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Chronic Urticaria in Older Adults: Treatment Considerations

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Abstract

Chronic urticaria is characterized by recurrent wheals and/or angioedema lasting for more than 6 weeks. Chronic urticaria is an extremely disabling disease limiting daily activities, compromising patient quality of life, and frequently associated with psychiatric comorbidities (depression and/or anxiety). Unfortunately, there are still gaps in the knowledge regarding treatment in special populations, especially in older patients. Indeed, there are no specific recommendations for the management and treatment of chronic urticaria in older people; therefore, recommendations for the general population are used. However, the utilization of some medications may be complicated by potential concerns of comorbidities or polypharmacy. Currently, the diagnostic and therapeutic procedures for chronic urticaria in the older patient are the same as those indicated for other age groups. In particular, there is a limited number of blood chemistry investigations for spontaneous chronic urticaria and specific tests for inducible urticaria. With regard to therapy, second-generation anti-H1 antihistamines are used and, in recalcitrant cases, omalizumab (an anti-IgE monoclonal antibody) and possibly cyclosporine A are additional choices. Nonetheless, it should be underlined that in older patients the differential diagnosis can be more difficult, owing to the lower frequency of chronic urticaria and the likelihood of other pathologies that are peculiar for this age group and that can be included in the chronic urticaria differential diagnosis. As far as therapy is concerned, the physiological characteristics of these patients, the possible comorbidities, and the intake of other medications often require a very attentive drug selection for chronic urticaria compared with other age groups. The purpose of this narrative review is to provide an update on the epidemiology, clinical characteristics, and management of chronic urticaria in older patients.

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Authors and Affiliations

  1. Department of Health Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy

    Cataldo Patruno

  2. Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

    Gabriella Fabbrocini, Francesco Cillo & Ginevra Torta

  3. Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy

    Luca Stingeni

  4. Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy

    Maddalena Napolitano

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Cataldo Patruno, Gabriella Fabbrocini, Francesco Cillo, Ginevra Torta, Luca Stingeni, and Maddalena Napolitano have no conflicts of interest that are directly relevant to the content of this article.

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Patruno, C., Fabbrocini, G., Cillo, F. et al. Chronic Urticaria in Older Adults: Treatment Considerations. Drugs Aging 40, 165–177 (2023). https://doi.org/10.1007/s40266-023-01010-y

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