Purpose of Review <p>Anaphylaxis in older adults remains insufficiently studied despite a rising burden in an aging population. This review examines how comorbidities, polypharmacy, and atypical clinical presentations influence risk, diagnosis, and management in this group, and identifies major gaps in current evidence.</p> Recent Findings <p>Registry data show age-related differences in elicitors, with insect venom and drugs predominating in adults ≥ 65 years. Older patients more frequently present without skin symptoms and exhibit cardiovascular-dominant reactions, contributing to diagnostic delay. Cardiovascular and respiratory disease, beta-blockers, ACE inhibitors, and immunosenescence increase severity and complicate treatment. Real-world data suggest that epinephrine remains underused, and while intranasal adrenaline spray has emerged as an alternative, safety data in older patients are lacking. Long-term management is challenged by frailty, functional limitations, and reduced ability to use autoinjectors.</p> Summary <p>Older adults experience more severe, atypical anaphylaxis driven by multimorbidity, medication effects, and age-related immune changes. Early recognition, prompt epinephrine use, and individualized prevention plans are essential. Targeted research is needed to refine diagnostic criteria, clarify medication-related risks, and guide age-adapted management strategies.</p>