Auckland District Health Board, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand.
Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
J Allergy Clin Immunol Pract. 2021 Jun;9(6):2186-2194. doi: 10.1016/j.jaip.2021.03.034. Epub 2021 Apr 2.
Angioedema and urticaria affect people of all ages. Accurate diagnosis and optimum management is essential for healthy aging. Older people continue to experience mast cell-mediated urticaria and angioedema, with a higher prevalence of autoimmune and a lower prevalence of autoallergic disease. Bradykinin-mediated angioedemas are more common in the elderly because of their association with angiotensin-converting enzyme inhibitor (ACEI) treatment. Acquired C1-inhibitor deficiency, another bradykinin-mediated angioedema, occurs predominantly in older people, whereas hereditary angioedema due to C1-inhibitor deficiency continues to cause symptoms, even in old age. Drug-induced angioedemas disproportionately affect older people, the most frequent users of ACEIs, aspirin, and nonsteroidal anti-inflammatory drugs. Accurate diagnosis and targeted treatment prevent unnecessary morbidity and mortality. Second-generation antihistamines with omalizumab if required are effective and well tolerated in older people with mast cell-mediated urticaria. For bradykinin-mediated angioedemas, these drugs are ineffective. C1-inhibitor replacement or blockade of kallikrein or the bradykinin B2 receptor of the contact pathway is required to treat hereditary angioedema and may be considered in other bradykinin-mediated angioedemas, if supportive treatment is insufficient. For aspirin-related angioedema and urticaria, alternative medications or, exceptionally, desensitization may be required.
血管性水肿和荨麻疹可影响所有年龄段的人群。准确的诊断和最佳的管理对于健康老龄化至关重要。老年人仍会经历肥大细胞介导的荨麻疹和血管性水肿，自身免疫性疾病的患病率较高，而自身过敏性疾病的患病率较低。缓激肽介导的血管性水肿在老年人中更为常见，因为它们与血管紧张素转换酶抑制剂（ACEI）治疗有关。获得性 C1 抑制剂缺乏症，另一种缓激肽介导的血管性水肿，主要发生在老年人中，而由于 C1 抑制剂缺乏引起的遗传性血管性水肿即使在老年时仍会引起症状。药物引起的血管性水肿不成比例地影响老年人，他们是 ACEI、阿司匹林和非甾体抗炎药的最常使用者。准确的诊断和针对性治疗可预防不必要的发病率和死亡率。第二代抗组胺药加奥马珠单抗，如果需要，对肥大细胞介导的荨麻疹的老年人有效且耐受性良好。对于缓激肽介导的血管性水肿，这些药物无效。需要 C1 抑制剂替代或阻断激肽释放酶或接触途径的缓激肽 B2 受体，以治疗遗传性血管性水肿，如果支持性治疗不足，可能会考虑在其他缓激肽介导的血管性水肿中使用。对于与阿司匹林相关的血管性水肿和荨麻疹，可能需要替代药物或在特殊情况下进行脱敏治疗。
