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Abstract
The number of people over 65 is increasing around the world. At present, between 5 and 10% of allergic diseases affect the elderly. In particular, rhinitis is increasing worldwide; the presence of high comorbidity makes the therapy of asthma even more complicated. With reference to dermatological allergies, the dryness of the skin favors the onset of allergic contact and atopic dermatitis, while the senescence of mucous membranes and the impaired secretion of polymeric IgA could be linked to food allergy. Overcoming the problem of adverse drug reaction is limited by the diagnostic difficulty in patients taking multiple drugs. In addition, some drugs, such as β-blockers, angiotensin-converting enzyme (ACE)-inhibitors and NSAIDs, are relevant factors of urticaria and anaphylaxis. The aim of this review is to provide updated diagnostic and therapeutic guidelines through a better understanding of the pathophysiologic mechanisms, preventive measures and adherence to therapy.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
In the elderly, there is no downregulation of the immune system, but a proinflammatory state, called ‘inflammaging’ with overproduction of cytokines.
The prevalence of allergic rhinitis is increasing worldwide; it is associated with comorbidity and affects the quality of life. The treatment should be started early to avoid the possible evolution of the asthmatic disease; the possibility of an immune-specific therapy should be considered.
Asthma in the elderly will have greater importance for public health in the near future. The mortality from this disease is higher in the elderly than in the young, especially due to the presence of a high comorbidity that makes the therapy even more complicated.
Changes of skin in the elderly (atrophy, dryness etc.) favor the onset of allergic contact dermatitis and atopic dermatitis. From the epidemiological point of view, the onset of urticaria is associated with allergic diseases (especially due to drugs) and internal diseases (infections, infestations and tumors).
An allergy to food is also linked with the problems of gastrointestinal mucosa permeability and the function of the local immune system, which affects the production of secretory IgA.
Adverse drug reactions are, at the same time, underdiagnosed or overdiagnosed due to the diagnostic difficulties in patients taking multiple drugs. Some drugs, such as β-blockers, ACE-inhibitors and NSAIDs (in particular acetyl salicylic acid), are relevant factors of anaphylaxis risk.
In the elderly, the risk of anaphylaxis is often associated with increased contemporary consumption of many drugs, even though an unknown food allergy must always be suspected.