Current Allergy and Asthma Reports

, Volume 13, Issue 2, pp 131–141 | Cite as

Impact of Sleep as a Specific Marker of Quality of Life in Allergic Rhinitis

  • Vanesa González-Núñez
  • Antonio Luís Valero
  • Joaquim Mullol


Allergic rhinitis (AR) is a common disorder, which represents a considerable burden both on individual patients and society. It is associated with bothersome symptoms, which may impair usual daily activities, sleep quality, and productivity. Associated with impaired sleep, quality of life is significantly impaired in AR patients. AR significantly contributes to sleep-disordered breathing through multiple mechanisms, with the greatest impact mediated through nasal obstruction. Sleep impairment is very common in AR patients and has a significant impact on disease-specific measures of general health and quality of life. The degree of sleep disturbance is directly related to the severity of the disease. Nasal congestion also demonstrates circadian rhythm and positional variability, worsening during nighttime hours and in supine position. Increased sleep disordered events lead to poor sleep with fatigue and daytime somnolence, impaired performance, productivity and social functioning, and an increased risk of associated diseases.


Sleep Quality of life Allergic rhinitis Quality of sleep Nasal congestion Questionnaire Sleep disturbance Sleep problems Allergy Sleepiness Somnolence Sleep-disordered breathing Stuffy nose Blocked nose Circadian rhythm Nasal symptoms Persistent Intermittent Perennial Seasonal ARIA Daytime fatigue Intranasal corticosteroid Antihistamine 



Dr. Valero has served on boards for Stallergenes, Meda Pharmaceuticals, FAES, and ESTEVE; has received grant support from Uriach; and has received payment for development of educational presentations (including service on speakers’ bureaus) from FAES, Stallergenes, Novartis, and Pfizer.

Dr. Mullol has served on boards for Uriach, Meda Pharmaceuticals, Johnson & Johnson, FAES, and Hartington Pharma; has received grant support from GlaxoSmithKline, Uriach, FAES, and Merck Sharp & Dohme; and has received payment for development of educational presentations (including lectures and service on speakers bureaus) from Uriach, Hartington Pharma, FAES, Novartis, Boehringer-Ingelheim, ESTEVE, Merck Sharp & Dohme, and PIERRE-FABRE.

Dr. Gonzalez-Nuñez reported no potential conflicts of interest relevant to this article.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Bousquet J, Khaltaev N, Cruz A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008. Allergy. 2008;63 Suppl 86:8–160.CrossRefPubMedGoogle Scholar
  2. 2.
    Meltzer EO, Blaiss MS, Derebery J, et al. Burden of allergic rhinitis: results from the Pediatric Allergies in America survey. J Allergy Clin Immunol. 2009;124:S43–70.CrossRefPubMedGoogle Scholar
  3. 3.
    Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004;24:758–64.CrossRefPubMedGoogle Scholar
  4. 4.
    Bachert C, van Cauwenberge P, Olbrecht J, et al. Prevalence, classification and perception of allergic and nonallergic rhinitis in Belgium. Allergy. 2006;61:693–8.CrossRefPubMedGoogle Scholar
  5. 5.
    •• Craig TJ, Sherkat A, Safaee S. Congestion and sleep impairment in allergic rhinitis. Curr Allergy Asthma Rep. 2010;10:113–21. This review examines nasal congestion and the associated sleep impairment of allergic rhinitis patients.CrossRefPubMedGoogle Scholar
  6. 6.
    Meltzer EO, Nathan R, Derebery J, et al. Sleep, quality of life, and productivity impact of nasal symptoms in the United States: findings from the burden of rhinitis in America survey. Allergy Asthma Proc. 2009;30:244–54.CrossRefPubMedGoogle Scholar
  7. 7.
    Bousquet J, Van Cauwenberge P, Khaltaev N, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) in collaboration with the World Health Organization (WHO). J Allergy Clin Immunol. 2001;108:S147–336.CrossRefPubMedGoogle Scholar
  8. 8.
    Valero A, Ferrer M, Baró E, et al. Discrimination between moderate and severe disease may be used in patients with either treated or untreated allergic rhinitis. Allergy. 2010;65:1609–13.CrossRefPubMedGoogle Scholar
  9. 9.
    Valero A, Ferrer M, Sastre J, et al. A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the Allergic Rhinitis and its Impact on Asthma severity items. J Allergy Clin Immunol. 2007;120:359–65.CrossRefPubMedGoogle Scholar
  10. 10.
    Pratt EL, Craig TJ. Assessing outcomes from the sleep disturbance associated with rhinitis. Curr Opin Allergy Clin Immunol. 2007;7:249–56.CrossRefPubMedGoogle Scholar
  11. 11.
    Shedden A. Impact of nasal congestion on quality of life and work productivity in allergic rhinitis. Treat Respir Med. 2005;4:439–46.CrossRefPubMedGoogle Scholar
  12. 12.
    Juniper EF, Guyatt GH. Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis. Clin Exp Allergy. 1991;21:77–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Smolensky M, Reinberg A, Labrecque G. Twenty-four hour pattern in symptom intensity of viral and allergic rhinitis: treatment implications. J Allergy Clin Immunol. 1995;95:1084–96.CrossRefPubMedGoogle Scholar
  14. 14.
    Santos CB, Pratt EL, Hanks C, et al. Allergic rhinitis and its effect on sleep, fatigue, and daytime somnolence. Ann Allergy Asthma Immunol. 2006;97:579–87.CrossRefPubMedGoogle Scholar
  15. 15.
    Reinberg A, Gervais P, Levi F, et al. Circadian and circannual rhythms of allergic rhinitis: an epidemiologic study involving chronobiologic methods. J Allergy Clin Immunol. 1988;81:51–62.CrossRefPubMedGoogle Scholar
  16. 16.
    • Bousquet J, Neukirch F, Bousquet PJ, et al. Severity and impairment of allergic rhinitis in patients consulting in primary care. J Allergy Clin Immunol. 2006;117:158–62. In this study, performed in general practice on a large number of patients with allergic rhinitis, the severity of the rhinitis was having more effect on QOL, sleep, daily activities, and work performance than in the duration.CrossRefPubMedGoogle Scholar
  17. 17.
    Leynaert B, Neukirch C, Liard R, et al. Quality of life in allergic rhinitis and asthma. Am J Respir Crit Care Med. 2000;162:1391–6.PubMedGoogle Scholar
  18. 18.
    Juniper EF, Thompson AK, Ferrie PJ, et al. Validation of the standardized version of the Rhinoconjunctivitis Quality of Life Questionnaire. J Allergy Clin Immunol. 1999;104:364–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Baiardini I, Braido F, Brandi S, et al. Allergic diseases and their impact on quality of life. Ann Allergy Asthma Immunol. 2006;97:419–29.CrossRefPubMedGoogle Scholar
  20. 20.
    Juniper EF, Guyatt GH, Andersson B, et al. Comparison of powder and aerosolized budesonide in perennial rhinitis: validation of rhinitis quality of life questionnaire. Ann Allergy. 1993;70:225–30.PubMedGoogle Scholar
  21. 21.
    Juniper EF, Thompson AK, Ferrie PJ, et al. Development and validation of the Mini Rhinoconjunctivitis Quality of Life Questionnaire. Clin Exp Allergy. 2000;30:132–40.CrossRefPubMedGoogle Scholar
  22. 22.
    Juniper EF, Rohrbaugh T, Meltzer EO. A questionnaire to measure quality of life in adults with nocturnal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2003;111:484–90.CrossRefPubMedGoogle Scholar
  23. 23.
    Santilli J, Nathan R, Glassheim J, et al. Validation of the rhinitis outcomes questionnaire (ROQ). Ann Allergy Asthma Immunol. 2001;86:222–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Baiardini I, Pasquali M, Giardini A, et al. Rhinasthma: a new specific QoL questionnaire for patients with rhinitis and asthma. Allergy. 2003;58:289–94.CrossRefPubMedGoogle Scholar
  25. 25.
    Juniper EF, Howland WC, Roberts NB, et al. Measuring quality of life in children with rhinoconjunctivitis. J Allergy Clin Immunol. 1998;101:163–70.CrossRefPubMedGoogle Scholar
  26. 26.
    Flemons WW, Tsai W. Quality of life consequences of sleep-disordered breathing. J Allergy Clin Immunol. 1997;99:S750–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Bousquet J, Bullinger M, Fayol C, et al. Assessment of quality of life in patients with perennial allergic rhinitis with the French version of the SF-36 Health Status Questionnaire. J Allergy Clin Immnol. 1994;94:182–8.CrossRefGoogle Scholar
  28. 28.
    Juniper EF. Measuring health-related quality of life in rhinitis. J Allergy Clin Immunol. 1997;99:S742–9.CrossRefPubMedGoogle Scholar
  29. 29.
    ESPRINT study group. Development and validation of a new Spanish instrument to measure health-related quality of life in patients with allergic rhinitis: The Esprint Questionnaire. Val Health. 2007;10(6):466–77.CrossRefGoogle Scholar
  30. 30.
    Kremer B, den Hartog HM, Jolles J. Relationship between allergic rhinitis, disturbed cognitive functions and psychological well-being. Clin Exp Allergy. 2002;32:1310–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Blaiss MS. Quality of life in allergic rhinitis. Ann Allergy Asthma Immunol. 1999;83:449–54.CrossRefPubMedGoogle Scholar
  32. 32.
    Kremer B. Quality of life scales in allergic rhinitis. Curr Opin Allergy Clin Immunol. 2004;4:171–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Miraglia Del Giudice M, Marseglia A, Leonardi S, et al. Allergic rhinitis and quality of life in children. Int J Immunopathol Pharmacol. 2011;24(S):25–8.PubMedGoogle Scholar
  34. 34.
    van Oene CM, van Reij JF, Sprangers MAG, et al. Quality-assessment of disease-specific quality of life questionnaires for rhinitis and rhinosinusitis: a systematic review. Allergy. 2007;62:1359–71.CrossRefPubMedGoogle Scholar
  35. 35.
    Stuck BA, Czajkowski J, Hagner A, et al. Changes in daytime sleepiness, quality of life, and objective sleep patterns in seasonal allergic rhinitis: a controlled clinical trial. J Allergy Clin Immunol. 2004;113:663–8.CrossRefPubMedGoogle Scholar
  36. 36.
    •• Colás C, Galera H, Añibarro B, et al. Disease severity impairs sleep quality in allergic rhinitis (The SOMNIAAR study). Clin Exp Allergy. 2012;42:1080–7. This study shows that sleep quality is altered in AR patients, and that a greater severity of AR is correlated with a poorer sleep quality.CrossRefPubMedGoogle Scholar
  37. 37.
    Juniper EF, Guyatt GH, Dolovich J. Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: development and testing of a questionnaire for clinical trials. J Allergy Clin Immunol. 1994;93:413–23.CrossRefPubMedGoogle Scholar
  38. 38.
    Valero A, Alonso J, Antépara I, et al. Health-related quality of life in allergic rhinitis: comparing the short form ESPRINT-15 and MiniRQLQ questionnaires. Allergy. 2007;62(12):1372–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Valero A, Baró E, Sastre J, et al. Reference values for facilitating the interpretation of the ESPRINT-15 questionnaire (Spanish version). J Investig Allergol Clin Immunol. 2009;19(5):396–403.PubMedGoogle Scholar
  40. 40.
    Vuurman EF, van Veggel LM, Uiterwijk MM, et al. Seasonal allergic rhinitis and antihistamine effects on children’s learning. Ann Allergy. 1993;71(2):121–6.PubMedGoogle Scholar
  41. 41.
    Léger D, Annesi-Maesano I, Carat F, et al. Allergic rhinitis and its consequences on quality of sleep. Arch Intern Med. 2006;166:1744–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Soose RJ. Role of allergy in sleep-disordered breathing. Otolaryngol Clin N Am. 2011;44:625–35.CrossRefGoogle Scholar
  43. 43.
    Hoddes E, Zarcone V, Smythe H, et al. Quantification of sleepiness: a new approach. Psychophysiology. 1973;10:431–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Jenkins CD, Stanton BA, Niemcryk SJ, et al. A scale for the estimation of sleep problems in clinical research. J ClinEpidemiol. 1988;41:313–21.CrossRefGoogle Scholar
  45. 45.
    Lallukka T, Dregan A, Armstrong D. Comparison of a sleep item from the General Health Questionnaire-12 with the Jenkins Sleep Questionnaire as measures of sleep disturbance. J Epidemiol. 2011;21:474–80.CrossRefPubMedGoogle Scholar
  46. 46.
    Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.CrossRefPubMedGoogle Scholar
  47. 47.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14:540–5.PubMedGoogle Scholar
  48. 48.
    Weaver TE, Laizner AM, Evans LK, et al. An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep. 1997;20:835–43.PubMedGoogle Scholar
  49. 49.
    Hays RD, Martin SA, Sesti AM, et al. Psychometric properties of the Medical Outcomes Study Sleep measure. Sleep Med. 2005;6:41–4.CrossRefPubMedGoogle Scholar
  50. 50.
    Chervin RD, Hedger K, Dillon JE, et al. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000;1:21–31.CrossRefPubMedGoogle Scholar
  51. 51.
    • Ishman SL, Smith DF, Benke JR, et al. The prevalence of sleepiness and the risk of sleep-disordered breathing in children testing positive for allergy. Int Forum Allergy Rhinol. 2012;2:139–43. This study suggests that children with AR are at increased risk for sleep-disordered breathing.CrossRefPubMedGoogle Scholar
  52. 52.
    Drake C, Nickel C, Rothe T, et al. The pediatric daytime sleepiness scale (PDSS): sleep habits and school outcome in middle-school children. Sleep. 2003;26:455–8.PubMedGoogle Scholar
  53. 53.
    Baiardini I, Braido F, Cauglia S, et al. Sleep disturbances in allergic diseases. Allergy. 2006;61:1259–67.CrossRefPubMedGoogle Scholar
  54. 54.
    • Sardana N, Craig TJ. Congestion and sleep impairment in allergic rhinitis. Asian Pac J Allergy Immunol. 2011;29:297–306. This review examines nasal congestion and the associated sleep impairment in allergic rhinitis.PubMedGoogle Scholar
  55. 55.
    Gurevich F, Glass C, Davies M, et al. The effect of intranasal steroid budesonide on the congestion-related sleep disturbance and daytime somnolence in patients with perennial allergic rhinitis. Allergy Asthma Proc. 2005;26:268–74.PubMedGoogle Scholar
  56. 56.
    Lavie P, Gertner R, Zomer J, et al. Breathing disorders in sleep associated with “microarousals” in patients with allergic rhinitis. Acta Otolaryngol. 1981;92:529–33.CrossRefPubMedGoogle Scholar
  57. 57.
    Young T, Finn L, Kim H. Nasal obstruction as a risk factor for sleep-disordered breathing. J Allergy Clin Immunol. 1997;99:S757–62.CrossRefPubMedGoogle Scholar
  58. 58.
    Craig TJ, Teets S, Lehman E, et al. Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids. J Allergy Clin Immunol. 1998;101:633–7.CrossRefPubMedGoogle Scholar
  59. 59.
    Young T, Finn L, Palta M. Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study. Arch Intern Med. 2001;161:1514–9.CrossRefPubMedGoogle Scholar
  60. 60.
    Krouse HJ, Davis JE, Krouse JH. Immune mediators in allergic rhinitis and sleep. Otolaryngol Head Neck Surg. 2002;126:607–13.CrossRefPubMedGoogle Scholar
  61. 61.
    Craig TJ, Mende C, Hughes K, et al. The effect of topical nasal fluticasone on objective sleep testing and the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis. Allergy Asthma Proc. 2003;24:53–8.PubMedGoogle Scholar
  62. 62.
    Hughes K, Glass C, Ripchinski M, et al. Efficacy of the topical nasal steroid budesonide on improving sleep and daytime somnolence in patients with perennial allergic rhinitis. Allergy. 2003;58:380–5.CrossRefPubMedGoogle Scholar
  63. 63.
    Benninger MS, Benninger RM. The impact of allergic rhinitis on sexual activity, sleep, and fatigue. Allergy Asthma Proc. 2009;30:358–65.CrossRefPubMedGoogle Scholar
  64. 64.
    Stull DE, Schaefer M, Crespi S, et al. Relative strength of relationships of nasal congestion and ocular symptoms with sleep, mood and productivity. Curr Med Res Opin. 2009;25:1785–92.CrossRefPubMedGoogle Scholar
  65. 65.
    Yuksel H, Sogut A, Yilmaz H, et al. Sleep actigraphy evidence of improved sleep after treatment of allergic rhinitis. Ann Allergy Asthma Immunol. 2009;103:290–4.CrossRefPubMedGoogle Scholar
  66. 66.
    Meltzer EO, Munafo DA, Chung W, et al. Intranasal mometasone furoate therapy for allergic rhinitis symptoms and rhinitis-disturbed sleep. Ann Allergy Asthma Immunol. 2010;105:65–74.CrossRefPubMedGoogle Scholar
  67. 67.
    Meng J, Xuan J, Qiao X, et al. Assessment of sleep impairment in persistent allergic rhinitis patients using polysomnography. Int Arch Allergy Immunol. 2011;155:57–62.CrossRefPubMedGoogle Scholar
  68. 68.
    Sherkat AA, Sardana N, Safaee S, et al. The role of pseudoephedrine on daytime somnolence in patients suffering from perennial allergic rhinitis (PAR). Ann Allergy Asthma Immunol. 2011;106:97–102.CrossRefPubMedGoogle Scholar
  69. 69.
    Yamada T, Yamamoto H, Kubo S, et al. Efficacy of mometasone furoate nasal spray for nasal symptoms, quality of life, rhinitis-disturbed sleep, and nasal nitric oxide in patients with perennial allergic rhinitis. Allergy Asthma Proc. 2012;33:e9–e16.CrossRefPubMedGoogle Scholar
  70. 70.
    Chivato T, Valovirta E, Dahl R, et al. Allergy, living and learning: diagnosis and treatment of allergic respiratory diseases in Europe. J Investig Allergol Clin Immunol. 2012;22:168–79.PubMedGoogle Scholar
  71. 71.
    Blaiss M, Reigel T, Philpot E. A study to determine the impact of rhinitis on sufferers’ sleep and daily routine [abstract 787]. J Allergy Clin Immunol. 2005;115:S197.CrossRefGoogle Scholar
  72. 72.
    Kakumanu S, Glass C, Craig T. Poor sleep and daytime somnolence in allergic rhinitis: significance of nasal congestion. Am J Respir Med. 2002;1(3):195–200.CrossRefPubMedGoogle Scholar
  73. 73.
    McNicholas WT, Tarlo S, Cole P, et al. Obstructive sleep apneas during sleep in patients with seasonal allergic rhinitis. Am Rev Respir Dis. 1982;126:625–8.PubMedGoogle Scholar
  74. 74.
    Rappai M, Collop N, Kemp S, et al. The nose and sleep-disordered breathing. What we do not know. Chest. 2003;124:2309–23.CrossRefPubMedGoogle Scholar
  75. 75.
    Modrzynski M, Zawisza E. An analysis of the incidence of adenoid hypertrophy in allergic children. Int J Pediatr Otorhinolaryngol. 2007;71:713–9.CrossRefPubMedGoogle Scholar
  76. 76.
    Craig TJ, Ferguson BJ, Krouse JH. Sleep impairment in allergic rhinitis, rhinosinusitis, and nasal polyposis. Am J Otolaryngol. 2008;29:209–17.CrossRefPubMedGoogle Scholar
  77. 77.
    Zwillich CW, Picket C, Hanson FN, et al. Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Am Rev Respir Dis. 1981;124(2):158–60.PubMedGoogle Scholar
  78. 78.
    Anuntaseree W, Rookkapan K, Kuasirikul S, et al. Snoring and obstructive sleep apnea in Thai scool-age children: prevalence and predisposing factors. Pediatr Pulmonol. 2001;32:222–7.CrossRefPubMedGoogle Scholar
  79. 79.
    Chng SY, Goh DY, Wang XS, et al. Snoring and atopic disease: a strong association. Pediatr Pulmonol. 2004;38:210–6.CrossRefPubMedGoogle Scholar
  80. 80.
    Kalra M, Lemasters G, Bernstein D, et al. Atopy as a risk factor for habitual snoring at age 1 year. Chest. 2006;129:942–6.CrossRefPubMedGoogle Scholar
  81. 81.
    McCollley SA, Carroll JL, Curtis S, et al. High prevalence of allergic sensitization in children with habitual snoring and obstructive sleep apnea. Chest. 1997;111:170–3.CrossRefGoogle Scholar
  82. 82.
    Mullol J, Maurer M, Bousquet J. Sleep and allergic rhinitis. J Investig Allergol Clin Immunol. 2008;18:415–9.Google Scholar
  83. 83.
    Craig TJ, Hanks CD, Fisher LH. How do topical nasal corticosteroids improve sleep and daytime somnolence in allergic rhinitis? J Allergy Clin Immunol. 2005;116:1264–6.CrossRefPubMedGoogle Scholar
  84. 84.
    Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review or randomized controlled trials. BMJ. 1998;317:1624–9.CrossRefPubMedGoogle Scholar
  85. 85.
    Bender BG, Milgrom H. Comparison of the effects of fluticasone propionate aqueous nasal spray and loratadine on daytime alertness and performance in children with seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2004;92:344–9.CrossRefPubMedGoogle Scholar
  86. 86.
    Brozek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010. J Allergy Clin Immunol. 2010;126:466–7.CrossRefPubMedGoogle Scholar
  87. 87.
    Potter PC, Van Niekerk CH, Schoeman HS. Effects of triamcinolone on quality of life in patients with persistent allergic rhinitis. Ann Allergy Asthma Immunol. 2003;91:368–74.CrossRefPubMedGoogle Scholar
  88. 88.
    Mintz M, Garcia J, Diener P, et al. Triamcinolone acetonide aqueous nasal spray improves nocturnal rhinitis-related quality of life in patients treated in a primary care setting: the Quality of Sleep in Allergic Rhinitis study. Ann Allergy Asthma Immunol. 2004;92:255–61.CrossRefPubMedGoogle Scholar
  89. 89.
    Mansfield LE, Posey CR. Daytime sleepiness and cognitive performance improve in seasonal allergic rhinitis treated with intranasal fluticasone propionate. Allergy Asthma Proc. 2007;28:226–9.CrossRefPubMedGoogle Scholar
  90. 90.
    Valero A, Izquierdo I, Giralt J, et al. Rupatadine improves nasal symptoms, quality of life (ESPRINT-15) and severity in a subanalysis of a cohort of Spanish allergic rhinitis patients. J Investig Allergol Clin Immunol. 2011;21(3):229–35.PubMedGoogle Scholar
  91. 91.
    Katayose Y, Aritake S, Kitamura S, et al. Carryover effect on next-day sleepiness and psychomotor performance of nighttime administered antihistaminic drugs: a randomized controlled trial. Hum Psychopharmacol Clin Exp. 2012;27:428–36.CrossRefGoogle Scholar
  92. 92.
    Milgrom H, Biondi R, Georgitis JW, et al. Comparison of ipratropium bromide 0.03 % with beclomethasone dipropionate in the treatment of perennial rhinitis in children. Ann Allergy Asthma Immunol. 1999;83:105–11.CrossRefPubMedGoogle Scholar
  93. 93.
    Cingi C, Ozlugedik S. Effects of montelukast on quality of life in patients with persistent allergic rhinitis. Otolaryngol Head Neck Surgery. 2010;142:654–8.CrossRefGoogle Scholar
  94. 94.
    Meltzer EO, Malmstrom K, Lu S, et al. Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a randomized, placebo-controlled clinical trial. J Allergy Clin Immunol. 2000;105:917–22.CrossRefPubMedGoogle Scholar
  95. 95.
    Ferguson BJ. Influences of allergic rhinitis on sleep. Otolaryngol Head Neck Surg. 2004;130:617–29.CrossRefPubMedGoogle Scholar
  96. 96.
    Jáuregui I, Mullol J, Bartra J, et al. H1 antihistamines: psychomotor performance and driving. J Investig Allergol Clin Immunol. 2006;16:S37–44.Google Scholar
  97. 97.
    Montoro J, Mullol J, Dávila I, et al. Bilastine and the central nervous system. J Investig Allergol Clin Immunol. 2011;S3:9–15.Google Scholar
  98. 98.
    Fang BJ, Tonelli LH, Soriano JJ, et al. Disturbed sleep: linking allergic rhinitis, mood and suicidal behavior. Front Biosci. 2010;2:30–46.CrossRefGoogle Scholar
  99. 99.
    Smolensky M, di Milia L, Ohayon MM, et al. Sleep disorders, medical conditions, and road accident risk. Accid Anal Prev. 2011;43:533–48.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Vanesa González-Núñez
    • 1
  • Antonio Luís Valero
    • 2
  • Joaquim Mullol
    • 3
  1. 1.Department of AllergologyHospital Quirón. BarcelonaCataloniaSpain
  2. 2.Allergy Unit, Department of Pneumology and Respiratory Allergy, ICT, Hospital Clínic i UniversitariInstitut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); and CIBER de Enfermedades Respiratorias (CIBERES)BarcelonaSpain
  3. 3.Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clínic i UniversitariInstitut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); and CIBER de Enfermedades Respiratorias (CIBERES)BarcelonaSpain

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