Chronic Urticaria in Elderly—New Insights

Background: Many medical conditions have a unique profile in older adults. Chronic urticaria (CU) is a common disease, but data regarding elderly patients are limited. Objective: To describe the demographics, clinical characteristics, comorbidities, and outcome of elder patients with CU. Methods: This retrospective, single-center study included patients older than 65 years, diagnosed with CU in our clinic. Data for the entire cohort were retrieved from electronic medical records. Results: Of 1859 patients older than 65 years, 181 patients diagnosed with CU were included: 166 had chronic spontaneous urticaria (CSU) and 15 chronic inducible urticaria. Most patients with CSU were female (119, 72%). The mean age at diagnosis was 72 ± 5.9 years. Comorbidities included autoimmunity in 38 (22.9%), malignancy in 23 (13.8%), and atopy in 19 (11.5%). The time to referral to a specialist was 22.8 ± 53 months from the onset of symptoms. Specialist intervention improved patient outcomes. This was evident by reduced systemic steroid use (odds ratio [OR] = 0.145, [95% confidence interval (CI): 0.08-0.26], P < .001), all-cause hospitalization (OR = 0.09, [95% CI: 0.01-0.75], P = .01), emergency department visits (OR = 0.08, [95% CI: 0.08-0.35], P < .001), and primary physician visits (P < .001, Cramer's V = 0.528). Conclusions: Older people with CU have unique characteristics, including high prevalence of autoimmunity and malignancy and lower prevalence of atopy. Raising awareness of CU in elderly and prompt referral to an allergy specialist may improve outcomes.