Food Allergies in Adults

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Spring is almost here.  The pollen will soon be in the air.  People will begin sneezing and buying kleenex in bulk to deal with their runny noses.  One area we evaluate and treat that is not seasonal is food allergy.  Most people think of children when they think of food allergies.  Looking at the numbers they would be correct.  Between 6 and 8 percent of children in the U.S. suffer from food allergies compared to between 3 and 4 percent of the adult population.  Fortunately for children, many food allergies can be outgrown.  Peanut allergy in children is the most prevalent allergy that is not outgrown.  This is often not the case with adults.

I saw a gentleman yesterday in his early 50s.  He waited to make his appointment because he thought that only children had food allergyes.  He wanted to be evaluated because he thought he might be allergic to shrimp.  He had shrimp 2 weeks ago and within an hour he was covered in hives.  He was evaluated in the local emergency room and discharged without difficulty.  When I tested him yesterday in the office for shellfish allergy, he was grossly positive to shrimp, lobster, and crab. 

There are a few points that I want to highlight in regards to this patient.  When I asked him if he had ever had difficulty with shrimp or other fish/shellfish previously, he was not sure.  He did recall that whenever he helped his wife clean shrimp, his hands would itch.  They did not eat shellfish often so this was not a common occurrence.  Do I think this man in his 50s just developed an allergy to shellfish at this point in time.  No.  I think that he has had an allergy to shrimp for years.  That is based on the itching that he had when he came in contact with the shrimp.  He did not consume shellfish often so whatever symptoms may have been present were likely forgotten over time.  This man is fortunate.  The most prevalent food allergy which results in death in adults is shellfish.  Just because you have an upset stomach or hives with the first reaction does not mean that the next time you will not have a life-threatening condition called anaphylaxis. 

He was evaluated and treated at the local emergency room.  The great omission in this case is that he was discharged from the emergency room without a prescription for injectable epinephrine.  Epinephrine is the one treatment that significantly decreases the risk of death associated with severe allergic reactions.  Many people also use this for stinging insect allergies.  Emergency rooms failing to do this is not an uncommon problem and has been reviewed in many articles in the medical literature.  As mentioned previously, just because you have hives with one reaction does not mean you will not have a fatal reaction the next time. 

The patient was evaluated in my office yesterday and he was diagnosed with shellfish allergy.  I instructed him to avoid all shellfish since avoidance is the only definitive treatment for food allergy.  However, in case of an accidental exposure, he was prescribed injectable epinephrine.  We discussed when you would use this medication as well as demonstrated to the patient how to administer the medication.

If you have noticed problems after eating certain foods such as hives, upset stomach or abdominal pain, rash, swelling, itching, difficulty breathing, or a feeling of lightheadedness, you may have a food allergy.  The diagnosis is simple and the treatment may save your life.  Don’t think that because you are an adult that you may not have food allergies.

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