Changes in atopy over 25 years: atopy now affects wider age range

In the past five years 956 patients (306 male and 650 female) aged 60 and older (median 76, range 60-93) were referred to our allergy clinic for suspected atopic conditions. All of them underwent skin prick testing with the most common inhalant allergens, and 318 (33%) were found positive with a wheal of at least 3 mm, men being more often positive than women: 40% (123/306) v 30% (195/650), P < 0.005. The median age of these subjects was 65 (range 60-86). The allergen profile of skin positivity was similar in men and women and was characterised by a clear prevalence of pollens (78% v 75% ) over dust mites (41% v 36%), animal danders (18% v 16%) and moulds (6% v 8% ). Rhinitis (hay fever) was the most common complaint (74%), whereas asthma was present in 33% (105/318). In 22% (70/318) of the subjects the clinical onset of atopy was at or after their 60th birthday. We conclude that atopy is spreading to old age. We need to be aware of this phenomenon so as not to underestimate the role of atopy in the respiratory conditions affecting elderly people. We will also need to draw specific guidelines for the management (allergen avoidance, pharmacological treatment, immunotherapy) of atopy in such patients, who often have important comorbidities.