Management of Food Allergy in Elder People

Introduction

In food allergy, even a very small amount of allergy-causing food can trigger signs and symptoms associated with a condition. Food that is responsible for an allergic reaction is called an allergen. In food allergies, the immune system mistakenly identifies a specific protein in food as a pathogen, harmful, or something that may cause disease. To respond to this system, the immune system produces antibodies to attack this protein. When even the smallest amount of that food is eaten again, the antibodies are ready and signal the immune system to release a chemical known as histamine as well as other chemicals into the bloodstream. Histamine and these other chemicals cause the symptoms of food allergy.

What Are the Types of Food Allergies?

There are two types of food allergies-

• IgE Mediated- It is the most common type in which the immunoglobin E or IgE antibody is released by the immune system to fight the threat.

• Non-IgE Mediated- In this type, IgE antibodies are not released, and other parts of the immune system are used to fight the perceived threat.

What Causes Food Allergies?

The most common food allergies, which account for about 90 percent of all food allergies, often referred to as the big eight, are:

• Milk.

• Eggs.

• Peanuts.

• Tree nuts.

• Seafood.

• Shellfish.

• Soy.

• Wheat.

What Are the Signs and Symptoms?

Sometimes allergy symptoms are mild, but they can be severe. Hence, all allergic symptoms should be taken seriously. Both mild and severe symptoms can lead to serious allergic reactions referred to as anaphylaxis. This reaction usually involves more than one part of the body, can impair breathing and can, cause dramatic drops in blood pressure, and affect heart rate. Other symptoms include:

• Hives.

• Dizziness.

• Abdominal pain.

• Tingling.

• Swelling.

• Nasal congestion.

• Nausea.

• Diarrhea.

• Tightening of the airway.

• Shock.

• Swollen throat.

• Loss of consciousness.

How Does Food Cause an Allergic Reaction?

When the food enters our body and gets absorbed or processed, the allergen that comes with the food gets transmitted to the antigen-presenting cell and gets attached to it. This will cause the production of T-cells. When the T-cells are activated, it is called a non-IgE-mediated allergic reaction. When the allergen goes to the B-cell along with immunoglobin E, it will cause an immunoglobin-mediated allergic response. Allergens can also spread to mast cells and basophils and will cause the release of histamine, which further initiates symptoms of hives, vomiting, swelling, and breathing difficulty.

How Are Food Allergies Diagnosed?

Before making a diagnosis, the doctor will consider a number of factors, such as the symptom of the patient, a family history of allergies, and a physical examination to identify or exclude other medical problems.

• Skin Prick Test- It is used to determine the reaction to a particular food.

• Blood Test- It is used to measure a patient’s immune system response to particular food by measuring the allergy-related antibody known as IgE.

• Elimination Diet- The patient is asked to eliminate suspected food for four to six weeks to see if the symptoms clear up.

• Oral Food Challenge- During this test, the patient will be given a small but increasing amount of food suspected of causing the symptoms, and then they will be watched for signs and symptoms.

How Is Food Allergy Treated?

The only and best way to avoid an allergic reaction is by avoiding the food that causes symptoms. For minor cases, medications are available such as antihistamines may help. For severe cases, an emergency injection of Epinephrine can be administered.

What Are the Complications of Food Allergies in Older People?

In elderly people, certain nutritional abnormalities, vitamin deficiencies, and hormonal imbalances can alter the immune response and lead to food allergy development. There are various factors that complicate the treatment of food allergies in older people, such as:

• Immunologic responses to food can often be confused with the symptoms of other common age-related diseases.

• In the elderly, decreased stomach acid leads to decreased protein digestion. There is also an increase in vivo exposure to absorbed allergenic epitopes and an age-related decrease in total serum immunoglobulin E.

• Malnutrition is another significant factor in the elderly and is critical in maintaining immune system efficiency. An insufficiency or deficiency in calcitriol (an active form of vitamin D) can negatively affect food-related IgE reactions. Poor zinc bioavailability (absorbed from food) and in vivo homeostasis can further alter immune efficiency, leading to the development of food allergies. Iron deficiency is also associated with immune system issues which decrease antibody responses and increase the risk of food allergy.

How to Manage Food Allergies in Older People?

Once the food allergy has been diagnosed, avoiding the allergen is the only approved method for effective management. It is important to observe that once a food allergen is completely eliminated from the diet, food reactions become more obvious, and they will usually increase in severity. With respect to avoidance, there are some foods that are easier to eliminate than others. Even minor allergy symptoms should be reported to a healthcare professional as they can lead to serious complications in older people. The first step for an elderly person is to seek medical help and follow the medications advised by the physician. Various methods to manage food allergies in older people are as follows:

• Food labels that contain ingredient lists are important tools for prepackaged foods, and they should be checked properly. However, when older adults eat out or visit friends and family, this avoidance becomes a bit challenging.

• An older person should request to check the ingredient list from a package or a recipe. If the establishment or the individual cannot answer questions or provide the requested food label or ingredient list, then it is best to avoid the food.

• Many websites provide appropriate substitutions and modified recipes for certain foods that someone is allergic to.

• Avoid cross-contact with allergens by cleaning food preparation areas, including utensils and other kitchen appliances.

• Some dietary and lifestyle recommendations include avoiding trans fats and saturated fats, which may exacerbate food allergy reactions.

• Physical activity for 30 minutes five days per week helps in reducing inflammation and helps maintain a healthy immune system.

• Alcohol consumption should be avoided.

• It is advised to monitor other nonfood substances for the allergen, which can also be present in lotions, cosmetics, medications, and hair products.

• Dietitians specializing in food allergy management should be consulted as they can assist in detecting potential allergens by comparing detailed food logs with other self-reported symptoms and also helps in forming nutritional adequacy and a balanced menu plan.

Conclusion

There is a lack of evidence on elderly people for the development of food allergies and alternative therapies, and more research is needed. Hence, with the help of proper strategies and safe practices, improvement in food allergy sensitization and management can be achieved.