Twenty-four hour pattern in symptom intensity of viral and allergic rhinitis: Treatment implications Michael H. Smolensky, PhDa, Alain Reinberg, MDb,

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Presentation transcript:

Twenty-four hour pattern in symptom intensity of viral and allergic rhinitis: Treatment implications Michael H. Smolensky, PhDa, Alain Reinberg, MDb, Gaston Labrecque, PhDc Journal of Allergy and Clinical Immunology Volume 95, Issue 5, Pages 1084-1096 (May 1995) DOI: 10.1016/S0091-6749(95)70212-1 Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 1 Circadian rhythm of cough frequency in groups of cold sufferers studied for 24 hours before and 36 hours during treatment with placebo or guaifenesin (400 mg) syrup four times daily at 6-hour intervals. Cough frequency is greater in the morning and afternoon than overnight. Sloping line depicts average rate of decline in cough frequency over 60 hours around which 24-hour variability is manifested. (Redrawn from Kuhn JJ, Hendley JO, Adams KF, et al. Antitussive effect of guaifensein in young adults with natural colds. Chest 1982;82:713-8.) Journal of Allergy and Clinical Immunology 1995 95, 1084-1096DOI: (10.1016/S0091-6749(95)70212-1) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 2 Day-night distribution of onset of "hay fever" symptoms by 246 presumably diurnally active British sufferers. Data obtained by survey questionnaire show that nasal and eye symptoms commence most commonly in the morning; this is not the case for cough and wheeze. (from Nicholson PA, Bogie W. Curr Med Res Opin 1973;1:395-401) Journal of Allergy and Clinical Immunology 1995 95, 1084-1096DOI: (10.1016/S0091-6749(95)70212-1) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 3 Day-night pattern in occurrence of most severe symptom of presumbably diurnally active Finnish patients suffering from seasonal and perennial rhinitis. Data obtained by anamnestic recall demonstrate that the most difficult time of day is the morning for most persons. (from Binder E, et al. Allergy 1982;37:389-96. © 1982 by Munksgaard international Publishers Ltd., Copenhagan, Danmark.) Journal of Allergy and Clinical Immunology 1995 95, 1084-1096DOI: (10.1016/S0091-6749(95)70212-1) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 4 Day-night variation in occurrence and intensity of allergic rhinitis in 765 diurnally active French study participants. Data were obtained by self-assessment of symptom intensity four times daily with visual analog scales. Morning prominent and evening secondary peaks in nasal symptoms are evident in both men and women (left) and smokers and nonsmokers. (From Reinberg A, et al. J ALLERGY CLIN IMMUNOL 1988;81:51-62 Journal of Allergy and Clinical Immunology 1995 95, 1084-1096DOI: (10.1016/S0091-6749(95)70212-1) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 5 Administration-time (7:00 AM versus 7:00PM) differences in terfenadine-and clemastine-induced inhibition of local cutaneous reaction to intradermally injected histamine (2 æg/0.1 ml). Double-blind protocol was used to test medication effects. Strength of antihistamine effect according to treatment time and dose is expressed as clock-time difference in cutaneous response to histamine during antihistamine versus placebo treatments. Antihistamine effect was longer in a dose-dependent manner when medications were ingested in the morning. Magnitude of peak effect was greater in a dose-dependent manner after evening treatment. (From Reinberg A, et al. Eur J Clin Pharmacol 1976;14:245-52, by permission of Elsevier Science Publishers.) Journal of Allergy and Clinical Immunology 1995 95, 1084-1096DOI: (10.1016/S0091-6749(95)70212-1) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 5 Administration-time (7:00 AM versus 7:00PM) differences in terfenadine-and clemastine-induced inhibition of local cutaneous reaction to intradermally injected histamine (2 æg/0.1 ml). Double-blind protocol was used to test medication effects. Strength of antihistamine effect according to treatment time and dose is expressed as clock-time difference in cutaneous response to histamine during antihistamine versus placebo treatments. Antihistamine effect was longer in a dose-dependent manner when medications were ingested in the morning. Magnitude of peak effect was greater in a dose-dependent manner after evening treatment. (From Reinberg A, et al. Eur J Clin Pharmacol 1976;14:245-52, by permission of Elsevier Science Publishers.) Journal of Allergy and Clinical Immunology 1995 95, 1084-1096DOI: (10.1016/S0091-6749(95)70212-1) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 6 Time-dependent effects of 7.5 mg of antihistamine mequitazine (Pharmaka, France) administrated in unequal morning (breakfast, B) and evening (dinner, D) doses for allergic rhinitis. When all or most of the daily dose of mequitazine was ingested in the evening, there was enhancement of drug effect. (From Reinberg A. Chronopharmacology of H1 - antihistamines. In: Lemmer BJ, ed. Chronopharmacology: cellular and biochemical interactions. New York: Marcel Dekker, 1989:115-35, by courtesy of Marcel Dekker.) Journal of Allergy and Clinical Immunology 1995 95, 1084-1096DOI: (10.1016/S0091-6749(95)70212-1) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 6 Time-dependent effects of 7.5 mg of antihistamine mequitazine (Pharmaka, France) administrated in unequal morning (breakfast, B) and evening (dinner, D) doses for allergic rhinitis. When all or most of the daily dose of mequitazine was ingested in the evening, there was enhancement of drug effect. (From Reinberg A. Chronopharmacology of H1 - antihistamines. In: Lemmer BJ, ed. Chronopharmacology: cellular and biochemical interactions. New York: Marcel Dekker, 1989:115-35, by courtesy of Marcel Dekker.) Journal of Allergy and Clinical Immunology 1995 95, 1084-1096DOI: (10.1016/S0091-6749(95)70212-1) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 6 Time-dependent effects of 7.5 mg of antihistamine mequitazine (Pharmaka, France) administrated in unequal morning (breakfast, B) and evening (dinner, D) doses for allergic rhinitis. When all or most of the daily dose of mequitazine was ingested in the evening, there was enhancement of drug effect. (From Reinberg A. Chronopharmacology of H1 - antihistamines. In: Lemmer BJ, ed. Chronopharmacology: cellular and biochemical interactions. New York: Marcel Dekker, 1989:115-35, by courtesy of Marcel Dekker.) Journal of Allergy and Clinical Immunology 1995 95, 1084-1096DOI: (10.1016/S0091-6749(95)70212-1) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 7 Differential effect of 10 mg of mequitazine as a once-daily evening versus morning strategy for treatment of allergic rhinitis in a group of 98 diurnally active adult patients with history of very prominent morning symptoms. Treatment effects were evaluated by self-assessments of symptoms with visual analog scales four times daily during a 7-day period. Evening in comparison with morning ingestion of antihistamine resulted in a statistically significant (p < 0.005) better control of symptoms. (From Reinberg A. Chronopharmacology of H1-antihistamines. In: Lemmer BJ, ed. Chronopharmacology: cellular and biochemical interactions. New York: Marcel Dekker, 1989:115-35, by permission of Marcel Dekker.) Journal of Allergy and Clinical Immunology 1995 95, 1084-1096DOI: (10.1016/S0091-6749(95)70212-1) Copyright © 1995 Mosby, Inc. Terms and Conditions