Do People With HIV Get More Allergies?

People infected with human immunodeficiency virus (HIV) experience high rates of allergic conditions, including allergic rhinitis (hay fever), drug allergies, and asthma. The HIV virus infects and destroys CD4+ T-cells, a type of white blood cell. This results in altered immune function that contributes to the development of infections, cancer, and other immune problems.

HIV and the Connection With Allergies

HIV infection is associated with high levels of the allergic antibody (IgE), especially as the CD4+ T-cell levels drop. The high IgE levels are not necessarily correlated with worsening allergies, however, but can be associated with worsening immunodeficiency due to B-cell dysfunction. The IgE antibodies may be directed against various allergens or may be nonspecific.

These changes may occur due to ​a disruption in the balance of the immune system, which can lead to alterations of the normal allergy control mechanisms—and consequently, development of symptoms of allergic disease.

Hay Fever

People with HIV experience very high rates of nasal symptoms. Studies show that 60% of people with HIV complain of chronic sinusitis symptoms, and more than one-third of hospitalized HIV patients have evidence of sinusitis.

Various studies also show that people infected with HIV have high rates of positive results on allergy skin testing, compared to people without HIV infection.

Treatment of allergic rhinitis with HIV infection is similar to treatment of the condition without HIV. Allergen avoidance is the most effective way to prevent an allergic reaction. If allergen avoidance is not possible, oral antihistamines, nasal steroid sprays, and other allergy medicines are generally considered safe if you have HIV.

Whether it is safe for you to take allergen immunotherapy (allergy shots) when you have HIV is a question for your allergist to answer, particularly if your CD4+ counts are 400 or higher. There have been concerns regarding the safety of stimulating the immune system in people who have HIV, but this allergy therapy has been used for people with HIV.

Drug Allergy

HIV infection is associated with high rates of drug allergy reactions, likely as a result of disruption of the normal immune system regulations.

Trimethoprim-sulfamethoxazole (TMP-SMX), a sulfa-containing antibiotic, is often required to prevent and treat commonly seen infections in people with HIV. Adverse reactions occur in more than half of HIV-infected people (compared to less than 10% of people not infected with HIV). Desensitization for TMP-SMX allergy is frequently successful.

Abacavir, a drug used for treating HIV, is a nucleoside reverse transcriptase inhibitor. It can cause a life-threatening hypersensitivity reaction in 5-8% of HIV-infected people. Some people have a genetic predisposition to abacavir hypersensitivity. This predisposition can be identified with the use of a blood test prior to starting abacavir. If a person does not have the gene that is associated with the reaction, then abacavir can usually be safely taken.

Asthma

There is an increase in asthma symptoms with HIV. In fact, people with asthma symptoms such as shortness of breath and wheezing do not necessarily have improved lung function with HIV treatment. In some cases, asthma may even worsen.

HIV-infected men have been shown in studies to have higher rates of wheezing compared to men without HIV infection, especially those who smoke tobacco products. HIV-infected children receiving antiviral medications show increased rates of asthma compared to HIV-infected children not taking antiviral medications.

These studies suggest that people with HIV infection are particularly susceptible to the irritant effects of tobacco smoke. Furthermore, HIV treatments protect against the loss of immune function—which may increase the risk for inflammatory allergic conditions, such as asthma.

These issues are not an indication to delay or avoid HIV treatment. HIV is a fatal disease if it's not treated, but wheezing and other asthma symptoms can be managed. More research is required to better understand the connection between HIV treatment and asthma symptoms.

Asthma treatments for people who have HIV are similar to the treatments that people without HIV infection would take. However, oral corticosteroids should be avoided whenever possible, due to their suppressive effect on the immune system.