Circadian rhythm of cutaneous hypersensitivity reactions in nocturnal asthma

Diurnal variation in mast cell discharge may play a central role in the early morning fall in peak expiratory flow rate (PEFR) in nocturnal asthmatic patients.

We tested the hypothesis that there is a circadian rhythm in mast cell response to allergen in 15 patients with nocturnal asthma by measuring the magnitude of cutaneous hypersensitivity reactions at 0600, 1200, 1800, and 2400 hours. Pre-admission, prick skin testing on the ventral aspect of the forearm to various allergens was performed. The allergen producing the largest wheal was tested at six sites on one forearm. Response was quantified after 20 minutes by measuring the area of the wheal produced using planimetry. Every six hours the skin testing was repeated at six new sites on alternating forearms. The average area of the six wheals was calculated and recorded at each time. The prick skin technique was used at all times.

Maximal reactions occurred in 10 of the 15 patients at noon (P = .031, Friedman's two way analysis of variance). In these 10 patients wheal area at the time of maximum reactivity was on average 3.3-fold higher than at the time of minimum reactivity. The mean wheal areas for all 15 patients at 0600, 1200, 1800, and 2400 hours were 34 mm2, 42 mm2, 34 mm2, and 35 mm2 respectively.

These observations support the concept of a circadian rhythm in mast cell activity in patients with severe nocturnal asthma.