Objective To evaluate and compare the clinical characteristics of middle-aged and elderly Kimura disease patients with young patients, so as to enhance better understanding of the disease. Methods The clinical data of the patients with pathologically confirmed Kimura disease in Peking Union Medical College Hospital from January 1980 to December 2020 were collected. The patients were divided into middle-aged and elderly group (≥45 years old) and young group (18-44 years old). The epidemiological characte-ristics, clinical manifestations, results of laboratory examinations, diagnosis, treatment and outcomes of these patients were analyzed retrospectively, and the differences between them were compared. SPSS statistics 22.0 was used for data analysis. According to the different data types, student′s t test, Mann-Whitney U test or Chi-square test was adopted for comparison between groups. Results A total of 52 patients with Kimura disease were included in this study, including 20 cases (38.46%) in the middle-aged and elderly group and 32 cases (61.54%) in the young group. The middle-aged and elderly group had significantly larger tumor size [5.0 (4.0,6.3) vs 3.0 (2.0,4.0) cm] and higher proportions of skin itching [70.0% (14/20) vs 40.6% (13/32)] and skin pigmentation [35.0% (7/20) vs 3.1% (1/32)] than the young group (all P<0.05). There were no statistical differences between the 2 groups in gender ratio, time from symptom onset to diagnosis, complications, multi-site involvement, salivary gland involvement, blood eosinophil count, and IgE level, biopsy sites, treatment options and prognosis. Conclusion The prevalence of Kimura disease is not rare in the middle-aged and elderly people. Their clinical characteristics does not differ from those of young patients. But larger tumor mass, skin itching and pigmentation are more common in the middle-aged and elderly patients.