Allergies in the Aging

D'Arcy Little, MD, CCFP


Geriatrics and Aging. 2005;8(5):52-53. 

In This Article

Geriatric Rhinitis: Under-diagnosed and Undertreated

To make matters more complicated, not all rhinitis in the older adult has an allergic basis. Nasal problems are a common complaint in the older adult.[6] These problems are often presented to the physician as "sinus trouble" with thick postnasal drainage associated with frequent throat clearing and nasal congestion.[6] While these symptoms are nonspecific, and similar to other types of rhinitis, the use of decongestants and antihistamines may make the symptoms of geriatric rhinitis worse.[6]

The etiology of geriatric rhinitis is best explained by examining the physiology of the aging nose.[6] With aging, there is nasal airway narrowing secondary to weakening of the supporting cartilage.[6] This may render symptomatic any minor deviations in the septal cartilage that were previously asymptomatic and give rise to a complaint of nasal obstruction.[6] In addition, nasal glandular atrophy reduces the number of submucosal glands; this leads to thicker mucus, which presents as the need for repeated throat-clearing, coughing, or persistent foreign body sensation in the throat.[6] Aging also gives rise to a decrease in microvascular blood flow, leading to dryness and crusting.[6] In addition, medications commonly used in older adults such as diuretics, beta-blockers, anxiolytics, and antivertigo drugs also contribute to nasal dryness and congestion.[6]

The differential diagnosis of rhinitis in older adults includes allergic rhinitis, chronic sinusitis, and vasomotor rhinitis, in addition to the age-related changes leading to geriatric rhinitis.[6] As a result, certain cases may benefit from allergy testing and/or a CT scan of the sinuses. If allergy testing is carried out, due to changes in aging skin, prick-puncture skin testing is advocated as the best method for allergy testing in the older adult.[7]

Once the diagnosis of geriatric rhinitis is made, the treatment is to increase moisture inside the nose.[6] This may be accomplished by increasing mucus production with a maximum dose of guaifenesin 2,400 mg/day, increasing moisture by the topical application of saline via nasal spray four to six times daily, and/or the use of home humidifiers.[6] First-generation antihistamines such as chlorpheniramine should be avoided because they can dry nasal membranes. Therefore, if allergic rhinitis is suspected in the older adult, second- or third-generation antihistamines such as loratidine should be considered.[6] Nasal corticosteroids should used cautiously in the older person as they can worsen drying and crusting.[6,8] Cromolyn sodium nasal solution may be more effective in treating older adults with documented allergic rhinitis.[6]