Why do some people develop allergies in adulthood?

Lu Morales, 32, grew up eating a wide variety of Mexican seafood dishes. But at age 25, a takeout meal of shrimp egg rolls suddenly led to anaphylactic shock, an ambulance ride to the hospital and the diagnosis of a shellfish allergy.

Morales, who uses they/them pronouns, said the egg rolls caused coughing, wheezing and red, puffy eyelids. Now, Morales said, shellfish is completely off limits.

While most people won’t experience the gain — or loss — of allergies in adulthood, it is also not unusual, said Dr Shradha Agarwal, an allergist and immunologist at the Icahn School of Medicine at Mount Sinai in New York City. Why allergies wax or wane, especially in adulthood, is largely not understood by scientists.

“There’s a lot of mystery in allergy,” Agarwal said.

What experts know

Allergies come in many forms and generally develop when your immune system mistakenly treats a harmless allergen, like pollen or animal dander, as a threat, Agarwal said. It then reacts every time it encounters that allergen, with symptoms that can vary from coughing, sneezing and itchiness to more serious reactions including hives, vomiting, trouble breathing and loss of consciousness.

About 26 per cent of adults and 19 per cent of children in the United States have a seasonal allergy, and about 6 per cent of adults and children have a food allergy, according to the Centres for Disease Control and Prevention.

The causes of allergies are complex, said Dr Corinne Keet, a professor of paediatric allergy immunology at the University of North Carolina School of Medicine — depending on your genes and what kinds of allergens you’re exposed to and when.

But experts think that, in general, things that disrupt your immune system — such as puberty, pregnancy, transient or chronic illnesses, or organ transplants — “can change your allergic responses to things that you previously tolerated,” Keet said.

Experts don’t know how common it is for allergies to develop in adulthood, said Ruchi Gupta, a professor of pediatrics who specialises in allergy at the Northwestern University Feinberg School of Medicine, although we do have some data related to food allergies. In a survey of more than 40,000 adults in the United States published in 2018, Gupta and her colleagues found that about 45 per cent of those who had food allergies developed at least one new food allergy in adulthood. Of this group, a quarter never experienced food allergies as children.

An important question for researchers, Gupta said, is what exactly might cause adults to develop an allergy to a food they’ve eaten before. Right now, she said, we don’t know.

Dr Jyothi Tirumalasetty, a practising allergist and clinical assistant professor of medicine at Stanford University, has seen patients of all ages develop various kinds of new allergies, including some to common allergens such as pollen, pet dander or tree nuts.

What about allergies that disappear?

“Losing” an allergy, or becoming “desensitised” to an allergen, happens frequently, Tirumalasetty said, especially beginning around (or after) middle age. Our immune responses “quiet down,” becoming weaker and less vigorous as we age, she said.

Some allergies are more likely to “resolve” than others, Keet said. Most penicillin allergies disappear over time, and seasonal allergies tend to lessen as you age, she said.

This article originally appeared in The New York Times