Old, Wise and Allergic: Allergies Are No Longer Solely Diseases of the Grandchildren

Abstract

ties, loss of memory, dependence and polymedication are some of the factors that affect treatment in elderly patients. The influence of immunosenescence (the aging of the immune system), drug interactions or age-related side effects have to be taken into account, too [4] . Immunosenescence may be reflected by age-related declines in serum total IgE and different other immunological parameters, which have been reported in elderly patients compared to younger patients without any allergic disease [5, 6] . However, it seems that immunosenescence does neither affect increased IgE levels in diseased patients with atopic dermatitis [7] nor the results of skin provocation tests as well as specific IgE to inhalant, food or drug allergens [8–10] . In the nose, typical symptoms of allergic rhinitis, e.g. nasal obstruction, itching, sneezing and rhinorrhea, may be worsened by age-related changes in the anatomy and physiology of the nose, e.g. a slower mucociliary transport time or increased dryness for example [11, 12] . In the skin, aging is characterized by atrophy of the epidermis and dermis due to loss of hydration, function and structural integrity resulting in impaired immune responses and skin barrier function, especially due to components of the extracellular matrix, vascular impairment and the resulting metabolic disturbance and oxidative stress [13, 14] . In developed countries, the demographic distribution of the population is changing towards a higher proportion of elderly persons. Especially the group of persons 65 years or older is the fastest growing segment of the population in many countries. It is estimated that by 2040 this group will comprise about 25% of the total population and that the percentage of patients above 80 years of age will increase disproportionately fast. Per definition, the term older adult is applied to persons 65 years or older (in some studies 60 years or older). So far, it was estimated, that the prevalence of allergic diseases in the elderly population segment is around 5–10% [1, 2] . Wuthrich et al. [3] have now been able to determine the age-related prevalence of allergic diseases in the Swiss population using data of the very well-defined SAPALDIA study population. Prevalence rates of self-reported allergic rhinitis in subjects >60 years were 13.0% for men and 15.4% for women, and 6.6% (men) versus 7.6% (women) for doctor’s diagnosed asthma. Thus, allergic diseases in this age group seem to be much higher than previously thought – even though the prevalence rates of both rhinitis and asthma were still higher in persons below age 60. This indicates that further scientific evaluations of allergic diseases in this age segment are in great demand. But why may allergies in grandparents differ from the same disease in their grandchildren? Frailty, comorbidiPublished online: November 30, 2013