Abstract
Purpose
The type of allergy and other diagnostic procedures were analyzed in a group of elderly seasonal allergic rhinitis (SAR) patients and were compared with young SAR people and a control group.
Materials and methods
Study group consisted of 248 patients with mean age 64.1 ± 4.2 years. They were compared with 289 young SAR people (mean age, 23.7 ± 5.8 years) and with a control group. Allergic sensitization was assessed using the skin prick test (SPT) and specific immunoglobulin (Ig) E measurements. The SAR symptoms were monitored using visual graphic scale. Measurement of nasal fractional exhaled nitric oxide (FeNO) level obtained with handheld chemiluminescence analyzer during and after pollen season was compared with control groups.
Results
In the elderly patient group, a prevalence of allergy to grass, rye, and mugwort was noticed. In 134 (54%) patients, SPT results to grass were positive; and the specific IgE level was elevated (mean value, 22.8 ± 13.1 IU/mL), whereas in 83 (33%) subjects, positive SPT results to mugwort and elevated serum specific IgE concentration (mean value, 31.9 ± 9.1 IU/mL) were observed. During the pollen season, a significantly higher FeNO level was noted in both young and elderly SAR patients in comparison with their respective control groups. In young patients, the mean FeNO level was 61.8 ± 17.2 parts per billion, whereas in the elderly group, it was 58.2 ± 11.8 parts per billion.
Conclusions
SAR in elderly patients is a problem that cannot be neglected. The natural course of SAR in the elderly is similar to other age groups. However, hypersensitivity to different pollens in the analyzed group needs further study.
Allergic rhinitis is a global health problem affecting the quality of life in all age groups. The problem of allergic rhinitis is increasing in most countries and concerns about 500 million people. Seasonal allergic rhinitis (SAR) is related to a wide variety of outdoor allergens such as pollens and molds . The diagnosis of SAR is often quite simple, based on concordance between a typical history of nasal and nonnasal symptoms and diagnostic procedures such as skin prick tests (SPTs), specific immunoglobulin E (sIgE), nasal provocation with allergens, cytology, and new techniques including nasal nitric oxide assay. The increasing incidence of allergies and the aging of the population lead to increased hay fever in older patients. Although many studies have analyzed the epidemiology, diagnostics, and treatment of SAR, the occurrence and natural course in elderly patients have been somewhat neglected . Other serious diseases and aversion to examination and diagnostic procedures divert attention from senile rhinitis and contribute to the lack of knowledge about SAR in this age category.
In the present study, a group of elderly patients diagnosed with SAR was analyzed and compared with a group of younger people similarly diagnosed. The natural course, type of allergy, and diagnostic procedures were the main benchmarks followed.
1
Material and methods
1.1
Patients
Six hundred twenty patients of at least 60 years of age with chronic rhinitis treated in outpatient allergological clinics were analyzed. A subgroup of 248 (40%) SAR patients (165 women and 83 men with a mean age of 64.1 ± 4.2 years) was included into the main study. The preliminary SAR diagnosis was confirmed on the basis of retrospective history and positive SPT result to pollens. Patients with asthma were excluded. The study group was compared with 289 young SAR patients (185 women and 104 men with a mean age 23.7 ± 5.8 years) and also with a nonallergic comparative group (120 women and 76 men with a mean age of 65 ± 8.4 years). The study was approved by the local ethics committee.
Diagnosis of seasonal rhinitis sensitization was assessed using SPT (Allergopharma, Hamburg, Germany) with a panel of 15 allergens: grass mix, timothy grass, rye, oat, wheat, corn, tree mix, birch, alder, hazel, mugwort, nettle, Alternaria , Plantago, and Cladosporium . The response of serum immunoglobulin level (serum sIgE) to all mentioned allergens was measured using the immunoenzymatic test HYTEC (HYCOR Biomedical, Wien, Austria). The results were assessed as positive when the serum sIgE concentration was greater than 0.75 IU/mL (class II according to the manufacturer’s brochure). Careful examination of eyes, ears, nose, throat, and nasal cytology was carried out on all patients. The severity of SAR was assessed according to the Allergic Rhinitis and its Impact on Asthma (ARIA) document. Patients with other nasal problems such as chronic nasal obstruction, reduced sense of smell, bacterial infestation, and chronic sinusitis were diagnosed on the basis of computed tomography and nasal endoscopy. As a result of these problems, a part of them was excluded from further observations. Subjects with other clinically chronic or acute disorders and with history of respiratory tract infections 4 weeks prior and during the study were also excluded.
Allergic rhinitis symptoms were monitored using a 7-point visual graphic scale (published by the Joint Task Force and modified by ARIA) for grading the severity of nasal (sneezing, runny nose, congestion, itchy nose, postnasal drip) and nonnasal (eye symptoms, throat symptoms, chronic cough, ear symptoms, headache, mental function, and quality of life) symptoms . It was based on patient diaries completed during 1 year of observation (January–December 2007) when all protocol procedures were performed.
1.2
Measurements of nitric oxide
Measurements of the nasal FeNO level were obtained using a handheld chemiluminescence analyzer (NIOX MINO Airway Inflammation Monitor; Aerocrine AB, Solna, Sweden). It was calibrated with a nitric oxide calibration gas mixture. Nasal steroids, nasal decongestants, and antihistamine drugs were not applied within 2 weeks before the examinations. A single measurement was made both during nasal exhalation and after 10 seconds of breath-holding against an expiratory resistance of 5 to 25 cm H 2 0 with a flow 50 mL/s using a nasal mask. Measurements were performed during the pollen season (May–August 2007) when patients demonstrated SAR symptoms and 4 to 6 months after (October–December 2007). All measurements were repeated the following day at the same time. Three acceptable FeNO results and mean value were included in the analysis. The detection limit was 1 part per billion (ppb). The measurement range was 5 to 400 ppb.
1.3
Statistical analysis
Data were analyzed with the statistical software package STATISTICA version 8.0 (StatSoft, Cracow, Poland). The mean, standard deviation, 95% confidence interval for data description, and χ 2 test (and also the Mann-Whitney U test to compare FeNO values) were used for comparison of groups, with P < .01.
2
Results
2.1
SPTs and sIgE
In the group of elderly patients, the prevalence of allergy to grass, rye, and mugwort was especially evident. In 34 patients, the onset of SAR was after 50 years. One hundred thirty-four (54%) patients had positive SPT result to grass with elevated sIgE level (mean value, 22.8 ± 13.1 IU/mL), whereas 83 (33%) of them had positive SPT result to mugwort with a mean sIgE concentration of 31.9 ± 9.1 IU/mL. Seventy-eight (31%) elderly patients had positive SPT result to grass mix, more than one tree, and mugwort. Allergy to Alternaria in 49 (20%) patients and to Cladosporium in 21 (8%) was diagnosed. In 30% of the elderly patients, besides a positive history to SAR and positive results of sIgE to pollens, SPT results were negative, in comparison with 7% in the young group. The results of SPT and sIgE determinations are shown in Table 1 .
| Allergen | SPT-positive results | P , χ 2 | sIgE-positive results | P , χ 2 | ||
|---|---|---|---|---|---|---|
| Elderly SAR n = 320 (%) | Young SAR n = 289(%) | Elderly SAR n = 331(%) | Young SAR n = 289(%) | |||
| Grass mix | 115 (36%) | 147 (51%) | P < .01 | 122 (37%) | 162 (56%) | P < .01 |
| Timothy | 102 (32%) | 142 (49%) | P < .01 | 109 (33%) | 147 (51%) | P < .01 |
| Rye | 154 (48%) | 153 (53%) | P = .81 | 169 (51%) | 143 (49%) | P = .71 |
| Oat | 70 (22%) | 78 (27%) | P = .41 | 66 (20%) | 87 (30%) | P = .21 |
| Wheat | 90 (28%) | 111 (38%) | P = .05 | 76 (23%) | 103 (36%) | P = .06 |
| Corn | 58 (18%) | 72 (25%) | P = .15 | 63(19%) | 74 (26%) | P = .16 |
| Tree mix | 115 (36%) | 119 (41%) | P = .49 | 129 (39%) | 121 (42%) | P = .47 |
| Birch | 74 (23%) | 89 (31%) | P = .04 | 83 (25%) | 85 (29%) | P = .21 |
| Alder | 26 (8%) | 29 (10%) | P = .13 | 20 (6%) | 28 (10%) | P = .25 |
| Hazel | 77 (24%) | 74 (26%) | P = .59 | 93 (28%) | 71 (25%) | P = .07 |
| Mugwort | 106 (33%) | 63 (22%) | P < .01 | 108 (33%) | 63 (22%) | P < .01 |
| Plantago | 19 (6%) | 13 (4%) | P = .48 | 26 (8%) | 10 (3%) | P = .43 |
| Nettle | 35 (11%) | 19 (7%) | P = .08 | 30 (9%) | 12 (4%) | P = .08 |
| Alternaria | 83 (26%) | 27 (9%) | P < .01 | 102 (31%) | 28 (10%) | P < .01 |
| Cladosporium | 26 (8%) | 13 (5%) | P = .16 | 23 (7%) | 11 (4%) | P = .21 |
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