Contact sensitization in the elderly
Introduction
Life expectancy in industrialized countries has increased consistently in recent decades. In the United States of America, the proportion of people aged 65 or older increased from 4% in 1900 to about 12% in 2000. In 1900, only about 3 million of the country's citizens had reached 65. By 2000, the number of senior citizens had increased to about 35 million. It is estimated that more than 50 million Americans—about 17 % of the population—will be 65 or older in 2020.1 The number of elderly people is growing around the world, so that provision and standards of health care are increasing too.
Section snippets
Pathogenesis of allergic contact dermatitis
Allergic contact dermatitis (ACD), one of the most common skin diseases with a great socioeconomic impact, is a T-cell–mediated inflammatory reaction (delayed-type hypersensitivity reaction) occurring at the site of challenge with a contact allergen (hapten) in sensitized individuals.2 As in all delayed-type hypersensitivity reactions, the pathophysiology of ACD consists classically of two distinct phases: the sensitization and the elicitation phases, which are considered to be temporally and
Immunosenescence
The immune system of older people is usually perceived as declining in fidelity and efficiency with age, resulting in an increased susceptibility to infectious diseases and pathologic conditions relating to inflammation or autoreactivity.14 Immunosenescence is a term used to represent changes to the immune system associated with aging.15
Immunity is classically conceptualized as two distinct but interacting systems: innate and adaptive. Innate immunity may be thought of as the basal or first
Prevalence of contact sensitization in the elderly
Contact dermatitis from irritant and allergic sources is the reason for 6% to 10% of all dermatologic visits, with considerable morbidity and economic impact. This is aggravated by the fact that contact sensitization is not curable and necessitates lifelong avoidance of the allergens for secondary prevention.30, 31
Aging is correlated with the rate and type of contact sensitization, but only a few studies have evaluated patch test reactivity in elderly individuals with an adequately large
Allergens
Establishing the most frequent allergens responsible of ACD in the elderly is a hard task. Here we report the prevalence of previously published studies on contact dermatitis in the elderly, focusing on the commonest allergens. The age and sex distribution of positive patch test reactions in 234 children, 1200 adults, and 295 elderly patients was investigated. Nickel sulfate and balsam of Peru were the most represented haptens, with 11.2% and 6.7% of positive reactions in old men, whereas they
Contact sensitization in elderly patients with leg ulcers
Leg ulcers represent a chronic condition affecting more than 1.7% of the population aged older than 65 years.47 Many topical medications are used for leg ulcers, so some have proposed that patients with chronic leg ulcers should be tested because they have a very high risk of contact allergy. Their sensitization rate increases with the duration of the chronic leg ulcers. In 1185 cases published from 1991 to 2003, 72% had a positive patch test. This meta-analysis was undertaken on studies from
Features of contact sensitization in the elderly
This section summarizes the main findings from published epidemiologic studies on contact allergy in old populations. Contact allergy is caused by skin contact with low-molecular-weight haptens and may evolve to allergic contact dermatitis if exposure exceeds the individual's threshold. It can be a distressing skin problem for those who have it and may cause sick leave as well as an increase in national health expenses. The diagnosis of contact allergy is mainly determined by the outcome of
Conclusions
Apart from the controlled and retrospective studies of a large population reviewed here, several reports about ACD in older patients have highlighted that contact sensitization is also a burden problem in the elderly. Allergens surveillance is needed to realize an “elderly series” for having a useful adjunct to contact allergy, which may help in tailoring the treatment for each patient.
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Cited by (30)
Diagnosis and Management of Common Inflammatory Skin Diseases in Older Adults
2024, Clinics in Geriatric MedicineContact dermatitis: An important consideration in leg ulcers
2021, International Journal of Women's DermatologyCitation Excerpt :The diagnosis is confirmed with patch testing to a 0.5% concentration of chlorhexidine in water (Lachapelle, 2014). Contact urticaria and anaphylactic reactions have been reported with chlorhexidine (Balato et al., 2011). Polyhexamethylene biguanide is a derivative of chlorhexidine that has been used in dressings and can be a potential allergen.
Allergic contact dermatitis: Kids are not just little people
2015, Clinics in DermatologyCitation Excerpt :ACD affecting the legs in adults is commonly seen as a complication of stasis dermatitis, especially when a leg ulcer is present. Leg ulcer patients have been found to be sensitized to a variety of allergens including lanolin, balsam of Peru and fragrance mix, rubber allergens, topical antibiotics, and preservatives including FRPs.44 In children, ACD affecting the legs is most likely a reaction to a garment, athletic guard, or brace worn for sports related activities/injuries or prosthetic devices.
Allergy in the elderly: Retrospective cohort study of 533 patients having visited the allergy hospital unit
2015, Revue Francaise d'AllergologieAtopic dermatitis results in intrinsic barrier and immune abnormalities: Implications for contact dermatitis
2013, Journal of Allergy and Clinical Immunology