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Aging and disease    2017, Vol. 8 Issue (2) : 162-175     DOI: 10.14336/AD.2016.0831
Review |
Allergy and Aging: An Old/New Emerging Health Issue
De Martinis Massimo*, Sirufo Maria Maddalena, Ginaldi Lia
Department of Life, Health, & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Abstract  

Allergy reactions are the most common immunological diseases and represent one of the most widespread and fast growing chronic human health problems among people over 15 years of age in developed countries. As populations get older worldwide, allergy manifestations in aged persons will occur more often in the future. To date, there has been much more studies on allergies in children than in adults. As the population ages, clinicians must be prepared to meet all the elderly's health care needs, including these new and emerging health issue. Allergic diseases represent an old/new emerging health issue. Because many common illnesses masquerade as atopic disease, the differential diagnosis of suspected allergic diseases becomes more expanded in an aging population. Research in the field needs to focus on both human and animal model systems to investigate the impact of the aging process on the immunologic pathways underpinning allergy and its different facets.

Keywords aging      allergy      elderly      immunosenescence      translational immunology      geriatrics     
Corresponding Authors: De Martinis Massimo   
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These authors contributed equally to this work

Issue Date: 01 April 2017
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De Martinis Massimo
Sirufo Maria Maddalena
Ginaldi Lia
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De Martinis Massimo,Sirufo Maria Maddalena,Ginaldi Lia. Allergy and Aging: An Old/New Emerging Health Issue[J]. Aging and disease, 2017, 8(2): 162-175.
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http://www.aginganddisease.org/EN/10.14336/AD.2016.0831     OR     http://www.aginganddisease.org/EN/Y2017/V8/I2/162
• The elderly population is steadily increasing and issues related to his state of health will become a topic of increasing relevance.
• With increasing age, numerous underlying physiological changes occur, and the risk of chronic diseases rises. At the same time allergy is increasing worldwide, and 5-10% of allergies is affecting elderly people.
• Taking into consideration the dramatic increase of all forms of allergies during the last decades also in the elderly, they are considered a real "epidemic" of the XXIst century, being classified by the WHO as the fourth most frequent chronic diseases.
• Despite the great importance of the problem, allergic diseases, compared to all other chronic diseases, are neglected and undervalued.
• In old people a number of factors may contribute to trigger allergy and/or to disguise it, making it longer and difficult to achieve the right diagnosis and relief suffering persons often already affected by several other diseases and in presence of many other causes of frailty.
• The multifaceted dynamics among multimorbidity, disease, and underlying physiological change, can result in health states in older age that are not captured by traditional disease classifications and not easily diagnosed.
• Many epidemiological surveys have shown that the number of allergic patients in Europe and other developed and developing countries is increasing dramatically. A notable proportion of individuals with respiratory allergy in Europe are underdiagnosed, undertreated and dissatisfied with their treatment and among these most are elderly people.
• Recently there has been a large increase in knowledge about the immunological processes that play a role in allergic diseases and about environmental exposure (irritants and allergens), a tendency that will continue, and this gain in knowledge has led to changes in diagnostic and therapeutic possibilities (component-resolved diagnosis, new forms of immunotherapy), and to a better understanding of the role and the possibilities of primary and secondary prevention (benefits and risks of allergen avoidance, infant feeding, application of pro-/prebiotics, risk of tobacco smoke, role of epigenetics).
Table 1  Allergy in the elderly: a panoramic view
• The issue of the health of the elderly has become a topic in modern medicine as older people represent the most rapidly expanding part of the population and reached the highest levels in the history
• Immediate hypersensitivity (type I) is the most common immunological disease. It represents the most widespread and fast growing chronic human health condition in people aged 15th years and older in industrialized countries. About 25% of the population is affected, with manifestations which range from only irritating to severe life-threatening conditions
• Allergic diseases are mostly caused by inhalant allergens, in particular mold and pollens and climate changes modify their deployment and amount
• The onset of allergic diseases in older people is driven by immunosenescence, the changes of immune function observed with aging and tissue structure modifications typical of advanced age. Concurrent diseases, drug polytherapy and adverse drug reactions could be frequent complications
• The contribution of epigenetic regulation to allergic diseases is a crucial topic. Discovering and validating epigenetic biomarkers linking exposure to allergic diseases could help to a better definition of risk, prognosis, response to therapy and development of novel treatments
• Collaborative translational and interdisciplinary research is needed to identify new biomarkers of disease, accounting for the unique phenotypic makeup of the elderly allergic and for the immunological and physiological changes associated with the natural process of aging that affect diagnosis and management
Table 2  key issues
Figure 1.  Age-related changes underlying allergy in the elderly. The onset of allergic diseases in the elderly is driven by cell aging at large and by immunosenescence and tissue structure modifications typical of advanced age. The figure illustrates the age-related functional and structural changes in upper and lower airways, skin and gut underlying the onset of allergy reactions in the elderly. ACE = angiotensin-converting-enzyme; CHF = chronic heart failure; COPD = chronic obstructive pulmonary disease; GERD = gastroesophageal reflux disease; NSAIDs = nonsteroidal anti-inflammatory drug; PPI = proton pump inhibitors.
• New and detailed epidemiological research is needed. Most studies on allergy prevalence were conducted in childhood than in adulthood, when immune-senescence, concurrent diseases, polytherapy and adverse drug reactions could be frequent confounding factors and could potentially impact on diagnosis, assessment and management.
• Research in the field needs to focus on both human and animal model systems to investigate the impact of the aging process on the immunologic pathways underpinning allergy and its different facets.
• Particular attention must be paid to diagnostic tools. The same diagnostic tests and clinical findings applied in young are used to diagnose allergy in older people, but interpreting clinical data becomes more difficult in the elderly. Future research should also address the identification of possible new biomarkers for early diagnosis and prognosis in the elderly. While new standardization of old diagnostic procedure is essential in a geriatric setting.
• The contribution of epigenetic regulation to allergic diseases is another crucial topic that needs to be further investigated. The identification of more specific biomarkers and key pathogenic molecules will add valuable insights into molecular networks operative in allergic diseases in the elderly. Moreover, it could be the base for both discovering potential mechanisms linking environment and epigenetics, and for modern therapeutic approaches. Indeed, new treatment strategies must be developed: translational investigation of novel therapeutic targets must be pursued.
Table 3  Future perspective
[1] Burch JB, Augustine AD, Frieden LA, et al. (2014). Advances in geroscience: impact on healthspan and chronic disease. J Gerontol A Biol Sci Med Sci, 69 Suppl 1: S1-3.
[2] HayGlass KT (1995). Allergy: who, why and what to do about it? Immunol Today, 16: 505-517.
[3] Kim BJ, Lee SY, Kim HB, Lee E, Hong SJ. (2014). Environmental changes, microbiota, and allergic diseases. Allergy Asthma Immunol Res, 6: 389-400.
[4] Hypponen E, Berry DJ, Wjst M, Power C (2009) Serum 25-hydroxyvitamin D and IgE - a significant but nonlinear relationship. Allergy, 64: 613-620
[5] Mohrenschlager M, Ring J (2011). Food allergy: an increasing problem for the elderly. Gerontology, 57: 33-36.
[6] Milgrom H, Huang H (2014). Allergic disorders at a venerable age: a mini-review. Gerontology, 60: 99-107.
[7] Wuthrich B, Schmid-Grendelmeier P, Schindler C, Imboden M, Bircher A, Zemp E, Probst-Hensch N. (2013). Prevalence of atopy and respiratory allergic diseases in the elderly SAPALDIA population. Int Arch Allergy Immunol, 162: 143-8.
[8] Bozek A, Jarzab J (2013). Epidemiology of IgE-dependent allergic diseases in elderly patients in Poland. Am J Rhinol Allergy, 27: e140-5.
[9] Ginaldi L, Mengoli LP, De Martinis M (2007). Review on Immunosenescence. Reviews in Clin Gerontol, 17: 161-9
[10] Campisi G, Chiappelli M, De Martinis M, et al. (2009). Pathophysiology of age-related diseases. Immun Ageing, Sep 8; 6-12.
[11] Cardona V, Guilarte M, Luengo O, Labrador-Horrillo M, Sala-Cunill A, Garriga T (2011). Allergic disease in the elderly. Clin Exp Allergy, 1:1-11
[12] De Martinis M, Ginaldi L (2014) Rethinking the “Sunshine” Vitamin. J Osteopor Phys Act, 2: e110
[13] Muller L, Pawelec G (2014). Aging and Immunity - Impact of behavioral intervention. Brain Behav Immun, 39: 8-22
[14] Denkinger MD, Leins H, Schirmbeck R, Florian MC, Geiger H (2015). HSC aging and senescent immune remodeling. Trends Immunol, 36(12): 815-24.
[15] Jenny NS (2012). Inflammation in aging: cause effect or both? Discover Med, 13: 451-460
[16] De Martinis M, Franceschi C, Monti D, Ginaldi L (2006). Inflammation markers predicting frailty and mortality in the elderly. Exp Mol Pathol, 80: 219-27.
[17] Heffner KL (2011) Neuroendocrine effects of stress on immunity in the elderly: implications for inflammatory disease. Immunol Allergy Clin North Am, 31: 95-108.
[18] Chen Y, Lyga J (2014). Brain-Skin Connection: Stress, Inflammation and Skin Aging. Inflamm Allergy Drug Targets, 13, 177-190.
[19] Carneiro SC, Azevedo-e-Silva MC, Ramos-e-Silva M (2011). Drug eruptions in the elderly. Clin Dermatol, 29: 43-48.
[20] Onder G, Marengoni A, Russo P, et al. (2016). Medicines Utilization Monitoring Center Health Database Network. Advanced age and medication prescription: more years, less medications? A nationwide report from the Italian Medicines Agency. J Am Med Dir Assoc, 17: 168-72.
[21] Cardoso CR, Teixeira G, Provinciatto PR, et al. (2008). Modulation of mucosal immunity in a murine model of food-induced intestinal inflammation. Clin Exp Allergy, 38(2): 338-349
[22] Brunner R, Wallmann J, Szalai K, Karagiannis P, Altmeppen H, Riemer AB, Jensen-Jarolim E, Pali-Schöll I (2009). Aluminium per se and in the anti-acid drug sucralfate promotes sensitization via the oral route. Allergy, 64: 890-897
[23] Corazza GR, Ginaldi L, Quaglione G, Ponzielli F, Vecchio L, Biagi F, Quaglino D (1998). Proliferating cell nuclear antigen expression is increased in small bowel epithelium in the elderly. Mech Ageing Dev, 104: 1-9.
[24] Diesner SC, Pietschmann P, Jensen-Jarolim E (2011). Food allergy: only a pediatric disease? Gerontology, 57: 28-32.
[25] Wöhrl S, Stingl G (2004) Underestimation of allergies in elderly patients. Lancet, 363:249.
[26] Zuberbier T, Edenharter G, Worm M, Ehlers I, Reimann S, Hantke T, Roehr CC, Bergmann KE, Niggemann B (2004). Prevalence of adverse reactions to food in Germany - a population study. Allergy, 59:338-345.
[27] Bakos N, Scholl I, Szalai K, Kundi M, Untersmayr E, Jensen-Jarolim E (2006). Risk assessment in elderly for sensitization to food and respiratory allergens. Immunol Lett, 107(1):15-21
[28] Kivity S (2012). Adult-onset food allergy. Isr Med Assoc J, 14(1): 70-72
[29] Sahin Yilmaz AA, Corey JP (2006). Rhinitis in the elderly. Curr Allergy Asthma Rep, 6:125-131.
[30] Paul P, Johnson P, Ramaswamy P, Ramadoss S, Geetha B, Subhashini AS (2013). The Effect of Ageing on Nasal Mucociliary Clearance in Women: A Pilot Study. ISRN Pulmonology, Article ID 598589, 5 pages.
[31] Edelstein DR (1996). Aging of the normal nose in adults. Laryngoscope, 106(9 Pt 2):1-25.
[32] Pontes P, Yamasaki R, Behlau M (2006). Morphological and functional aspects of the senile larynx. Folia Phoniatr Logop, 58:151-8.
[33] Sato K, Hirano M (1998). Age-related changes in the human laryngeal glands. Ann Otol Rhinol Laryngol, 107(6): 525-9.
[34] Sakai H, Nakano Y, Muro S, et al. (2010). Age-related changes in the trachea in healthy adults. Adv Exp Med Biol, 662:115-120.
[35] Wansleeben C, Bowie E, Hotten DF, Yu YRA, Hogan BLM (2014). Age-Related Changes in the Cellular Composition and Epithelial Organization of the Mouse Trachea. PLoS One, 9(3): e93496.
[36] De Martinis M, Timiras PS (2007). Aging of the pulmonary respiration, aging of the hematopoiesis and erythrocytes. In: Timiras PS, editor. Physiological basis of aging and Geriatrics. Boca Raton: CRC Press, 277-295
[37] Bom Todo, Pinto A Mota (2009) Allergic respiratory diseases in the elderly. Respiratory Medicine, 103, 1614-1622.
[38] Meiners S, Eickelberg O, Königshoff M (2015) Hallmarks of the ageing lung. Eur Resp J, 45: 807-27
[39] Murray MA, Chotirmall SH (2015). The Impact of Immunosenescence on Pulmonary Disease. Mediators Inflamm, 2015:692546
[40] Chotirmall SH, Burke CM (2015). Aging and the microbiome: implications for asthma in the elderly? Expert Rev Respir Med, 9(2):125-8.
[41] Nyenhuis S, Mathur SK (2013). Rhinitis in older adults. Curr Allergy Asthma Rep, 13(2): 171-177.
[42] Baptist AP, Nyenhuis S (2016) Rhinitis in the elderly. Immunol Allergy Clin N Am, 36: 343-357.
[43] Mims JW (2014). Epidemiology of allergic rhinitis. Int Forum Allergy Rhinol, 4(Suppl2): S18-20.
[44] King MJ, Phillips SE, Lockey RF (2014) Effect of photoaging on skin test response to histamine independent of chronologic age. Ann Allergy Asthma Immunol, 113(6):647-51.
[45] Song WJ, Kim MY, Jo EJ, Kim MH, Kim TH, Kim SH, Kim KW, Cho SH, Min KU, Chang YS (2013). Rhinitis in a community elderly population: relationships with age, atopy and asthma. Ann Allergy Asthma Immunol, 111(5):347-51.
[46] Bousquet J, Khaltaev N, editor. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach, World Health Organization. 2017
[47] Pite H, Pereira AM, Morais-Almeida M, Nunes C, Bousquet J, Fonseca JA (2014). Prevalence of asthma and its association with rhinitis in the elderly. Respir Med, 108(8):1117-26.
[48] Yáñez A, Cho SH, Soriano JB, et al (2014). Asthma in the elderly: what we know and what we have yet to know. World Allergy Organ J, 7(1):8.
[49] Al-Alawi M, Hassan T, Chotirmall SH (2014). Advances in the diagnosis and management of asthma in older adults. Am J Med, 127(5):370-8.
[50] Brandensberger C, Li N, Jackson-Humbles DN, Rockwell CE, Wagner JG, Harkema JR (2014). Enhanced allergic airway disease in old mice is associated with Th17 response. Clin Exp Allergy, 44(10):1282-1292.
[51] Viswanathan RK, Mathur SK (2011). Role of allergen sensitization in older adults. Curr Allergy Asthma Rep, 11:427-433.
[52] Zuo L, Pannell BK, Liu Z (2016). Characterization and redox mechanism of asthma in the elderly. Oncotarget, 7: 25010-21
[53] Columbo M, Rohr AS (2016). Asthma in the elderly: the effect of choline supplementation. Allergy Asthma Clin Immunol, 12:15
[54] Kuo CH, Hsieh CC, Lee MS, Chang KT, Kuo HF, Hung CH (2014). Epigenetic regulation in allergic diseases and related studies. Asia Pac Allergy, 4(1):14-8.
[55] Klimek L (2014). Old, Wise and Allergic: Allergies Are No Longer Solely Diseases of the Grandchildren. Int Arch Allergy Immunol, 163:75-76
[56] Marek Svoboda, Zuzana Bílková, Tomáš Muthný (2016). Could tight junctions regulate the barrier function of the aged skin? J Dermatol Sci, 81;3:147-152.
[57] Mathur SK (2013). Rhinitis in older adults. Curr Allergy Asthma Rep, 13(2):171-177.
[58] De Amici M, Ciprandi G (2013). The Age Impact on Serum Total and Allergen-Specific IgE. Allergy Asthma Immunol Res, 5(3):170-4.
[59] Khan DA (2012). Cutaneous drug reactions. J Allergy Clin Immunol, 130(5):1225-1225.e6.
[60] Ventura MT, Scichilone N, Gelardi M, Patella V, Ridolo E (2015). Management of allergic disease in the elderly: key considerations, recommendations and emerging therapies. Expert Rev Clin Immunol, 11(11):1219-28
[61] Tanei R, Hasegawa Y (2016). Atopic dermatitis in older adults: a viewpoint from geriatric dermatology. Geriatr Gerontol Int, 16(Suppl 1):75-86.
[62] Tokura Y (2010). Extrinsic and intrinsic types of atopic dermatitis. J Dermatol Sci, 58(1):1-7.
[63] Tanei R, Hasegawa Y, Sawabe M (2013). Abundant immunoglobulin E-positive cells in skin lesions support an allergic etiology of atopic dermatitis in the elderly. J Eur Acad Dermatol Venereol, 27(8):952-60.
[64] Norman RA (2003). Xerosis and pruritus in the elderly: recognition and management. Dermatol Ther, 16: 254-9.
[65] Dobos G, Lichterfeld A, Blume-Peytavi U, Kottner J (2015). Evaluationof skin ageing: a systematic review of clinical scale. Br J Dermatol, 172:1249-1261.
[66] Ahmed AM, Pritchard S, Reichenberg J (2013). A review of cutaneous drug eruptions. Clin Geriatr Med, 29(2):527-545.
[67] Routledge PA, O'Mahony MS, Woodhouse KW (2004). Adverse drug reactions in elderly patients. Br J Clin Pharmacol, 57(2): 121-126.
[68] Dagli RJ, Sharma A (2014). Polypharmacy: A Global Risk Factor for Elderly People. J Int Oral Health, 6(6): i-ii.
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