Older adults are at heightened risk for severe anaphylaxis but are less likely than younger adults to receive the recommended treatment of epinephrine, according to findings from two recent studies and reported by Medscape. These findings call attention to a critical gap in allergy care for the elderly, highlighting the need for increased awareness and improved clinical protocols.
A study published in JACI in Practice analyzed emergency department (ED) visits between 2008 and 2022 and found that adults aged 65 and older were more likely to experience anaphylaxis triggered by medications and intravenous (IV) contrast agents, as well as to develop serious cardiovascular symptoms such as low blood pressure, fainting, and cyanosis. Unlike younger adults, older patients were less apt to show classic signs like hives or throat tightness, making anaphylaxis harder to recognize and diagnose in this population.
The research, led by Dr. Ronna Campbell of the Mayo Clinic, reviewed 1,422 ED cases, 212 of which involved older adults. The findings revealed that older adults had a significantly higher likelihood of having anaphylaxis caused by medications (34% vs 21.3%) or IV contrast (13.2% vs 5.6%) compared to their younger counterparts. They also faced a greater risk of severe outcomes, including intubation and intensive care admission, and were more likely to arrive at the ED via emergency medical services (EMS).
Despite their increased vulnerability, older adults were less likely to receive epinephrine from EMS providers (26% vs 32.4%). The underuse of epinephrine may stem from difficulties in recognizing atypical symptoms in older patients or concerns about potential cardiovascular side effects. However, as Dr. Campbell stressed, complications from epinephrine are rare and its benefits overwhelmingly outweigh the risks, even in older adults.
A second study led by Dr. Moshe Ben-Shoshan and published in the International Archives of Allergy and Immunology echoed these results. Using Canadian data collected from five EDs and one EMS, researchers found that drugs and insect venom, rather than food, were the primary triggers of anaphylaxis among older adults. The study also confirmed that older patients were less likely to receive epinephrine during an anaphylactic episode, despite being at increased risk of ICU admission.
Symptoms in older adults differed from those in younger people, with less frequent gastrointestinal complaints and throat tightness, but a higher likelihood of drug and venom allergies. Notably, older adults were less likely to be discharged with a prescription for self-injectable epinephrine or referred to an allergy specialist, raising concerns about ongoing prevention.
Both studies emphasized the urgent need for better training of EMS providers and clinicians to recognize anaphylaxis in older adults and to administer epinephrine promptly. Early recognition and treatment are crucial for saving lives, especially in this medically vulnerable group.
