Women hormones and hypersensitivity: allergic diseases in menopause

Menopause is a midlife endocrinological transition that profoundly affects immune regulation, vascular function, and tissue homeostasis, influencing the onset, severity, and clinical expression of allergic diseases. Declining and fluctuating estrogen and progesterone levels modulate mast-cell activity, T2 inflammation, and vascular permeability, contributing to distinct phenotypes in asthma, allergic rhinitis, chronic cough, skin allergies, drug hypersensitivity, anaphylaxis, and angioedema. Clinical observations suggest menopause may exacerbate existing conditions or trigger new-onset disease, with hormone replacement therapy (HRT) potentially modifying disease trajectories. Obesity, comorbidities, polypharmacy, and age-related physiological changes further shape symptom patterns and therapeutic responses. Despite increasing recognition of these effects, mechanistic understanding remains limited, and evidence-based guidelines for diagnosis, management, and individualized therapy in peri- and postmenopausal women are scarce. This review synthesizes current knowledge on hormonal influences in allergic diseases, highlights menopause-specific clinical considerations, and identifies major research gaps. Understanding the interplay between sex hormones, immune function, and allergic disease expression is critical for optimizing care. Clinicians should integrate peri-/menopause status into assessment and management, and future research should aim to clarify pathophysiologic mechanisms, risk factors, and tailored interventions for women in midlife.