Special considerations in treatment of allergic rhinitis in the elderly: role of intranasal corticosteroids

Abstract

Once viewed as a "young person's disease," allergic rhinitis (AR) is becoming increasingly common in the elderly. Effective treatment is necessary not only to minimize the impact of AR in the older population, but to prevent the onset or exacerbation of asthma. This review was conducted to examine the clinical evidence regarding the efficacy and safety of therapies for AR in the elderly. MEDLINE searches of the literature were performed to identify key consensus statements, expert opinions, and clinical trials related to the management of AR in older individuals. The selection of treatment for elderly patients with AR must consider age-dependent physiologic factors (such as metabolic alterations, changes in the nasal mucosa, difficulty swallowing, and visual or motor problems) that may affect responses to therapy. Both first- and second-generation antihistamines are associated with a higher incidence of adverse events and drug:drug interactions in older than younger individuals, and oral decongestants pose risks in the presence of a variety of comorbidities known to be more common in the elderly. Leukotriene receptor antagonists are as effective as antihistamines, but are inferior to intranasal corticosteroids and have the potential for interactions with a wide range of drugs. Intranasal corticosteroids have the most favorable safety and efficacy profiles in older individuals with AR. The diagnosis and management of AR in the elderly require approaches tailored to specific age-related factors. Based on the available evidence, intranasal corticosteroids offer the best option for the treatment of older patients with AR.