If you are a woman in your 40s or 50s you might have noticed that some things - like jewellery or certain clothes – increasingly bring you out in an itchy skin rash. Or that you have suddenly begun to develop other new allergic symptoms including menopause-induced hives (urticaria)1 or typical signs of allergy such as allergic rhinitis2 (when your nose becomes irritated by something irritating it) and wheezing, coughing and sore, watery eyes in response to allergens such as dust or pollen which previously haven’t troubled you. Many women also report that any existing allergic conditions such as eczema, dermatitis, asthma and even hay fever worsen around these times of hormonal change. As things stand there are no statistics to show how many women are affected but anecdotally these symptoms appear surprisingly common.
So why are you more likely to suffer with allergies during these times of hormonal transition? It is thought that fluctuating and declining oestrogen during perimenopause and menopause is what drives these changes. There are oestrogen receptors all over the body including in immune-regulating cells and it seems that erratic - high or dwindling - oestrogen levels can upset the body’s immune response making it suddenly react differently and more severely to previous harmless allergens. The body then defends itself by producing more histamine, the chemical which triggers typical allergy symptoms. Histamine levels are known to peak when oestrogen levels are high (which is often the case during the perimenopause and during ovulation – that is, around day 13-14 of a normal 28 cycle) and this may lead to a build-up of histamine potentially resulting in histamine intolerance (the inability to break down histamine in the body)3.
Whilst evidence remains sketchy around the precise mechanisms of how hormones impact allergies the potential link between asthma and menopause is the aspect which has been researched most closely. Why this is such a significant area of study is that women are more likely to have asthma, have more acute symptoms and women in the UK are almost twice as likely to die from an asthma attack than men4. During the perimenopause there also appears to be a decline in lung function for women, although once they have been through menopause they are then at a lower risk of developing this respiratory condition5. Women who go on to develop new onset asthma after menopause6 – and this can happen in early post-menopause and late post-menopause - are also more likely to have symptoms which are difficult to control and manage. What we also know is that fluctuations in oestrogen levels are associated with inflammation in the lungs and potentially impaired respiratory function7 and many women experience a significant worsening of symptoms and asthma flare-ups at times of hormonal change – particularly when pre-menstrual and at the time of ovulation8. In fact, one in three women report that their symptoms worsen before or during their period9.
Whilst we wait for more research around hormone-related allergies if you are becoming increasingly allergic and/or existing allergy symptoms are worsening always get advice from your doctor about the best way to treat and manage them.
How to manage hormone-related allergy symptoms
Chart your menstrual cycle and keep an allergy symptom diary
If you are peri-menopausal use the free Health & Her menopause tracking app to keep a record of your menstrual cycle. Symptoms of asthma, for example, are known to get worse right before your period when oestrogen levels are known to drop. If you are perimenopausal or menopausal use the app to detail any potential allergy symptoms, including how severe they are and what is possibly triggering them. This is also useful information to take to your doctor to help establish if there is any link between your hormones and asthma, or other allergy, symptoms you might have.
Reduce your exposure to allergens
It might seem blindingly obvious but if something – be it a food, alcohol, smoke, pollen, perfume or pet dander - appears to trigger an intolerance or allergic response try to avoid it as far as possible.
Manage your weight
Being overweight or obese is linked to changes in the immune system which appear to exacerbate allergic responses and conditions such as asthma and allergic rhinitis.10,11 Being overweight can also increase your risk of developing asthma for the first time around the time of the menopause.
Keep stress under control
Stress and anxiety can trigger asthma and you are more likely to feel stressed and anxious when perimenopausal and menopausal so try to find ways to manage it effectively. Stress can also trigger the production of histamine and make your skin more prone to itching and rashes.
Avoid smoking
Research suggests smoking (both passive and active) can cause, or exacerbate, allergy symptoms like allergic rhinitis and dermatitis12.
Protect your skin
Skin is known to become thinner and drier around the time of the menopause. Try to drink plenty of water to keep your skin well hydrated and if it is becoming increasingly sensitive and itchy it might be worth switching to unperfumed and more natural organic products.
Try a low histamine diet
Treating histamine intolerance involves trying to avoid histamine-releasing foods and drinks. These typically include fermented foods like aged cheeses, other dairy foods, cured meats and alcohol. A low histamine diet should include plenty of fresh and unprocessed foods but, confusingly, certain ordinarily healthy and nutritious foods like some fruit and vegetables, nuts and pulses,13 can cause problems if you are hyper sensitive to histamine.
Take probiotics
It is thought that poor gut health and a lack of diverse gut bacteria can contribute to allergies. For sinus allergies like allergic rhinitis probiotics containing Lactobaccilus acidophillus have been found helpful.14
Think about HRT
Research around HRT and asthma is mixed with some studies suggesting it may increase the risks of attacks and symptoms in women who already have the condition.15 A large UK study that examined the records of over 350,000 women over 17 years suggested it reduced the risk of developing the condition post menopause.16 Another study shows that perimenopausal women have a reduced risk of allergic rhinitis when taking HRT.17 Women taking HRT also generally report an improvement in skin conditions like hives, eczema or dermatitis.
Use medication when needed – treatments for allergies during perimenopause and menopause are the same for at any other time of your life. Depending on the kind of allergy and where in the body you are experiencing it you might be prescribed or recommended creams, anti-histamine tablets or an inhaler.
References:
1. https://www.nhs.uk/conditions/hives/
2. https://www.nhs.uk/conditions/allergic-rhinitis/
3. https://www.allergyuk.org/resources/histamine-intolerance/
4. https://www.ed.ac.uk/usher/aukcar/news/news-stories/2022/women-almost-twice-likely-die-from-asthma-attack
5. https://www.asthmaandlung.org.uk/sites/default/files/2023-02/asthma-is-worse-for-women-report-1.pdf
6. https://pubmed.ncbi.nlm.nih.gov/26435006/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008417/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8870409/
9. https://www.asthmaandlung.org.uk/conditions/asthma/asthma-triggers/female-sex-hormones-and-asthma
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10489982/#:~:text=Obesity%20leads%20to%20changes%20in,allergic%20diseases)%20%5B43%5D.
11. https://www.jacionline.org/article/S0091-6749(14)03173-X/fulltext
12. https://speakingofmedicine.plos.org/2014/11/19/exposure-smoking-either-passive-active-lead-increased-allergies/
13. https://www.histamineintolerance.org.uk/about/the-food-diary/the-food-list/
14. https://pubmed.ncbi.nlm.nih.gov/15059192/
15. https://pubmed.ncbi.nlm.nih.gov/33705997/
16. https://pubmed.ncbi.nlm.nih.gov/33279576/
17. https://link.springer.com/article/10.1186/s13223-023-00839-7
