Patruno Cataldo, Fabbrocini Gabriella, Cillo Francesco, Torta Ginevra, Stingeni Luca, Napolitano Maddalena
Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy.
Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Drugs Aging. 2023 Mar;40(3):165-177. doi: 10.1007/s40266-023-01010-y. Epub 2023 Feb 18.
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.
慢性荨麻疹的特征是反复出现风团和/或血管性水肿，持续时间超过6周。慢性荨麻疹是一种极其致残的疾病，限制日常活动，损害患者生活质量，并常伴有精神共病（抑郁和/或焦虑）。不幸的是，在特殊人群尤其是老年患者的治疗知识方面仍存在差距。确实，对于老年人慢性荨麻疹的管理和治疗没有具体建议；因此，采用针对一般人群的建议。然而，某些药物的使用可能因共病或多重用药的潜在问题而变得复杂。目前，老年患者慢性荨麻疹的诊断和治疗程序与其他年龄组相同。特别是，自发性慢性荨麻疹的血液化学检查数量有限，诱导性荨麻疹的特异性检查也有限。在治疗方面，使用第二代抗H1组胺药，在难治性病例中，奥马珠单抗（一种抗IgE单克隆抗体）以及可能的环孢素A是额外的选择。尽管如此，应该强调的是，在老年患者中鉴别诊断可能更困难，这是由于慢性荨麻疹的发病率较低，以及该年龄组特有的其他可能被纳入慢性荨麻疹鉴别诊断的疾病。就治疗而言，与其他年龄组相比，这些患者的生理特征、可能的共病以及其他药物的摄入通常需要在选择治疗慢性荨麻疹的药物时非常谨慎。本叙述性综述的目的是提供老年患者慢性荨麻疹的流行病学、临床特征和管理方面的最新信息。
