This summary was compiled from the tweets posted by the following allergists/immunologists who attended the 2012 annual meeting of the American Academy of Allergy Asthma and Immunology (AAAAI): From Sakina Bajowala, M.D @allergistmommy. The tweets were labeled #AAAAI. The text was edited and modified by me.The “Atopy in older adults” lecture was presented by Paula Busse and Vinay Mehta:
We usually think of allergy as a disease of the young, but older adults can also suffer from allergic conditions.
Pulmonary function tests (PFTs)
In the elderly, normal diffusing capacity (DLCO) suggests asthma vs. COPD. Reversibility of airway obstruction is not specific for asthma.
Skin test and sIgE
Total IgE and allergen-specific IgE levels decrease with increasing age (by approximately 20% per decade). At any given age, IgE levels in males are higher than females.
Atrophic and sun-damaged skin demonstrates decreased skin test reactivity.
Subcutaneous allergen immunotherapy (SCIT)
Immunotherapy can be effective in the elderly, but risk-benefit ratio should be carefully evaluated, due to increased risk factors.
Comorbidities
Sleep apnea can significantly impact respiratory control in older patients with asthma. CPAP can reduce symptoms in affected patients.
Theophylline use is discouraged in the elderly due to narrow therapeutic window and issues surrounding drug metabolism.
Omalizumab appears effective in older adults. Once again, cardiovascular risks must be weighed.
It is recommended that aspirin desensitization not be attempted in patients with FEV1 < 70% predicted.
Chronic treatment with proton pump inhibitors (PPI) is associated with increased fracture risk (hip, wrist, spine). As many asthmatics have confluence of risk factors (steroids, PPI, etc.) consider screening with bone density at regular intervals.
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