DADE CE Program 1: Case 3

Program 1: Don't Start: Growing Evidence Against Anticholinergic Drug Use in the Elderly:
Case 3

JJ is a 71-year-old woman coming to your office today for her annual check up. Her overall health is very good. The only medications she takes on a regular basis are hydrochlorothiazide 25 mg daily for mild isolated systolic hypertension and calcium/vitamin D for osteoporosis prevention. After her examination is complete, she states that her only complaint is new onset postnasal drip and chronic mild cough. She notes that the symptoms are present all year round. She is planning to purchase an over-the-counter product on her way home and asks for your advice.

Before recommending an over the counter product for perennial allergic rhinitis for this patient, it is important to consider:

Nasally administered steroids are recommended as first line therapy for perennial allergy symptoms in the elderly.
If patient is not willing to use a nasal dosage form, systemic agents such as antihistamines may be considered. Non-sedating antihistamines, such as loratidine, are preferred in the elderly to minimize side effects.
Anticholinergic antihistamines, such as diphenhydramine, are considered to be potentially inappropriate for seniors, as they are more sedating and are more likely to cause cognitive side effects (e.g. confusion) in the elderly.
Nonpharmacologic measures to manage symptoms of allergic rhinitis include saline and sodium bicarbonate nasal irrigation and avoiding allergens.

References:

Kaliner MA. H1-antihistamines in the elderly. Clin Allergy Immunol 2002;17:465-81.

Plaut M, Valentine MD. Allergic rhinitis. New Engl J Med 2005;353:1934-44.

Reuben DB, Herr KA, Pacala JT, et al. Geriatrics at Your Fingertips: 2005, 7th edition. New York: The American Geriatrics Society; 2005.