergy and a sensitivity or other type of reaction may not be meaningful to people whose symptoms are less than severe. But it’s important when the patient is a child, doctors say, because many parents associate certain foods with behavior problems in kids and decide their children are allergic.  

“Allergic reactions to foods don’t cause behavioral problems,” Secord says. “Many things could cause behavioral problems, but allergies to foods do not.”

Baldwin encounters similar misunderstanding in his practice.

“If Johnny acts crazy when he has chocolate milk, it’s probably not because he’s milk-allergic,” Baldwin says. “There are other issues. And a skin test won’t help you [diagnose them].” 

Secord says parents of children with special needs often have heightened concerns about allergies. “A lot of people who have children with autism and other neurological problems — I feel they’re taken advantage of,” she says. “People are desperate when their children are not OK, and they’re trying so hard to make something work. The kids are often put on very restrictive diets. 

“I have an autistic child,” she adds. “The social part is very important. To be put on a diet where they can’t eat what the other kids are eating, is maybe not a kind thing to do.” 

Parents of special-needs kids who think a given food could be contributing to their child’s problems should work with their pediatrician, a registered dietitian, or a nurse specializing in dietary health, Secord says, and should eliminate one food at a time to gauge impact. 

“Fifteen years ago everyone was keeping their kids from drinking milk because it causes mucus,” she says. “Then it was wheat. But food fads are what they are, so maybe take it easy on the kids.”


Cleaning House

If you suffer from environmental allergies, your house is most likely a hotbed for what ails you.

Environmental allergens are hard to avoid, in part because they’re so pervasive and in part because they’re often invisible. Dust mites and pet dander, two major offenders, burrow into our carpet and towels and snuggle into our pillows and furniture. Pollen wafts in though open windows and makes the journey indoors on the soles of our shoes. 

And let’s not forget about chemicals. Though pollutants like cleaning products, cigarette smoke, pesticides, and even air fresheners aren’t typically allergens, they are often irritants, causing headaches, shortness of breath, dizziness, and fatigue in those who are sensitive to them.

Follow these tips to help control environmental allergies and sensitivities:

  • Ditch the carpet, especially in the bedroom.
  • Keep pets out of the bedroom. 
  • Remove stuffed animals. If your child can’t part with all of them, get the pile down to as few as possible, and then wash them in hot water. 
  • Keep the windows closed.
  • Use air conditioning to reduce humidity.
  • Install a high-efficiency particulate air cleaner in your home.
  • Clean floors with a HEPA vacuum.
  • To kill dust mites, wash towels and bedding in water that is 130 degrees or hotter, and dry them in a hot dryer. (Avoid using an outdoor clothesline in the warm-weather months.)
  • Use hypo-allergenic bedding and allergy-proof covers for pillows and mattresses.
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