Roles of histamine in regulation of arousal and cognition: functional neuroimaging of histamine H1 receptors in human brain

Quality of life of elementary school students with sleep-disordered breathing and allergic rhinitis: A population-based study in Thailand

BACKGROUND

Sleep-disordered breathing (SDB) and allergic rhinitis (AR) are common problems that can lead to worsening quality of life (QOL) in children with these conditions. There is scarce evidence on the QOL of children with SDB outside of the hospital setting with inconsistent evidence on the association of AR and QOL concerning the SDB in children. Thus, the primary objective of this study is to determine the QOL concerning the SDB of elementary school students by using OSA-18. We also aim to provide the relationship of allergic rhinitis to the QOL.

METHODS

A cross-sectional study was conducted on all elementary school students, aged 6-12 years, from 10 elementary schools. The QOL of all participants was evaluated by the Thai version of the caregiver-administered OSA-18 questionnaire. The simple and multiple linear regression models were used to determine the effect of allergic rhinitis on the OSA-18 total scores.

RESULTS

A total of 3,053 children were included in the final analysis, 50.1% male. At least a moderate impact on QOL from SDB was observed in 9.4% of the population. Children with AR had significantly higher mean total OSA- 18 scores than the children without AR (47.5 ± 15.0 VS 38.5 ± 13.1, p < 0.001). After the adjustment for age, gender, body mass index, household income, and history of asthma, the point estimate of the adjusted beta regression coefficient on the OSA-18 total score in children with AR was 7.82 (95% CI: 6.00-9.65, p < 0.001). Significant associations were observed between AR and all domains except for emotional distress.

CONCLUSIONS

A substantial number of elementary school children had at least a moderate impact on the QOL from SDB, especially those with AR. Thus, effective screening of SDB in children with AR should be done to improve the QOL of these children.

Effect of Anti-Allergic Therapy on Sleep Quality of Children with Allergic Conjunctivitis and Their Parents

PURPOSE

To assess the effect of anti-allergic therapy on sleep quality of children with allergic conjunctivitis (AC) and their parents.

METHODS

This prospective single-arm intervention study included 54 AC child-parent dyads. Chinese versions of the Children's Sleep Habits Questionnaire (CSHQ) and Pittsburgh Sleep Quality Index (PSQI) were used to assess the sleep quality of children and their parents, respectively.

RESULTS

CSHQ and PSQI total scores were significantly decreased after treatment, with fewer children and parents reporting poor sleep quality. Part impaired sleep behaviors of children and parents can recover to the normal levels. Sleep quality improved greater in children with a severe type of AC, those with worse baseline signs, and without other allergic diseases. For both children and parents, greater improvements in sleep quality were associated with longer treatment duration and with worse baseline sleep quality.

CONCLUSION

Successful management of AC improves sleep quality for both children and their parents.

Histamine and receptors in neuroinflammation: Their roles on neurodegenerative diseases

Histamine, an auto-reactive substance and mediator of inflammation, is synthesized from histidine through the action of histidine decarboxylase (HDC). It primarily acts on histamine receptors in the central nervous system (CNS). Increasing evidence suggests that histamine and its receptors play a crucial role in neuroinflammation, thereby modulating the pathology of neurodegenerative diseases. Recent studies have demonstrated that histamine regulates the phenotypic switching of microglia and astrocytes, inhibits the production of pro-inflammatory cytokines, and alleviates inflammatory responses. In the CNS, our research group has also found that histamine and its receptors are involved in regulating inflammatory responses and play a central role in ameliorating chronic neuroinflammation in neurodegenerative diseases. In this review, we will discuss the role of histamine and its receptors in neuroinflammation associated with neurodegenerative diseases, potentially providing a novel therapeutic target for the treatment of chronic neuroinflammation-related neurodegenerative diseases in clinical settings.

Targeting Histamine and Histamine Receptors for Memory Regulation: An Emotional Perspective

Histamine has long been accepted as a pro-cognitive agent. However, lines of evidence have suggested that the roles of histamine in learning and memory processes are much more complex than previously thought. When explained by the spatial perspectives, there are many contradictory results. However, using emotional memory perspectives, we suspect that the histaminergic system may interplay with stress, reward inhibition, and attention to modulate emotional memory formation. The functional diversity of histamine makes it a viable target for clinical management of neuropsychiatric disorders. Here, we update the current knowledge about the functions of histamine in emotional memory and summarize the underlying molecular and neural circuit mechanisms. Finally, we review the main clinical studies about the impacts of histamine-related compounds on memory and discuss insights into future research on the roles of histamine in emotional memory. Despite the recent progress in histamine research, the histaminergic emotional memory circuits are poorly understood, and it is also worth verifying the functions of histamine receptors in a more spatiotemporally specific manner.

Effect of Noise and Music on Neurotransmitters in the Amygdala: The Role Auditory Stimuli Play in Emotion Regulation

Stress caused by noise is becoming widespread globally. Noise may lead to deafness, endocrine disorders, neurological diseases, and a decline in mental health. The mechanism behind noise-induced neurodevelopmental abnormalities is unclear, but apoptosis and pro-inflammatory signals may play an important role. In this study, weaned piglets were used as a model to explore noise-induced neurodevelopmental abnormalities. We hypothesized that long-term noise exposure would induce anxiety and cause acute stress, exhibited by alterations in neurotransmission in the amygdala. A total of 72 hybrid piglets (Large White × Duroc × Min Pig) were randomly divided into three groups, including noise (exposed to mechanical noise, 80-85 dB), control (blank, exposed to natural background sound, <40 dB), and music (positive control, exposed to Mozart K.448, 60-70 dB) groups. The piglets were exposed to 6 h of auditory noise daily (10:00-16:00) for 28 days. Compared with the control group, piglets exposed to noise showed more aggressive behavior. The expression of Caspase3, Caspase9, Bax, NF-κB (p56), TLR4, MYD88, I κ B α, IL-1 β, TNF-α, and IL-12RB2 was significantly upregulated in the amygdala, while the expression of Nrf2, HO-1, CAT, and SOD was downregulated in piglets in the noise group. Cell death occurred, and numerous inflammatory cells accumulated in the amygdala of piglets in the noise group. Targeted metabolomics showed that the content of inhibitory neurotransmitter GABA was higher in the amygdala of piglets in the noise group. Compared with the noise group, piglets in the music group displayed more positive emotion-related behaviors. Compared with the noise group, the expression of genes related to apoptosis, inflammation, and oxidative damage was lower in the music group. Cells of the amygdala in the music group were also of normal morphology. Our results show that noise-induced stress causes apoptosis and neuroinflammation in the amygdala and induces anxiety during the early neonatal neural development of piglets. In contrast, to some extent, music alleviates noise-induced anxiety.

Beyond monoamines: I. Novel targets and radiotracers for Positron emission tomography imaging in psychiatric disorders

With the emergence of positron emission tomography (PET) in the late 1970s, psychiatry had access to a tool capable of non-invasive assessment of human brain function. Early applications in psychiatry focused on identifying characteristic brain blood flow and metabolic derangements using radiotracers such as [¹⁵ O]H₂ O and [¹⁸ F]FDG. Despite the success of these techniques, it became apparent that more specific probes were needed to understand the neurochemical bases of psychiatric disorders. The first neurochemical PET imaging probes targeted sites of action of neuroleptic (dopamine D₂ receptors) and psychoactive (serotonin receptors) drugs. Based on the centrality of monoamine dysfunction in psychiatric disorders and the measured success of monoamine-enhancing drugs in treating them, the next 30 years witnessed the development of an armamentarium of PET radiopharmaceuticals and imaging methodologies for studying monoamines. Continued development of monoamine-enhancing drugs over this time however was less successful, realizing only modest gains in efficacy and tolerability. As patent protection for many widely prescribed and profitable psychiatric drugs lapsed, drug development pipelines shifted away from monoamines in search of novel targets with the promises of improved efficacy, or abandoned altogether. Over this period, PET radiopharmaceutical development activities closely paralleled drug development priorities resulting in the development of new PET imaging agents for non-monoamine targets. Part one of this review will briefly survey novel PET imaging targets with relevance to the field of psychiatry, which include the metabotropic glutamate receptor type 5 (mGluR5), purinergic P₂ X₇ receptor, type 1 cannabinoid receptor (CB₁ ), phosphodiesterase 10A (PDE10A), and describe radiotracers developed for these and other targets that have matured to human subject investigations. Current limitations of the targets and techniques will also be discussed.

Integration of the Cortical Haemodynamic Response Measured by Functional Near-Infrared Spectroscopy and Amino Acid Analysis to Aid in the Diagnosis of Major Depressive Disorder

Background: Major depressive disorder (MDD) is a debilitating condition with a high disease burden and medical comorbidities. There are currently few to no validated biomarkers to guide the diagnosis and treatment of MDD. In the present study, we evaluated the differences between MDD patients and healthy controls (HCs) in terms of cortical haemodynamic responses during a verbal fluency test (VFT) using functional near-infrared spectroscopy (fNIRS) and serum amino acid profiles, and ascertained if these parameters were correlated with clinical characteristics. Methods: Twenty-five (25) patients with MDD and 25 age-, gender-, and ethnicity-matched HCs were recruited for the study. Real-time monitoring of the haemodynamic response during completion of a VFT was quantified using a 52-channel NIRS system. Serum samples were analysed and quantified by liquid chromatography-mass spectrometry for amino acid profiling. Receiver-operating characteristic (ROC) curves were used to classify potential candidate biomarkers. Results: The MDD patients had lower prefrontal and temporal activation during completion of the VFT than HCs. The MDD patients had lower mean concentrations of oxy-Hb in the left orbitofrontal cortex (OFC), and lower serum histidine levels. When the oxy-haemoglobin response was combined with the histidine concentration, the sensitivity and specificity of results improved significantly from 66.7% to 73.3% and from 65.0% to 90.0% respectively, as compared to results based only on the NIRS response. Conclusions: These findings demonstrate the use of combination biomarkers to aid in the diagnosis of MDD. This technique could be a useful approach to detect MDD with greater precision, but additional studies are required to validate the methodology.

Chemical Probes for Histamine Receptor Subtypes

Ligands with different properties and different selectivity are highly needed for in vitro and in vivo studies on the (patho)physiological influence of the chemical mediator histamine and its receptor subtypes. A selection of well-described ligands for the different receptor subtypes and different studies is shown with a particular focus on affinity and selectivity. In addition, compounds with radioactive or fluorescence elements will be presented with their beneficial use for other species or different investigations.

Unintentional cetirizine overdose causing anticholinergic syndrome: A case report

The incidence of anticholinergic syndrome due to second generation antihistamines is infrequently reported. Largely due to their decreased affinity for central nervous system (CNS) receptors, second generation antihistamines are rarely associated with anticholinergic symptoms, though toxicity is still possible particularly when taken in excess. We report a case of a six year old boy who presented with agitation, hallucinations, fixed and dilated pupils, tachycardia, and hyperthermia consistent with anticholinergic toxicity several hours after accidental overdose of a second generation antihistamine, cetirizine. Early identification of this rare phenomenon is important not only for appropriate emergency management but also for avoidance of potentially invasive and unnecessary tests which may further increase patient morbidity.

The Association Between Obstructive Sleep Apnea and Allergic Rhinitis: Current Literature Review

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Sleep-disordered breathing (SDB) is now a significant health problem in today's culture. It ranges from a spectrum of abnormal conditions during sleep from the primary snorer to mild, moderate, or severe obstructive sleep apnea (OSA). SDB also comprises other conditions, such as sleep-related hypoventilation, sleep-related hypoxemia, and central sleep apnea syndromes.

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One of the components of the pathophysiology of OSA that remain unclear is the association of allergic rhinitis (AR) in the evolution of OSA. Several studies relate the co-existence of OSA and AR in the common clinical practice, but its correlation was not clear. This review article aimed to review the pathophysiological relationship between OSA and AR in terms of the role of chemical mediators and the effect of AR treatment in support of OSA.

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The symptoms of AR further accelerate the clinical progression to OSA development. Inflammatory mediators such as histamine, cysteinyl leukotrienes, and interleukins are found at a high level in AR, which can aggravate AR symptoms such as nasal obstruction, rhinorrhea, and itchiness, which can then lead to sleep disruption in OSA patients. In addition, OSA patients also have increased chemical mediators such as tumor necrosis factor, interleukin 6, and 1, which would activate the T helper 2 phenotypes that can aggravate AR symptoms. This vicious cycle can potentiate each other and worsen the condition. Few studies have shown that treatment of AR can improve OSA, especially the use of intranasal steroid and leukotriene receptor antagonists.

:

A detailed evaluation of rhinitis symptoms should be made for OSA patients so that they can benefit not only from the improvement of AR but also the good sleep quality.

Association between allergic rhinitis-related factors and sleep duration in adolescents: Korea National Health and Nutrition Examination Survey V (2010-2012)

OBJECTIVES

Previous studies have shown that sleep and allergic rhinitis (AR) is closely associated, bidirectionally affecting each other. Adolescence is a period that adequate sleep is essential, and the burden of AR increases, both of which greatly affect the quality of life. The aim of the present study was to investigate the correlation between inappropriate sleep duration and each AR-related subjective/objective factor in Korean adolescents.

METHODS

We analyzed the data of 1936 adolescents aged between 12 and 18 years who participated in the Korea National Health and Nutrition Examination Survey from 2010 to 2012. Data on sleep duration, physician-diagnosed AR, and presence of rhinitis symptoms were collected using a self-administered questionnaire. Nasal endoscopic findings, including watery rhinorrhea and pale inferior turbinate mucosa, and aeroallergen sensitization based on serum specific immunoglobulin E levels were examined.

RESULTS

There was a higher prevalence of AR (23.68%) in the inappropriate sleep duration group than in the control group (16.56%; odds ratio = 1.56, p = 0.0024). The presence of endoscopic findings of AR showed a positive association with inappropriate sleep duration in males (odds ratio = 1.52, p = 0.008). In addition, in all three indoor allergens investigated, aeroallergen sensitization was not associated with inappropriate sleep duration.

CONCLUSION

Inappropriate sleep duration was associated with increased prevalence of AR in Korean adolescents. Especially, this association was relevant in nasal endoscopic findings in male.

More sneezing, less crime? Health shocks and the market for offenses

A large literature points out that exposure to criminal victimization has far-reaching effects on public health. What remains surprisingly unexplored is that role that health shocks play in explaining aggregate fluctuations in offending. This research finds novel evidence that crime is sensitive to health shocks. We consider the responsiveness of crime to a pervasive and common health shock which we argue shifts costs and benefits for offenders and victims: seasonal allergies. Leveraging daily variation in city-specific pollen counts, we present evidence that violent crime declines in U.S. cities on days in which the local pollen count is unusually high and that these effects are driven by residential violence. While past literature suggests that property crimes have more instrumental motives, require planning, and hence are particularly sensitive to permanent changes in the cost and benefits of crime, we find that violence may be especially sensitive to health shocks.

Allergic Rhinitis and OSA in Children Residing at a High Altitude

BACKGROUND

OSA affects 2% to 4 % of the pediatric population; allergic rhinitis (AR) has been identified as a risk factor in sleep-disordered breathing, but no studies evaluating such an association have been conducted in high-altitude environments. The goal of this study was to assess whether the severity of AR is associated with the severity of OSA in children undergoing polysomnography (PSG) in the high-altitude city of Bogotá, Colombia.

METHODS

A cross-sectional observational study of children with AR was conducted. Severity of AR was evaluated by using the AR health-related quality of life questionnaire for children (ESPRINT-15) and the Allergic Rhinitis and its Impact on Asthma (ARIA) classification. Diagnosis and severity of OSA were established by using PSG. Potential associations between AR severity and OSA severity were assessed by using binary logistic regression and the Spearman correlation coefficient (ρ).

RESULTS

A total of 99 children (mean age, 7.9 years; 45% female) were included; 53% had OSA. An ESPRINT-15 score was associated with severe OSA (OR, 2.0; 95% CI, 1.12-6.04; P = .01). Patients with moderate/severe persistent rhinitis according to ARIA exhibited a 10.1-fold greater risk of severe OSA (OR, 10.15; 95% CI, 1.15-89.0). Furthermore, the apnea-hypopnea index was associated with the ESPRINT-15 score (ρ = 0.215; P = .03) and with the ARIA severity scale (P = .04; ρ = 0.203).

CONCLUSIONS

In symptomatic children with AR residing at a high altitude, increasing AR severity is associated with more severe OSA.

Histamine and Delirium: Current Opinion

Delirium is a very common, but refractory clinical state, notably present in intensive care and in the growing aging community. It is characterized by fluctuating disturbances in a number of key behavioral features, namely cognition, mood, attention, arousal, and self-awareness. Histamine is arguably the most pleotropic neurotransmitter in the human brain, and this review provides a rationale, and proposes that this neuroactive amine plays a role in modulating the characteristic features of delirium. While centrally permeable H1 and H2 histamine receptor antagonists have pro-delirium potential, we propose that centrally permeable H3 histamine receptor antagonists may provide an exciting new strategy to combat delirium. The Histamine H4 receptor may also have an indirect inflammatory neuroglial role which requires further exploration.

Establishing a Patent Nasal Passage in Obstructive Sleep Apnea

The role of the nose in the pathophysiology and treatment of sleep-disordered breathing (SDB) has not been fully understood and might have been underestimated. In the Staring resistor model, the nose is regarded as a passive and noncollapsible tube, but recent studies have shown that the nose might participate more in the pathophysiology of SDB as anatomic, neuromuscular, and respiratory factors than previously reported, which might imply the nose is an active noncollapsible tube. The roles of nasal treatments for OSA are not only the reduction of AHI, but also the improvement of subjective symptoms, sleep quality, and CPAP adherence.

Association between allergic and nonallergic rhinitis and obstructive sleep apnea

PURPOSE OF REVIEW

Allergic rhinitis and nonallergic rhinitis (NAR) are common disorders, which have been considered as potential risk factors for obstructive sleep apnea (OSA). This review summarizes the proposed underlying pathophysiological mechanisms to provide a better understanding of the relationship between these conditions.

RECENT FINDINGS

In adults, allergic rhinitis and NAR may be considered as symptoms potentiating, rather than risk potentiating factors in the pathophysiology of OSA, whereas in children, these are considered to be independent predictors for sleep-disordered breathing (SDB) and failure of adeno-tonsillectomy, the recommended first-line therapy for children with OSA. Current advances suggest IL-6 may be important in regulating the sleep-wake cycle, and serum soluble IL-6 receptor (sIL-6R) levels may reflect the severity of OSA. Elevated Th17/Treg ratio correlates positively with apnea-hypopnea index of OSA patients, and Th17 and Treg imbalances caused by allergic rhinitis and OSA, respectively, may possibly promote each other, leading to further imbalance. Moreover, obesity is a strong risk factor for OSA, and leptin plays an important role in ventilatory function and upper airway obstruction. The variant trigeminocardiac reflex and nasotrigeminal reflex may also be involved in the association between rhinitis and OSA.

SUMMARY

Allergic rhinitis/NAR and OSA are closely associated, and each condition can be detrimental to the other. Thus, clinicians should pay attention to the potential presence of allergic rhinitis/NAR in OSA patients and vice versa.

Association between allergic rhinitis and poor sleep parameters in U.S. adults

BACKGROUND

Evidence suggests relationships between allergic rhinitis (AR) and poor sleep parameters, but population-based studies in the United States are lacking. This study investigates the relationship between AR and sleep parameters in a representative sample of U.S. adults.

METHODS

Cross-sectional study of 5563 participants ≥18 years old from the 2005-2006 National Health and Nutrition Examination Survey who participated in the allergy and sleep questionnaires. The predictor variable was AR (self-reported hay fever and/or nasal symptoms in the past 12 months). The outcome variables were individual sleep parameters (sleep latency, sleep duration, sleep disorders, sleep habits, sleep medication use, daytime dysfunction). Covariates included age, gender, race, and obesity.

RESULTS

The population-weighted prevalence of AR was 36.5%. Adjusting for covariates, subjects with AR had higher odds of sleep latency ≥30 minutes (OR 1.24; 95% CI, 1.01 to 1.51; p = 0.04), sleep apnea (OR 1.86; 95% CI, 1.22 to 2.82; p < 0.01), insomnia (OR 1.85; 95% CI, 1.04 to 3.32; p = 0.04), trouble falling asleep (OR 1.43; 95% CI, 1.17 to 1.75; p < 0.01), waking up during the night (OR 1.49; 95% CI, 1.11 to 1.99; p = 0.01), waking up too early in the morning (OR 1.46; 95% CI, 1.20 to 1.79; p < 0.01), feeling unrested during the day (OR 1.76, 95% CI, 1.43 to 2.16; p < 0.01), feeling overly sleeping during the day (OR 1.54; 95% CI, 1.25 to 1.90; p < 0.01), not getting enough sleep (OR 1.68; 95% CI, 1.41 to 1.99; p < 0.01), using sleep medication (OR 1.69; 95% CI, 1.23 to 2.33; p < 0.01), difficulty concentrating (OR 1.93; 95% CI, 1.30 to 2.88; p < 0.01), remembering (OR 1.91; 95% CI, 1.22 to 2.97; p < 0.01), managing finances (OR 1.68; 95% CI, 1.09 to 2.56; p = 0.02), working (OR 2.16; 95% CI, 1.45 to 3.22; p < 0.01), and getting things done (OR 2.35; 95% CI, 1.36 to 4.06; p < 0.01) due to daytime sleepiness.

CONCLUSION

This analysis of a representative sample of U.S. adults revealed associations between AR and poor sleep parameters including prolonged sleep latency, insomnia, sleep apnea, sleep disturbances, sleep medication use, and daytime dysfunction. These findings reinforce the need to assess sleep quality in patients undergoing evaluation for AR.

The Effects of Mometasone Furoate and Desloratadine in Obstructive Sleep Apnea Syndrome Patients with Allergic Rhinitis

Background

Allergic rhinitis (AR) and obstructive sleep apnea syndrome (OSAS) are worldwide prevalent diseases. These diseases impair patient quality of life. The aim of this study was to investigate and compare the efficacy of treatment of AR on OSAS by objective and subjective methods.

Methods

The study group was composed of 80 OSAS patients with AR between the ages of 30 and 50 years. The patients were admitted with the complaint of snoring, and they were asked about AR-related symptoms (nasal discharge, nasal itching, sneeze, and nasal obstruction). Daytime somnolence was measured by the Epworth sleepiness scale (ESS). Sleep parameters on polysomnography tests before and after treatment were compared, and the effects of different AR treatment protocols on sleep quality were evaluated.

Results

When pretreatment and posttreatment apnea–hypopnea index (AHI) values of the groups were compared, the most significant difference was observed in the nasal steroid (Ns) + antihistamine (Ah) group (p < 0.05). The ESS results were significantly decreased in the Ns and Ns + Ah groups after treatment (p < 0.05). AHI oxygen saturation <90% were significantly decreased in the Ns and Ns + Ah groups after treatment (p < 0.05).

Conclusion

Nasal obstruction due to nasal congestion causes increases in airway resistance and can lead to development of OSAS. We concluded that treating AR with Ns has both positive effects on OSAS and daily activity. However, adding Ah to this treatment did not show improved effects compared with placebo treatment.

Effects of levocetirizine and diphenhydramine on regional glucose metabolic changes and hemodynamic responses in the human prefrontal cortex during cognitive tasks

OBJECTIVE

Antihistamines often have sedative side effects. This was the first study to measure regional cerebral glucose (energy) consumption and hemodynamic responses in young adults during cognitive tests after antihistamine administration.

METHODS

In this double-blind, placebo-controlled, three-way crossover study, 18 healthy young Japanese men received single doses of levocetirizine 5 mg and diphenhydramine 50 mg at intervals of at least six days. Subjective feeling, task performances, and brain activity were evaluated during three cognitive tests (word fluency, two-back, and Stroop). Regional cerebral glucose consumption changes were measured using positron emission tomography with [¹⁸ F]fluorodeoxyglucose. Regional hemodynamic responses were measured using near-infrared spectroscopy.

RESULTS

Energy consumption in prefrontal regions was significantly increased after antihistamine administration, especially diphenhydramine, whereas prefrontal hemodynamic responses, evaluated with oxygenated hemoglobin levels, were significantly lower with diphenhydramine treatment. Stroop test accuracy was significantly impaired by diphenhydramine, but not by levocetirizine. There was no significant difference in subjective sleepiness.

CONCLUSIONS

Physiological "coupling" between metabolism and perfusion in the healthy human brain may not be maintained under pharmacological influence due to antihistamines. This uncoupling may be caused by a combination of increased energy demands in the prefrontal regions and suppression of vascular permeability in brain capillaries after antihistamine treatment. Further research is needed to validate this hypothesis.

Clinical associations between allergies and rapid eye movement sleep disturbances

Background

Allergic rhinitis, an immunoglobulin E inflammatory condition including nasal congestion, obstruction, sneezing, pruritus, and fatigue symptoms, has significant impact on quality of life and impairs sleep. Sleep‐disordered breathing (SDB) patients often have normal all‐night apnea‐hypopnea (AHI) or respiratory‐disturbance (RDI) indices on polysomnography (PSG). We hypothesized that the rapid eye motion–respiratory disturbance index (REM‐RDI) may be a novel predictor of allergic status.

Methods

A retrospective analysis of 100 patients compared REM‐RDI results in 67 allergen‐positive patients with 33 nonallergic patients who presented with nasal blockage. Subjects completed STOP‐Bang©, 22‐item Sino‐Nasal Outcome Test (SNOT‐22)©, and Epworth Sleepiness Scale© questionnaires and underwent skin‐prick testing (SPT) and PSGs including REM‐RDI values. Using multivariate logistic regression models, we evaluated relationships between allergic status and sleep parameters while controlling for possible confounders including body mass index (BMI).

Results

Using REM‐RDI as the outcome of interest, allergen‐positive patients were 3.92 times more likely to have REM‐RDI values in a moderate/severe range (≥15 events/hour); and patients with moderate/severe REM‐RDI values were more likely to be allergen positive (p < 0.05). Allergic status was not significantly related to all‐night AHI, RDI, or REM‐AHI. BMI was not significantly related to REM‐RDI. STOP‐Bang© was related to allergy status (p = 0.02) and REM‐RDI (p < 0.01). Allergic patients had increased REM latency and less total amount of REM.

Conclusion

We revealed significant bidirectional associations between allergen positivity and increased REM‐RDI values independent of BMI, AHI, RDI, and REM‐AHI. Allergic inflammation and REM‐RDI data may play important roles in diagnosing and treating fatigued SDB patients and as objective perioperative safety and outcomes measures.

Effect of Cellular Mobile Phone Use and Cetrizine on Hand-Eye Coordination and Visual Acuity

INTRODUCTION

Cellular mobile phones are a major cause of distraction especially while driving. The aggressive and inappropriate use of cellular mobile phones has increased the risk of accidents. Similar alerts are available in literature for certain substances and drugs (e.g. second generation anti H1 drug -Cetirizine) which also derange psychomotor performance and parameters of alertness.

AIM

This study measured variations in hand-eye coordination and visual acuity due to use of cellular mobile phone in comparison to that of commonly used antihistaminic drug viz., single dose Cetirizine 10 mg.

MATERIALS AND METHODS

It was a single blind, single dose, interventional study, 100 healthy human volunteers divided into two groups. Baseline readings of all volunteers were noted. Group-I (n=50) was Cetirizine group (10mg orally stat), Group -II (n=50) Cellular mobile phone user group. Alertness was tested on hand- steadiness tester (Reaction Time Index = RTI) and on Flicker-fusion apparatus (visual acuity - Critical Flicker Fusion Frequency per second= CFFF/sec). Baseline readings of all volunteers were noted before intervention. Baseline was compared with readings at three hour post-intervention and was analysed by paired t-test. Inter-group comparison of parameters was also done and was analysed by unpaired t-test.

RESULTS

The baseline RTI (95.46±41.74, 85.11±39.05) and CFF low and high (40.07±9.970, 40.76±9.309 and 40.42±9.035, 40.48±9.863) respectively, in Cetirizine group and Mobile user group were comparable. The RTI increased significantly (116.4±51.46, 102.8±49.26) in both the groups after intervention. However, there is no significant change in CFF intensity from baseline in either group post-intervention.

CONCLUSION

Concurrent use of mobile phone while performing tasks, showed significant impairment of hand-steadiness which was comparable to that produced by single dose Cetirizine 10 mg and this may be one of the factors contributing to their close association with road traffic accidents.

Can human allergy drug fexofenadine, an antagonist of histamine (H1) receptor, be used to treat dog and cat? Homology modeling, docking and molecular dynamic Simulation of three H1 receptors in complex with fexofenadine

Fexofenadine, a potent antagonist to human histamine 1 (H₁) receptor, is a non-sedative third generation antihistamine that is widely used to treat various human allergic conditions such as allergic rhinitis, conjunctivitis and atopic dermatitis. Encouragingly, it's been successfully used to treat canine atopic dermatitis, this supports the notion that it might have a great potential for treating other canine allergic conditions and other mammal pets such as dog. Regrettably, while there is a myriad of studies conducted on the interactions of antihistamines with human H₁ receptor, the similar studies on non-human pet H₁ are considerably scarce. The published studies using the first and second generation antihistamines drugs have shown that the antihistamine response is varied and unpredictable. Thus, to probe its efficacy on pet, the homology models of dog and cat H₁ receptors were built based on the crystal structure of human H₁ receptor bound to antagonist doxepin (PDB 3RZE) and fexofenadine was subsequently docked to human, dog and cat H₁ receptors. The docked complexes are then subjected to 1000ns molecular dynamics (MD) simulations with explicit membrane. Our calculated MM/GBSA binding energies indicated that fexofenadine binds comparably to the three receptors; and our MD data also showed the binding poses, structural and dynamic features among three receptors are very similar. Therefore, our data supported the application of fexofenadine to the H₁ related allergic conditions of dog and cat. Nonetheless, subtle systemic differences among human, dog and cat H₁ receptors were also identified. Clearly, there is still a space to develop a more selective, potent and safe antihistamine alternatives such as Fexofenadine for dog or cat based on these differences. Our computation approach might provide a fast and economic way to predict if human antihistamine drugs can also be safely and efficaciously administered to animals.

Sleep dysfunction and its association to chronic rhinosinusitis: Updated review

Background

Poor sleep has significant effects on health contributing to increased morbidity and mortality. The direct and indirect costs of sleep dysfunction total well in to the billions of dollars annually in the United States. Chronic rhinosinusitis (CRS) affects up to 16% of the US population and has been linked to poor sleep quality with up to three quarters of patients with CRS reporting poor sleep quality. There is a growing body of literature evaluating the relationship between sleep and CRS. In this review, we organize and present the current knowledge on the associations between sleep and CRS as well as identify areas for further investigation.

Data sources

A structured literature search from 1946 to 2016 was conducted in the English language using OVID MEDLINE database, PubMed, and EMBASE.

Review methods

Abstracts were reviewed for relevance and appropriate studies were included in the narrative review.

Results

Studies were analyzed and discussed as they pertained to the following categories of CRS and sleep: (1) subjective measures of sleep dysfunction, (2) objective measures of sleep dysfunction, and (3) outcomes on sleep quality following treatment of CRS. Articles on the pathophysiology of sleep dysfunction in CRS were separately reviewed.

Conclusions

An evolving body of research demonstrates that quality of sleep is compromised in the majority of patients with CRS. Following treatment of CRS, there is significant improvement in subjective sleep quality, but additional research investigating objective measures following treatment is still needed. Additionally, further investigation is required to better elucidate the underlying pathophysiology of the relationship between sleep dysfunction and CRS.

Level of Evidence

N/A.

You sneeze, you lose:: The impact of pollen exposure on cognitive performance during high-stakes high school exams

Pollen is known to cause allergic reactions and affect cognitive performance in around 20% of the population. Although pollen season peaks when students take high-stakes exams, the effect of pollen allergies on school performance has received nearly no attention from economists. Using a student fixed effects model and administrative Norwegian data, this paper finds that increasing the ambient pollen levels by one standard deviation at the mean leads to a 2.5% standard deviation decrease in test scores, with potentially larger effects for allergic students. There also appear to be longer-run effects. The findings imply that random increases in pollen counts reduce test scores for allergic students relative to their peers, who consequently will be at a disadvantage when competing for jobs or higher education. This paper contributes to the literature by illuminating the interplay between individual health and human capital accumulation, which in turn can impact long-run economic growth.

On-the-road driving performance after use of the antihistamines mequitazine and l-mequitazine, alone and with alcohol

OBJECTIVE

Previous studies demonstrated that mequitazine produces mild sedation after single doses. Its enantiomer, l-mequitazine, has a stronger potency for the H1 receptor. The aim of the current study was to assess the effects of l-mequitazine and mequitazine, alone and with alcohol, on driving.

METHODS

Twenty-five healthy volunteers were treated with l-mequitazine 2.5, 5.0 and 10 mg, mequitazine 10 mg and placebo, alone and in combination with alcohol in a double-blind crossover design. Driving performance was assessed using the standardized highway driving test in normal traffic. Its primary measure is the Standard Deviation of the Lateral Position (SDLP). Secondary measures consisted of an auditory word learning test during driving, and subjective measures of driving performance.

RESULTS

L-mequitazine 2.5 and 5.0 mg showed no effect on SDLP in the highway driving test, while SDLP significantly increased after l-mequitazine 10 mg (alone +1.59 cm; with alcohol +1.41 cm) and mequitazine 10 mg (with alcohol +1.17 cm). Alcohol significantly impaired all performance measures (SDLP +2.63 cm) but did not interact with the effects of treatment. Subjective measures indicated that participants were aware of the impairing effects of alcohol, but not of l-mequitazine and mequitazine.

CONCLUSION

L-mequitazine can be considered safe to drive in dosages of 2.5 and 5.0 mg. L-mequitazine 10 mg led to mild driving impairment. Alcohol impaired all performance measures and added to the effects of l-mequitazine and mequitazine.

Mastocytosis in adulthood and neuropsychiatric disorders

Patients with mastocytosis can display various disabling general and neuropsychological symptoms among one third of them, including general signs such as fatigue and musculoskeletal pain, which can have a major impact on quality of life. Neurological symptoms are less frequent and mainly consist of acute or chronic headache (35%), rarely syncopes (5%), acute onset back pain (4%), and in a few cases, clinical and radiological symptoms resembling or allowing the diagnosis of multiple sclerosis (1.3%). Headaches are associated with symptoms related to mast cell activation syndrome (flushes, prurit, and so forth) and more frequently present as migraine (37.5%), with often aura (66%). Depression-anxiety like symptoms can occur in 40% to 60% of the patients and cognitive impairment is not rare (38.6%). The pathophysiology of these symptoms could be linked to tissular mast cell infiltration or to mast cell mediators release or both. The tryptophan metabolism could be involved in mast cell-induced neuroinflammation through indoleamine-2,3-dioxygenase activation. Treatments targeting mast cell may be useful to target neuropsychological features associated with mastocytosis, including tyrosine kinase inhibitors.

A simulated car-driving study on the effects of acute administration of levocetirizine, fexofenadine, and diphenhydramine in healthy Japanese volunteers

OBJECTIVE

Antihistamines are often used for treating allergic rhinitis. However, many older antihistamines cause sedative side effects. The sedative effects of antihistamines on car-driving have been investigated. This has not been investigated for levocetirizine, a new-generation antihistamine, in Asian populations, and so we evaluated its sedative effects in healthy Japanese subjects.

METHODS

In this double-blind, placebo-controlled, four-way crossover study, healthy volunteers received single doses of levocetirizine 5 mg, fexofenadine 60 mg, diphenhydramine 50 mg, and placebo at intervals of at least 6 days. Simple brake reaction time and choice brake reaction time task (CBRT), a lateral tracking (LT) task, and a multiple task, a mixture of CBRT and LT task, were used to compare driving performance between the four drugs. Subjective sedation was also assessed.

RESULTS

The simple brake reaction time and CBRT, and the CBRT component of the multiple task, did not show any significant differences between the drugs. In contrast, the LT, both as a single parameter and as a component of the multiple task, showed significant differences between diphenhydramine and the newer-generation antihistamines in a manner that corresponds with subjective sedation.

CONCLUSIONS

Levocetirizine and fexofenadine did not impair psychomotor performance in subjects performing simulated car-driving tasks, while diphenhydramine did impair psychomotor performance in the subjects. Copyright © 2016 John Wiley & Sons, Ltd.

Complications of Rhinitis

Chronic rhinitis involves inflammation of the upper airways. An association with comorbid conditions, such as rhinosinusitis, asthma, and chronic obstructive pulmonary disease, has been commonly observed in epidemiologic studies. The underlying pathogenesis of these disorders may be similar. Complications of rhinitis include sleep disturbances, learning impairment, and decreased quality of life. It is vital to recognize the complications of rhinitis so that treatment strategies can address rhinitis as well as its comorbidities and complications in a coordinated manner.

Molecular Dynamics: New Frontier in Personalized Medicine

The field of drug discovery has witnessed infinite development over the last decade with the demand for discovery of novel efficient lead compounds. Although the development of novel compounds in this field has seen large failure, a breakthrough in this area might be the establishment of personalized medicine. The trend of personalized medicine has shown stupendous growth being a hot topic after the successful completion of Human Genome Project and 1000 genomes pilot project. Genomic variant such as SNPs play a vital role with respect to inter individual's disease susceptibility and drug response. Hence, identification of such genetic variants has to be performed before administration of a drug. This process requires high-end techniques to understand the complexity of the molecules which might bring an insight to understand the compounds at their molecular level. To sustenance this, field of bioinformatics plays a crucial role in revealing the molecular mechanism of the mutation and thereby designing a drug for an individual in fast and affordable manner. High-end computational methods, such as molecular dynamics (MD) simulation has proved to be a constitutive approach to detecting the minor changes associated with an SNP for better understanding of the structural and functional relationship. The parameters used in molecular dynamic simulation elucidate different properties of a macromolecule, such as protein stability and flexibility. MD along with docking analysis can reveal the synergetic effect of an SNP in protein-ligand interaction and provides a foundation for designing a particular drug molecule for an individual. This compelling application of computational power and the advent of other technologies have paved a promising way toward personalized medicine. In this in-depth review, we tried to highlight the different wings of MD toward personalized medicine.

Risk factors for sleep impairment in adult patients with chronic rhinosinusitis

OBJECTIVE

Although sleep impairment is reported by patients with chronic rhinosinusitis, the associated factors have not been well studied. Therefore, we determined the associated risk factors for sleep impairment in patients with chronic rhinosinusitis (CRS).

METHODS

This study was a prospective cohort study. A total of 572 adult patients (171 women, 401 men; mean age, 49.0 years; range, 18-64 years) who completed a questionnaire, had a clinical examination, and underwent endoscopic sinus surgery were analyzed using stepwise multiple linear regression.

RESULTS

With regard to subjective symptoms, nasal obstruction (beta coef., 0.27; p<0.001), anterior nasal drainage (beta coef., 0.13; p=0.004), facial pain/pressure (beta coef., 0.09; p=0.048), headache (beta coef., 0.10; p=0.010), and cough (beta coef., 0.14; p<0.001) were predictors of an increased risk of sleep impairment of CRS (adjusted R(2), 0.240; p=0.048). In the matter of background parameters, total polyp score (polyp grading system) (beta coef., 0.16; p<0.001) and allergic rhinitis (beta coef., 0.09; p=0.034) were predictors of an increased risk of sleep impairment of CRS (adjusted R(2), 0.029; p=0.034).

CONCLUSION

These results suggest that sleep impairment in these patients is caused by the various mechanisms associated with nasal symptoms themselves, CRS and allergic rhinitis. However, the specific pathophysiology has not been clarified yet; further studies are expected to elucidate that of sleep impairment in patients with CRS.

The effect of histidine on mental fatigue and cognitive performance in subjects with high fatigue and sleep disruption scores

Our previous study reported that a dried bonito broth known in Japan as 'dashi' improved or ameliorated mood states, including fatigue, during the daily lives of human subjects. Histidine is an amino acid that is present in dried bonito broth, and we sought to evaluate whether histidine would affect feelings of fatigue in humans. We investigated the effects of histidine intake on the feeling of fatigue, mood states and mental task performance by performing a placebo-controlled, double-blind crossover trial. Twenty subjects with high fatigue and sleep disruption scores were asked to ingest histidine or a placebo every day for two weeks. The subjects' mood states were evaluated using the Profile of Mood States (POMS) scale and a visual analog scale (VAS) for eight feelings (fatigue, depression, carelessness, drowsiness, clear thinking, motivation, attentiveness and concentration). We also measured subjects' cognitive performance using the CogHealth test battery. The fatigue T-scores on the POMS test decreased significantly following histidine ingestion compared to placebo ingestion (p<0.05). After two weeks of histidine ingestion, the reaction time for the working memory task in the CogHealth test battery was significantly shorten compared to placebo ingestion. The VAS scores for clear thinking and for attentiveness were increased significantly following histidine ingestion compared to placebo ingestion (p<0.05). These results suggest that daily ingestion of histidine may ameliorate feelings of fatigue, increase performance during working memory tasks, and improve the clear thinking and attentiveness.

Allergy test: Seasonal allergens and performance in school

Seasonal pollen allergies affect approximately 1 in 5 school age children. Clinical research has established that these allergies result in large and consistent decrements in cognitive functioning, problem solving ability and speed, focus and energy. However, compared to air pollution, the impact of pollen and seasonal allergies on achievement in schools has received less attention from economists. Here, I use data on daily pollen counts merged with school district data to assess whether variation in the airborne pollen that induces seasonal allergies is associated with performance on state reading and math assessments. I find substantial and robust effects: A one standard deviation in ambient pollen levels reduces the percent of 3rd graders passing ELA assessments by between 0.2 and 0.3 standard deviations, and math assessments by between about 0.3 and 0.4 standard deviations. I discuss the empirical limitations as well as policy implications of this reduced-form estimate of pollen levels in a community setting.

Antihistamine induced blood oxygenation level dependent response changes related to visual processes during sensori-motor performance

The histaminergic involvement in selective processes underlying its role in human sensori-motor performance is largely unknown. Recently, selective effects of central H₁-inverse agonism on sensory visual processes were observed in electrophysiological--but not behavioral data; a discrepancy suggested to result from speeded response-choice related processes. This study attempts to establish the effects on visual processes and identify putative compensatory mechanisms related to increased visual and response-choice task demands by assessing H₁-inverse agonism induced changes in blood oxygenation level dependent (BOLD) response. Twelve participants received oral doses of dexchlorpheniramine 4 mg, lorazepam 1 mg, and placebo in a three-way crossover designed study. Brain activity was assessed for choice reaction time task performance in a 3 T magnetic resonance scanner 2 h after drug administration. Participants responded with their left or right hand and index or middle finger as indicated by the laterality of stimulus presentation and identity of the stimulus, respectively. Stimuli were intact or visually degraded and responses were compatible or incompatible with the laterality of stimulus presentation. Both dexchlorpheniramine and lorazepam affected the BOLD response in the occipital cortex indicating affected visual information processing. Dexchlorpheniramine decreased BOLD response in the dorsal precuneus and left precentral gyrus as part of a motor network, which however might not be interpreted as a compensatory mechanism, but may be the upstream consequence of impaired visual processing.

The modulatory role of spinally located histamine receptors in the regulation of the blood glucose level in d-glucose-fed mice

The possible roles of spinal histamine receptors in the regulation of the blood glucose level were studied in ICR mice. Mice were intrathecally (i.t.) treated with histamine 1 (H1) receptor agonist (2-pyridylethylamine) or antagonist (cetirizine), histamine 2 (H2) receptor agonist (dimaprit) or antagonist (ranitidine), histamine 3 (H3) receptor agonist (α-methylhistamine) or antagonist (carcinine) and histamine 4 (H4) receptor agonist (VUF 8430) or antagonist (JNJ 7777120), and the blood glucose level was measured at 30, 60 and 120 min after i.t. administration. The i.t. injection with α-methylhistamine, but not carcinine slightly caused an elevation of the blood glucose level. In addition, histamine H1, H2, and H4 receptor agonists and antagonists did not affect the blood glucose level. In D-glucose-fed model, i.t. pretreatment with cetirizine enhanced the blood glucose level, whereas 2-pyridylethylamine did not affect. The i.t. pretreatment with dimaprit, but not ranitidine, enhanced the blood glucose level in D-glucose-fed model. In addition, α-methylhistamine, but not carcinine, slightly but significantly enhanced the blood glucose level D-glucose-fed model. Finally, i.t. pretreatment with JNJ 7777120, but not VUF 8430, slightly but significantly increased the blood glucose level. Although histamine receptors themselves located at the spinal cord do not exert any effect on the regulation of the blood glucose level, our results suggest that the activation of spinal histamine H2 receptors and the blockade of spinal histamine H1 or H3 receptors may play modulatory roles for up-regulation and down-regulation, respectively, of the blood glucose level in D-glucose fed model.

The ventral-hypothalamic input route: a common neural network for abstract cognition and sexuality

Classically, external receptors of the body transmit information from the environment to the cerebral cortex via the thalamus. This review explains and argues that only concrete external information is transmitted from peripheral receptors to the cortex via a thalamic route, while abstract and sexual external information are actually transmitted from peripheral receptors to the cortex through a cognitive hypothalamic route. Sexual function typically implies participation of two distinct partners, ensuring reproduction in many species including humans. Human sexual response involves participation of multiple (environmental, biological, psychological) kinds of stimuli and processing, so the understanding of sexual control and response supposes integration between the classical physiological mechanisms with the more complex processes of our 'mind'. Cognition and sexuality are two relational functions, which are dependent on concrete (colours, sounds, etc.) and/or abstract (gestures, facial expression, how you move, the way you say something seemingly trivial, etc.) environmental cues. Abstract cues are encoded independent of the specific object features of the stimuli, suggesting that such cues should be transmitted and interpreted within the brain through a system different than the classical thalamo-cortical network that operates on concrete (material) information. Indeed, data show that the cerebral cortex is capable of interpreting two distinct (concrete and abstract) formats of information via distinct and non-compatible brain areas. We expand upon this abstract-concrete dichotomy of the brain, positing that the two distinct cortical networks should be uploaded with distinct information from the environment via two distinct informational input routes. These two routes would be represented by the two distinct routes of the ascending reticular activating system (ARAS), namely the classical/dorsal thalamic input route for concrete information and the ventral hypothalamic input route for abstract cognition and sexuality. Physiologically, the hypothalamic (dual-autonomic) route of the ARAS that processes abstract and sexual information is incompatible with the thalamic (somatic) route of the ARAS that processes concrete information, such that the two distinct routes would be needed to support the mind processes (awareness, consciousness, sexuality) through their own informational inputs from the environment. Informationally, the concrete external data are differentiated from abstract and sexual external data, so that they should be transmitted to cortex through distinct input routes. Pathologically, the hardware and/or software impairments of the hypothalamic default-mode network generate disturbed messages within the brain (related to information transmitted on this route), laying at the basis of mental and sexual disorders. The novel conceptualisations presented in the present paper help address issues surrounding the mind-brain dichotomy and, in doing so, suggest new possible avenues for exploration in the treatment and interventions for cognitive and sexual problems.

Intra-cerebellar microinjection of histamine enhances memory consolidation of inhibitory avoidance learning in mice via H2 receptors

Studies have demonstrated the relationship between the histaminergic system and the cerebellum, and we intend to investigate the role of the cerebellar histaminergic system on memory consolidation. This study investigated the effect of intra-cerebellar microinjection of histamine on memory retention of inhibitory avoidance in mice, and the role of H1 and H2 receptors in it. The cerebellar vermis of male mice were implanted with guide cannulae, and after three days of recovery, the inhibitory avoidance test was performed. Immediately after a training session, animals received a microinjection of histaminergic drugs: in the experiment 1, saline (SAL) or histamine (HA 0.54, 1.36, 2.72 or 4.07 nmol); experiment 2, SAL or 1.36 nmol HA 5 min after a pretreatment with 0.16 nmol chlorpheniramine (CPA) or SAL; and experiment 3, SAL or 1.36 nmol HA 5 min after a pretreatment with 2.85 nmol ranitidine (RA) or SAL. Twenty-four hours later, a retention test was performed. The data were analyzed using one-way analysis of variance (ANOVA) and Duncan's tests. In experiment 1, animals microinjected with 1.36 nmol HA showed a higher latency to cross to the dark compartment compared to controls and to 2.72 and 4.07 nmol HA groups. In experiment 2, the combined infusions revealed difference between control (SAL+SAL) and SAL+HA and CPA+HA; while in the experiment 3 the analysis indicated differences in retention latency between mice injected with SAL+SAL and SAL+HA. The groups that received the H2 antagonist RA did not show difference compared to control. These results indicate that 1.36 nmol HA enhances memory consolidation of inhibitory avoidance learning in mice and that the pretreatment with H2 antagonist RA was able to prevent this effect.

Antisomnogenic cytokines, quality of life, and chronic rhinosinusitis: a pilot study

OBJECTIVES/HYPOTHESIS

Sleep disturbance, reduced quality of life (QOL), and other components of "sickness behavior" in patients with chronic rhinosinusitis (CRS) are poorly understood. These complex changes in central behavior are due to the effects of immune mediators acting in the brain. We hypothesized that immune mediators that have been associated with CRS are also associated with sickness behavior, somnifacient complaints, and CRS disease-specific QOL.

STUDY DESIGN

Pilot study.

METHODS

Twenty patients with CRS were prospectively enrolled and completed the Pittsburgh Sleep Quality Index (PSQI), disease-specific QOL, and olfactory instruments. Ethmoid mucosa was obtained and reverse transcription-polymerase chain reaction was performed for the cytokines interleukin (IL)-4, -13, and transforming growth factor-β (TGF-β). Average change in crossover threshold was calculated, and differences in gene expression were correlated with sleep quality, CRS-specific QOL, and disease severity.

RESULTS

Patients with CRS reported overall poor sleep quality and poor CRS-specific QOL with significant correlations between them. Increased expression of TGF-β (r = -0.443; P = .050) and IL-4 (r = -0.548; P = .012) correlated with sleep dysfunction, whereas IL-13 expression was linearly associated with worse sleep quality (PSQI scores r = -0.417; P = .075). IL-4 and TGF-β expression was not associated with CRS disease severity or QOL, whereas significantly higher levels of IL-13 expression correlated with worse CRS disease severity and QOL.

CONCLUSIONS

Patients with CRS exhibited behavioral changes commonly referred to as sickness behavior, which include poor sleep quality and reduced QOL. The upregulation of IL-4 and TGF-β may contribute to inflammatory brain-mediated effects on sleep quality, whereas IL-13 may be a pleiotropic signaling molecule influencing sleep, QOL, and CRS disease severity.

LEVEL OF EVIDENCE

2b.

Chronic rhinosinusitis and sleep: a contemporary review

BACKGROUND

Patients with chronic rhinosinusitis (CRS) exhibit centrally mediated behavioral changes commonly referred to as "sickness behavior." Sleep alteration is a component of sickness behavior which is estimated to affect up to 70 million patients annually. Patients with CRS have poor sleep quality, and little is known about the underlying etiology and pathophysiology. This narrative review aims to further organize and present the current knowledge associating sleep and CRS.

METHODS

A literature search was conducted of the OVID MEDLINE database using key search words including: "chronic rhinosinusitis," "sleep," "sleep disorders," and "sleep dysfunction." Additional keywords "nasal obstruction," "nasal polyp," and "fatigue" were identified and used to further delineate relevant articles.

RESULTS

The articles that specifically addressed sleep and CRS were dissected and presented as follows: (1) chronic rhinosinusitis and sleep; (2) chronic rhinosinusitis and fatigue; (3) chronic rhinosinusitis, nasal obstruction, and sleep; and (4) pathophysiology of sleep in chronic rhinosinusitis (cytokines in both sleep and chronic rhinosinusitis and their association to the neuroimmune biology of chronic rhinosinusitis).

CONCLUSION

Patients with CRS have sleep dysfunction that is associated with their disease severity and overall quality of life. The etiology of sleep dysfunction in CRS is most likely multifactorial. Increasing evidence suggests sleep dysfunction in patients with CRS is partly due to the inflammatory disease process, and sleep physiology in patients with CRS may be actively regulated by the inflammatory component of the disease.

Sleep impairment and daytime sleepiness in patients with allergic rhinitis: the role of congestion and inflammation

OBJECTIVE

To investigate the association of rhinitis with stress, fatigue, decrease productivity, inflammation, and sleep disordered breathing.

DATA SOURCES

Medical literature obtained from OVID and PubMed searches in February 2013 using the search terms "sleep," "rhinitis," "allergic rhinitis," "somnolence," and "fatigue".

STUDY SELECTIONS

Studies were selected based on the US Preventive Services Task Force levels 1, 2, and 3.

RESULTS

Allergic rhinitis is a disease that severely affects patients' quality of life and is increasing in prevalence worldwide. Nasal congestion is reported as the most common and bothersome symptom; it is often associated with sleep-disordered breathing, a likely cause of sleep impairment in rhinitis-affected individuals. The end result is a reduced quality of life and productivity and an increase in daytime sleepiness, fatigue, and stress. Current treatment modalities include intranasal corticosteroids, which have been found to reduce nasal congestion. Clinical trials on intranasal corticosteroids have provided data on sleep-related end points, and these studies report that the improved nasal congestion is associated with improved quality of life with better sleep and reduced daytime fatigue. Alternate therapies, including montelukast, also decrease nasal congestion and positively influence sleep, but to a lesser extent.

CONCLUSION

This review examines nasal congestion and cytokine changes and the associated sleep impairment in allergic rhinitis patients and the effect on daytime performance. It elaborates the adverse effects of disturbed sleep on quality of life and how therapies directed at reducing nasal congestion can relieve such effects.

Sleep and allergic disease: a summary of the literature and future directions for research

Atopic diseases, such as asthma and allergic rhinitis, are common conditions that can influence sleep and subsequent daytime functioning. Children and patients with allergic conditions from ethnic minority groups might be particularly vulnerable to poor sleep and compromised daytime functioning because of the prevalence of these illnesses in these groups and the high level of morbidity. Research over the past 10 years has shed light on the pathophysiologic mechanisms (eg, inflammatory mediators) involved in many atopic diseases that can underlie sleep disruptions as a consequence of the presence of nocturnal symptoms. Associations between nocturnal symptoms and sleep and poorer quality of life as a result of missed sleep have been demonstrated across studies. Patients with severe illness and poor control appear to bear the most burden in terms of sleep impairment. Sleep-disordered breathing is also more common in patients with allergic diseases. Upper and lower airway resistance can increase the risk for sleep-disordered breathing events. In patients with allergic rhinitis, nasal congestion is a risk factor for apnea and snoring. Finally, consistent and appropriate use of medications can minimize nocturnal asthma or allergic symptoms that might disrupt sleep. Despite these advances, there is much room for improvement in this area. A summary of the sleep and allergic disease literature is reviewed, with methodological, conceptual, and clinical suggestions presented for future research.

Acupuncture compared with oral antihistamine for type I hypersensitivity itch and skin response in adults with atopic dermatitis: a patient- and examiner-blinded, randomized, placebo-controlled, crossover trial

BACKGROUND

Itch is the major symptom of atopic dermatitis (AD). Acupuncture has been shown to exhibit a significant effect on experimental itch in AD. Our study evaluated acupuncture and antihistamine itch therapy (cetirizine) on type I hypersensitivity itch and skin reaction in AD using a patient and examiner-blinded, randomized, placebo-controlled, crossover trial.

METHODS

Allergen-induced itch was evaluated in 20 patients with AD after several interventions in separate sessions: preventive (preceding) and abortive (concurrent) verum acupuncture (VAp and VAa), cetirizine (10 mg, VC), corresponding placebo interventions (preventive, PAp, and abortive, PAa, placebo acupuncture; placebo cetirizine pill, PC) and a no-intervention control (NI). Itch was induced on the forearm and temperature modulated over 20 min, using our validated model. Outcome parameters included itch intensity, wheal and flare size and the D2 attention test.

RESULTS

Mean itch intensity (SE: 0.31 each) was significantly lower following VAa (31.9) compared with all other groups (PAa: 36.5; VC: 36.8; VAp: 37.6; PC: 39.8; PAp: 39.9; NI: 45.7; P < 0.05). There was no significant difference between VAp and VC (P > 0.1), although both therapies were significantly superior to their respective placebo interventions (P < 0.05). Flare size following VAp was significantly smaller (P = 0.034) than that following PAp. D2 attention test score was significantly lower following VC compared with all other groups (P < 0.001).

CONCLUSIONS

Both VA and cetirizine significantly reduced type I hypersensitivity itch in patients with AD, compared with both placebo and NI. Timing of acupuncture application was important, as VAa had the most significant effect on itch, potentially because of counter-irritation and/or distraction. Itch reduction following cetirizine coincided with reduced attention.

Safety considerations in the management of allergic diseases: focus on antihistamines

OBJECTIVE

To conduct a systematic review of evidence supporting the safety profiles of frequently used oral H(1)-antihistamines (AHs) for the treatment of patients with histamine-release related allergic diseases, e.g. allergic rhinitis and urticaria, and to compare them to the safety profiles of other medications, mostly topical corticosteroids and leukotriene antagonists (LTRA).

RESEARCH DESIGN AND METHODS

Systematic search of the published literature (PubMed) and of the regulatory authorities databases (EMA and FDA) for oral AHs.

RESULTS

Similarly to histamine, antihistamines (AHs) have organ-specific efficacy and adverse effects. The peripheral H(1)-receptor (PrH1R) stimulation leads to allergic symptoms while the brain H(1)-receptor (BrH1R) blockade leads to somnolence, fatigue, increased appetite, decreased cognitive functions (impaired memory and learning), seizures, aggressive behaviour, etc. First-generation oral AHs (FGAHs) inhibit the effects of histamine not only peripherally but also in the brain, and additionally have potent antimuscarinic, anti-α-adrenergic and antiserotonin effects leading to symptoms such as visual disturbances (mydriasis, photophobia, and diplopia), dry mouth, tachycardia, constipation, urinary retention, agitation, and confusion. The somnolence caused by FGAHs interferes with the natural circadian sleep-wake cycle and therefore FGAHs are not suitable to be used as sleeping pills. Second-generation oral AHs (SGAHs) have proven better safety and tolerability profiles, much lower proportional impairment ratios, with at least similar if not better efficacy, than their predecessors. Only SGAHs, and especially those with a proven long-term (e.g., ≥12 months) clinical safety, should be prescribed for young children. Evidence exist that intranasally applied medications, like intranasal antihistamines, have the potential to reach the brain and cause somnolence.

CONCLUSIONS

Second-generation oral antihistamines are the preferred first-line treatment option for allergic rhinitis and urticaria. Patients taking SGAHs report relatively little and mild adverse events even after long-term continuous treatments. An antihistamine should ideally possess high selectivity for the H(1)-receptor, high PrH1R occupancy and low to no BrH1R occupancy.

The effect of allergic rhinitis on the degree of stress, fatigue and quality of life in OSA patients

Both allergic rhinitis (AR) and obstructive sleep apnea (OSA) are known to increase stress and fatigue, but the result of their coexistence has not been studied. The objective of this study was to evaluate the amount of stress and fatigue when AR is combined with OSA. One hundred and twelve patients diagnosed with OSA by polysomnography were enrolled. Among them, 37 patients were diagnosed with AR by a skin prick test and symptoms (OSA-AR group) and 75 patients were classified into the OSA group since they tested negative for allergies. We evaluated the Epworth sleepiness scale (ESS), stress score, fatigue score, ability to cope with stress, and rhinosinusitis quality of life questionnaire (RQLQ) with questionnaires and statistically compared the scores of both groups. There were no significant differences in BMI and sleep parameters such as LSAT, AHI, and RERA between the two groups. However, the OSA-AR group showed a significantly higher ESS score compared to the OSA group (13.7 ± 4.7 vs. 9.3 ± 4.8). Fatigue scores were also significantly higher in the OSA-AR group than in the OSA group (39.8 ± 11.0 vs. 30.6 ± 5.4). The OSA-AR group had a significantly higher stress score (60.4 ± 18.6 vs. 51.2 ± 10.4). The ability to cope with stress was higher in the OSA group, although this difference was not statistically significant. RQLQ scores were higher in the OSA-AR group (60.2 ± 16.7 compared to 25.1 ± 13.9). In conclusion, management of allergic rhinitis is very important in treating OSA patients in order to eliminate stress and fatigue and to minimize daytime sleepiness and quality of life.