How To Take Care of a Senior With Food Allergies (Late Onset Food Allergies)

by | Aug 28, 2018


It was once thought that food allergies can only develop during childhood.  However, an increasing number of seniors are being diagnosed with food allergies.  About 10% of adults have food allergies and the most common ones include peanuts, tree nuts, shellfish, and (fin) fish.[1]  Food allergies can develop at any time and can be particularly dangerous for seniors as they have weakened immune systems.[2] These late onset food allergies are becoming a growing problem and as a caregiver, it is important to be educated in them, especially if your client has one.    


Symptoms of Food Allergies[3]

The symptoms of food allergies range from mild to severe.  They can be unpredictable and life-threatening. However, all should be taken seriously.  

Mild symptoms include:

  • Redness of skin or eyes
  • Hives
  • Sneezing or nasal congestion

Severe symptoms include:

  • Drop in blood pressure
  • Shortness of breath
  • Swelling of the throat, lips, or tongue
  • Anaphylaxis

Even the smallest traces of food can cause a severe reaction.  For example, if a senior with a peanut allergy touches an item that had peanut butter on it and then touches their eyes or mouth, they can have a reaction.  Clean surfaces thoroughly if you suspect an allergen has been on or near it. Be sure to ask questions about food and its ingredients if you did not prepare the food yourself.  Cross contamination can also cause a reaction, even if an allergen-free dish is ordered.


Storing an Epinephrine Pen (EpiPen)

EpiPens are a life-saving medication that decrease your body’s allergic reaction by:[4]

  • Reversing the dangerous decrease in blood pressure
  • Relaxing the muscles in airways to make breathing easier
  • Relaxing the muscles in the stomach, intestines, and bladder

It’s important to store EpiPens properly.  If they are not stored correctly, their effectiveness can decrease.  According to the EpiPen company, the following are instructions on how to store EpiPens:[5]

  • Always store EpiPens in its carrier tube with the safety release on until it needs to be used
  • Always store EpiPens at room temperature.  Do not refrigerate.
    • EpiPens can be exposed to temperatures in the range of 60° to 86°F.
    • Do not store EpiPens in a hot vehicle (such as during hot, summer weather).
  • Regularly check the EpiPen in its viewing window and replace it if the solution is discolored, cloudy, or brown

Always have an EpiPen on hand.  It’s better to take precautions and make sure your client has life-saving medication at all times.


Peanut Allergies[6]

Peanut allergies is one of the most common food allergies.  They are not the same as tree nuts.  There is no current cure for peanut allergies, but to prevent a reaction, it is imperative that your client avoids all peanuts and peanut products.  You can identify if a product has peanuts in it by reading its ingredients and food labels. The following are common ingredients that contain peanuts, but are unexpected (avoid these ingredients as well):

  • Arachis oil (peanut oil)
  • Lupin or lupine (flour substitute for gluten-free food)
  • Mandelonas (peanuts in almond flavoring)

There are plenty of great alternatives to peanut butter such as:[7]

  • Nut butters
    • Almond, hazelnut, walnut, pecan, and cashew
  • Seed butters
    • Pumpkin, sunflower, Tahini (sesame butter)
  • Seeds
    • Chia, flax, and hemp

Still double-check the ingredients before purchasing/ingesting.


Tree Nut Allergies[8]

Tree nuts include:

  • Walnuts
  • Hazelnuts
  • Almonds
  • Cashews
  • Brazil nuts
  • Pistachios
  • Coconuts

It’s worth noting that the FDA has determined that coconuts are tree nuts, however not all tree nut allergies patients are allergic to coconuts as they are not a true nut.  Check with your client’s doctor before your client consumes or becomes exposed to coconuts. Tree nuts are not the same as peanuts or seeds.  Avoid the above tree nuts to prevent reactions.

If your client is allergic to one tree nut, they have an increased chance of being allergic to other types.  Therefore, your client’s doctor may recommend they avoid all nuts.

Avoid the tree nuts listed above as well as nut-based dairy products.  Nut-based dairy products such as almond milk are gaining popularity, but avoid them if your client is allergic.

Common tree nut alternatives include:[9]

  • Sesame seeds
  • Seed butters
    • Pumpkin, sunflower, Tahini (sesame butter)
  • Seeds
    • Chia, flax, and hemp

Still double-check the ingredients before purchasing/ingesting.


Shellfish Allergies[10]

Late onset shellfish allergies are very common – “about 60 percent of people with shellfish allergy experience their first allergic reaction as adults.”  

Shellfish include:

  • Crustacea
    • Shrimp, crab, and lobster  
  • Mollusks
    • Clams, mussels, oysters, and scallops

Shellfish are not related to finned fish – an allergy in one doesn’t necessarily mean the patient has to avoid both.  Again, check with your client’s doctor. Make sure your client avoids all shellfish and shellfish products to prevent a reaction.  The following are common ingredients that contain shellfish, but are unexpected (avoid these ingredients as well):

  • Barnacles
  • Crawfish
  • Krill
  • Prawns
  • Fish stock

Your client’s doctor may also advise your client to also avoid:

  • Abalone
  • Cuttlefish
  • Octopus
  • Snails (escargot)
  • Squid

Shellfish alternatives include:[11]

  • Beef
  • Chicken
  • Beans
  • Lentils
  • Eggs


Fish Allergies (Finned Fish)[12]

Similarly to shellfish allergies, late onset fish allergies are very common – “about 40 percent of people with fish allergy experience their first allergic reaction as adults.”  Fish allergies are instigated by finned fish.

Common fin fish include:

  • Salmon
  • Tuna
  • Halibut

Finned fish and shellfish are not related – an allergy in one doesn’t necessarily mean the patient has to avoid both.  Again, check with your client’s doctor. Avoid all finned fish to prevent a reaction. Avoid seafood restaurants, even if your client does not order finned fish as cross contamination can occur.  The following are common ingredients that contain fin fish, but are unexpected (avoid these ingredients as well):

  • Bouillabaisse
  • Barbecue sauce
  • Caesar salad/dressing
  • Imitation fish
  • Caponata
  • Worcestershire sauce

   The alternatives to fin fish are the same as shellfish:

  • Beef
  • Chicken
  • Beans
  • Lentils

It’s important to check with your client’s doctor, read food labels/ingredients, and clean surfaces that may have traces of the allergen.  These items can be life-saving preventions of a reaction.

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