How to fit allergen immunotherapy in the elderly

Abstract

Asthma, allergic rhinitis (AR) and atopic dermatitis are very common in young people, but in the latest decades it was increasingly recognized that also individuals of higher ages, including the population over 65 years, are concerned. Actually, it is now acknowledged the aging does not considerably alter the immune response to allergens. Allergen immunotherapy (AIT) is the only treatment that works on the causes of allergy, but elderly people are commonly excluded from AIT, except the cases of insect sting allergy. A number of recent studies showed that aged individuals also successfully respond to AIT for respiratory allergy. Therefore, there is no reason to exclude elder patients from AIT. Anyhow, clinical conditions that are considered absolute or relative contraindications are quite frequent in this aged population, thus the risk/benefit ratio must be carefully evaluated for each patient, taking into account that the more frequent occurrence of co-morbidities and the consequent need of daily-based multidrug regimen can favor adverse effects. An important issue concern the ability of AIT, and particularly of sublingual immunotherapy, to significantly improve the quality of life, that often is particularly impaired in the elderly, reducing symptoms and drugs consumption.

Evolving patterns in the diagnosis and management of allergy‐mediated disorders

“…Regardless, many physicians are still reluctant to prescribe AIT to elderly patients . This is despite numerous studies having confirmed that the efficacy of AIT in the geriatric population is no different from the non‐geriatric population . Therefore, notwithstanding these limitations, we feel that results from our large‐scale analysis provide insight on trends that may in turn impact any multiple contributors our healthcare system, including physicians, patients, and policymakers.…”

“…Moreover, of payers that reimburse for healthcare procedures, Medicare remains the largest. Regardless, many physicians are still reluctant to prescribe AIT to elderly patients . This is despite numerous studies having confirmed that the efficacy of AIT in the geriatric population is no different from the non‐geriatric population .…”

Contraindications to immunotherapy: a global approach

“…Although epidemiological studies support a decline of the prevalence of allergic diseases in elderly, there are immunological data suggesting that type-2 cytokines pattern is not defective in older age [45–47]. Even though debated, late-onset allergy to airborne allergens should be treated with AIT, taking under consideration concomitant diseases that pose contraindications.…”

Food Allergies and Ageing

“…Anaphylaxis is a severe and life-threatening hypersensitivity reaction that can affect allergic patients at any age [45]. Clinical manifestations of anaphylaxis caused by food allergens are less frequent in the elderly compared to young subjects [71]. However, although less common, anaphylaxis exhibits a worst prognosis in older patients [72].…”