Food Allergies in Adults Have Low Prevalence but High Anaphylaxis Risk

Although research indicated adults have a low prevalence of food allergies, those who do experience allergies, such as hen’s egg allergy, can still be at risk of anaphylaxis, a recent study found.1

A vast amount of research has been conducted on food allergies in the pediatric population.2 But when it comes to the adult population, little data exists on the prevalence of food allergies.

“Our retrospective study at the Ankara Bilkent City Hospital focused on the unique characteristics and prevalence of [food allergies] in adults, revealing an actual prevalence rate of 0.31%, which is considerably lower than rates reported in various international studies,” wrote investigators, led by Betül Özdel Öztürk, from the Ankara Bilkent City Hospital in Turkey.1 “This discrepancy highlights the complex nature of [food allergy] recognition and diagnosis in adults, and it suggests that many cases may go unnoticed or misdiagnosed.

Öztürk and colleagues’ study assessed the prevalence and clinical characteristics of food allergies in patients aged 18 – 80. Between 2019 and 2024, participants received a food allergy diagnosis at the Immunology and Allergy Diseases Clinic of Ankara Bilkent City Hospital, Turkey.

Among 10,505 patients evaluated for a food allergy, 563 were suspected of having food allergies, and it was confirmed in 33 patients (60.6% female; mean age: 34.74 ± 12.57 years). Thus, in this clinic, adults had a food allergy frequency of 0.31%.

Common food allergens included hen’s egg (n = 6; 18.2%), fish and shellfish (n = 4; 12.1%), various nuts (n = 2; 6.1%), hazelnut (n = 1; 3%), almond (n = 1; 3%), seeds (n = 2; 6.1%), sweet corn (n = 6; 6.1%), banana (n = 4; 12.1%), and kiwi (n = 4; 12.1%). Participants had a mean time interval between food consumption and allergic reactions of 10 minutes (range: 2 – 120 minutes).

For an egg allergy, the most prevalent allergen, participants had a mean time interval between consumption and allergic reaction of 5 minutes, indicating its rapid onset. Among these participants, 4 could tolerate thoroughly cooked eggs, and diagnostics indicated they had sensitization to ovalbumin (Gal d2) but not ovomucoid (Gal d1); 2 participants could not tolerate an egg regardless of cooking methods. The study indicates that an egg allergy presents a concern for adult patients. Individuals with an egg allergy in this sample ranged from 18 – 35 years.

“Interestingly, while most adult-onset egg allergy cases in the literature are attributed to clear paths of sensitization, such as cross-reactivity with other allergens or environmental or occupational exposure, the sensitization pathways in our case series were largely indeterminate,” investigators wrote. “The absence of identifiable triggers, such as those associated with bird-egg syndrome or occupational exposure to egg aerosols, suggests the need for further investigation into the complex and often poorly understood mechanisms underlying adult-onset [food allergies].”

Despite the low food allergy frequency, anaphylaxis was the most frequently observed clinical characteristic (n = 24; 72.7%).

“…a significant number of patients reported a history of anaphylaxis, which suggests that they tend to seek care mainly when confronted with severe reactions,” investigators wrote.

For emergency treatments, participants used antihistamines and steroids (n = 15; 65.2%), antihistamines, steroids, and epinephrine (n = 5; 21.7%), or epinephrine alone (n = 3; 13%). As seen here, the use of epinephrine was notably lower than other emergency treatments, and other studies have shown that epinephrine, the first-line treatment for anaphylaxis, is underused. This highlights a gap in anaphylaxis management.

“This underscores the critical need for enhanced education and awareness surrounding [food allergies] as well as the importance of prompt access to adrenaline for individuals at risk,” investigators concluded. “The rapid onset of allergic symptoms, with a median time of just 10 minutes after consumption, further emphasizes the necessity for individuals with [food allergies] to have access to autoinjectable epinephrine.”

References

1. Öztürk BÖ, Akın BG, Durmaz MSB, Soyyiğit Ş. Is hen's egg a significant allergen in adults too? Findings from an investigation into food allergy prevalence. Allergol Immunopathol (Madr). 2025 Mar 1;53(2):13-23. doi: 10.15586/aei.v53i2.1263. PMID: 40088016.

2. Sicherer SH, Warren CM, Dant C, Gupta RS, Nadeau KC. Food Allergy from Infancy Through Adulthood. J Allergy Clin Immunol Pract. 2020 Jun;8(6):1854-1864. doi: 10.1016/j.jaip.2020.02.010. PMID: 32499034; PMCID: PMC7899184.