Ventura Maria Teresa, Scichilone Nicola, Paganelli Roberto, Minciullo Paola Lucia, Patella Vincenzo, Bonini Matteo, Passalacqua Giovanni, Lombardi Carlo, Simioni Livio, Ridolo Erminia, Del Giacco Stefano R, Gangemi Sebastiano, Canonica Giorgio Walter
Interdisciplinary Department of Medicine, Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy.
DIBIMIS, University of Palermo, Palermo, Italy.
Clin Mol Allergy. 2017 Feb 3;15:2. doi: 10.1186/s12948-017-0059-2. eCollection 2017.
Life expectancy and the number of elderly people are progressively increasing around the world. Together with other pathologies, allergic diseases also show an increasing incidence in geriatric age. This is partly due to the growing emphasis on a more accurate and careful diagnosis of the molecular mechanisms that do not allow to ignore the real pathogenesis of many symptoms until now unknown, and partly to the fact that the allergic people from 20 years ago represent the elderly population now. Moreover, environmental pollution predisposes to the onset of allergic asthma and dermatitis which are the result of internal pathologies more than the expression of allergic manifestations. At the same time the food contamination permits the onset of allergic diseases related to food allergy. In this review we provide the state of the art on the physiological changes in the elderly responsible for allergic diseases, their biological characteristics and the major immunological and extra immunological mechanisms. Much emphasis is given to the management of several diseases in the elderly, including anaphylactic reactions. Moreover, some new features are discussed, such as management of asthma with the support of physical activity and the use of the AIT as prevention of respiratory diseases and for the purpose of a real and long lasting benefit. The mechanisms of adverse reactions to drugs are also discussed, due to their frequency in this age, especially in polytherapy regimens. Study of the modifications of the immune system is also of great importance, as regards to the distribution of the lymphocytes and also the presence of a chronic inflammatory disease related to the production of cytokines, especially in prevision of all the possible therapies to be adopted to allow an active and healthy aging.
全球的预期寿命和老年人数量都在逐步增加。与其他疾病一样，过敏性疾病在老年人群中的发病率也呈上升趋势。部分原因是越来越强调对分子机制进行更准确、细致的诊断，而这些机制使得许多至今未知的症状的真正发病机制不容忽视；另一部分原因是20年前的过敏人群如今已步入老年。此外，环境污染易引发过敏性哮喘和皮炎，这些疾病更多是内部病变的结果，而非过敏表现的体现。同时，食物污染会引发与食物过敏相关的过敏性疾病。在本综述中，我们阐述了导致老年人过敏性疾病的生理变化、其生物学特征以及主要的免疫和非免疫机制的最新研究状况。重点讨论了老年人多种疾病的管理，包括过敏反应。此外，还探讨了一些新特点，如在体育活动支持下的哮喘管理以及使用变应原特异性免疫疗法预防呼吸道疾病并实现切实持久的益处。由于药物不良反应在这个年龄段很常见，尤其是在联合治疗方案中，因此也对药物不良反应的机制进行了讨论。免疫系统变化的研究也非常重要，这涉及淋巴细胞的分布以及与细胞因子产生相关的慢性炎症性疾病的存在，特别是在规划所有可能采用的疗法以实现积极健康的老龄化方面。
