Today's post is dedicated to Mr. S. My sad, sniffly Mr. S, who has welcomed the advent of spring with raucous sternutation. We don't understand it. There's no grass yet, the tree pollen is low. But the poor guy is a mess. And over the weekend, as his playing of Black Ops was continually interrupted by vigorous sneezes, we began to notice a certain amount of diurnal rhythm.
The mornings are the worst, no question. Dawn breaks out, and the tissues do too. He's full of gluey misery until about 11am or so, when things seem to generally quiet down. And then, then comes sundown, and the mucus flows most robustly until poor Mr. S finally passes out in a pile of used tissues. Don't worry, we've got antihistamine and lots of it, but it never gets rid of the symptoms entirely.
But being the scientist that I am, I noticed the pattern, he always seemed less miserable in the middle of the day. But the POLLEN can't be all that much better in the middle of the day, right? And at night, shouldn't it be better? But his allergies are worse! Is this normal? What does it MEAN?
I turned to the lit.
Nicholson and Bogie (a very appropriate name given the subject material...) "Diurnal variation in the
symptoms of hay fever: implications for pharmaceutical development" Current Medical Research and Opinion, 1973.
(Source)
Note: Thanks to Le Physiologiste for the paper!!
Many of you have probably heard of hay fever. Am I alone in thinking this must have been a specific allergy? I thought if you had "hay fever" you had to be allergic to something specific...like hay (except I figured it wouldn't be hay). I was thinking it'd be something really common like grass or ragweed. But it turns out that hay fever is MUCH less specific than that, and refers just to allergenic rhinitis, the combination of dust or pollen and a sensitized immune system resulting in one very irritated airway.
Symptoms include: sneezing, watery eyes, runny nose (rhinitis), coughing, wheezing, and acute whinging and misery. The inflammatory responses are triggered via the chemical histamine. When we take allergy meds, we are usually taking antihistamines, drugs which act as competitors for the histamine receptors, binding them up so that histamine cannot hit them, and thus saving us some misery. But this means that you'll have the BEST response to the antihistamines if you can get them in your system before the major histamine flood occurs. So you want to take the meds before your symptoms are worst.
But when is that?
To examine this, the scientists called up over 2000 people around the UK, and asked them about their allergies. Did they suffer from hay fever, what was their primary symptom, at what time of day does it begin to bother them, and when were their symptoms worst. And then they came up with maps of where allergies were the worst around the UK, and how they varied over time of day.
It turns out about 12% of people in the UK suffered from hay fever in 1973 (the numbers are apparently lower now, but it's still about 12% in the US). The area with the most allergy symptoms per capita was south east England (the area surrounding London to the south, containing Kent, Sussex, Surrey, Oxfordshire, and other places that I mainly recognize from Jane Austen novels), followed by London itself (smog anyone?), and south west England (with counties like Cornwall, Gloucestershire, and Dorset). The lowest was Yorkshire (which is toward the north of England). You'd think Scotland would be lowest in hay fever, being a bit colder (less pollen?), but no dice.
The biggest symptom of hay fever was sneezing, followed by runny nose, red itchy eyes, wheezing, and coughing came in last. But the time of onset was what I was REALLY after.
You can see above that the allergies really dominated the morning hours, with a big drop around midday, and a small increase at night (though it looks like wheezing and coughing had bigger increases).
The worst intensity graph looks similar.
And it appears that Mr. S's allergies follow the general trend, getting worse in the morning and at night. The authors talk about how formulations of antihistamines should take this into account, releasing most in the morning or at night. Or you could just take the pill right when you get up.
But I still have questions, and my brief search through the literature found me nothing. WHY do allergies have diurnal variation? The morning I understand, all the flowers opening, the breeze picking up, the pollen counts getting high. But doesn't pollen decrease at night? And shouldn't pollen levels be just as bad at midday when the symptoms appear to often be better? What is going on here? Is there diurnal regulation of histamine receptors, getting lower at midday? Or is there diurnal release of histamine itself? Studies on diurnal release of histamine haven't found any changes, so perhaps its the receptors. Is there some other cause? And why haven't people studied this? Or is it just my failed Pubmed-fu?
If anyone wants to pass along an abstract or three, I'd love to see them! In the meantime, I'm putting Mr. S to bed, and he's taking his antihistamine first thing in the morning, to try and head off the sneezing before it starts.
Nicholson PA, & Bogie W (1973). Diurnal variation in the symptoms of hay fever: implications for pharmaceutical development. Current medical research and opinion, 1 (7), 395-400 PMID: 4149254
Some plants bloom or release their fragrance in the evening to attract moths and other nocturnal pollinators. (One example is Evening Primrose.) So it is possible that the evening uptick in allergies is related to that.
I'm among the 12% of Americans who suffer from hay fever. My allergies are definitely worse in the morning, and have cleared up by noon except on really bad days.
If I had to guess, cortisol release might have some mildly suppressive effect on the immune system during the prime waking hours?
This is my guess too! When I have a cold, it's always worse at night, which I attribute to a drop in cortisol.
True! Drop in cortisol starts in the evening and last the all night as the inevitable effect of our circadian rhythm. The consequence: our immune system can freely work against all kind of bugs, including releasing histamine against allergens.
Have you considered gravity vs mucus membrane swelling? After laying down at night my nose is the worst, but a few hours standing up helps things. Perhaps we need some hay fever sufferers to volunteer for a midday nap!
Actually, good point.
My "cure" for horrendous sneezing and a runny nose while in the office (worst between the hours of 7am-11am) has been simply to walk.
When my sneezing gets to the point that I am a distraction to others (and I've used up all my tissues) I just take a quick 1-2 min. walk outside (it must be the musty air ducts of the building...although my doctor says I'm allergic to pollen, too).
Almost instantly, I feel (hyperbole coming) a million times better - just by standing and walking around!
Yet, I sit back down and five to ten minutes later I'm afflicted again.
Could someone clarify as to "gravity vs mucus membrane swelling" if that is an actual possibility? Clearly, I am not in the medical profession.
Also, I should have added it works simple standing up and walking down the hall while still in the OFFICE, too, or else it just looks like I'm removing myself from the allergen zone.
My guess is walking increasing blood flow and circulation in the inflamed area and therefore clear and clean the Histamin, contributing to temporary relief of the symptoms.
I have had hayfever since adolescence - now 70. At times, typically spring and early summer, when it afflicts me 24 hrs a day, it is particularly bad, not only on hot dry windy days, but when there is a cool change and rain. Moistness causes pollen grains to extend pollen tubes, I am told, which makes them much more irritating.
I often wake with an irritated nose and throat, but it is far better since I changed feather and down pillows for synthetic ones. Bedroom dust and dust mites also affect people overnight, and daily vacuuming might well help. Particularly if a non-sufferer does the vacuuming.
Thank God for anti-histamines. And down with all the medicos who told me that it was probably due to 'the stress of exams' in my student days (the fact that exams took place in springtime was ignored).
During the summer months I wear a surgical mask during my morning commute and sometimes at other times of day when the pollen count is very high. This seems to help and does make me wonder why medical advice on hay fever treatment rarely if ever mentions the idea. (I could be cynical and suggest it's because it doesn't earn vast splodges of money for Big Pharma.) At any rate it's much more practical than the usual advice of "avoid outdoors during peak pollen periods" and "keep windows closed".
totally agree, my allergies worst in the morning too..
Yeah, your Pubmed-fu is no good. There is a huge literature on daily rhythms of allergy and inflammation, but the key word you need is "circadian", not "diurnal".
Another source of early spring, pre-pollen season allergens is leaf mold. I'm not sure if there's any diurnal variation to it though.
@John
There are definitely plants that bloom at night, but the example that you cite (or any other plant that uses insect or other animal pollinators) does not significantly contribute to hay fever symptoms. Hay fever is caused by the pollen of plants that are wind pollinated. (As an aside, this fact should be the first--of many--warning sign that the claims that honey relieves allergy symptoms are complete bunkum.)
I suspect that the culprit here is something circadian or is perhaps related to the level of activity. I tend to have the same pattern of allergy symptoms described above, but I've noticed that my activity level has a lot to do with it. For example, if I go out for a bike ride, even on a day with a high pollen count, the worst of my allergy symptoms won't kick in until after I'm home and getting ready to shower.
Hi Sci,
There is a known diurnal variation in presence of eosinophils in the blood (they can move out of bloodstream into connective tissues.) They serve several purposes, including cleaning up histamine. They are more prevalent in the afternoon. (saw it first hand when I used to run labs where students made blood smears).
I don't have a paper here for you.
I’ve suffered from terrible hay fever ever since I was a child and experience a noticeable daily rhythm. A doctor once told me that this is due to the cycle of additional pollen being released by plants in the early morning, triggered by the sun, which is then heated by rising temperatures before cooling again and falling back to Earth in the evening, hence the noticeable peaks in symptoms at those times. I’d be interested to know if there is any scientific basis for this claim, but it seems plausible enough.
FWIW, I find it helpful to take anti-histamine medication at these specific times, even if this means taking half a pill in the morning and the other half in the evening. This is true even if the treatment is supposed to be slow-release as the effects are always greater an hour or two after taking a tablet than later in the day. Taking a tablet literally before you move or get out of bed can also be helpful.
There's still more to it than circadian or diurnal rhythms or the times when pollen abounds. I'm plagued by terrible hayfever symptoms. Yet I don't sneeze in the morning until I "wake up", that is, until I'm awake enough for the thoughts to flow. And intense concentration seems to put a damper on symptoms. That is, if I'm attending a lecture or trying to understand something complex, I will stop sneezing for the period of intense concentration, and then start sneezing again as soon as focus shifts to something lighter. I figure that in my case, the onset of morning sneezes might have something to do with circulation. But how is concentration connected to the sinuses? Why isn't there more research published on variation of symptoms within individuals?
Follow the money. It is obvious that the tissue industry is behind this.
Could the meteorology have something to do with it, in the middle of the day the boundary layer is higher - in the morning and evening it shrinks. We know this traps pollutants in a lower layer so it could do the same with pollen...probably not the full cause but an added effect on top of all the others mentioned above
http://www.unis.thinf.net/data/studium/BL.pdf
A clue is all I can offer you, but ...
During the daytime, the sun warms the earth, which warms the air immediately above it, which lifts pollen and spores higher into the air. At night, no sun, things settle down. Long ago I remember reading that the density of pollen (and presumably spores) near the ground peaks in the early morning just before and just after dawn.
This shouldn't be hard to track in your area since IIRC the usual pollen/mold count sites sample more than daily.
I find when my allergies are bad correlates to the heating/air coming on, even with filters on the vents and an air purifier. Forced air systems really suck if you have allergies.
This is a slight tangent - but it might be related, so please bear with me -and apologies for grossness!
Coughing (particularly productive coughing where mucus is cleared) is also worse in the morning in diseases that cause lung and bronchial congestion - bronchitis, asthma, pneumonia, COPD, etc. Doctors will usually tell you that it's because breathing rate is slower during sleep and if you are congested, then breathing can also be shallower, and therefore the mucus isn't cleared as effectively while you sleep. When you wake up, your body starts clearing the airways again.
So maybe the worsened hay fever symptoms is similar - perhaps it's not only due to diurnal rhythms of histamine or receptor function, it might be due to changes in breathing during sleep (particularly switching to breathing through the mouth when your nose is congested) so when morning comes, your body is just trying to clear the airways - and sneezing is effective.
A remedy that worked for me was to move to another continent. I got a better job as well
Hey there, take it easy on our botanical friends. There's a lot of plant-bashing in these comments. Plants have a rough time in the morning, too, you know!
Researchers at Duke and my alma mater used microarray gene expression data to show that Arabidopsis maximally activates its immune system in the morning—the same time that the spores from one of its pathogens, downy mildew, are also peaking.
http://www.nature.com/nature/journal/v470/n7332/full/nature09766.html
http://www.dukenews.duke.edu/2011/02/plantimmune._print.ht
Were these people's allergies studied in the context of them having hypoallergenic pillows and bedding? I don't know if I could really trust the data to not be skewed by allergy to dust/mites otherwise.
I agree, bedding could be a culprit. I used to spend the first half of each day carrying a box of tissues.... Then I got a new pillow. Ok so I was a grad student at the time, and a new pillow was an extravagance! Wish I had done so sooner. Allergies mostly gone now although they do flare up seasonally, but nothing nearly as bad as in my younger days. I get new pillows every year now that I have tenure.
Try Googling [histamine circadian]. I haven't looked at this in a decade or so.. not as many papers as I'd expected by now.. but that's been my working-hypothesis as a major influence on morning allergies for a long time. I recall at least a couple of instances of rapidly transitioning from sleep to being awake co-occurring with a sudden massive swelling of nasal-passages inflammation over the course of what seemed like 15-45 seconds. (Minor aside and major speculation: Co-occurrence of allergies and ~some~ ADDs may be result of altered .. heigthened?.. activity of brain histamine, or H3 receptors. Not sure if research/research-tech has progressed on that. Further Spect'n.. suspect H3 and NE somehow in competition/alternation.)
Follow-up clarification -- I should probably avoid abbreviations, H3 means the histamine receptors that are in the brain, and NE means norepinephrine. ADDs means Attention Deficit Disorders.
My allergies tend to be the worst in the morning. Not by definition, but whenever my body thinks it's morning. I'm on a "graveyard" sleeping schedule and go to sleep around 1-2 pm in the afternoon. I wake up around 8-9 pm and that's when it's usually the absolute worst.
I have relatively mild allergy symptoms, and only when tree pollen is high in the late spring (in my area birch, oak, and maple). I don't even take anything, because the symptoms start in the middle of the night (usu don't wake me) and only last about an hour or two after I wake up.
I don't have central air to circulate the tree pollen within my apt., so one would think symptoms would be worst immediately after time outside in a park, AFTER my morning, afternoon, or evening dog walk, if it had to do with circadian tree pollen rhythms.
To me it is definitely something about me and not the trees, because no outside air can get in my house at 4 am to start it. Maybe I have a delayed response, but why is it always precisely in the middle of the night, regardless of my time of exposure? The answer that the person left about reduced breathing during sleep makes a lot of sense to me-- when I get up and start breathing, blowing my nose, it goes away pretty fast. The breathing doesn't explain the puffy eyes, though, so it could also be about circadian histamines or something else immunological.
Thanks for this interesting post!
As the results in your article show, my hayfever is worse in the morning and the evening and less in the day, unless I am in a field or gardening, which makes it worse.
Oddly, by "morning" and "evening" (especially the latter), I mean when I get up and am about to go to bed, which is not necessarily actually morning etc. (I'm not an early riser so 12:00pm-1:00pm is common for me). This suggests that it is connected to me getting up, rather than the time of day.
Also, I tend to feel out of breath a lot, athsmatic, along with my nose feeling abit blocked sometimes. I often have to take deep breaths like I've just been running (although I haven't) I used to get athsma when I was younger so it may be the return of that.
Certainly morning are the worst and definitely it is not due to pollen (my case) but due to some type of dust in the apartment..outside does not affect me but actually helps when I go for early jog in the park full of trees and grass fields, no problems..has to be the apartment..pillows, immune system?..Currently I'm on a vacation and sleep the normal rhythm, that is, at night (as I usually sleep in daytime due to night work) and it is a disaster in the morning..horrible..have to buy new pillows, more frequent vacuuming of carpet, changing window curtains/washing them more frequently, bed sheets? change more frequently...this is what I will do to see if it makes any difference.
Forgot to mention that on days that I work at nights, 8p to 8am I have no problems with allergies, only on days I'm off but only a little bit as compared to now when I'm off work for about 2 weeks and sleeping every night.
OK...I'd like to pose a very easy theory as to why allergies are worse in the morning and night. Let's examine the root of allergies...
Allergies are caused by an overactive immune system that activates histamine which in turns triggers an inflammatory response - feel like crap. A study in 2008 showed that the immune system is much more active during the night when your body is at rest. See below -
"These results suggest that immunity is stronger at night, consistent with the hypothesis that circadian proteins upregulate restorative functions such as specific immune responses during sleep, when animals are not engaged in metabolically costly activities," Stanford researcher Mimi Shirasu-Hiza said in a news release issued by the conference organizers.
http://topnews.us/content/2908-immune-system-more-active-during-night
It makes sense (to me) that as we lay down or are awakening our bodies already over-active immune system goes bizerk and releases histamine (probably a lot) to any allergen our body encounters - Response from Koko and K backs this theory. I think the whole "pollens and flowers open up in the morning" idea is BS.
defined nicely the body s inner temperature and outer atomospheres temp differs in the morning time !so more sneezing takes place !
I also suffer from seasonal allergies and true to form, they are for the most part worse in the AM. One thing I've found that helps with my symptoms is the consumption of a complete EFA morning and night. By EFA, I mean Essential Fatty Acid pill. I'm interested in garnering any insight as to why EFA's seems to abate my symptoms. My guess is that the fatty acids reduce the inflammation caused by the allergic response in my body, but I have neither data to confirm this theory, nor have I seen any related information. Cheers!
As a lifelong sufferer of allergies and asthma and thus being a mouth-breather, I have had some respite from lining my nasal passages with either Vaseline or Sav-lon (an antibacterial cream) before sleeping at night, and again during the night if I wake up. It does not abate the violent morning sneezing sessions completely, but it seems to help the overall immune system cope a bit better with the onslaught of waking up. Keeping feet the same temperature as they were in bed at all times upon waking - no matter what season - also seems to help. aCHOO.
Perhaps he is allergic to something in or around his bed. I used to have the worst allergies in the morning, but also sometimes at night. It turned out that I had mold inside one of the air ducts that was located right above my head. Dust and animal dander could play a role too if a room is carpeted.
My allergies are worst in the morning. If I wake up an lay in bed I am fine, but when I sit upright, my sinus cavity begins to tingle as my fluids re-adjust. It's that very same tingle which causes the bombardment of sneezes. After my daily morning attack, pretty much anything with a fragrancy smell will irritate my sinus and begin the itchy sneezing fiasco all over again.