Allergies in Elderly Patients

Estimations range from 5-10 % of our elderly patients who deal with seasonal allergies.  Our elderly are more susceptible to the typical symptoms of allergic rhinitis (AR), due to the anatomic and physiologic changes that occur with age.  These include nasal obstruction, post-nasal drip and cough.  Post-nasal drip and cough can be worsened by thickened mucus along with decreased mucociliary clearance that comes with aging. 

Severity of symptoms has also been closely related to the decreased mucociliary transport.  As well, temperature and humidity in the nasal cavity are significantly lower in the elderly.  This can cause more irritation symptoms and have more dryness and crusting in the nasal cavity.

Pharmacology Options

Allergic Rhinitis – Nasal steroids, topical antihistamines and non-sedating antihistamines are safest.

1st Generation Antihistamines à DIPHENHYDRAMINE, CHLORPHENIRAMINE

  • Lypophilic and can cross the Blood Brain Barrier (BBB), so increased chance of CNS side effects (confusion, dizziness, drowsiness and decreased cognitive dysfunction)
  • Also have less affinity for H1 receptor, so have additional Dopaminergic, Serotonergic and Cholinergic side effects

2nd Generation Antihistamines – ZYRTEC, CLARITIN, ALLEGRA

  • Low potential to cross the BBB and selectively blocks H1 receptor, so side effects diminished
    • May require dose decrease in hepatic dysfunction (Cetirizine, Loratadine)
    • May require dose decrease in renal dysfunction (Cetirizine, Fexofenadine)

Corticosteroids

Useful in the treatment of acute and delayed hypersensitivity reactions.  However, must monitor

  • Diabetes in increased 2-fold in elderly patients newly initiated on steroid therapy
  • Increase risk of Peptic Ulcer disease in patients receiving steroids and concomitant NSAIDs
    • Risk is 15x greater than that of non-users of either class of drug