'Not the Time' to Be Daring With New Foods, Allergists Warn

Elizabeth Millard

April 20, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The prevalence of food allergies in adults is higher than previously estimated, according to investigators, who report that about one in five people are having a first-time allergic reaction later in life.

Research on food allergies is usually conducted in children, so less is known about the allergy burden in adults, explained Ruchi Gupta, MD, and Christopher Warren, PhD, from the Feinberg School of Medicine at Northwestern University in Chicago, who were scheduled to present their research at the cancelled American Academy of Allergy, Asthma and Immunology 2020 Meeting.

The team conducted a survey of nearly 50,000 households in the United States to assess childhood and adult allergies, and they asked about negative reactions that have led to food avoidance.

They determined that the prevalence of food allergies in adults is 1.9%, which is similar to the rate in children.

Overall, the allergy burden for the entire population is higher than we thought.

"Overall, the allergy burden for the entire population is higher than we thought," Warren told Medscape Medical News.

"We don't have a clear idea why this is happening," Gupta said. "It's probably multifactorial.

Environmental triggers might cause some adult-onset allergies, and the overuse of antibiotics, hormonal changes, and the effects of viral or bacterial infections might all be contributing factors.

"Right now, the most important message is that adult-onset food allergies may be an issue for many people, and may be causing symptoms that require consultation with a healthcare provider," she told Medscape Medical News.

But for many patients, nonurgent allergy treatments are on hold right now.

Jeffrey Factor, MD, from the Connecticut Asthma & Allergy Center in West Hartford, pointed out that his patients undergoing desensitization to foods usually increase their dose every 2 weeks, but he has discontinued that practice to reduce the risk for allergic reactions.

The best approach is to be extra careful about food choices right now, he emphasized.

"The last thing you want is to have to go to the emergency room and be exposed to whatever is there," Factor explained. "What I'm telling my patients is that now is not the time to be adventuresome with new foods. Maintain what you're doing; don't try new things."

But for parents of children with food allergies, closed schools and stay-at-home orders might actually be an advantage, he pointed out to Medscape Medical News.

"Some people are breathing a little sigh of relief right now because their biggest concern is usually what kids eat when they're out of the house," he explained. Now parents can maintain dietary restrictions but take "kind of a break from their constant vigilance."

"I'm not hearing about any increases in allergic emergencies right now, and this is probably why," he added.

This is good news because before the pandemic there were already manufacturing problems delaying EpiPen availability, and concerns linger these challenges will be amplified by the crisis.

EpiPen Shortages

The EpiPen 0.3 mg and EpiPen Jr. 0.15 mg auto-injectors and the corresponding generic versions have been dogged by manufacturing interruptions, and these "challenges are expected to result in tighter supplies and greater variability in pharmacy-level access at this time," according to a status update on the Mylan website.

And in March, the US Food and Drug Administration warned that auto-injectors could malfunction — delaying injection or failing to inject as intended — because of device-design problems or operator error.

As a result, Factor has already switched all of his patients to AUVI-Q, another prescription epinephrine injection. He checked with the manufacturer that availability would not be interrupted and made sure all of his patients are equipped to use AUVI-Q, and they are proceeding with the alternative at this time.

American Academy of Allergy, Asthma and Immunology (AAAAI) 2020 Meeting.

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