Chronobiology and chronotherapy of allergic rhinitis and bronchial asthma☆
Introduction
This article reviews the 24-h variation in the symptoms of allergic rhinitis (AR) and bronchial asthma (BR) and underlying chronobiologic mechanisms. It also reviews the findings relating to administration-time (i.e., circadian rhythm-determined) differences in the kinetics and effects of the various medications used in their treatment (i.e., chronopharmacology). The two medical conditions share a common core pathophysiology, that is, inflammation of the upper airways in AR and of the lower airways in BA. Moreover, both exhibit a remarkably similar temporal pattern in the occurrence and/or exacerbation of their respective symptoms. A relatively large number of studies have been devoted to the chronobiology of AR and BA and to the chronopharmacology of the several classes of therapeutic agents used to treat them. Due to the limited page budget, it is impossible to present a truly exhaustive review of the entire literature. Many circadian rhythm studies have been conducted on first-generation medications that are no longer considered front-line therapies for these conditions. Nonetheless, we have chosen to present illustrative examples of these therapies to demonstrate how the timing, with reference to circadian rhythms in drug handling and disease pathophysiology, can affect the evaluation of prescribed medications as well as the control of AR and BA symptoms. Moreover, given the current strong market for generic therapies, in developed and in developing nations, information on the chronopharmacology and chronotherapy of early-generation AR and BA medications could prove useful, through the application of new drug-delivery systems, in enhancing their safety and efficacy.
Section snippets
Allergic rhinitis (AR): introduction and history
AR is highly prevalent, affecting approximately 25% of adults and 40% of children in USA. The most common symptoms of AR are sneezing, nasal rhinorrhea (“runny nose”), nasal pruritus (“itching”), and nasal congestion. The nasal congestion and obstruction during the nighttime can be so severe that it often disrupts sleep, resulting in daytime fatigue, poor work and school performance, irritability, and altered or depressed mood. Although AR is not a life-threatening condition, it can profoundly
Chronopharmacology and chronotherapy of H1-receptor antagonist medication
Chronopharmacology is the study of biological rhythm influences, in relation to drug administration-time, on the pharmacokinetics and dynamics of medications and other chemical substances. Chronotherapy is either the delivery of medications in synchrony with endogenous biological rhythms in the pathophysiology of disease states to optimize treatment outcomes or the timed delivery of medications according to biological rhythm determinants to minimize or avoid troublesome and/or dose-limiting
Bronchial asthma (BA)
The second part of this article addresses the chronobiology and chronotherapy of BA. BA is characterized by airway inflammation, which results in hyperresponsivness of the lower respiratory tact to various environmental stimuli. The main symptom of BA is difficult breathing due to reduced airway caliber, bronchospam, and excessive secretion of mucus. BA is a reversible airways disease, since the abnormally low airflow rates can be partially of fully restored by prescription bronchodilator and
Chronopharmacology and chronotherapy of BA medications
The goals of BA therapy are: (a) prevention of acute and chronic symptoms of asthma during the day and night; (b) maintenance of normal or near normal pulmonary function, life style, activity, and sleep; and (c) avoidance of medication-induced adverse effects. Specific algorithms have been published by medical societies and governmental agencies [e.g., 89] to guide patient management and to achieve therapeutic goals, and both national and international guidelines now exist for the grading of
Discussion
This article addressed the chronobiology and chronotherapy of AR and BA. We chose to consider these two medical conditions together in a single article since they share common circadian rhythm dependencies, pathophysiologic mechanisms, and comparable day–night patterns in symptom manifestation and intensity. The symptoms of AR and BA both worsen overnight resulting in disturbed sleep and/or intense symptoms in the morning upon waking. The chronotherapy of AR and BA generally takes into
References (266)
- et al.
Circadian and circannual rhythms of allergic rhinitis: an epidemiologic study involving chronobiologic methods
J. Allergy Clin. Immunol.
(1988) - et al.
The correlation between allergic rhinitis and sleep disturbance
J. Allergy Clin. Immunol.
(2004) - et al.
Changes in daytime sleepiness, quality of life, and objective sleep patterns in seasonal allergic rhinitis: a controlled clinical trial
J. Allergy Clin. Immunol.
(2004) - et al.
Pollen and mold exposure impairs work performance of employees with allergic rhinitis
Ann. Allergy, Asthma, & Immun.
(2001) Influences of allergic rhinitis on sleep
Otolaryngol. Head Neck Surg.
(2004)Minimal persistent inflammation, an emerging concept in the nature and treatment of allergic rhinitis: the possible role of leukotrienes
Ann. Allergy, Asthma, & Immun.
(2003)Pharmacologic approaches to daytime and nighttime symptoms of allergic rhinitis
J. Allergy Clin. Immunol.
(2004)- et al.
Nasal obstruction as a risk factor for sleep-disordered breathing
J. Allergy Clin. Immunol.
(1997) - et al.
High prevalence of allergic sensitization in children with habitual snoring and obstructive sleep apnea
Chest
(1997) - et al.
Circadian changes in the inhibitory effects of an antihistaminic drug in man
J. Invest. Dermatol.
(1966)
Circadian rhythms of human skin to histamine or allergen and the adrenal cycle
J. Allergy Clin. Immunol.
Circadian reactivity rhythms of human skin to house dust, penicillin and histamine
J. Allergy Clin. Immunol.
Desloratadine: a new, nonsedating, oral antihistamine
J. Allergy Clin. Immunol.
Epidemiology of nocturnal asthma
Am. J. Med.
Asthma at night
Clin. Chest Med.
Twenty-four hour pattern in symptom intensity of viral and allergic rhinitis: treatment implication
J. Allergy Clin. Immunol.
Twenty-four-hour rhythm in the bronchial hyperreactivity to house dust in asthmatics
J. Allergy Clin. Immunol.
Nocturnal asthma attacks: their relationship to the circadian adrenal cycle
J. Allergy
Altered pituitary–adrenal interaction in nocturnal asthma
J. Allergy Clin. Immunol.
Nocturnal asthma is associated with reduced glucocorticoid receptor binding affinity and decreased steroid responsiveness at night
J. Allergy Clin. Immunol.
Elevated serum metabolism is associated with the nocturnal worsening of asthma
J. Allergy Clin. Immunol.
Protection against allergen-induced asthma by salmeterol
Lancet
Formoterol attenuates neurophilic airway inflammation in asthma
Chest
Relative efficacy of maintenance therapy with theophylline, inhaled albuterol, and the combination for chronic asthma
J. Allergy Clin. Immunol.
Diurnal variation in the symptoms of hay fever: implications for pharmaceutical development
Curr. Med. Res. Opin.
Anamnestic data in allergic rhinitis
Allergy
Seasonal allergic rhinitis and antihistamine effects on children's learning
Ann. Allergy, Asthma, & Immun.
Effect of fexofenadine HCL on quality of life and work, classroom, and daily activity impairment in patients with seasonal allergic rhinitis
Ann. J. Managed Care
New insights into the pathophysiology of allergic rhinitis
Allergy Asthma Proc.
Mediators of inflammation in the early and late phase of allergic rhinitis
Curr. Opin. Allergy Clin. Immunol.
Recent advances in the pathogenesis of atopic dermatitis
Eur. J. Pediatr.
Pathogenesis and pharmacologic modulation of the cutaneous late-phase reaction
Ann. Allergy
Nocturnal asthma and changes in circulating epinephrine, histamine, and cortisol
N. Engl. J. Med.
Circadian variations in nasal reactivity in children with allergic rhinitis: correlation with the activity of eosinophils and basophilic cells
Int. Arch. Allergy Immunol.
Postural variations of nasal patency
Acta Otolaryngol.
Breathing disorders in sleep associated with “microarousals” in patients with allergic rhinitis
Acta Otolaryngol.
Chronopharmacologic study of antihistamines with special reference to terfenadine
Eur. J. Clin. Pharmacol.
Antihistamine and other effects of 5 mg mequitazine vary between morning and evening acute administration
Annu. Rev. Chronopharmacol.
Chronopharmacology of H1-antihistamines
Circadian rhythms in cutaneous sensitivity to histamine and selected antigens including phase relationship to urinary cortisol excretion
Ann. Allergy
Circadian and circamensual rhythmicity in cutaneous reactivity to histamine and allergenic extracts
A multicentric chronotherapeutic study of mequitazine in allergic rhinitis
Annu. Rev. Chronopharmacol.
Morning versus evening dosing of desloratadine in seasonal allergic rhinitis: a randomized controlled study
Clin. Mol. Allergy
De Morbis Acutis and Chronicis, J.C. Amman, recensuit, emaculavit, notulasque adjecit, Editio nova
The Extant Works of Aretaeus (Printed for the Syndenham Society)
Arzney-Buch
Exercitationes Medicinales Ad Omnes Thoracis Affectus, Decem Tractatibus Absoluta, Raymon Colomerius, Toulouse
A Treatise of the Asthma
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This review is part of the Advanced Drug Delivery Reviews issue on “Chronobiology, Drug Delivery, and Chronotherapeutics”.