Ask the expert –  Adults with food allergy: Why it’s important to see your allergist

Many adults with food allergy have been diagnosed with the condition in childhood. Find out why it’s important to see your allergist in the article below by Dr. Sari Herman, a specialist practicing in Allergy and Clinical Immunology in Toronto, Ontario. Her special interests include: food allergy, eosinophilic esophagitis and molecular allergy testing.

Dr. Herman shares her top 10 reasons for an adult to see an allergist, especially if a diagnosis of allergy was given in childhood:

1. Confirm persistence of food allergy – Some food allergy may be outgrown by adulthood while others may be lifelong. A detailed discussion with an allergist, skin prick tests, and/or blood tests, and/or an oral food challenge can clarify if food allergy persists. Newer diagnostic tools are available for select allergens, and can be used to determine the risk of a systemic reaction (anaphylaxis).

2. Assess for new food allergy – Food allergy can develop at any age. While seafood allergy can appear in adulthood, adults may also develop pollen food allergy syndrome (also known as oral allergy syndrome), involving reactions to one or more fresh food(s) over time including fruits, vegetables, tree nuts, seeds, legumes or spices, especially if there is a history of seasonal allergy.

3. Updated management of food allergy – Allergists can address food avoidance strategies and possibilities for treatment, assist in the selection of an epinephrine auto-injector, review its proper use and storage, and re-establish an anaphylaxis emergency plan. Although clinical and research initiatives for oral immunotherapy for food allergy have primarily been focused on children, allergists will continue to provide safe and effective evidence-based therapies for food allergy in adult patients as research evolves.

4. Minimize cofactors – Cofactors such as certain medications,  exercise, and illness can significantly worsen reactions to foods, especially in adults. Routine assessment of cofactors by an allergist is critical for the care of adult patients.

5. Coexisting health conditions – Adults may be affected by chronic health problems (e.g. heart disease, high blood pressure, diabetes, kidney disease) which require careful selection of treatment for allergic disease. An allergist may also check that medications for other diseases do not interfere with allergy, asthma, or anaphylaxis care.

6. Pregnancy – An allergist can create a management plan which is safe during pregnancy and breastfeeding.

7. Asthma – Shortness of breath, chest-tightness, wheezing and/or cough may often be aggravated by allergic triggers. Poor control of asthma increases the risk of life-threatening reactions to foods. It is essential to see an allergist if symptoms occur several times a week and/or at night-time, a rescue inhaler (puffer) is frequently being used, if there are limitations in your ability to exercise, and/or you have required visits to the emergency room. Allergists are equipped to arrange for specialized testing (pulmonary function tests) for diagnosis, and provide individualized treatment plans utilizing new medication.

8. Allergic rhinoconjunctivitis – Symptoms such as sneezing, nasal congestion, itchy nose, roof of the mouth, and/or eyes, may occur in seasonal pattern (hay fever) triggered by pollens and/or outdoor moulds. Symptoms may also occur with animal exposure such as a dog, or cat, and/or may persist throughout the year with exposure to house dust mite. Adult allergy care is crucial to prevent progression of rhinitis to the development or worsening of asthma. Allergists are trained to develop avoidance strategies to minimize symptoms, treat patients with medication if necessary, and/or immunotherapy/desensitization (administered either as allergy shots or sublingual (under the tongue) tablets).

9. Eosinophilic esophagitis (EoE) – Some adults with longstanding allergy may experience gastrointestinal symptoms; dysphagia (difficulty swallowing), heartburn, or food becoming stuck, if too many eosinophils (white cells) collect in the esophagus (swallowing tube). An allergist can work with a gastroenterologist to diagnose and treat this condition with dietary strategies and/or prescribed medications.

10. Atopic dermatitis (eczema) – Red, dry, itchy skin often coexists with food allergy in childhood, but this skin condition may progress to different regions of the body in some adults. A secondary contact allergy from exposure to a personal care product (e.g. soap, lotion), or a workplace exposure may also lead to the onset, or worsening of preexisting eczema in adults. Patch testing may be arranged in select circumstances. Allergists are skilled in guiding skin care, and treatment using medicated creams, tablet and/or injectable therapies.

For a listing of physicians trained in Allergy and Clinical Immunology who see adult patients, visit csaci.ca and search the Find an Allergist directory to locate an allergist close to your home.

Thanks for your insights on this topic, Dr. Herman! More information for adults with food allergies is on our site, along with sections covering asthma, EoE and eczema.