May 15th will mark the conclusion of Food Allergy Awareness Week, a time dedicated to spreading factual information about the ever-increasing experience of food allergies.
The general population of the United States and the global world is aging. According to the US Census Bureau, in 2016, there were 47 million individuals that were over the age of 65 (Jensen & Jensen-Jarolim, 2016, p. 472) which accounts for 15% of the total population. By the year 2050, this number is projected to increase to 20% of the population or 83.7 million people. This group has many unique needs, one of which being food allergies. While food allergies are often thought to be illnesses of the youth, they profoundly impact older adults (472).
Currently, allergies are the most common immunological diseases and one of the most widespread and continuously growing chronic health conditions (DeMartinis, Ginaldi, Sirufo, 2017). The World Health Organization posits that allergies are the fourth most frequent chronic disease overall with over 5% of adults in the United States being affected (Noone, 2019). There are a range of symptoms of food allergy including hoarseness, cough, wheezing, chest tightness, nausea, vomiting, diarrhea, dizziness, fainting and anaphylaxis (Sampson, 2016). Anaphylaxis is a medical emergency that includes hives, swelling, throat closure, rapidly lowering blood pressure, and shock (Ramanathan, 2018). Food-allergic reactions are the leading cause of anaphylaxis overall (Noone, 2019). Because reactions vary and can be severely affected by factors such as alcohol consumption or exercise, many people will doubt themselves or their diagnosis (Ramanathan, 2018). These thoughts can be very dangerous as anaphylactic reactions can be life-threatening (A. Muraro et. al. 2014, p. 1464).
Individuals must practice life-long food allergen avoidance in order to prevent such reaction. This includes being aware of the risk of cross-contamination through foods that are processed on shared equipment. While the United States does mandate some food allergen labeling, older adults may have trouble reading small labels, or understanding what all of the nutritional information means.
Undertreatment of allergies can be extremely dangerous in the case of anaphylactic reactions, however it can also lead to an abundance of less-immediate adverse health conditions such as malaise, malabsorption, and inflammation, not to mention the psychological and mental health effects of struggling with a chronic health condition. The burden of avoidance, fear of exposure, and experience of not being taken seriously can result in anxiety and a reduced quality of life (Noone, 2019). Many older adults are surviving on a fixed income and accrue incredible medical costs each year. Having a low-income makes it difficult to afford healthy food- especially food that is allergy-friendly (Flaherty, 2017).
In the early 1980s, food allergy overall was thought to be extremely rare. There was little public awareness surrounding the issue, and clinicians could be skeptical of the diagnosis (Sampson, 2016). While the perceived prevalence was similar to today at around 20%, some doctors believed the actual prevalence was less than 1%. Currently, it is estimated that 5% of adults have severe food allergies, and 8% of children. However, this number may be underestimated, especially in the older adult cohort. It is also important to note that while young children may “outgrow” certain allergies to foods such as milk, eggs, soy and wheat, allergies to peanuts, tree nuts, and seafood will generally persist throughout the lifetime (Sampson, 2016). As the population of the United States continues to age, it is imperative that older adults know that their food allergies and sensitivities may not go away or diminish with age.
Diagnosis for food allergies in general is often a complex process that may include skin testing, blood tests, and food challenges. Because older adults are susceptible to a wide range of health complications as they age, allergies are sometimes misdiagnosed as other conditions (Brophy, 2015). Allergy testing itself can be less reliable in older adults- skin test results can have false negatives and leave folks feeling an incorrect sense of security. Additionally, having multi drug prescriptions can complicate anaphylactic events. For example, drugs that contain betablockers decrease the effects of epinephrine and others may increase the risk of cardiac failure when combined with epinephrine (Jenson & Jenson-Jarolim, 2016, p. 474). These factors inform the point that doctors and other health care providers must deeply consider age and other comorbidities when treating for allergies, and take all reactions seriously.
If you are interested in learning more about food allergy advocacy, visit Homepage | Food Allergy Research & Education.
Brophy, L.T, MS, LD (2015). Late-onset food allergies. Today’s Geriatric Medicine. Vol. 8(3):
DeMartinis, M., Ginaldi, L., Sirufo, M. (2017). Allergy and aging: an old/new emerging health issue. Aging and Disease. Vol. 8(2): 162-175.
Diesner, S., Untersmayr, E., Pietschmann, P., Jensen-Jarolim, J. (2010). Food allergy: only a pediatric disease? Gerontology. Vol. 57(1): 28-32
FARE (2019). Food allergy research and education. Retrieved from: https://www.foodallergy.org
Flaherty, J. (2017). Nutrition challenges as we age. TuftsNow. Retrieved from:
Jensen, A.F., Jensen-Jarolim, E. (2016). Food allergies in the elderly- collecting the evidence.
Ann Allergy Immunol p: 472-475.
Montanaro, A., MD (2000). Allergic disease management in the elderly: a wakeup call for the
allergy community. Annals of Allergy, Asthma, and Immunology. Vol. 85 (2): 85
Muraro, A., Hoffmann-Sommergruber, K., Holzhauser, T., Poulsen, L.K., Gowland, M.H.,
Akdis, C.A., Mills, E.N.C., Papadopoulos, N., Roberts, G., Schnadt, S., Van Ree, R., Sheikh, A., Vieths, S. (2014). EAACI food allergy and anaphylaxis guidelines: protecting consumers with food allergies: understanding food consumption, meeting regulations, and identifying unmet needs. Allergy: European Journal of Allergy and Clinical Immunology
Noone, S., RN, MSN (2019). Food allergy: impact on health-related quality of life. Retrieved from: https://www.uptodate.com/contents/food-allergy-impact-on-health-related-quality-of-life
Manna (2019). Our meals. Retrieved from: https://www.mannapa.org/services/our-meals/
Ramanathan, L. (2018). It’s bad enough to have a food allergy, but then you have to deal with the skepticism. The Washington Post.
Sampson, H.A. (2016). Food allergy: past, present, and future. Allergology International. Vol. 65(4)363-369.
Siegal, M. (2017). PCA’s food lifeline. Retrieved from: www.pcacares.org/blog/pcas-nutrition-lifeline/
Smith, A. (2017). CVS cuts cost for generic EpiPen competitor. Retrieved from:
The General Assembly of New Jersey, Session 2015. House Bill No. 4094. 216th Legislature.
“Epinephrine Access and Emergency Treatment Act”
The General Assembly of Pennsylvania, Session 2019. Feb. 1, 2019. House Bill No. 345
United States Congress, Allergy Act (House, June 22, 2018).