Older adults face higher anaphylaxis risks

Published online April 22, 2025

Anaphylaxis is a rapid, life-threatening allergic reaction that affects up to 5% of people in their lifetime. While often associated with children and younger adults, rates of anaphylaxis-related emergency department (ED) visits and hospitalizations among older adults have been rising steadily. Despite this trend, little is known about how anaphylaxis presents or is treated in people aged 65 and older. Concerns about giving epinephrine, the first-line treatment for anaphylaxis, to older adults with heart conditions or other chronic illnesses may lead to delays in care. 

In a new study published in The Journal of Allergy and Clinical Immunology: In Practice, Nduwimana et al. explored how anaphylaxis presentations, treatments, and outcomes differ between older and younger adults in real-world emergency settings, with the goal of improving treatment and outcomes. The researchers conducted a single-center cohort study at a large Midwestern academic medical center, analyzing visits for anaphylaxis between 2008 and 2022. The study included both retrospectively and prospectively enrolled patients aged 18 and older who met national criteria for anaphylaxis. Patients were grouped by age: 18–64 years (younger adults) and 65 years or older (older adults). The investigators compared symptoms, triggers, EMS and hospital treatments, and clinical outcomes between these groups. They also used advanced statistical models to adjust for factors such as medical history, delayed treatment, and medication use. A subgroup analysis focused on the use of EMS to evaluate how pre-hospital care differed by age.

Older adults were more likely than younger adults to experience severe anaphylactic reactions, especially those triggered by medications or contrast dyes. They also had more cardiovascular symptoms, such as low blood pressure or chest pain, and were more likely to have underlying heart or lung disease. Despite arriving by ambulance more often, older adults were significantly less likely to receive epinephrine from EMS providers after adjusting for comorbidities and other factors. Age was the strongest predictor of severe anaphylaxis. Notably, follow-up care with an allergy specialist and prescriptions for self-injectable epinephrine were low across all age groups, but especially so for older patients. These findings suggest that older adults may not only be at higher risk of poor outcomes from anaphylaxis but may also be less likely to receive timely or appropriate treatment. The study emphasizes the need for targeted education and clearer clinical guidance to ensure early recognition and safe epinephrine use in older populations.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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