Management of Chronic Spontaneous Urticaria in the Elderly

Abstract

The guidelines for the management of urticaria in adults and children have been revised and updated recently. However, there are few data in the literature concerning several aspects of this disease in the elderly (e.g., epidemiology, etiopathogenesis, clinical aspects, association with co-morbidities, efficacy and safety profiles of treatments, and management strategies). This is an obvious deficiency in the data, as this disease causes a deterioration in quality of life, affecting the quality of sleep, everyday life habits and activities, and inducing severe disability. Chronic spontaneous urticaria (CSU) can also be associated with internal, infectious, autoimmune, or neoplastic diseases. It is therefore necessary to pay particular attention to these clinical issues through appropriate clinical examinations. At the same time, the specific features of medications used to treat CSU in the elderly should be carefully evaluated, as its pharmacological treatment raises a number of problems related both to the clinical condition of the patient and to concomitant diseases, as well as to the polypharmacotherapy, which is common in older subjects and may cause safety problems because of the drug interactions. Non-sedating new-generation antihistamines are the mainstay treatment of CSU for the elderly. The efficacy and safety of alternative treatment options have not been assessed in the geriatric population with CSU; corticosteroids and cyclosporine (ciclosporin) should be used by this population with extreme caution. Similarly, there are no data regarding the actual safety profile of the new-generation antihistamines at higher doses than those recommended in elderly patients.

Epidemiology, comorbidities, and healthcare utilization of patients with chronic urticaria in Germany

“…General practitioners are likely to treat a higher percentage of mild CU cases and may be more conservative with respect to innovative and costly biological treatments, and in elderly patients in need of poly-pharmacotherapy. 37 Dermatologists are more likely to prescribe biologicals for severe disease and to be more aware of international guidelines. In Germany, unlike other countries such as the United States, allergology is a sub-speciality, and dermatologists are generally responsible for any conditions related to the skin.…”

Clinical features of chronic urticaria in aging population

“…5,6 Polypharmacy (multiple medication usages and/or the administration of more clinically indicated medications) 7 and the aging process may interfere with pharmacokinetics and pharmacodynamics, resulting in different responses to treatments. 8 Chronic urticaria (CU) is a common skin disease characterized by the presence of itchy wheals with or without angioedema lasting for at least six weeks. In general, CU occurs most frequently after adolescence with the highest incidence in young adults.…”

Food Allergies and Ageing

“…However, in addition to FAs, even drugs and systemic diseases, mainly hematologic and immune dysfunctions, can also induce urticaria in the elderly. Underlying diseases must, therefore, always be suspected, especially when a new diagnosis of chronic urticaria is made in an elderly person [66,67]. Although aged individuals can respond to immunotherapy for a respiratory allergy, as well as to biological drugs commonly used for the treatment of allergic manifestations, such as urticaria and atopic dermatitis, they are usually excluded from these kinds of therapy [68,69].…”

“…Several other drugs may interfere with allergic effector cells of FAs. Nonsteroidal anti-inflammatory drugs, taken for chronic osteoarticular pain, are relevant cofactors in urticaria and anaphylaxis in aged subjects [67]. Tricyclic antidepressants, monoamine oxidase inhibitor, and neuroleptics may increase the cardiac risk of epinephrine administration.…”