Adult-Onset Food Allergies

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Food allergies aren’t just for kids…

Jennifer Venuti thought the spiciness of a fish taco was making her lips tingle. But when she felt her heart racing and was hit with horrible stomach pains, she knew something else was going on.

She and her teenage son quickly left the restaurant to drive to her hometown in New York’s Finger Lakes region. But the 20-minute drive was not possible. She had difficulty breathing and her skin became blotchy. Wheezing and coughing, she stopped at a nearby emergency department and passed out as she entered the hospital. She woke up in a bed and was told that the staff had administered epinephrine, prednisone and Benadryl.

A few bites of a fish taco that she had eaten many times before introduced Venuti, then 44, to the world of adult-onset food allergies. While she had reacted to penicillin as a child and to morphine after surgery in her 30s, she had never before been allergic to any foods.

allergy testing

Shutterstock/Imagepoint FR

Food Allergy Tips

Sloane Miller, founder and president of Allergic Girl Resources, says there are several
basic tools everyone should have in their arsenal to deal with an anaphylactic reaction:

1. Access to emergency medication. Have two epinephrine auto-injectors and any other prescribed medications with you at all times.

2. A safe person. There should be at least one person in your daily life who
knows where you keep your medication and is trained how to help you in an
emergency.

3. Anaphylaxis action plan. This written plan is created with your allergist.
Have a hard a copy at home, keep a photo of it on your smart phone and share
a copy with your safe friends and loved ones so they know how to aid you in an
emergency.

4. Medical alert jewelry. This lets others know about your medical condition. This is especially important if you are unable to communicate.

5. Buddy system. Whenever you are out and your allergens are present, pick a buddy to help you in case there is an emergency. It can be a co-worker, your romantic partner, a trusted family member or a good friend.

6. Restaurant backup. When at a restaurant or bar alone, make friends with the manager or bartender. Tell them: “I have severe, life-threatening food allergies. Here’s where I keep my medications. If there’s a problem, call 911.”

Immune System Shift

It is not clear why some adults suddenly react to foods that they’ve been eating without incident their entire lives, says Sayantani (Tina) Sindher, MD, clinical assistant professor of allergy and immunology in the Department of Medicine, division of Pulmonary & Critical Care Medicine at the Sean N. Parker Center for Allergy & Asthma Research at Stanford University.

About 15 percent of adults with food allergies developed their condition after age 18, according to a 2014 study from Northwestern University’s Feinberg School of Medicine.

“Prior to the study, it was thought that adult-onset food allergies were quite rare,” Sindher says.

While pediatric allergies skew male, the Northwestern study found that more women than men develop adult-onset food allergies. Adults typically have their first reaction in their early 30s. Study results suggest that an older age at diagnosis is associated with more severe reactions.

In the study, the most common foods implicated were shellfish, tree nuts, finned fish, soy and peanuts. While it was already known that shellfish and fish would be at the top of the list, Sindher says, the surprise was seeing tree nuts, soy and peanuts, which are usually associated with childhood food allergies.

common food allergens

Shutterstock.com/Africa Studio

Adults at risk for food allergy tend to have other allergic diseases, such as seasonal allergies and eczema. The Northwestern study showed that 67 percent of people with adult-onset food allergies also have atopic conditions, such as asthma, allergic rhinitis (often called hay fever) or chronic dermatitis.

There’s a shift in the immune system of allergic individuals compared to non-allergic individuals, Sindher says. But when the shift occurs, what triggers it and whether it can be reversed are still unknown. More research is needed.

“Once we have a better understanding about why and how food allergies develop in the first place, we can better understand why and how food allergies may develop in adulthood,” she says.

The Emotional Toll of Food Allergies

Experiencing anaphylaxis to food for the first time during adulthood has been life-changing for Venuti.

Just one week after the fish taco incident, she was still trying to figure out which foods to avoid and how to eliminate cross-contact. She innocently grabbed a French fry that was sitting on her husband’s plate next to lobster and had an anaphylactic reaction within minutes of eating it, requiring epinephrine. She has had eight anaphylactic reactions in the two years since.

Venuti has had multiple tests for food allergies (going into anaphylaxis during one of the skin tests) and other medical conditions, but the results have been inconclusive. Her doctor has told her to always carry epinephrine, not to eat any seafood, avoid food made in fryers (a common place for cross-contact with seafood) and emphasize unknown food allergies to waiters when eating out.

“It has completely changed my social life,” Venuti says. “I was a foodie and now I’m afraid to eat most things that I don’t cook myself.”

That fear is not uncommon, nor is the feeling of being upset by the diagnosis and its implications. Since adult brains are more firmly set in their thoughts and behaviors, the need for drastic lifestyle changes usually elicits internal conflict and emotional resistance, says Sloane Miller, LMSW, psychotherapist, specialist in food allergy management and founder and president of Allergic Girl Resources.

“For adults who have been eating a certain way for their entire lives suddenly to have an extremely negative physiological response to a trusted food is not only terrifying but also requires a whole new set of thoughts and behaviors—quickly,” says Miller, author of Allergic Girl: Adventures in Living Well With Food Allergies (Wiley).

Although Amanda J. Moore, MSHS, grew up allergic to tree nuts, she was shocked that she could develop new allergies as an adult. A severe reaction to avocado in her 20s was the start of several new food allergies, including peanuts, tomatoes, apples and peaches. She also avoids gluten.

During her early 30s, when she and a friend were traveling by ferry between the Greek islands, Moore ate a plain cut-up tomato (previously a safe option). She started reacting instantly with an itchy mouth, swelling of her lips and tongue, nausea and wheezing. When she reacts, she usually becomes confused and feels the desire to be alone.

“That’s always the scariest part. I’m absolutely terrified that I will be reacting and go somewhere by myself away from help,” says Moore, 38, who used her epinephrine auto-injector to stop the reaction on the ferry.

How to Manage

When faced with a new food allergy, adults must learn how to handle various professional and social situations, such as dating, travel, business meals and family functions.

To navigate business dinners, Moore regularly works to manage her anxiety. Before a meal, she does a visualization exercise of seeing safe food and eating safely so that she can go into the situation calmly. Diligence also helps Moore enjoy travel. She makes sure to inform the people she is with about her allergies and always carries food allergy cards (translated for international travel) to present at restaurants.

“I no longer feel shame about it,” says Moore, who is a member of the Food Allergy Research & Education (FARE) Community Engagement Council for the Boston area. “Speaking up about my allergies also helps educate others. Then when I go out to dinner, I have the whole table of people looking out for me.”

To get a proper diagnosis, adults should visit an allergist if they think a food might be causing them to react, says James R. Baker Jr., CEO and chief medical officer of FARE. He recommends writing down the symptoms experienced, the foods that were ingested and how soon the symptoms appeared after eating.

“Developing a food allergy as an adult may require big adjustments,” Baker says. “But keep in mind that you can continue to live well with food allergies.”

Contributor Wendy Mondello is a health writer. She has a teen with asthma and multiple food allergies.

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