Can You Develop Allergies as an Adult? with Dylan Timberlake, MD

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Aging can bring a lot of changes to your body, but here's one you probably don't think about much: the development of new allergies. Adults who have never dealt with allergies before might wake up one day and find themselves with itchy eyes from spring blooms or a case of hives after eating a favorite meal. It's kind of bizarre, right?

To find out what's going on, we're going to chat today with allergist Dylan Timberlake. He's one of the many experts at Cleveland Clinic who visit our weekly podcast to help us better understand our bodies and how they work. Now, let's see why allergies might pop up later in life and what you can do about it. Welcome to the podcast, Dr. Timberlake. Thanks for stopping by to chat about sniffles and sneezes and everything else that comes with allergies.

Dr. Dylan Timberlake:

Awesome. Thanks, John. I'm glad to be here.

John Horton:

Now, allergies are pretty common overall, but the idea that you can gain allergies as you get older just isn't what folks want to hear. So give it to us straight: How common are adult-onset allergies?

Dr. Dylan Timberlake:

Right. So, when I hear that question, I think about two kinds of allergies most likely that we want to talk about. And so, that one side of allergies is going to be more of your hay fever, environmental allergies, runny nose, stuffy nose, those kinds of things. And then, I know, potentially, we want to maybe branch off and talk a little bit about new-onset food allergy as well.

John Horton:

We're going to cover a lot of stuff, yeah.

Dr. Dylan Timberlake:

Yeah. So, let's start on the runny, stuffy, sneezy. It seems kind of relevant this time of year especially, too. So what I would say is the majority of people who develop allergies are going to develop those in childhood. But we do also see adults developing new-onset allergies and sensitizations to things.

John Horton:

Man, that was just such a bummer. I got to say, just once, I want to hear that we gain some sort of superpower as we get older instead of picking up all this stuff that we really don't want.

Dr. Dylan Timberlake:

Right. And then, the other thing, John, I want to talk about, too, is when we talk about allergies, I feel like, just amongst friends, family even, sometimes, in medicine, we talk about pretty much anytime people have recurrent runny noses, stuffy noses, things like that, as allergies — but there are other things that can cause those.

And so when you ask me about new-onset adult allergies — predominantly outside things or indoor allergens, pollens, pet danders, dust mites — we do see people develop those as adults, predominantly adults into 30s or maybe 40s.

Most of the time after that, we don't see those kinds of allergies developing. But we can see people developing some of these non-allergic symptoms that look like allergies — recurrent runny nose, stuffy nose, sneezing and that — from other mechanisms.

John Horton:

What would those other mechanisms be?

Dr. Dylan Timberlake:

Yeah, that's a great question. And so, the best way I can think and describe about it is, and those mechanisms aren't fully understood, but it seems like some of that is more of these nervous system processes in the nose.

And so the best equivalent I can think of is you go outside, you get a runny or stuffy nose, we know you're not allergic to the cold. But we understand that that can cause those same symptoms as allergies, runny or stuffy. There are some people, where their nose, those pathways are more sensitive, so it doesn't have to be those extremes.

John Horton:

So you're saying, kind of, allergies sometimes get a little bit of a bad rap. They're the catchall blame for our runny nose or itchy eyes?

Dr. Dylan Timberlake:

You got it. And to be honest, some of my patients who come in, and they don't have allergies, we've allergy tested them and we know it's not allergies. We'll even just sometimes talk about, "How are your allergies doing?" Because it's easier to say that than, "How's your runny nose doing?"

John Horton:

Yeah, I love it. They're like the one guy defending allergies here. I kind of like it. They get a little bit of help on their side, because they do get a bad rap.

Dr. Dylan Timberlake:

Yes, definitely, definitely.

John Horton:

So we look at this, then, as you get older, and you said sometimes people in their 30s and beyond, may start picking up some allergies. And like I said, there's other mechanisms. But you do see allergies just start with folks at that age. Why does this happen? What's going on in your body where all of a sudden it's like, "You know what? This pollen, it's a no-go, it's bugging me."

Dr. Dylan Timberlake:

Yeah, yeah. It's kind of the million-dollar question. We don't really know. And so we don't have great ways to say, "How do you go about this?"

So the allergy part of your body is part of your immune system. And so there are allergic diseases that seem to go together because you may just be a more allergic person.

And so then, when you get exposed to things recurrently throughout your life, you now may develop an allergy to them. So if you're someone who has eczema, which is an allergic skin condition, you're someone who has asthma growing up, an allergic lung condition, you're one of those people who's probably more prone to pick up these new allergies when you keep getting exposed to these things.

John Horton:

OK, that makes sense. It's almost like it just kind of deteriorates or kind of breaks down over time, and it gets a little bit worse as you advance on?

Dr. Dylan Timberlake:

Yeah, absolutely. So every time you get exposed to something, you could, in theory, develop a reaction to that thing. And if you are someone who has this allergic default immune response, it may be an allergic response that time. And then, once you develop that allergy, now, it's there moving forward.

John Horton:

What about, just, does your body just change, too? As we all know, you go through hormonal changes as you get older. Things just don't work the same way they used to. Does that maybe play a role?

Dr. Dylan Timberlake:

Yeah, definitely. And so I know we're talking about adult-onset, but if you look at hormonal changes, we see allergies changing a lot of time with these big hormonal fluctuation periods. So teenagers, when they're going through puberty … I definitely have adult patients who either have allergies before pregnancy and their allergies are better afterward. Or flip. They've never really dealt with allergy problems. Now, they go through a pregnancy, and now, they have allergy conditions. Around that perimenopause, menopause period, we can see some of these shifts as well. And so, I know I used a lot of women in that, but we see a lot of those pretty easily identifiable hormonal shifts there.

John Horton:

Right. They're kind of milestone moments, yeah.

Dr. Dylan Timberlake:

You got it, yeah.

John Horton:

And we had mentioned too when we spoke earlier, as you go through life, just situations change, people move. And if you go from one place and you go someplace else, there's different allergens floating around. And sometimes we don't think about just those sorts of differences, but it sounds like those are very real and might just trigger a response in someone.

Dr. Dylan Timberlake:

Yeah, definitely. And so, you can be a non-allergic person, move somewhere and then develop allergies when you move. Another big thing we see is someone who has allergies previously, and then they move, areas of the country, and they're now exposed to new allergens. And so here, we're talking about pollens. Typically, it'll take a couple of seasons for your body to see those allergens develop that allergic response, but then, after a couple of years, we'll see people who have moved, and now, they have worsening allergies.

And then, when we look at it, too — once again, so much of this is complex and we don't completely understand — but we have areas of the country where people, they move from one area and they feel like their allergies are really bad, and they move to another area, even with the same pollen counts, and now their allergies are either better or worse. And so it's definitely a complex system that's ... we understand a lot about it, but there's a lot we still don't know.

John Horton:

No, I believe it … with, when you go places … I have a son who goes to Ohio University, and we left, kids get there, and they call it the “hawking hack” because it's like your first year or two there, everybody, they sound horrible. And there's all this new stuff in the air, and you see it really gets to them. And these are all young kids and they get hit with it.

Dr. Dylan Timberlake:

Yeah, absolutely. And you look at going … if you're someone who's lived more in a suburban area, now, you're going out to a more rural area and you have, during different agricultural seasons, all of this crud, for lack of a better word, being knocked up in the air, right?

We can see that being irritated. We can see that being allergens. People who live in a different environment and then move to a more urban environment, where potentially more pollution is relevant. Those things all can play a role in this whole process.

John Horton:

Yeah. And to be honest, “crud” is a perfect medical term. We love using it here. It comes up very well.

Dr. Dylan Timberlake:

I know. I know. I use it all the time in clinic, and I laugh every time, because patients are like, "You don't have a better word for that?" Not really!

John Horton:

It's the perfect word. It fits it exactly.

So, one other thing I want to kind of touch on is maybe something that could trigger allergies would be stress, which I think gets about as much bad rap as allergies does, maybe even a little bit more. Can stress kind of trigger a response in your body, where all of a sudden, something just bugs you a little bit more than it did before?

Dr. Dylan Timberlake:

Yeah, absolutely. So once again, all of these systems in your body, there's this complex interplay. And so, we definitely see stress doing different things. I know we're talking about environmental allergies, but I feel like it's even more clear if we talk about food allergies, because in people who have food allergies, they have a very defined threshold. So meaning, some people who have a peanut allergy won't have anaphylaxis, a full-body allergic reaction until they eat half a peanut. Some people, it's a quarter, some people, it's one. So that's called a threshold.

We have all of these different stressors that we know — sleep deprivation, just stress in general, exercise, things like that — that when we are challenging these people or they're doing therapies and we can see where their threshold is, all of those things lower those thresholds. And so, making you essentially more allergic or more likely to have an allergic reaction. It's really easy to show that in the food allergy. If we sweep that to what you're talking about, yes, same thing. When these stresses are on your body, some things that may not have bothered you previously now are going to kind of throw you over the edge.

John Horton:

Yeah. It always amazes me, whenever I talk with doctors on the show, it kind of comes up. The body is such a sensitive place, and that balance you need to maintain with sleep and stress, and exercise and diet, and it all plays a role in so many different things that are going on. It just really kind of emphasizes the need to just live a healthy life.

Dr. Dylan Timberlake:

Yeah. Yeah, absolutely.

John Horton:

We've kind of been throwing a lot of different allergies out there, so let's narrow it down a little bit and focus on each one. When we talk about adult-onset allergies, it sounds like we could talk about food, environmental, all those sorts of things. So let's kind of break it down a little bit, and the adult-onset allergies you see most frequently develop.

Dr. Dylan Timberlake:

So predominantly, three of them, and I know we talked about two originally. And the third is drug allergy, and I feel like that's a whole conversation by itself.

John Horton:

That would just be to medications, right? Is what you're talking about?

Dr. Dylan Timberlake:

Exactly. Thank you, yep.

John Horton:

OK.

Dr. Dylan Timberlake:

So environmental allergies, when I've said that multiple times throughout this podcast, environmental allergies, sometimes we talk about it as hay fever when it's more seasonal, but those are going to be your allergies that cause nose and eye symptoms, runny nose, stuffy nose, sneezing, itching, sinus pressure symptoms, itchy, watery eyes and those.

Those allergens are going to be the things that are ... pollens are a big one. So tree pollens, grass pollens and weed pollens are big contributors there. Those are the ones that we think. Predominantly, outdoor, there are some outdoor molds that people will have issues with. So think of dead, decaying leaves, mulch.

John Horton:

When you cut the grass. I know a lot of people, that'll trigger stuff. You go by that freshly cut lawn.

Dr. Dylan Timberlake:

You got it, right? So there's those.

And then, we have our indoor allergens. And so those are things like pet danders, cats and dogs notoriously, dust mites, and then some of the indoor molds as well. So those are kind of the environmental allergies we keep talking about.

John Horton:

And those are the things that we'll see that people will just all of a sudden, they wake up one morning and you go outside on a spring day and take a deep breath in, and all of a sudden, you start sneezing?

Dr. Dylan Timberlake:

Yeah, definitely. And I keep pausing — and I don't want to be a stickler on it because some of it ends up changing, whether it's allergies or not allergies, a lot of time, in that spring and fall period, sometimes, changes in air pressure could be one of these non-allergic triggers. Said my peace there.

Yes, you can wake up and start to develop those allergies over time. And normally, what ends up happening, John, is normally, it's a little bit of a gradual or progressive thing. And so people come and they see me and they're like, "For the last two years, three years, four years, I've noticed every spring now, I'm miserable where I wasn't previously.”

John Horton:

"Yeah. Well, and that's what I was going to ask, how do you know? because as we said, there's a fine line there. You can get a runny nose from a lot of different things. Heck, I sneeze if you get too much pepper in something. So when do you know, "Hey, I think I'm developing allergies," as opposed to, "Hey, things are just a little bit off right now"?

Dr. Dylan Timberlake:

So really, the only way we know is if you see one of us and we do allergy testing. And that's honestly why I tell people, one of the big reasons I do allergy testing is if you've tried some of these over-the-counter allergy medicines and you are not getting better, these allergy, non-allergy processes, they can look almost identical. And so that's really the big way.

But when people come and see me, and I'm kind of getting clued in on it, do they have any of these other allergic diseases that they've had throughout their life, eczema, asthma or those kinds of allergies? Patterns are a big one for it. If it's every single spring, and it's spring throughout spring when the pollen counts are high. So it's not just that transition period. Someone comes and sees me, and it's that transition where it's starting to warm up into spring, winter into spring, but then it's not throughout spring, I'm probably less concerned about allergies because the pollen's going to be there all spring.

So pattern, every time you go to a friend's house and they have cats there, and then you're runny, stuffy … pattern most likely going to be that.

John Horton:

Right. You felt that, you can find the triggers? If you start paying attention to when you're feeling this stuff-

Dr. Dylan Timberlake:

…absolutely.

John Horton:

...you kind of start to see the trend and you can connect the dots?

Dr. Dylan Timberlake:

Absolutely.

John Horton:

Yeah. I know my wife always ... the house we used to live at, across the street, there was a tree that used to blossom every year, and she would have horrible allergies. I always told my neighbor, "You come out one morning and it's down, you know who did it."

Dr. Dylan Timberlake:

They'll know where to look.

John Horton:

So environmental, it sounds like there's a lot of different factors that come in. It's a lot of just paying attention to when you have these symptoms, what triggers them, and just kind of like I said, connecting those dots.

With food allergies, that's a whole different game. And what do you see there when people develop these problems later in life? What kind of things come up?

Dr. Dylan Timberlake:

Yeah. And so, same conversation we've had with environmental. We, a lot of the time, use the word “allergy” fairly broadly when we're talking about reactions to food. So people, they eat a food and something happens and we say," I have an allergy to it."

Most of the time, and there's always exceptions, but most, by and large, what we're talking about in our allergy clinic with allergies to foods is, “I eat a food and I'm having this one specific immune system reaction that's going to be the hives, swelling, potentially difficulty breathing or throat closing off, abdominal pain, nausea, vomiting.” So kind of this full-body allergic reaction.

So those are really the ones that we kind of are homing in on when we talk about allergy versus people who eat a food and hours later have other symptoms and things like that. That, we're typically not talking about as an adult-onset allergy.

John Horton:

Right, right. If you just feel a little like you have some Thai food, and all of a sudden you're not feeling great later on, you can't just blame that on allergies. It just might be your gut's not quite ready for the spice there.

Dr. Dylan Timberlake:

Absolutely. And there's people, once again, kind of a classic example, lactose intolerance. So lactose intolerance … lactose is a sugar that's in dairy products. Our body can't just absorb lactose in its normal form into your blood, so it has to break it down. Some people's bodies, they don't have that machinery to break it down as well. So they drink a glass of milk, they have ice cream, they get a lot of bloating, upset stomach, diarrhea. Yes, that is a reaction that they're going to have every time they have those dairy foods, but we're not calling that an allergy because it's the issue with processing the sugar, not your body's immune system reaction to that thing.

John Horton:

So, how common are adult-onset food allergies then? Is this something you see a lot?

Dr. Dylan Timberlake:

So there's certain foods that we see a fair bit of it in. And it's kind of interesting, because once again, we kind of have thoughts as to maybe why. And so, we don't see a lot of new-onset milk allergy, egg allergies, so true allergies like that. We normally see those in childhood. On the adult side, we typically see more of new-onset shellfish allergy, TRINA allergies, fish allergies, occasionally, wheat or soy.

But honestly, the big ones that if someone comes to me and the very first thing is, "I'm concerned I developed a new allergy to milk." "Yes, let's talk about it and see," but I'm less concerned. But if an adult comes to me and they're like, "I'm concerned I have a new allergy to shrimp," now you've got my attention because that typically is going to be more of the pattern.

John Horton:

Yeah. And I take it people just see that when you're at a party, you have some, and like you said, you might get those hives or a little swelling or things like that. If that happens to you, is that something you should go see somebody pretty immediately?

Dr. Dylan Timberlake:

Yeah, definitely. And so, those reactions can be severe. And so, typically, if your kind of first reaction is mild and you're treating with antihistamines and things like that, you have a couple hives. But yeah, if you have hives after you eat a food, you really should see either your primary care doctor or go see an allergist and we should talk more about it.

Obviously, if that's more a severe reaction, you feel like you're having trouble breathing, you're calling 911 and then you're seeing us for sure afterward as an allergist.

John Horton:

Well, and it sounds like when you start playing with food allergies, and I have some experience with this because I know we have one in my family, somebody with it, you don't quite know what the reaction's going to be. And you could always have one sort of reaction, and that thing could just dial up at some point. So it sounds like knowledge is key with that. You need to know that your body, just your immune system's not responding well to a certain food, and then you can react accordingly going on from there?

Dr. Dylan Timberlake:

Yeah, you got it. And so seeing an allergist in that scenario, it can do a couple of things for you. And so, number one is we can make sure we get the diagnosis right. There are other things out there that can cause hives. And I will just say this: I see weird, fluke things all the time. Someone eats a food, they have hives right after they eat it, the allergy test and they're negative, we introduce it back to their diet and they're OK, and who knows?

But definitely, if you've had it, we should look in. So one: Make sure we get the diagnosis right. Two: Some of these foods cross-react with other foods. And so we can kind of help with that navigation of if you're shrimp allergic — can you eat clams or muscles? And so we can kind of help with that as well.

And then, a lot of it is education, making sure that you have epinephrine of some form in case you need it. And then, most of my adults, we don't go into this as much, and we don't have to go into it now, but there's links out there. There are things that you kind of do to help with food allergy. Nothing that we have right now is curative from a food allergy standpoint, but there are things that we can do to make people essentially less allergic so that they're less likely to have a reaction with a cross-contamination accidental exposure.

John Horton:

We've spoken about that a few times on a podcast with Dr. Bjelac.

Dr. Dylan Timberlake:

Yeah, perfect.

John Horton:

It's fascinating what they're doing in the research. So I think everyone, fingers crossed, they kind of figure this out at some point.

Dr. Dylan Timberlake:

Definitely.

John Horton:

So it sounds like food allergies, if you immediately start noticing issues whenever you have something, get in, get tested so you have some answers.

What about with the environmental allergies? When should you go in and see a doctor to try to get to the bottom of what's going on?

Dr. Dylan Timberlake:

Yeah. Yeah. So, my rule of thumb is, essentially, if you want to know for any reason, great, see us. So if you think that you might have dog allergies, cat allergies, you're looking at planning life around that, absolutely come see us and let's do the allergy testing. That's probably the minority.

Really, where I start to see is, if you're starting to use some of these over-the-counter allergy medicines, one, two of those, and you're not getting the relief you want, then typically I say, come and see us as an allergist because then we can do allergy testing to once again, one, make sure we get the diagnosis right. Is this allergies or is it something else?

And then, if it is allergies, we can potentially identify what are your triggers? Are there ways we can reduce those exposures? And then, we can kind of help to optimize those medicines and then talk about any other therapies we have for that.

John Horton:

Do you find a lot of times that people just kind of needlessly struggle and suffer through years of just trying to gut through this sort of allergic reaction without really reaching out to get the answers and the help that are available?

Dr. Dylan Timberlake:

Absolutely. I think allergies are so common and prevalent that sometimes, it's just assumed that this is how we live. Life is busy. I get it. So taking a couple of hours out of your day to come and see an allergist is a big ask for most people.

But yeah, definitely, I see a lot of people who come in and they're kind of like, "I've been miserable for five years, and finally, this is it. I'm going to see you now." And it's like, "I wish we would've seen each other four or five years ago and made that difference for you."

John Horton:

Yeah. When you feel like you can't even go outside during a certain stretch of spring, it's like, "If you go and see somebody, you might be able to get some treatments and you can go and enjoy everything."

Dr. Dylan Timberlake:

Yeah, absolutely.

John Horton:

So when somebody comes in and they finally identify, "All right, I have an allergy" — and I guess this depends on the allergy — but what do you recommend for people to manage that condition? What kind of tips do you give them?

Dr. Dylan Timberlake:

Yeah, great question. So, we always talk about … there's three ways we can treat allergies. There's avoidance or at least decreasing your exposure to what you're allergic to, there's medications, and then there's something called allergy immunotherapy, or allergy shots, is what most people know it as. And so once we know what you're allergic to, we can go through those three things.

And a lot of our field is, we call it “shared decision-making,” and so it's really sitting down and talking about, "Are you someone who wants to avoid medicines? Are you someone who can't make the time commitment for allergy shots?" So trying to figure out what's going to work best for you. And then, almost always, we're going to talk about avoidance or at least once again, decreasing your exposure to those things.

John Horton:

Yeah. It sounds like people have a lot of options. It's just a matter of figuring out what the problem is and then talking to somebody to really get a plan in place.

Dr. Dylan Timberlake:

Yeah, absolutely. And I want to put a real quick plug…

When I keep saying avoidance or decreasing exposure, a lot of people are concerned that they're going to see us if they're concerned like they're allergic to their pets. Most of us as allergists don't tell people to get rid of their pets. There's ways that we kind of work around that. So, just want to put that plug, don't be afraid to have us tell us that you need to get rid of your pet.

John Horton:

Nobody's getting rid of their pets. All right, that's a good point to make there. Nobody wants to get rid of their favorite cat or dog or-

Dr. Dylan Timberlake:

…absolutely, absolutely.

John Horton:

Dr. Timberlake, we've covered a lot of ground here, and really kind of show what can happen and what people might deal with. So here's the big question: If allergies can suddenly develop later in life, is there any chance that they might also disappear? That only seems fair.

Dr. Dylan Timberlake:

You got it. So environmental allergies, most people end up outgrowing those or they do get better over time. If you're someone who develops them as an adult, you're probably going to be less likely to outgrow those because they're kind of solidified at that point.

Same thing with food allergies. We see certain food allergies that people are more likely to outgrow. Some of the ones, like what we talked about, the tree nuts and the shellfish and those ones, they're a little bit less likely to outgrow. And same thing, if you develop them as an adult, you're going to be less likely to outgrow them, unfortunately. But if you're someone who's earlier on in life, there is a chance.

John Horton:

All right. Well, I'm going to take all the good news out of what you just said and just kind of glom onto that.

Dr. Dylan Timberlake:

I know, John, I'm giving you the little nugget I can.

John Horton:

Oh, that's great. I think we got a glimmer of hope in there. So hopefully, if you don't outgrow it sounds like there's a lot of solutions to-

Dr. Dylan Timberlake:

…I was going to say, the glimmer of hope is there's ways we can treat and deal with it. So even if it's there, see us, we'll help you out.

John Horton:

Well, hey, that's a perfect way to end things. Dr. Timberlake, I really appreciate you taking the time to come in today, and looking forward to having you on again.

Dr. Dylan Timberlake:

You're welcome. Thanks, John. It's been fun.

John Horton:

Allergies can develop at any age, so don't be surprised if they hit later in life. The good news: There are really effective ways to manage allergies once you know they're present. Talk to your doctor to get a plan in place.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.