Allergic Rhinitis in the Elderly. In Collaboration With the ARIA Guidelines.

Abstract

Rhinitis in the elderly represents a unique challenge, due to specific clinical profiles, needs, and expectations. Allergic rhinitis (AR) in the elderly is often intertwined with nonallergic rhinitis. Multimorbidity, frailty, disability, and polypharmacy leading to drug-drug interactions are all important in the elderly. Epidemiological data remain limited. AR in the elderly often follows an earlier onset, but some patients may start AR symptoms later. Rhinitis in the elderly is often underrecognized because the symptoms are those of AR possibly combined with nonallergic rhinitis influenced by age-related structural and functional changes in the nose. These include nasal dryness, congestion without clear trigger, and rhinorrhea alone. Several characteristics of AR in the elderly render AR diagnosis more challenging in this age group. An assessment of control and severity is needed to optimize person-centered treatment. There is no specific guideline for the management of AR in the elderly. However, although AR in the elderly may differ from rhinitis in younger adults, and medication efficacy may be reduced, the main management trend is the same as that in younger patients. The key problem is safety, because some drugs may cause specific severe side effects. First-generation oral antihistamines should be avoided. Intranasal corticosteroids, second-generation oral antihistamines, as well as intranasal H₁-antihistamine and intranasal H₁-antihistamine-intranasal corticosteroid fixed combination are the first-line therapeutic options. Digital health associated with artificial intelligence has a promising future for AR management.