“More attention to occupation and lifestyle of individual patients is recommended to avoid asynchronous drug/meal interactions,” said Roberto Paganelli, MD, professor of medicine and sciences of aging, the University of the Adriatic, Pescara, Chieti, Italy. “Frequent travelers across time zones and shift workers are particularly at risk of developing severe symptoms despite normally adequate treatment. Side effects of antihistamines and steroids should be also considered in the frame of our inner clocks.”

Atopic Dermatitis Is Linked to Time-Sensitive Inflammation

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Similar in time-of-day peak activity to asthma, atopic dermatitis pruritus tends to worsen at night and is regulated by skin temperature, pH, and transepidermal water loss.3 In murine studies, circadian clocks regulated the immunoglobulin E-induced allergic reactions in skin.2 The clock gene caused psoriasis-like inflammation via the interleukin (IL-23R) pathway in mice.2

Food Allergies Worsen With Circadian Disruptions

Evidence suggests that eating during the resting period, rather than during the active phase, can induce food allergies.3 Mice fed during their resting phase were likelier to have allergic diarrhea and weight loss compared with those fed during their peak or active phase.3 Researchers conjecture that eating in opposition to the circadian clock disrupts the intestinal epithelial barrier function.3

Chronotype Matters When Dosing for Allergies

When a patient is at his or her peak physical and mental activity should also be a consideration for devising an allergy regimen.5 A person’s chronotype refers to whether he or she is a morning, evening, or neither type, an important distinction because peak activity could vary by 12 hours among the different chronotypes.5

“In the case of asthma, clinicians should take into account the patients’ chronotype and the temporality of asthma response before deciding the medication,” said pulmonary physiologist Subhabrata Moitra, PhD, AMRSPH (Lond), from ISGlobal in Barcelona, Spain. “There are some studies now coming up, not in asthma, but in other diseases, that dosing the patients at that specific time based on the temporal pattern of the symptoms and biomarkers could be more useful than the conventional way of treatment.”

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Summary and Clinical Applicability

Allergies are regulated by the circadian clock. Asthma attacks and atopic dermatitis pruritus, for example, occur at night. Patients can reduce the severity of these attacks by maintaining good sleep hygiene and adapting their medication schedule to their chronotype.

Limitations and Disclosures



  1. NobelPrize.org. The Nobel Prize in Physiology or Medicine 2017. Nobel Media AB 2018. https://www.nobelprize.org/prizes/medicine/2017/summary/. Accessed November 17, 2018.
  2. Paganelli R, Petrarca C, Di Gioacchino M. Biological clocks: their relevance to immune-allergic diseases. Clin Mol Allergy. 2018;16:1.
  3. Nakao A. Clockwork allergy: How the circadian clock underpins allergic reactions. J Allergy Clin Immunol. 2018;142(4):1021-1031.
  4. Ehlers A, Xie W, Agapov E, et al. BMAL1 links the circadian clock to viral airway pathology and asthma phenotypes. Mucosal Immunol. 2018;11(1):97-111.
  5. Moitra S, Haldar P, Moitra S. Individual chronotype may confound with asthma symptoms and therapy [published online October 22, 2018]. Am J Respir Crit Care Med. doi:10.1164/rccm.201809-1630LE