Managing Chronic Urticaria and Recurrent Angioedema Differently with Advancing Age.

Angioedema and urticaria affect people of all ages. Accurate diagnosis and optimum management is essential for healthy ageing. Older people continue to experience mast cell-mediated urticaria and angioedema, with a higher prevalence of autoimmune and lower prevalence of autoallergic disease. Bradykinin-mediated angioedemas are more common in the elderly because of their association with ACE inhibitor treatment. Acquired C1-inhibitor deficiency, another bradykinin-mediated angioedema, occurs predominantly in older people, while hereditary angioedema due to C1 inhibitor deficiency continues to cause symptoms, even in old age. Drug-induced angioedemas disproportionately affect older people, the most frequent users of ACE inhibitors, aspirin and non-steroidal anti-inflammatory drugs. Accurate diagnosis and targeted treatment prevents unnecessary morbidity and mortality. Second generation antihistamines with omalizumab if required are effective and well tolerated in older people with mast cell-mediated urticaria. For bradykinin-mediated angioedemas, these drugs are ineffective. C1 inhibitor replacement or blockade of kallikrein or the bradykinin B2 receptor of the contact pathway is required to treat hereditary angioedema and may be considered in other bradykinin-mediated angioedemas, if supportive treatment is insufficient. For aspirin-related angioedema and urticaria, alternative medications or, exceptionally, desensitization may be required.