Why Your Allergies Are Suddenly Worse in Your 40s (Perimenopause & Hormones) | Episode 18

Did Your Allergies Come Back in Your 40s? It Might Be Your Hormones.

Did your allergies suddenly get worse (or appear out of nowhere) in your 30s or 40s? Do your allergy or asthma symptoms seem to flare at certain times of the month? You’re not losing it—it’s in your hormones AND your immune system!

In this eye-opening episode of Allergy Actually, your bestie allergist moms – Dr. Kara Wada, Dr. Amber Patterson, and Dr. Meagan Shepherd – are having the conversation no one else is: the powerful link between hormonal shifts and allergic diseases.

They dive deep into how the rollercoaster of perimenopause, puberty, and pregnancy can put your allergy cells on high alert. Learn how estrogen can act as the "gas pedal" for inflammation and progesterone as the "brake," and what happens when that balance is disrupted. From new-onset asthma to increased reactivity, this episode is a validating and empowering guide for women at every stage of life.

EPISODE IN A GLANCE
00:22 New Allergies in Your 40s? You're Not Alone
02:26 Why Symptoms (Not Labs) are Key for Perimenopause
05:02 The Science: Estrogen "Gas Pedal" & Progesterone "Brake"
06:53 How Puberty & Pregnancy Change Allergies & Asthma
12:33 Practical & Lifestyle Tips for Managing Hormonal Flares
14:22 The Domino Effect: How Treating Allergies Helps Everything Else

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ABOUT HOSTS
KARA WADA, MD
Dr. Kara Wada is a quadruple board-certified physician in allergy, immunology, and lifestyle medicine, and founder of the Immune Confident Institute. As a Sjogren’s patient and life coach, she combines modern medicine with lifestyle and mindset practices to help patients harness their body's ability to heal.
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AMBER PATTERSON, MD
Dr. Amber Patterson is a world-renowned allergy and immunology expert pioneering the future of immunotherapy. As the U.S. ambassador for ILIT™ Protocol (a 3-injection allergy shot protocol), she is redefining allergy care through her practice, Auni Allergy®, and the groundbreaking Auni® ILIT™ Learning Network.
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MEAGAN SHEPHERD, MD
Dr. Meagan Shepherd is a board-certified allergist and immunologist with nearly 15 years of experience specializing in advanced immunotherapy. She is known for her practical, evidence-based approach and her unique focus on "allergy-conscious living"—designing homes, habits, and lifestyles that improve her patients' quality of life.

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Transcript

Episode 18 - Why Your Allergies Are Suddenly Worse in Your 40s (Perimenopause & Hormones) | Allergy Actually
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Dr. Kara: Wait, did my allergies just come back in my forties? Women oftentimes will feel blindsided in perimenopause. Never had allergies before, and now they're itchy, sneezy, congested, having new onset asthma. Many worry that they're losing it, but there are some biologic explanations behind their experiences.


New Allergies in Your 40s? You're Not Alone
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Dr. Kara: Welcome back to Allergy Actually where we as three allergist moms and best friends are chatting about the science behind what we experience as, you know, professionals and as friends. And today we are talking all about those hormonal changes, especially focusing in on perimenopause. And also though talking a little bit about how other hormonal shifts like puberty, pregnancy, and postpartum are also key times when our immune system may not quite follow the textbook.

Dr. Amber: This is such a needed topic to talk about. No one talks about this. We're talking about it.

Dr. Kara: I increasingly am talking about it with my patients. Well, in part because, well one, I kind of like had this realization in the last six months of like following all of my colleagues and girlfriends who are practicing medicine in this space and hearing all of the knowledge that they're sharing with us of like, oh, wait a sec. I've been waking up at two or three in the morning consistently. I'm having hot flashes the second half of my cycle. My ADHD symptoms have like the dial has been turned up considerably. And frankly, you know, a little TMI, but my periods have been, you know, sometimes light, sometimes really heavy, and that inconsistency has never really been a big issue.

And so after hearing it enough, I was like, Oh, I am 41. Maybe I need to look into this. And so, you know, made an appointment with a colleague girlfriend who's menopause certified and talked things through with her and really got me thinking about how I'm seeing this too in my patients. I see a lot of patients that look like us in my practice, that have that kind of are on this, spectrum of allergy and autoimmunity. And we know that hormonal fluctuations are a huge trigger for any type of inflammatory condition to potentially go haywire. 


Why Symptoms (Not Labs) are Key for Perimenopause
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Dr. Kara: So I started asking more about it and actually starting to treat it a little bit. I don't consider myself a hormone expert. I, I tell my patients that, you know, verbatim, but I say there are some low hanging fruit things we can do that may really move the dial in regards to turning down this excess inflammation.

Dr. Amber: And I think one of the important things to say upfront is we're not talking about necessarily doing labs to see what are your hormone levels? Does a certain hormone level mean that you need replacement? It's not that. It's based off of symptoms, and particularly with menopause, there are validated symptom scores.

So what does that mean? Because I, you know, I have friends who are like, all right, what do I need to do? Am I checking my hormone levels if my doctor's not checking my hormone levels? Are they not doing their job? That's not true. So a validated questionnaire is basically something that asks you questions related to a certain condition and has a scoring mechanism that has been studied to show that if your score is this, then it means this. If your score is this, it means that. Takes me back to those teen magazine quizzes about 

Dr. Kara: it. 

Dr. Amber: But yeah.

So this is better than going to the lab and checking your progesterone or estrogen levels is, you know, for menopause, doing one of these validated questionnaires. So what you're talking about, Kara, for our field, is we're asking our patients questions. Are you experiencing increase in these mast cell symptoms? Like what do you see with your patients mostly? Is it like the flushing? Is it the dryness?

Dr. Kara: So flushing, dryness, increased just in their overall reactivity. Especially that second half of the cycle, that is more often what I will hear from folks when I, you know, and then I'll ask some of those other, like, menopausal, how's your sleep? Like, are you having hot flashes? Are you having vaginal dryness, or other dryness elsewhere? How are your periods? You know, are they still regular? Is there fluctuation in how heavy they are or how light they are?

Dr. Amber: And these questions are very intentional because if you're answering yes, yes to some of these, then it helps us know, okay, you're in this perimenopausal time of your life where we know from data that progesterone is decreasing, estrogen is decreasing. Do you wanna share, Kara, what you were talking about with us earlier offline, about specifically with progesterone and estrogen and how those impact mast cells?

Dr. Kara: yeah,


The Science: Estrogen 'Gas Pedal' & Progesterone 'Brake'
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Dr. Kara: so I think of estrogen. Well, we know it's a key immune system regulator. And typically estrogen has an ability to act like a gas pedal for our allergy flavor of inflammation and mast cells. It can increase histamine release from mast cells and increase their activity in a few other mechanisms too. So that's like a gas pedal. Progesterone also can act like the brake pedal. It helps to stabilize mast cells and can help keep them from being so reactive. So if you are living through this rollercoaster of symptoms where your body has sometimes both its foot on the gas and the brake or off the brake and on the gas or you know, vice versa, you can see these big swings in how your immune system and specifically your allergy cells are functioning. And we've known since, you know, beginning of our training that there's kind of this rule of thirds that we're taught that a third of patients with allergies or asthma will have those get worse at times of hormonal fluctuation, puberty, pregnancy, postpartum, and perimenopause.

That, you know, if you have someone with asthma, a third of those folks with asthma will get worse, a third will stay the same, and a third will get better. And this holds true across other inflammatory conditions too, like autoimmune conditions like lupus, rheumatoid arthritis, Sjogren's.

So what I find fascinating is that even people with the same underlying condition, inflammatory condition may experience differences in how their body responds during these times of hormonal change.

Dr. Meagan: Yeah. That's one thing that I have started thinking a lot about in younger patients as well, because like you said, we were always taught, and I specifically would always focus on pregnancy. I just remember that number for asthma, that there's, you know, data that shows a third get better, a third get worse, and a third stay the same.

So we, we know that there is clearly something happening whenever you have this hormonal change, but there's honestly not a lot of great research done in all of these other areas. We know that in general, there's a lack of research done for perimenopause and menopause. That is a real lack of I guess knowledge in medicine.


How Puberty & Pregnancy Change Allergies & Asthma
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Dr. Meagan: And one of the things that I always, you know, I've started asking because I've been having some teenagers. Yesterday I had one and they said, you know, she had some, like, had to use albuterol a couple times when she was little. But really she didn't struggle with that throughout the years, it went away. And all of a sudden, the last six months she just started having, you know, all of a sudden she's coughing all the time and has wheezing and has, you know, nasal discharge and itchiness and eye symptoms.

And yesterday I said to this patient, I actually said, "So can you tell me when you started your period?" And I, you know, for a young person, you also have to kind of preface that and I say, "I'm sorry, I have a reason for asking this." And they said "About six months ago." And then mom was like, "That's when all this started."

And I was like, yes. You know, we don't have, there's not great research that supports that this definitely does happen in this like for puberty specifically, but we know anecdotally that it does. We see this and then also we have that factual information for a minimum asthma and pregnancy. So, I think that that is something that we as allergists need to be aware of.

And then as parents as well, there are big changes that come with puberty and we all know that, but it could be more than just what you have been taught to expect. And one of the things that fascinates me is that for food allergy studies looking at natural resolution and things like that, no one has really extended done studies looking at from childhood to puberty, because I think we would get a lot more answers then versus choosing an arbitrary like age five or ten or whatever. Because I always tell families, once puberty hits, I definitely think we should retest for this. I usually don't retest every food allergy every single year. But definitely if we haven't done it in a while, we need to see where you are once puberty happens, because there are changes and, I don't know what to predict. I can't, I just know that things change. Have you guys experienced sort of the same thing or know any, I guess, actual facts about any of that that I'm unaware of?

Dr. Amber: I mean, that's kind of our general philosophy that we grow up in allergy immunology talking about that that kind of thing tends to get worse at puberty. And talking about it is so important because patients aren't gonna think to bring it up. Like they're not coming to us saying, "Hey, you know what? I think that my symptoms are worse because I'm in perimenopause." Or "You know what? I just started my period and I think it's causing this." They're not gonna say that. I mean, hopefully our good friends out there in Allergy Actually Land are now going to be feel confident to talk about it and share this with friends.

So the conversation started, and maybe you'll connect the dots. But as allergists, that's part of our job is to help people connect the dots for them, ask the pointed questions to piece that out of the history if it's part of it. I think talking about this is enlightening in that regard that it's like for a lot of people, they're gonna listen to this and have this light bulb go off and say, "Oh my gosh, this is my problem." And so the good news is there's something that you can do about it, at least in perimenopause, right? 

Dr. Kara: Yeah. Well, and you know, I'm just thinking back, not super common, but another topic we're gonna have to cover another day is progesterone hypersensitivity. But we kind of will think about, so we've known for a long time that there are some folks that will have increase in their chronic hives or their eczema rashes in that week or so before their period, and then it gets better once their period starts.

And so, you know, when we think and learn about that, we think about the whole toolbox that we could use at our disposal. And part of the tools that we discuss with a patient depend on their goals in regards to they wanna have a baby, are they done having kids? Do they not have any interest in having kids? You know? And so this is an extension of that conversation. And is there then some potential role for thinking about HRT or hormone replacement? I think the new term might be, 

Dr. Amber: MHT, modified hormone replacement therapy. 

Dr. Kara: Yes. Thank you. And so, you know, I think that just adds an additional tool to that toolbox and that discussion that frankly wasn't quite a part of my conversations up until recently. And I, I really give so much credit, you know, if you are out there and you want some great, reliable sources on who to follow on social media to listen out for, Dr. Heather Hirsch, Dr. Rachel Rubin, Dr. Kelly Casperson. I don't know if you guys have some additional folks that you like to follow,

Dr. Amber: Yeah. Dr. Mary Claire Haver 

Dr. Meagan: Yes. 

Dr. Amber: She wrote on menopause that talks a lot about the impact of these types of things.

Dr. Meagan: Yeah, and her podcast is really great too. There's a really an excellent episode. I remember listening to it. A friend sent it to me and I was like, wow, like so many light bulbs just started for me, you know, personal symptoms and then things that I also see in my patients. So.

Dr. Kara: And


Practical & Lifestyle Tips for Managing Hormonal Flares
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Dr. Kara: you may decide with your healthcare professional you're working with personally, whether or not using hormones as something that is a good idea or not. But there are some other lifestyle things that we can do that can decrease allergic inflammation, decrease the overall allostatic load that your body's seeing. So using fragrance free products, gentle detergents, prioritizing sleep and making time for yourself some stress reduction. I'm saying that with some emphasis because I need to hear that right now. And eating a more anti-inflammatory diet. And treating your allergies too. Getting reevaluated, that's a huge lever to really turn down a big driver of systemic inflammation.

Dr. Amber: Yeah, that's a good point because things really add up, like they stack, right? You have allergies. There's some Th2 inflammation there. You add autoimmune disease, there's more inflammation you add, oh, now I'm in some type of hormonal change period of my life, add another stack. And if we can take away layer by layer, you're gonna feel better.

Even just taking away one thing at a time, treating your allergies, getting, you know, something like intralymphatic immunotherapy to start feeling better faster from your allergies. And then it takes off one layer of symptoms and then you say, okay, well that's better. Now I can focus on the remaining symptoms. Maybe that's from my hormone situation right now.

Dr. Kara: Well, and I know for me just starting a little bit of addressing my hormones, it has given me so much more bandwidth to focus on my work, to plan out my week so that I have time to work out and meal prep and do other healthy habits that I know like they add up over time.

Dr. Amber: For sure.


The Domino Effect: How Treating Allergies Helps Everything Else
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Dr. Meagan: Amber, that was such a beautiful way, I think, to describe the layers. What I, I try to tell people in my clinic, and it's not necessarily thinking specifically about perimenopausal patients or anything like that, but sometimes people will say, well, well this specific treatment helped this other big thing that really bothers me.

And I'll say, well, whenever you have issues or your body feels a certain way, it's often multifactorial. So if we can take away at least a few of those things or make better a few of those things that aggravate you on a daily basis, that will help. And it helps with overall health and just feeling better.

So I, I love the way you put that, that yes is this one thing, the fix for everything? Not necessarily. Fixing that can significantly improve the quality of your life. 

Dr. Kara: It's like the domino effect too, that you hit one thing and then you're able to make all of those subsequent changes afterwards. So in summary, it's not all in your head. It's in your hormones and your immune system. We encourage you, reach out to your personal healthcare team. If we can help you with your allergies, we would love to do that. We've added the links to our practices in our show notes as well. And you know, this is really a call to normalize this conversation that our hormone and immune system health are not two separate silos. You are all one human. So if you found this conversation helpful, we would love for you to share it with your network, share it with your girlfriends. And we'd love to hear your stories in the comments and any suggestions you have for future topics that we can chat about. Till next time, take care. 

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