A recent systematic review and meta-analysis published in the World Allergy Organization Journal finds that food allergy symptoms and sensitization may be surprisingly common among older adults, although the prevalence of clinically confirmed food allergy remains uncertain. While allergy research has historically focused on children and younger populations, older adults face unique physiological vulnerabilities—including immunosenescence, chronic low-grade inflammation, micronutrient deficiencies, multimorbidity, and polypharmacy—that may alter allergic responses and increase susceptibility.
Because food allergy management relies primarily on avoiding the problem food, misdiagnosis or unnecessary elimination diets can pose serious nutritional risks for older adults. Domenico Azzolino, PhD, a nutritional scientist at the Ospedale Maggiore Policlinico in Milan and lead author of the review, highlighted the dietary dangers: “Inadequate consumption of protein-rich foods like meat, milk, eggs, and fish is common in older adults and, when compounded by allergen avoidance, may create a vicious cycle of further protein restriction and increased risk of under-nutrition and functional decline.” In the United States alone, food-induced anaphylaxis accounts for 6% of emergency department visits and 4.1% of hospitalizations among adults aged 65 and older.
Analyzing 16 studies involving 33,165 older adults across 11 countries—with 14 studies included in the quantitative analysis—the researchers found a pooled self-reported food allergy prevalence of 12% and a self-reported physician-diagnosed rate of 7%. Sensitization measured by specific immunoglobulin E (sIgE) was identified in 14% of older adults, with rates for common allergens reaching 3% for cow’s milk and peanuts, 2% for eggs, and 1% for soy. However, only one study assessed challenge-confirmed food allergy, reporting a prevalence of just 0.5%. The striking differences between these measures underscore how little is known about the true prevalence of clinically confirmed food allergy among older adults.
The authors emphasized the need for greater attention to identifying food allergies as part of routine clinical practice, both to protect older adults from potentially severe allergic reactions and to prevent unnecessary dietary restrictions that could contribute to malnutrition. Azzolino and his team also stressed the limitations of the available evidence, noting: “The limited evidence and heterogeneity across studies highlight the need for standardised diagnostic criteria and greater inclusion of older adults in future food allergy research.”
Providing an outside clinical perspective, Dr David Corry, a professor of immunology, allergy, and rheumatology at Baylor College of Medicine, noted an observable rise in consultations for adult food allergies over the past decade. “My experience is that food allergies are quite uncommon in the over-60 age group but still markedly higher now,” Corry stated. He cautioned that frontline physicians often lack sufficient awareness of the need to identify food allergies, noting that while some screen adequately, most do not. Corry also stressed that the review’s prevalence estimates should be interpreted cautiously because high-quality confirmatory evidence was lacking in most of the included studies.
Food allergies are also not solely childhood conditions that persist into adulthood—they can first appear later in life. Dr Ruchi Gupta, director of the Center for Food Allergy & Asthma Research at Northwestern Feinberg School of Medicine, noted that “half of adults reporting convincing allergies report developing a new allergy as an adult.” She explained that age-related changes to the immune system can lead to secondary sensitization, including pollen-food allergy syndrome. Delayed gastric emptying and widespread use of proton pump inhibitors (PPIs) may also impair protein digestion, potentially allowing more intact proteins to reach the intestinal lining and stimulate new IgE antibodies.
To address these challenges, experts recommend targeted clinical history-taking when older patients report consistent symptoms after eating rather than relying on unguided food elimination. When a food allergy is confirmed and an elimination diet is necessary, Gupta recommends immediate referral to a registered dietitian to ensure adequate protein and micronutrient intake and help protect older adults against frailty and malnutrition.
