Abstract
All over the world, there is an increase in the overall survival of the population and the number of elderly people. The incidence of allergic reactions is also rising worldwide. Until recently, allergies, and in particular food allergies (FAs), was regarded as a pediatric problem, since some of them start in early childhood and may spontaneously disappear in adulthood. It is being discovered that, on the contrary, these problems are increasingly affecting even the elderly. Along with other diseases that are considered characteristics of advanced age, such as cardiovascular, dysmetabolic, autoimmune, neurodegenerative, and oncological diseases, even FAs are increasingly frequent in the elderly. An FA is a pleiomorphic and multifactorial disease, characterized by an abnormal immune response and an impaired gut barrier function. The elderly exhibit distinct FA phenotypes, and diagnosis is difficult due to frequent co-morbidities and uncertainty in the interpretation of in vitro and in vivo tests. Several factors render the elderly susceptible to FAs, including the physiological changes of aging, a decline in gut barrier function, the skewing of adaptive immunity to a Th2 response, dysregulation of innate immune cells, and age-related changes of gut microbiota. Aging is accompanied by a progressive remodeling of immune system functions, leading to an increased pro-inflammatory status where type 1 cytokines are quantitatively dominant. However, serum Immunoglobulin E (IgE) levels and T helper type 2 (Th2 cytokine production have also been found to be increased in the elderly, suggesting that the type 2 cytokine pattern is not necessarily defective in older age. Dysfunctional dendritic cells in the gut, defects in secretory IgA, and decreased T regulatory function in the elderly also play important roles in FA development. We address herein the main immunologic aspects of aging according to the presence of FAs.
Highlights
Food allergies (FAs) are becoming a relevant public health concern, affecting over 200 million people worldwide and its prevalence is increasing, mainly in developed countries [1]
Allergies, and in particular food allergies (FAs), was regarded as a pediatric problem, since some of them start in early childhood and may spontaneously disappear in adulthood
We address the main immunologic aspects of aging according to the presence of FAs
Summary
Food allergies (FAs) are becoming a relevant public health concern, affecting over 200 million people worldwide and its prevalence is increasing, mainly in developed countries [1]. The demographic distribution of the world population is rapidly changing, with the proportion of older people on the rise and a significant percentage of them haveallergic diseases [9,10]. Parallel to these demographic changes, we can expect that FAs, already increasing in the general population, will increase in the elderly [11]. An increasing proportion of children with a FA reaches adulthood and old age, and in some of them, the persistence of the allergic problem occurs. The aim of this review is to analyze the pathophysiological mechanisms underlying food allergy in the elderly, emphasizing the most peculiar aspects in this segment of the population, which form the basis of possible intervention measures
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