Semin Respir Crit Care Med 2010; 31(5): 587-595
DOI: 10.1055/s-0030-1265899
© Thieme Medical Publishers

Allergy and Asthma in the Elderly

Sameer K. Mathur1
  • 1Department of Medicine, Section of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Further Information

Publication History

Publication Date:
12 October 2010 (online)

ABSTRACT

Allergies and asthma are diseases that affect individuals of all ages, and their prevalence is comparable in all age groups. As age demographics in the United States and other countries shift to greater proportions and numbers of patients in the “elderly” categories, it is becoming increasingly important for clinicians to become aware of the impact of aging on a variety of diseases. Allergy and asthma are recognized as inflammatory disorders, and there are data demonstrating that age-related changes in immune function can have a significant impact on these disorders.

REFERENCES

  • 1 National Asthma Education and Prevention Program (NAEPP) .Guidelines for the Diagnosis and Management of Asthma. Expert Panel Report 3. NIH Publication No. 07–4051. Bethesda, MD; National Institutes of Health; National Heart, Lung and Blood Institute 2007
  • 2 Delespesse G, De Maubeuge J, Kennes B, Nicaise R, Govaerts A. IgE mediated hypersensitivity in ageing.  Clin Allergy. 1977;  7 155-160
  • 3 Hanneuse Y, Delespesse G, Hudson D, de Halleux F, Jacques J M. Influence of ageing on IgE-mediated reactions in allergic patients.  Clin Allergy. 1978;  8 165-174
  • 4 Jarvis D, Luczynska C, Chinn S et al.. Change in prevalence of IgE sensitization and mean total IgE with age and cohort.  J Allergy Clin Immunol. 2005;  116 675-682
  • 5 Barbee R A, Kaltenborn W, Lebowitz M D, Burrows B. Longitudinal changes in allergen skin test reactivity in a community population sample.  J Allergy Clin Immunol. 1987;  79 16-24
  • 6 Annema J T, Sparrow D, O'Connor G T et al.. Chronic respiratory symptoms and airway responsiveness to methacholine are associated with eosinophilia in older men: the Normative Aging Study.  Eur Respir J. 1995;  8 62-69
  • 7 King M J, Bukantz S C, Phillips S, Mohapatra S S, Tamulis T, Lockey R F. Serum total IgE and specific IgE to Dermatophagoides pteronyssinus, but not eosinophil cationic protein, are more likely to be elevated in elderly asthmatic patients.  Allergy Asthma Proc. 2004;  25 321-325
  • 8 Rogers L, Cassino C, Berger K I et al.. Asthma in the elderly: cockroach sensitization and severity of airway obstruction in elderly nonsmokers.  Chest. 2002;  122 1580-1586
  • 9 Slavin R G. Asthma in the elderly.  Respiratory Digest. 2006;  8 3-13
  • 10 Moorman J E, Rudd R A, Johnson C A Centers for Disease Control and Prevention (CDC) et al. National surveillance for asthma—United States, 1980–2004.  MMWR Surveill Summ. 2007;  56(8, SS08) 1-54
  • 11 Moorman J E, Mannino D M. Increasing U.S. asthma mortality rates: who is really dying?.  J Asthma. 2001;  38 65-71
  • 12 Slavin R G, Haselkorn T, Lee J H, Zheng B, Deniz Y, Wenzel S E. TENOR Study Group . Asthma in older adults: observations from the epidemiology and natural history of asthma: outcomes and treatment regimens (TENOR) study.  Ann Allergy Asthma Immunol. 2006;  96 406-414
  • 13 Mannino D M, Gagnon R C, Petty T L, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988–1994.  Arch Intern Med. 2000;  160 1683-1689
  • 14 Enright P L, McClelland R L, Newman A B, Gottlieb D J, Lebowitz M D. Cardiovascular Health Study Research Group . Underdiagnosis and undertreatment of asthma in the elderly.  Chest. 1999;  116 603-613
  • 15 Hopp R J, Bewtra A, Nair N M, Townley R G. The effect of age on methacholine response.  J Allergy Clin Immunol. 1985;  76 609-613
  • 16 Rijcken B, Schouten J P, Mensinga T T, Weiss S T, De Vries K, Van der Lende R. Factors associated with bronchial responsiveness to histamine in a population sample of adults.  Am Rev Respir Dis. 1993;  147(6 Pt 1) 1447-1453
  • 17 Burney P GJ, Britton J R, Chinn S et al.. Descriptive epidemiology of bronchial reactivity in an adult population: results from a community study.  Thorax. 1987;  42 38-44
  • 18 Paoletti P, Carrozzi L, Viegi G et al.. Distribution of bronchial responsiveness in a general population: effect of sex, age, smoking, and level of pulmonary function.  Am J Respir Crit Care Med. 1995;  151 1770-1777
  • 19 Fabbri L M, Romagnoli M, Corbetta L et al.. Differences in airway inflammation in patients with fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2003;  167 418-424
  • 20 Kraft M. Asthma and chronic obstructive pulmonary disease exhibit common origins in any country!.  Am J Respir Crit Care Med. 2006;  174 238-240 discussion 243-244
  • 21 Barnes P J. Against the Dutch hypothesis: asthma and chronic obstructive pulmonary disease are distinct diseases.  Am J Respir Crit Care Med. 2006;  174 240-243, discussion 243–244
  • 22 Lange P, Parner J, Vestbo J, Schnohr P, Jensen G. A 15-year follow-up study of ventilatory function in adults with asthma.  N Engl J Med. 1998;  339 1194-1200
  • 23 O'Byrne P M, Pedersen S, Busse W W START Investigators Group et al. Effects of early intervention with inhaled budesonide on lung function in newly diagnosed asthma.  Chest. 2006;  129 1478-1485
  • 24 Metzger W J, Zavala D, Richerson H B et al.. Local allergen challenge and bronchoalveolar lavage of allergic asthmatic lungs: description of the model and local airway inflammation.  Am Rev Respir Dis. 1987;  135 433-440
  • 25 Wills-Karp M. Interleukin-13 in asthma pathogenesis.  Immunol Rev. 2004;  202 175-190
  • 26 Busse W, Kraft M. Cysteinyl leukotrienes in allergic inflammation: strategic target for therapy.  Chest. 2005;  127 1312-1326
  • 27 Reed C E. The natural history of asthma.  J Allergy Clin Immunol. 2006;  118 543-548, quiz 549–550
  • 28 Bentley A M, Menz G, Storz C et al.. Identification of T lymphocytes, macrophages, and activated eosinophils in the bronchial mucosa in intrinsic asthma: relationship to symptoms and bronchial responsiveness.  Am Rev Respir Dis. 1992;  146 500-506
  • 29 Bentley A M, Durham S R, Kay A B. Comparison of the immunopathology of extrinsic, intrinsic and occupational asthma.  J Investig Allergol Clin Immunol. 1994;  4 222-232
  • 30 Braman S S, Kaemmerlen J T, Davis S M. Asthma in the elderly: a comparison between patients with recently acquired and long-standing disease.  Am Rev Respir Dis. 1991;  143 336-340
  • 31 Nicholson K G, Kent J, Ireland D C. Respiratory viruses and exacerbations of asthma in adults.  BMJ. 1993;  307 982-986
  • 32 Castle S C, Uyemura K, Fulop T, Makinodan T. Host resistance and immune responses in advanced age.  Clin Geriatr Med. 2007;  23 463-479, v
  • 33 Boren E, Gershwin M E. Inflamm-aging: autoimmunity, and the immune-risk phenotype.  Autoimmun Rev. 2004;  3 401-406
  • 34 Derhovanessian E, Solana R, Larbi A, Pawelec G. Immunity, ageing and cancer.  Immun Ageing. 2008;  5 11-26
  • 35 Flurkey K, Stadecker M, Miller R A. Memory T lymphocyte hyporesponsiveness to non-cognate stimuli: a key factor in age-related immunodeficiency.  Eur J Immunol. 1992;  22 931-935
  • 36 Naylor K, Li G, Vallejo A N et al.. The influence of age on T cell generation and TCR diversity.  J Immunol. 2005;  174 7446-7452
  • 37 Swain S, Clise-Dwyer K, Haynes L. Homeostasis and the age-associated defect of CD4 T cells.  Semin Immunol. 2005;  17 370-377
  • 38 Cakman I, Rohwer J, Schütz R M, Kirchner H, Rink L. Dysregulation between TH1 and TH2 T cell subpopulations in the elderly.  Mech Ageing Dev. 1996;  87 197-209
  • 39 Sandmand M, Bruunsgaard H, Kemp K et al.. Is ageing associated with a shift in the balance between type 1 and type 2 cytokines in humans?.  Clin Exp Immunol. 2002;  127 107-114
  • 40 Zhou T, Edwards III C K, Mountz J D. Prevention of age-related T cell apoptosis defect in CD2-fas-transgenic mice.  J Exp Med. 1995;  182 129-137
  • 41 Jackola D R, Ruger J K, Miller R A. Age-associated changes in human T cell phenotype and function.  Aging (Milano). 1994;  6 25-34
  • 42 Lages C S, Suffia I, Velilla P A et al.. Functional regulatory T cells accumulate in aged hosts and promote chronic infectious disease reactivation.  J Immunol. 2008;  181 1835-1848
  • 43 Johnson S A, Cambier J C. Ageing, autoimmunity and arthritis: senescence of the B cell compartment: implications for humoral immunity.  Arthritis Res Ther. 2004;  6 131-139
  • 44 McKenna R W, Washington L T, Aquino D B, Picker L J, Kroft S H. Immunophenotypic analysis of hematogones (B-lymphocyte precursors) in 662 consecutive bone marrow specimens by 4-color flow cytometry.  Blood. 2001;  98 2498-2507
  • 45 Johnson S A, Rozzo S J, Cambier J C. Aging-dependent exclusion of antigen-inexperienced cells from the peripheral B cell repertoire.  J Immunol. 2002;  168 5014-5023
  • 46 Dailey R W, Eun S Y, Russell C E, Vogel L A. B cells of aged mice show decreased expansion in response to antigen, but are normal in effector function.  Cell Immunol. 2001;  214 99-109
  • 47 Doria G, D'Agostaro G, Poretti A. Age-dependent variations of antibody avidity.  Immunology. 1978;  35 601-611
  • 48 Miller C, Kelsoe G. Ig VH hypermutation is absent in the germinal centers of aged mice.  J Immunol. 1995;  155 3377-3384
  • 49 Corberand J, Ngyen F, Laharrague P et al.. Polymorphonuclear functions and aging in humans.  J Am Geriatr Soc. 1981;  29 391-397
  • 50 Fu Y K, Arkins S, Li Y M, Dantzer R, Kelley K W. Reduction in superoxide anion secretion and bactericidal activity of neutrophils from aged rats: reversal by the combination of gamma interferon and growth hormone.  Infect Immun. 1994;  62 1-8
  • 51 Tortorella C, Ottolenghi A, Pugliese P, Jirillo E, Antonaci S. Relationship between respiratory burst and adhesiveness capacity in elderly polymorphonuclear cells.  Mech Ageing Dev. 1993;  69 53-63
  • 52 Fülöp Jr T, Fouquet C, Allaire P et al.. Changes in apoptosis of human polymorphonuclear granulocytes with aging.  Mech Ageing Dev. 1997;  96 15-34
  • 53 Tortorella C, Piazzolla G, Spaccavento F, Pece S, Jirillo E, Antonaci S. Spontaneous and Fas-induced apoptotic cell death in aged neutrophils.  J Clin Immunol. 1998;  18 321-329
  • 54 Green R H, Brightling C E, McKenna S et al.. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial.  Lancet. 2002;  360 1715-1721
  • 55 Spahn J D. Asthma biomarkers in sputum.  Immunol Allergy Clin North Am. 2007;  27 607-622, vi
  • 56 Mathur S K, Schwantes E A, Jarjour N N, Busse W W. Age-related changes in eosinophil function in human subjects.  Chest. 2008;  133 412-419
  • 57 Facchini A, Mariani E, Mariani A R, Papa S, Vitale M, Manzoli F A. Increased number of circulating Leu 11 + (CD 16) large granular lymphocytes and decreased NK activity during human ageing.  Clin Exp Immunol. 1987;  68 340-347
  • 58 Miyaji C, Watanabe H, Toma H et al.. Functional alteration of granulocytes, NK cells, and natural killer T cells in centenarians.  Hum Immunol. 2000;  61 908-916
  • 59 DelaRosa O, Tarazona R, Casado J G et al.. Valpha24 + NKT cells are decreased in elderly humans.  Exp Gerontol. 2002;  37 213-217
  • 60 Kraft M, Cassell G H, Henson J E et al.. Detection of Mycoplasma pneumoniae in the airways of adults with chronic asthma.  Am J Respir Crit Care Med. 1998;  158 998-1001
  • 61 Holgate S T. Rhinoviruses in the pathogenesis of asthma: the bronchial epithelium as a major disease target.  J Allergy Clin Immunol. 2006;  118 587-590
  • 62 Franceschi C, Monti D, Sansoni P, Cossarizza A. The immunology of exceptional individuals: the lesson of centenarians.  Immunol Today. 1995;  16 12-16
  • 63 Ferguson F G, Wikby A, Maxson P, Olsson J, Johansson B. Immune parameters in a longitudinal study of a very old population of Swedish people: a comparison between survivors and nonsurvivors.  J Gerontol A Biol Sci Med Sci. 1995;  50 B378-B382
  • 64 Franceschi C, Capri M, Monti D et al.. Inflammaging and anti-inflammaging: a systemic perspective on aging and longevity emerged from studies in humans.  Mech Ageing Dev. 2007;  128 92-105
  • 65 Meyer K C, Rosenthal N S, Soergel P, Peterson K. Neutrophils and low-grade inflammation in the seemingly normal aging human lung.  Mech Ageing Dev. 1998;  104 169-181
  • 66 Meyer K C, Soergel P. Variation of bronchoalveolar lymphocyte phenotypes with age in the physiologically normal human lung.  Thorax. 1999;  54 697-700
  • 67 Wenzel S E. Asthma: defining of the persistent adult phenotypes.  Lancet. 2006;  368 804-813
  • 68 Litonjua A A, Sparrow D, Weiss S T, O'Connor G T, Long A A, Ohman Jr J L. Sensitization to cat allergen is associated with asthma in older men and predicts new-onset airway hyperresponsiveness. The Normative Aging Study.  Am J Respir Crit Care Med. 1997;  156 23-27
  • 69 Olin A C, Rosengren A, Thelle D S, Lissner L, Bake B, Torén K. Height, age, and atopy are associated with fraction of exhaled nitric oxide in a large adult general population sample.  Chest. 2006;  130 1319-1325
  • 70 Thomas R A, Green R H, Brightling C E et al.. The influence of age on induced sputum differential cell counts in normal subjects.  Chest. 2004;  126 1811-1814
  • 71 Di Lorenzo G, Mansueto P, Ditta V et al.. Similarity and differences in elderly patients with fixed airflow obstruction by asthma and by chronic obstructive pulmonary disease.  Respir Med. 2008;  102 232-238
  • 72 National Asthma Education and Prevention Program (NAEPP) .Considerations for Diagnosing and Managing Asthma in the Elderly. NIH Publication No. 96–3662. Bethesda, MD; National Institutes of Health; National Heart, Lung, and Blood Institute 1996
  • 73 Connolly M J, Crowley J J, Charan N B, Nielson C P, Vestal R E. Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale.  Thorax. 1992;  47 410-413
  • 74 Ekici M, Apan A, Ekici A, Erdemoğlu A K. Perception of bronchoconstriction in elderly asthmatics.  J Asthma. 2001;  38 691-696
  • 75 Korenblat P E, Kemp J P, Scherger J E, Minkwitz M C, Mezzanotte W. Effect of age on response to zafirlukast in patients with asthma in the Accolate Clinical Experience and Pharmacoepidemiology Trial (ACCEPT).  Ann Allergy Asthma Immunol. 2000;  84 217-225
  • 76 Maykut R J, Kianifard F, Geba G P. Response of older patients with IgE-mediated asthma to omalizumab: a pooled analysis.  J Asthma. 2008;  45 173-181
  • 77 Field S K, Underwood M, Brant R, Cowie R L. Prevalence of gastroesophageal reflux symptoms in asthma.  Chest. 1996;  109 316-322
  • 78 Bousquet J, van Cauwenberge P, Khaltaev N. Allergic Rhinitis and Its Impact on Asthma (ARIA): executive summary of the workshop report 7–10 December 1999, Geneva, Switzerland.  Allergy. 2002;  57 841-855
  • 79 Corren J, Adinoff A D, Irvin C G. Changes in bronchial responsiveness following nasal provocation with allergen.  J Allergy Clin Immunol. 1992;  89 611-618
  • 80 Corren J, Adinoff A D, Buchmeier A D, Irvin C G. Nasal beclomethasone prevents the seasonal increase in bronchial responsiveness in patients with allergic rhinitis and asthma.  J Allergy Clin Immunol. 1992;  90 250-256
  • 81 Harlin S L, Ansel D G, Lane S R, Myers J, Kephart G M, Gleich G J. A clinical and pathologic study of chronic sinusitis: the role of the eosinophil.  J Allergy Clin Immunol. 1988;  81(5 Pt 1) 867-875
  • 82 Newman L J, Platts-Mills T AE, Phillips C D, Hazen K C, Gross C W. Chronic sinusitis: relationship of computed tomographic findings to allergy, asthma, and eosinophilia.  JAMA. 1994;  271 363-367
  • 83 Nishioka G J, Cook P R, Davis W E, McKinsey J P. Functional endoscopic sinus surgery in patients with chronic sinusitis and asthma.  Otolaryngol Head Neck Surg. 1994;  110 494-500
  • 84 Newman K B, Mason III U G, Schmaling K B. Clinical features of vocal cord dysfunction.  Am J Respir Crit Care Med. 1995;  152(4 Pt 1) 1382-1386
  • 85 Martin R J, Blager F B, Gay M L et al.. Paradoxic vocal cord motion in presumed asthmatics.  Semin Respir Med. 1987;  8 332-337

Sameer K MathurM.D. Ph.D. 

Department of Medicine, Section of Allergy, Pulmonary, and Critical Care Medicine

University of Wisconsin School of Medicine and Public Health, K4/952 CSC, 600 Highland Ave., Madison, WI 53792

Email: sm4@medicine.wisc.edu

    >