Risk assessment in elderly for sensitization to food and respiratory allergens
Introduction
Most allergological studies today focus on allergic diseases in children and young adults. However, due to the shift of age distribution in the population in industrialized countries towards elderly, there is a growing need to investigate the prevalence of allergy in aged people. It is known since long that the proportion of asthmatics in this population has been underestimated and, therefore, undertreated [1], [2]. Roughly 10–30% of the asthmatics are above age 60 [3]. Previous studies reported a decrease of specific IgE with age [4]. However, recently a discussion whether allergy evaluation would be valuable in elderly patients has been taken up again [5], [6], and house dust mite has been identified as an important allergen source for asthma in this population [7]. In a French cohort with a mean age above 65 years, rhinitis and asthma were associated with smoking as an environmental factor [8], and thus paralleling the results from a younger population in the European Community Respiratory Health Survey report [9].
In the general population precise data on prevalence of food allergies are lacking, but anecdotic studies in younger cohorts indicate that the prevalence of food allergies is on the rise [10], [11]. Epidemiologic data on food allergy are completely missing and are rare for respiratory allergies in the elderly. This is also due to the fact that elderly are not given true attention by allergologists today [6]. Therefore, food allergy-related symptoms like dyspepsia, vomiting, diarrhea, and skin efflorescences might easily remain undiagnosed. Moreover, our recent studies indicated that the peptic stomach milieu is protective against food sensitizations [12], [13] and hypersensitivity reactions [14]. Thus settings with reduced gastric acid output, e.g. due to anti-ulcer drugs or chronic atrophic gastritis are likely to facilitate sensitization to food allergens and to trigger symptoms. Atrophy of the gastric mucosa advances with age, especially in connection with chronic alcohol abuse, being negatively correlated with the secretory capacity of the stomach [15]. Several studies have already pointed towards a relationship between alcohol consumption, IgE formation and allergic skin manifestations [16], [17].
Immunosenescence leads to an increased incidence and severity of infectious diseases in the elderly, and also vaccination induces only limited protective immunity. These effects are likely due to an accumulation of dysfunctional memory–phenotype cells, especially CD8+CD28− cells, poor T-cell proliferative responses, and relatively lower B-cell numbers with increasing age [18], [19]. An earlier Swiss study indicated that antibody titers against a number of infectious and food antigens can be detected in old people [20], still the antibody quality in elderly seems to be reduced [21]. Animal studies indicated a defect in type 2 cytokine responses and in IgE isotype switch in senescent mice [22]. In contrast, in human studies the type 2 responses including cytokines, IgE and CD23 were functional in a cohort of elderly with an age between 70 and 93 years [23], [24], indicating a discrepancy between the murine and human aged immune system. Thus, from an immunological point of view IgE-responses not only to respiratory but also to food allergens are likely to occur also in the geriatric population.
This study aimed, therefore, to collect epidemiologic data on the prevalence of sensitizations to respiratory and, importantly, also to food allergens by investigating an elderly, partly geriatric cohort of a nursing home. These individuals had throughout their lives lived in villages or on farms in a small rural town situated in an agricultural region in the middle of Hungary.
Section snippets
Study subjects
The investigated population of a geriatric nursing home in Újszász, a small rural town in Hungary, consisted of 183 people, 109 (59.6%) of which participated in the study. Seventy-four residents of the nursing home were excluded from the study because of their poor mental or physical conditions or their absence from the nursing home at the time of the study. Patients included in the study were all able to understand and answer the questions during the interview. Thirty-six young and middle-aged
Study subjects
The study included 109 patients (38 men and 71 women), aged from 60 to 97 years (mean 77 ± 9.3 years) (Table 1). They were all residents in the nursing home for a mean of 6.3 years and had previously lived in the same region, in villages or on farms. All but 8 study subjects (n = 101) suffered from co-morbidity as given in Table 1. Among the 109 study subjects, 25 were moderate to heavy alcoholics according to the criteria from the Rotterdam study [26] (current consumption of at least 20–25 g of
Discussion
Recent studies indicate that in senescent humans the Th2 branch of the immune system is as functional as in younger adults [24]. This explains the increased prevalence of allergic asthma in elderly [7]. Previous studies have indicated that the diagnosis of asthma in elderly may be difficult due to co-morbidity of the patients, leading to underdiagnosis [5]. Most elderly included in this study suffered from concomitant other diseases like diabetes or heart failure. They had not been suspected
Acknowledgements
Supported by grant SFB-F1808-B04 of the Austrian National Science Foundation (FWF), Anniversary grant 11375 of the Austrian National bank and a research grant of the Institute Danone.
References (36)
- et al.
Characteristics of asthma among elderly adults in a sample of the general population
Chest
(1991) - et al.
Underestimation of allergies in elderly patients
Lancet
(2004) - et al.
Rising prevalence of allergy to peanut in children: data from two sequential cohorts
J Allergy Clin Immunol
(2002) - et al.
Antiulcer drugs promote oral sensitisation and hypersensitivity to hazelnut allergens in BALB/c mice and humans
Am J Clin Nutr
(2005) - et al.
The effects of gastric digestion on codfish allergenicity
J Allergy Clin Immunol
(2005) - et al.
Marked increase with age of type 1 cytokines within memory and effector/cytotoxic CD8+ T cells in humans: a contribution to understand the relationship between inflammation and immunosenescence
Exp Gerontol
(2003) - et al.
Immune dysfunction in the elderly and its reversal by antihistamines
Biomed Pharmacother
(2003) - et al.
A study of age-related IgE pathophysiological changes
Mech Ageing Dev
(2003) - et al.
Alcohol consumption and risk of dementia: the Rotterdam Study
Lancet
(2002) - et al.
Antacid medication inhibits digestion of dietary proteins and causes food allergy: a fish allergy model in BALB/c mice
J Allergy Clin Immunol
(2003)
Association of asthma with serum IgE levels and skin test reactivity to allergens
N Engl J Med
Atopic asthma is dominant in elderly onset asthmatics: possibility for an alteration of mast cell function by aging through Fc receptor expression
Int Arch Allergy Immunol
Distribution of total serum IgE and specific IgE to common aeroallergens by sex and age, and their relationship to each other in a random sample of the Dutch general population aged 20–70 years. Dutch ECRHS Group, European Community Respiratory Health Study
Allergy
The elderly asthmatic patient
Allergy Asthma Proc
Serum total IgE and specific IgE to Dermatophagoides pteronyssinus, but not eosinophil cationic protein, are more likely to be elevated in elderly asthmatic patients
Allergy Asthma Proc
IgE level and phadiatop in an elderly population from the PAQUID cohort: relationship to respiratory symptoms and smoking
Allergy
The association of age, gender and smoking with total IgE and specific IgE
Clin Exp Allergy
Prevalence of self-reported food allergy and IgE antibodies to food allergens in Swedish and Estonian schoolchildren
Eur J Clin Nutr
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