SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
12/22/04
Allergy immunotherapy in older individuals
Summary
Background - Allergen-specific injection immunotherapy (SIT) has been shown to confer significant benefits in both seasonal allergic rhinitis (AR) and asthma due to pollen allergies. However, the role of SIT in older adults with these seasonal allergies is still debated.
Findings - Asero of the Clinica San Carlo in Italy carried out a comparison of SIT in three groups of individuals: with at least 10 years of SAR (and associated asthma in some) due to birch or ragweed allergy: Group 1- subjects over 54 years old (n=39); Group 2 patients less than 50 years old (n=36); Group 3- individuals over 54 years old who had refused to undergo SIT (n=37). In all patients the allergic manifestations were insufficiently controlled with current pharmacotherapy.
After a 1-5 year follow-up, over 95% of those who had received SIT (both older and younger patients) reported a reduction in respiratory symptoms of over 50% (no significant difference between groups 1 and 2 in this regard). In contrast, in the controls who had not received SIT respiratory symptoms were similar to baseline in 27 of 37 and
more severe in the other 10 patients.
Reference
Int Arch Allergy Immunol 2004;135:332-335
Editor's Comments
Although this was not a randomized, controlled, blinded study, the findings do suggest that SIT can be as effective in allergic patients older than age 54 years as in younger individuals. However, several caveats should be kept in mind. 1) It is common for seasonal allergic symptoms to spontaneously decrease in intensity when individuals enter the late 60's/70's years of their life. This could contribute to some of the "benefit" attributed to SIT in this study. However, the authors claims that the symptoms in similar older age allergic patients not receiving SIT worsened, if anything ' 2) one must be particularly careful about increasing allergen dosage in SIT given to elderly individuals; a systemic reaction to SIT with hypotension may lead to more serious consequences (e.g. - myocardial infarct) in elderly patients. This is of particular concern in patients taking beta-blocker drugs (a relatively common occurrence in elderly patients).
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