Allergic Disease in Elderly Person
Allergic Disease in Elderly Person
People 65 years old or more are the fastest growing segment of the population in the developed countries. The prevalence of allergic diseases, in the elderly is estimated around 5-10%. Although allergic conditions are often thought of as childhood disorders, the disease often persists into older age and can occasionally make its initial appearance in the elderly. A number of factors in older subjects contribute to their risk for developing allergic related conditions. These include frailty, coexisting medical problems, memory issues and use of multiple prescribed and non-prescribed medications. age-related declines in serum total immunoglobulin E (IgE) and allergen sensitization in the elderly.
Causes of Allergic Disease in Elderly Person
- Allergic diseases are mostly caused by inhalant allergens, in particular mold and pollens and climate changes modify their deployment and amount
- The onset of allergic diseases in older people is driven by immunosenescence, the changes of immune function observed with aging and tissue structure modifications typical of advanced age.
Clinical features of allergic diseases in the elderly
Most common allergies dealt with the elderly people include,
Allergic rhinitis
- Patients typically present with sneezing, pruritus and nasal congestion
- Reduction of blood flow to the nose can lead to progressive nasal atrophy and clinical manifestations of atrophic rhinitis, and thinning and dryness of the mucosa make the elderly especially prone to rhinitis
Anaphylaxis is rare, but it’s the most severe form of allergic response. Symptoms of anaphylaxis include:
Asthma
- Frequently in old people asthma remains underdiagnosed and the percentage increases when respiratory symptoms are present
- The severity of asthma strongly correlates with increased reactive oxygen species (ROS) levels which contribute to the airway inflammation. Thus, asthmatic symptoms related to oxidative stress in aged patients may be significantly affected by age-associated ROS. Additionally, oxidative stress and the resulting cellular modifications are prevalent in asthmatic patients during aging
Cutaneous allergic conditions
- Clinically, aged skin is characterized by atrophy, wrinkling, fragility, alterations in pigmentation, a higher frequency of benign and malignant tumors, and a greater tendency to xerosis. Altogether, these factors contribute to greater susceptibility to dermatologic diseases and pruritus, the most common skin complaint in patients over the age of 65 years, frequently associated with dry skin
- Atopic dermatitis is much less common in the elderly compared with children and young adults. It is associated with seasonal mucosal allergies, asthma and positive prick tests to various allergens.
- Urticaria (with or without angioedema), especially chronic spontaneous urticaria, is quite common in elderly patients. Systemic diseases that may induce urticaria should be ruled out
Food allergy
- Regarding clinical manifestations, anaphylaxis is less common in older patients
Drug allergy
- Adverse drug reactions (ADR) are very common in frail elderly, cause clinically significant morbidity and mortality, the use of large numbers of medications by older patients increases the likelihood of harmful drug interactions, adverse drug reactions and drug allergies
Ayurvedic View on Allergic disease in Elderly
Preventive Aspects:
For this Ayurveda strongly advices that the rules related to the deeds and sequence of daily routine (Dincharya), diet and behavior related rules for different seasons of the year (Ritucharya) and behavioral etiquettes for being wise, active and peaceful person (Sadvritta) should be followed. Behavioral Rasayana called as AachaarRasayana is described in detail in Charaka Samhita. It mainly comprises of the etiquettes and rules of healthy lifestyle, food habits to be consciously practiced and measures for willful individual spiritual upliftment. The person who follows this code of conduct mentioned as AchaarRasayana can easily maintain his immune health also.
Therapeutic Aspect:
All the disorders in elderly, children and pregnant women are difficult to treat according to Ayurveda. Especially diseases in elderly can only be managed; they can rarely be cured completely. As every disease in elderly has to be treated with holistic approach, Ayurveda can prove a very rich resource of safe drugs with multidimensional effects for various chronic, debilitating disorders.
Concept of Rasayana:
Ayurveda has tried to explain what exactly happens when the same person crosses two stages of life or age that is Childhood and Youth (Balya and Youvan) and enters the last, the third one – the Old age (Vriddha). The same food digested by the same body produces same nourishing juices absorbed in the same way, gradually slows down its function of building up of tissues. Rasayana in Ayurveda plays a role in delaying the anti- ageing process and also helps in enhancing immune power of the body
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Internal Medicines used in Ayurveda for enhancing Immunity and used in Allergic disorders in Elderly Person
- Haridrakhanda
- Taleesadichurna
- Dashamoolakatutrayadi Kashaya
- Bharangyadikwatha
- Indukanthamkashayam
- Guluchyadikashaya
- Drakshadi Kashaya
- Drakshavaleha
- Aravindasava
- Mahasudarshanghanvati
- Hingvadivati
- Amritarishtam
- Vasakasava
- Aswagandharishtam
- Balarishtam
- Indukantamghritam
- Dadimadighritham
- Guduchisatva
Rasayana include,
- ChyavanprashRasayana
- ChitrakaHaritakiRasayana
- Agastya HaritakiRasayana
- VyaghriHaritakiRasayana
- AshwagandhaAvaleha
- Brahma Rasayana
- Daily use of Milk with Ghee (cup of milk with a teaspoon of ghee)
- ShilajeetRasayana
- KhadiradiRasayana
- Shatavari Siddha Ghrita
Single herbs used inAllergic Diseases in Elderly Person
- Pippali (Piper longum)
- Pippalimoola (Piper longum)
- Chavya (Piper chaba)
- Chitraka (Plumbagozeylanica)
- Sunthi (Zingiberofficinale)
- Amlavetasa (Garcinia pedunculata)
- Maricha (Piper nigrum)
- Haridra (Curcuma longa)
- Kutaja (HolarrhenaAntidysenterica)
- Bilwa (Aegle marmelos)
- Musta (Cyperusrotundus)
Pathya in Allergic Diseases in Elderly Person
- Eat freshly prepared warm food when hungry.
- Liquids – Instead of Tea, either of the following are advised.
- Herbal tea prepared from ½ inch ginger + 2 Black pepper + ¼ cinnamon or lemon grass, tulsi leaves in 2 cups boiled water reduce it to 1 Cup & add honey 1 teaspoon
- 1 cup hot cow’s milk + dry Ginger powder/Haridra ½ teaspoon
- Cereals – Shalishashtika (Old Rice) / Laja/ Godhuma (Wheat) / Yava (Barley)
- Fruits – Draksha (Vitisvinifera L.), Kapittha (Feronia limonia (Linn.)), Dadima (Punicagranatum Linn) can be taken.
- Condiments and spices: Cardamom/dry ginger/ black pepper/ long pepper/ garlic
Yoga in Allergic Diseases in Elderly Person
The following Yoga-Asanas can be practiced for 15 to 20 minutes to improves flexibility of the body and relieve mental stress
- Sukshmavyayama (warm up) loosening exercises for all joints
- Sitting postures like padmasana, Sukhasana, Vajrasana, Paschimottanasana
- Yogasana in supine position: Pawanmuktasana, Halasana, Matsyasana
- Yogasana in Prone position: Bhujangasana, Shalabhasana
- Relaxing postures: Shavasana, Makarasana
- Pranayama: Deep Breathing, Nadishodhana pranayama, Bhramari Pranayama 10 repetitions each
References
- Sharma PC, Yelne MB, Dennis TJ. Database on Medicinal Plants used in Ayurveda. Vol. 5. New Delhi: Central Council for Research in Ayurveda & Siddha, Government of India; 2004.
- Astang Samgraha with the commentary of Indu, Published by Central Council for research in Ayurveda and Siddha (CCRAS), New Delhi.
- Agnivesha. Charak Samhita commentary by Chakrapani. Varanasi. Chaukhambha Sanskrit Sansthan; Ch. Chikitsa 8/49-50.
Article Written By: Dr. Sahil Gupta (B.A.M.S., M.H.A.)
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