Skip to main content
SpringerLink
Log in

Management of Chronic Spontaneous Urticaria in the Elderly

  • Therapy in Practice
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

The guidelines for the management of urticaria in adults and children have been revised and updated recently. However, there are few data in the literature concerning several aspects of this disease in the elderly (e.g., epidemiology, etiopathogenesis, clinical aspects, association with co-morbidities, efficacy and safety profiles of treatments, and management strategies). This is an obvious deficiency in the data, as this disease causes a deterioration in quality of life, affecting the quality of sleep, everyday life habits and activities, and inducing severe disability. Chronic spontaneous urticaria (CSU) can also be associated with internal, infectious, autoimmune, or neoplastic diseases. It is therefore necessary to pay particular attention to these clinical issues through appropriate clinical examinations. At the same time, the specific features of medications used to treat CSU in the elderly should be carefully evaluated, as its pharmacological treatment raises a number of problems related both to the clinical condition of the patient and to concomitant diseases, as well as to the polypharmacotherapy, which is common in older subjects and may cause safety problems because of the drug interactions. Non-sedating new-generation antihistamines are the mainstay treatment of CSU for the elderly. The efficacy and safety of alternative treatment options have not been assessed in the geriatric population with CSU; corticosteroids and cyclosporine (ciclosporin) should be used by this population with extreme caution. Similarly, there are no data regarding the actual safety profile of the new-generation antihistamines at higher doses than those recommended in elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69(7):868–87.

    Article  CAS  PubMed  Google Scholar 

  2. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. Methods report on the development of the 2013 revision and update of the EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2014;69(7):e1–29.

    Article  CAS  PubMed  Google Scholar 

  3. Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau A, et al. EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009;64(10):1417–26.

    Article  CAS  PubMed  Google Scholar 

  4. Maurer M, Weller K, Bindslev-Jensen C, Giménez-Arnau A, Bousquet PJ, Bousquet J, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force. Allergy. 2011;66(3):317–30.

    Article  CAS  PubMed  Google Scholar 

  5. Zuberbier T, Balke M, Worm M, Edenharter G, Maurer M. Epidemiology of urticaria: a representative cross-sectional population survey. Clin Exp Dermatol. 2010;35(8):869–73.

  6. Ramos-Romey C, López-Malpica F, Nazario S, Jiménez-Velázquez IZ. Urticaria in the elderly. Bol Asoc Med P R. 2008;100(3):32–5.

    PubMed  Google Scholar 

  7. Chen YJ, Wu CY, Shen JL, Chen TT, Chang YT. Cancer risk in patients with chronicurticaria: a population-based cohort study. Arch Dermatol. 2012;148(1):103–8.

    Article  PubMed  Google Scholar 

  8. Magen E, Mishal J. Schlesinger M. Clinical and laboratory features of chronic idiopathic urticaria in the elderly. Int J Dermatol. 2013;52(11):1387–91.

    Article  PubMed  Google Scholar 

  9. Ventura MT, Napolitano S, Buquicchio R, Cecere R, Arsieni A. An approach to urticaria in the elderly patients. Immunopharmacol Immunotoxicol. 2012;34(3):530–3.

  10. Seymour R, Routledge PA. Important drug–drug interactions in the elderly. Drugs Aging. 1998;12(6):485–94.

    Article  CAS  PubMed  Google Scholar 

  11. Malde B, Regalado J, Greenberger PA. Investigation of angioedema associated with the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Ann Allergy Asthma Immunol. 2007;98:57–63.

    Article  CAS  PubMed  Google Scholar 

  12. Ventura MT, Napolitano S, Menga R, Cecere R, Asero R. Anisakis simplex hypersensitivity is associated with chronic urticaria in endemic areas. Int Arch Allergy Immunol. 2013;160(3):297–300.

    Article  CAS  PubMed  Google Scholar 

  13. Cardona V, Guilarte M, Luengo O, Labrador-Horrillo M, Sala-Cunill A, Garriga T. Allergic diseases in the elderly. Clin Transl Allergy. 2011;1(1):11–20.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Lindelöf B, Sigurgeirsson B, Wahlgren CF, Eklund G. Chronic urticaria and cancer: an epidemiological study of 1155 patients. Br J Dermatol. 1990;123(4):453–6.

    Article  PubMed  Google Scholar 

  15. Karakelides M, Monson KL, Volcheck GW, Weiler CR. Monoclonal gammopathies and malignancies in patients with chronic urticaria. Int J Dermatol. 2006;45(9):1032–8.

    Article  PubMed  Google Scholar 

  16. Manganoni AM, Tucci G, Venturini M, Farisoglio C, Baronchelli C, Calzavara Pinton PG. Chronic urticaria associated with thyroid carcinoma: report of 4 cases. J Investig Allergol Clin Immunol. 2007;17(3):192–5.

  17. Sugiyama A, Nishie H, Takeuchi S, Yoshinari M, Furue M. Hashimoto’s disease is a frequent comorbidity and an exacerbating factor of chronic spontaneous urticaria. Allergol Immunopathol (Madr). 2014. doi:10.1016/j.aller.2014.02.007.

  18. Confino-Cohen R, Chodick G, Shalev V, Leshno M, Kimhi O, Goldberg A. Chronic urticaria and autoimmunity: associations found in a large population study. J Allergy Clin Immunol. 2012;129(5):1307–13.

    Article  PubMed  Google Scholar 

  19. Staubach P, Dechene M, Metz M, Magerl M, Siebenhaar F, Weller K, et al. High prevalence of mental disorders and emotional distress in patients with chronic spontaneous urticaria. Acta Derm Venereol. 2011;91(5):557–61.

    PubMed  Google Scholar 

  20. Gupta MA, Gupta AK. Chronic idiopathic urticaria and post-traumatic stress disorder (PTSD): an under-recognized comorbidity. Clin Dermatol. 2012;30(3):351–4.

  21. O’Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW. The impact of chronic urticaria on the quality of life. Br J Dermatol. 1997;136(2):197–201.

    Article  PubMed  Google Scholar 

  22. Baiardini I, Pasquali M, Braido F, Fumagalli F, Guerra L, Compalati E, et al. A new tool to evaluate the impact of chronic urticaria on quality of life: chronic urticaria quality of life questionnaire (CU-QoL). Allergy. 2005;60(8):1073–8.

    Article  CAS  PubMed  Google Scholar 

  23. Baiardini I, Giardini A, Pasquali M, Dignetti P, Guerra L, Specchia C, et al. Quality of life and patients’ satisfaction in chronic urticaria and respiratory allergy. Allergy. 2003;58(7):621–3.

    Article  CAS  PubMed  Google Scholar 

  24. Ban G-Y, Kim M-Y, Yoo H-S, Nahm D-H, Ye Y-M, Shin Y-S, et al. Clinical feature of elderly chronic urticaria. Korean J Intern Med. 2014;29(6):800–6.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Zuberbier T, Maurer M. Urticaria: current opinions about etiology, diagnosis and therapy. Acta Derm Venereol. 2007;87(3):196–205.

    PubMed  Google Scholar 

  26. Saini SS. Chronic spontaneous urticaria: etiology and pathogenesis. Immunol Allergy Clin North Am. 2014;34(1):33–52.

    Article  PubMed  Google Scholar 

  27. Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau AM, et al. Dermatology Section of the European Academy of Allergology and Clinical Immunology; Global Allergy and Asthma European Network; European Dermatology Forum; World Allergy Organization. EAACI/GA(2)LEN/EDF/WAO guideline: management of urticaria. Allergy. 2009;64(10):1427–43.

    Article  CAS  PubMed  Google Scholar 

  28. Simons FE, Simons KJ. H1 antihistamines: current status and future directions.World Allergy Organ J. 2008;1(9):145–55.

  29. Vena GA, Cassano N, Buquicchio R, Ventura MT. Antiinflammatory effects of H1-antihistamines: clinical and immunological relevance. Curr Pharm Des. 2008;14(27):2902–11.

    Article  CAS  PubMed  Google Scholar 

  30. Khan DA. Alternative agents in refractory chronic urticaria: evidence and considerations on their selection and use. J Allergy Clin Immunol Pract. 2013;1(5):433–440.

  31. Asero R, Tedeschi A, Cugno M. Treatment of refractory chronic urticaria: current and future therapeutic options. Am J Clin Dermatol. 2013;14(6):481–8.

    Article  PubMed  Google Scholar 

  32. Grattan CE, O’Donnell BF, Francis DM, Niimi N, Barlow RJ, Seed PT, et al. Randomized double-blind study of cyclosporin in chronic ‘idiopathic’ urticaria. Br J Dermatol. 2000;143(2):365–72.

    Article  CAS  PubMed  Google Scholar 

  33. Vena GA, Cassano N, Colombo D, Peruzzi E, Pigatto P, Neo-I-30 Study Group. Cyclosporine in chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled trial. J Am Acad Dermatol. 2006;55(4):705–9.

    Article  PubMed  Google Scholar 

  34. Maurer M, Rosén K, Hsieh HJ, Saini S, Grattan C, Gimenéz-Arnau A, et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013;368(10):924–35.

    Article  CAS  PubMed  Google Scholar 

  35. Kaplan A, Ledford D, Ashby M, Canvin J, Zazzali JL, Conner E, et al. Omalizumab in patients with symptomatic chronic idiopathic/spontaneous urticaria despite standard combination therapy. J Allergy Clin Immunol. 2013;132(1):101–9.

    Article  CAS  PubMed  Google Scholar 

  36. Saini SS, Bindslev-Jensen C, Maurer M, Grob JJ, Bülbül Baskan E, Bradley MS, et al. Efficacy and safety of omalizumab in patients with chronic idiopathic/spontaneous urticaria who remain symptomatic on H1 antihistamines: a randomized, placebo-controlled study. J Invest Dermatol. 2015;135(1):67–75.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Zuberbier T. Pharmacological rationale for the treatment of chronic urticaria with second-generation non-sedating antihistamines at higher-than-standard doses. J Eur Acad Dermatol Venereol. 2012;26(1):9–18.

    Article  CAS  PubMed  Google Scholar 

  38. Sánchez-Borges M, Caballero-Fonseca F, Capriles-Hulett A. Treatment of recalcitrant chronic urticaria with nonsedating antihistamines: is there evidence for updosing? J Investig Allergol Clin Immunol. 2013;23(3):141–4.

  39. Hansen J, Klimek L, Hörmann K. Pharmacological management of allergic rhinitis in the elderly: safety issues with oral antihistamines. Drugs Aging. 2005;22(4):289–96.

    Article  CAS  PubMed  Google Scholar 

  40. Hall MRP. Drug interactions in the elderly. J Am Geriatr Soc. 1982;28(Suppl 1):18–24.

    CAS  Google Scholar 

  41. Dávila I, delCuvillo A, Mullol J, Jáuregui I, Bartra J, Ferrer M, et al. Use of second generation H1 antihistamines in special situations. J Investig Allergol Clin Immunol. 2013;23(Suppl 1):1–16.

  42. Yanai K, Zhang D, Tashiro M, Yoshikawa T, Naganuma F, Harada R, et al. Positron emission tomography evaluation of sedative properties of antihistamines. Expert Opin Drug Saf. 2011;10(4):613–22.

    Article  CAS  PubMed  Google Scholar 

  43. Church MK, Church DS. Pharmacology of antihistamines. Indian J Dermatol. 2013;58(3):219–24.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Tashiro M, Kato M, Miyake M, Watanuki S, Funaki Y, Ishikawa Y, et al. Dose dependency of brain histamine H(1) receptoroccupancy following oral administration of cetirizine hydrochloride measured using PET with [11C]doxepin. Hum Psychopharmacol. 2009;24(7):540–8.

    Article  CAS  PubMed  Google Scholar 

  45. Gupta A, Gillard M, Christophe B, Chatelain P, Massingham R, Hammarlund-Udenaes M. Peripheral and central H1 histamine receptor occupancy by levocetirizine, a non-sedating antihistamine; a time course study in the guinea pig. Br J Pharmacol. 2007;151(7):1129–36.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  46. Dubertret L, Zalupca L, Cristoroulo T, Benea V, Medina I, Fantin S, et al. Once-daily rupatadine improves the symptoms of chronic idiopathic urticaria: a randomized, double-blind, placebo-controlled study. Eur J Dermatol. 2007;17(3):223–8.

    CAS  PubMed  Google Scholar 

  47. Barbanoj MJ, García-Gea C, Antonijoan R, Izquierdo I, Donado E, Pérez I, et al. Evaluation of the cognitive, psychomotor and pharmacokinetic profiles of rupatadine, hydroxyzine and cetirizine, in combination with alcohol, in healthy volunteers. Hum Psychopharmacol. 2006;21(1):13–26.

    Article  CAS  PubMed  Google Scholar 

  48. Slavin RG. Treating rhinitis in the older population: special considerations. Allergy Asthma Clin Immunol. 2009;5(1):9.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Bom AT, Pinto AM. Allergic respiratory diseases in the elderly. Respir Med. 2009;103(11):1614–22.

    Article  PubMed  Google Scholar 

  50. Scichilone N, Battaglia S, Benfante A, Bellia V. Safety and efficacy of montelukast as adjunctive therapy for treatment of asthma in elderly patients. Clin Interv Aging. 2013;8:1329–37.

    PubMed Central  PubMed  Google Scholar 

  51. Ingelsson E, Yin L, Bäck M. Nationwide cohort study of the leukotriene receptor antagonist montelukast and incident or recurrent cardiovascular disease. J Allergy Clin Immunol. 2012;129(3):702–7.

    Article  CAS  PubMed  Google Scholar 

  52. Riccioni G, Bäck M. Leukotrienes as modifiers of preclinical atherosclerosis? Sci World J. 2012;2012:490968.

    Article  Google Scholar 

  53. Altomare G, Ayala F, Bardazzi F, Bellia G, Chimenti S, Colombo D, et al. Consensus on the use of cyclosporine in dermatological practice. G Ital Dermatol Venereol. 2014;149(5):607–25.

  54. Kovarik JM, Koelle EU. Cyclosporin pharmacokinetics in the elderly. Drugs Aging. 1999;15(3):197–205.

    Article  CAS  PubMed  Google Scholar 

  55. Falck P, Asberg A, Byberg KT, Bremer S, Bergan S, Reubsaet JL, et al. Reduced elimination of cyclosporine A in elderly (>65 years) kidney transplant recipients. Transplantation. 2008;86(10):1379–83.

    Article  CAS  PubMed  Google Scholar 

  56. Lill J, Bauer LA, Horn JR, Hansten PD. Cyclosporine-drug interactions and the influence of patient age. Am J Health Syst Pharm. 2000;57(17):1579–84.

    CAS  PubMed  Google Scholar 

  57. Metz M, Ohanyan T, Church MK, Maurer M. Omalizumab is an effective and rapidly acting therapy in difficult-to-treat chronic urticaria: a retrospective clinical analysis. J Dermatol Sci. 2014;73(1):57–62.

    Article  CAS  PubMed  Google Scholar 

  58. Korn S, Schumann C, Kropf C, Stoiber K, Thielen A, Taube C, et al. Effectiveness of omalizumab in patients 50 years and older with severe persistent allergic asthma. Ann Allergy Asthma Immunol. 2010;105(4):313–9.

    Article  PubMed  Google Scholar 

  59. Omalizumab: a second look in severe persistent asthma: new adverse effects. Prescrire Int. 2011;20(115):90–2.

  60. Ali AK, Hartzema AG. Assessing the association between omalizumab and arteriothrombotic events through spontaneous adverse event reporting. J Asthma Allergy. 2012;5:1–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Kaplan AP. Treatment of chronic spontaneous urticaria. Allergy Asthma Immunol Res. 2012;4(6):326–31.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  62. Weller K, Viehmann K, Bräutigam M, Krause K, Siebenhaar F, Zuberbier T, et al. Management of chronic spontaneous urticaria in real life—in accordance with the guidelines? A cross-sectional physician-based survey study. J Eur Acad Dermatol Venereol. 2013;27(1):43–50.

  63. Piper JM, Ray WA, Daugherty JR, Griffin MR. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Intern Med. 1991;114(9):735–40.

    Article  CAS  PubMed  Google Scholar 

  64. Church MK, Maurer M, Simons FE, Bindslev-Jensen C, van Cauwenberge P, Bousquet J, et al. Global Allergy and Asthma European Network. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Allergy. 2010;65(4):459–66.

    Article  CAS  PubMed  Google Scholar 

  65. Kaliner MA. H1-antihistamines in the elderly. Clin Allergy Immunol. 2002;17:465–81.

  66. Simons FE. Advances in H1-antihistamines. N Engl J Med. 2004;351(21):2203–17.

    Article  CAS  PubMed  Google Scholar 

  67. Juniper EF, Stahl E, Doty RL, Simons FE, Allen DB, Howarth PH. Clinical outcomes and adverse effect monitoring in allergic rhinitis. J Allergy Clin Immunol. 2005;3(Suppl. 1):S390–413.

    Article  Google Scholar 

  68. Agostini JV, Leo-Summers LS, Inouye SK. Cognitive and other adverse effects of diphenhydramine use in hospitalized older patients. Arch Intern Med. 2001;161(17):2091–7.

    Article  CAS  PubMed  Google Scholar 

  69. Rothberg MB, Herzig SJ, Pekow PS, Avrunin J, Lagu T, Lindenauer PK. Association between sedating medications and delirium in older inpatients. J Am Geriatr Soc. 2013;61(6):923–30.

    Article  PubMed  Google Scholar 

  70. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.

Download references

Acknowledgments

Gino Vena has been a consultant, speaker, and an advisory board member for Novartis. Nicoletta Cassano has been a scientific consultant for Novartis. Maria Teresa Ventura, Paolo Romita, Michelangelo Vestita, and Caterina Foti declare no conflicts of interest. No sources of funding were used to support this manuscript.

Author information

Authors and Affiliations

  1. Department of Interdisciplinary Medicine (DIM), University of Bari, Medical School, Policlinico, Unit of Geriatric Immunoallergology, Policlinico, piazza G. Cesare, 70124, Bari, Italy

    Maria Teresa Ventura

  2. Dermatology and Venereology, Private Practice, Bari and Barletta, Italy

    Nicoletta Cassano & Gino Antonio Vena

  3. Dermatological Clinic, Department of Biomedical Science and Human Oncology, University of Bari Medical School, Policlinico, Bari, Italy

    Paolo Romita, Michelangelo Vestita & Caterina Foti

Authors
  1. Maria Teresa Ventura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicoletta Cassano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paolo Romita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michelangelo Vestita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Caterina Foti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gino Antonio Vena
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Teresa Ventura.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ventura, M.T., Cassano, N., Romita, P. et al. Management of Chronic Spontaneous Urticaria in the Elderly. Drugs Aging 32, 271–282 (2015). https://doi.org/10.1007/s40266-015-0249-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-015-0249-x

Keywords

Search

Navigation