Age-related patterns of allergen sensitization and clinical phenotypes in adults with rhinitis

Abstract

Aim: Allergic rhinitis (AR) is a common chronic condition that frequently coexists with asthma or urticaria. Allergen sensitization patterns vary by geography, environmental exposure, and age; however, data on adult and elderly populations remain limited. Understanding age-related sensitization trends is essential for optimizing diagnosis, prevention, and allergen immunotherapy (AIT) strategies.

Materials and Methods: This retrospective study included 1,982 adults diagnosed with rhinitis, drawn from 7,000 patients who underwent skin-prick testing at a tertiary allergy clinic in Türkiye. Patients were categorized by age as young (18–39 years), middle-aged (40–64 years), or elderly (≥65 years), and further classified according to clinical presentation as rhinitis alone, rhinitis with asthma, rhinitis with urticaria, or rhinitis with both asthma and urticaria. Polysensitization was defined as sensitization to ≥2 allergens, and complex polysensitization as sensitization across distinct allergen groups.

Results: Overall, 58.5% (n=1160) of patients demonstrated sensitization, with rates declining with age (62.0%, 52.7%, and 29.5%, respectively; p< .001). Among sensitized patients, 53.4% showed monosensitization and 46.6% showed polysensitization, of whom 63.3% exhibited complex patterns. Young adults, who most frequently presented with rhinitis alone (86.0%), were mainly sensitized to grass (29.5%), weed pollen (24.7%), and cat dander (13.0%); these rates were all significantly higher than those in middle-aged and elderly adults (p<0.01). Middle-aged and elderly adults, in contrast, showed significantly higher rates of mite sensitization than younger adults (up to 66.7%; p< .001 for both age groups). In these age groups, rhinitis was more frequently accompanied by asthma (10.3%) or urticaria (14.6%) (p< .01).

Conclusion: Allergen sensitization among adults with rhinitis demonstrates a dynamic, age-dependent pattern. Sensitization to pollen and pets predominates in younger adults, whereas sensitization to mites persists and intensifies with advancing age and comorbidities. These findings highlight age as a key determinant, whose effects are shaped by both immunologic and behavioral and environmental factors, underscoring the need for personalized, age-adapted approaches in allergy management.