丽江市大气花粉分布及其与变态反应性疾病的关系

目的为探明丽江市空气中花粉飘散特点,为当地变态反应性疾病患者提供特异性诊断、治疗和预防的依据。方法采用重力沉淀法,于2007年11月1日至2009年10月31日对丽江市进行连续2年的大气花粉曝片调查,同时对470例变态反应性疾病患者进行花粉变应原皮试,并询问发病季节。结果丽江市空气中常年有花粉飘散,两年共收到孢粉63027粒,已鉴定79个科属种;每年出现两次高峰,即3-5月和9-10月。花粉变应原皮试阳性率77.87%,春季主要致敏花粉为黎、油菜、松、柏,秋季主要致敏花粉为蒿、旱冬瓜,蒿属花粉为丽江市致敏性最强的花粉。变态反应性疾病的发生与花粉的数量和种类相关,发病季节与花粉飘散特点相吻合。结论花粉是丽江市变态反应性疾病的主要致敏原之一。     

气传变应原对呼吸道过敏性疾病的影响

过敏性疾病的患病率在全球范围内呈逐年增高的趋势,欧美发达国家过敏性疾病的发病率已达到25%～40%.过敏性疾病可严重影响患者的生活质量,也会造成巨大的经济损失,因而已成为严重的公众健康问题.气传变应原如花粉颗粒、真菌孢子、尘螨、动物排泄物等是过敏性疾病的重要诱因,其浓度与过敏性疾病症状严重程度明显相关.     

Diesel fumes and the rising prevalence of atopy: An urban legend?

Recently, the incidence of allergic diseases has increased in most industrialized countries of the world. Persistent exposure to particulate air pollution from motor vehicles has been implicated as one of the factors that is responsible for the observed increased prevalence of atopy. Epidemiologic studies conducted in different parts of the world have demonstrated an important association between ambient levels of motor vehicle traffic emissions and increased symptoms of asthma and rhinitis. Additionally, recent human and animal laboratory-based studies have shown that particulate toxic pollutants, and in particular diesel exhaust particles (DEP), can enhance allergic inflammation and induce the development of allergic immune responses. In this article, our current understanding of the mechanisms by which pollutants such as DEPs enhance the underlying allergic inflammatory response is reviewed, and the evidence that supports the causative link between particulate air pollution from motor vehicles and increasing allergic diseases is discussed.     

Serum levels of soluble CD23 in patients with asthma or rhinitis monosensitive to Parietaria. Its relation to total serum IgE levels and eosinophil cationic protein during and out of the pollen season.

The diagnostic value for allergies of the low affinity IgE receptor and its soluble circulating fragment (sCD23) remains unclear. In particular, little is know about seasonal influences on serum sCD23 levels in subjects with pollen allergy. In the present study, to gain insight into pathophysiological role of sCD23, we have analyzed, in blood from patients allergic to Parietaria sCD23, IgE, and eosinophil cationic protein (ECP) serum levels. IgE were assessed as atopy markers and ECP as an inflammation marker. Patients were studied during and out of pollen season, and results were compared to those obtained in nonallergic subjects. The study population included 42 nonsmoking outpatients, living in Palermo (Sicily, Italy) or in other west Sicilian towns, with a clinical diagnosis of seasonal asthma or rhinitis and monopositive skin test to Parietaria pollen. The group of asthmatic subjects consisted of 25 patients who had one or more of the usual asthma symptoms (wheezing, dyspnea, and cough) only during the pollen season. The group of rhinitis patients consisted of 17 patients, who, during pollen season, had the nasal symptoms (nasal blockage, sneezing, nasal itching, and rhinorrhoea) but no signs of asthma. As a control group, we studied 10 nonatopic subjects from laboratory staff. They had no history of seasonal or perennial rhinitis, asthma, or urticaria and had negative skin tests to a panel of allergens. Soluble CD23, IgE, and ECP were assessed in blood during and out of pollen season. Total serum IgE levels were clearly higher in atopic patients, as classically established. Concerning sCD23 serum levels, a similar pattern of results was obtained. Accordingly, significant correlations were shown between the levels of sCD23 and IgE in all groups of patients. A completely different pattern was observed by analyzing serum ECP levels because ECP levels were significantly increased only in asthmatic patients during pollen season. Accordingly, no significant correlations were observed between the levels of sCD23 and those of ECP. Identifying immune factors associated with the development of atopy can enhance our understanding of the in vivo mechanisms involved and may have utility in paradigms designed to prevent diseases. As demonstrated by the close correlation with total serum IgE values and the lack of correlation with serum ECP values, serum levels of sCD23 appear to be an additional marker for the diagnosis of atopy but not for the follow-up of allergic diseases.     

Month of birth, atopic disease, and atopic sensitization.

BACKGROUND: Japanese cedar (Cryptmeria japonica; CJ) pollen and house dust mites are the two important aeroallergens in Japan. However, no epidemiological survey has been performed in Japan to investigate the relationship between month of birth and manifestations of allergic disease and sensitization. OBJECTIVE: This study evaluates the correlation between month of birth and sensitization to aeroallergens or the occurrence of allergic disease on 755 Japanese school children aged 12-13 years. METHODS: The personal history of atopic disease (bronchial asthma, allergic rhinitis, eczema, and allergic conjunctivitis) as recorded by questionnaires was investigated in relation to total serum IgE and specific IgE toward house dust mites and CJ pollen. RESULTS: Positive specific IgE toward house dust mites was significantly less prevalent in the children born between January and March than those born during the rest of the year (p < 0.01). Positive specific IgE toward CJ pollen was significantly more prevalent in the children born between December and January than those born during the rest of the year (p < 0.05). High total IgE was less prevalent in the children born between February and April than in children born during the rest of the year (p = 0.05). The prevalence of bronchial asthma was 26.2% among children born between November and December, compared with a ratio of 17.3% among children born during the rest of the year (p < 0.05). A significantly higher proportion of the children with allergic rhinitis was born between August and October than during the rest of the year (p < 0.05). The prevalence of allergic conjunctivitis was 15.8% among the children who were born between December and January, compared with 9.1% among children born during the rest of the year (p < 0.01). No relationship between prevalence of eczema and season of birth was found. CONCLUSION: Month of birth appears to influence the risk in the development of allergic sensitization and atopic diseases. The findings concerning higher CJ pollen sensitization in children born in the months that proceed the CJ pollen seasons are as evident as the house-dust-mite-related findings.     

Symptoms of the olive pollen allergy: do they really occur only in the pollination season?

BACKGROUND: Olive (Olea europaea; O.e.) pollen is a major cause of seasonal respiratory allergy. The O.e. pollination season lasts two months from the beginning of May till the end of June. It was expected that patients with allergic disease from O.e. sensitization were symptomatic only during this period. However, during the last few years, we have observed that the clinical symptoms appear not only during the O.e. pollination season but also during the rest of the year. OBJECTIVE: The aim of this study was to observe and document symptoms of respiratory allergic diseases in the O.e. sensitized patients during the O.e. pollination season and after it. METHODS: One hundred and twenty-seven patients with respiratory allergic disease were enrolled in the study. Allergenic sensitizations were shown by SPT. Finally, patients were split into two groups as monosensitized with O.e. (n=19) and polysensitized (n=108). Patients were assessed by using scores of respiratory allergic disease symptoms and percentage of peak expiratory flow rate values (PEFR %) (only for asthmatic patients) during the O.e. pollination season and after it. RESULTS: Of the patients with O.e. monosensitization, 13 had allergic rhinitis (AR) only while six had allergic asthma (AA) additionally. AR alone and accompanied by AA was present in 84 and 24 polysensitized patients respectively. Eleven patients with O.e. sensitization (57.9 %) and 86 patients with polysensitization (79.6 %) had AR symptoms throughout the year irrespective of the O.e. pollination season. Similarly, three of the O.e. monosensitized and ten of the polysensitized patients with AA had asthmatic symptoms during the O.e. pollination season and also after it. CONCLUSIONS: In the patient group sensitive to O.e. along with other pollen extracts, it was possible to observe symptoms outside the pollination season. However, patients with O.e. monosensitization also had symptoms to a great extent outside the season.     

Modifications of airway responsiveness to adenosine 5'-monophosphate and exhaled nitric oxide concentrations after the pollen season in subjects with pollen-induced rhinitis

STUDY OBJECTIVE:s: To determine the effect of cessation of exposure to pollen on airway responsiveness to adenosine 5'-monophosphate (AMP) in subjects with pollen-induced rhinitis, and to explore the relationship between changes in airway responsiveness and changes in exhaled nitric oxide (ENO) levels. STUDY DESIGN: Subjects were studied during the pollen season and out of season. SETTING: Specialist allergy unit in a university hospital. PATIENTS: Fourteen subjects without asthma with pollen-induced rhinitis who showed bronchoconstriction in response to methacholine and AMP during the pollen season and 10 healthy nonatopic control subjects. MEASUREMENTS AND RESULTS: In subjects with pollen-induced rhinitis, ENO concentrations, provocative concentration of agonist causing a 20% fall in FEV(1) (PC(20)) methacholine, and PC(20) AMP were determined during the pollen season and out of season. Healthy control subjects were studied during the pollen season. In subjects with allergic rhinitis, PC(20) AMP increased from a geometric mean of 79.4 mg/mL (95% confidence interval [CI], 31.6 to 199.5 mg/mL) during the pollen season to 316.2 mg/mL (95% CI, 158.5 to 400.0 mg/mL) out of season (p = 0.004). The ENO concentrations decreased from 63.1 parts per billion (ppb) [95% CI, 50.1 to 79.4 ppb] during the pollen season to 30.2 ppb (95% CI, 23.4 to 38.0 ppb) out of season (p < 0.001). The ENO concentrations out of pollen season were still significantly increased in subjects with pollen-induced rhinitis when compared with healthy control subjects. There was no relationship between individual changes in ENO levels and changes in either PC(20) methacholine or PC(20) AMP. CONCLUSIONS: In pollen-sensitive subjects with allergic rhinitis, the cessation of exposure to pollen is associated with a significant reduction of airway responsiveness to inhaled AMP. However, no association was found between allergen-induced changes in ENO values and in airway responsiveness to either direct or indirect bronchoconstrictors. These findings suggest that modifications in ENO and in airway responsiveness are the consequence of different alterations induced by allergen exposure on the lower airways.     

雷暴哮喘

在过去的30余年,全球范围内关于雷暴相关严重哮喘发作事件的报道逐年增加,主要集中于澳大利亚、英国。这种因天气因素导致的哮喘发作或加重多发生于花粉季节,认为与花粉或霉菌过敏有关。雷暴哮喘发生机制可能是花粉颗粒在雷暴天气时溶胀、崩解释放大量具有变应原性的碎片,使空气中变应原浓度短时间内明显升高,气道高反应个体暴露后出现哮喘症状。花粉或霉菌导致的过敏性鼻炎、哮喘患者是雷暴哮喘的高危人群。了解雷暴哮喘有助于对其预防,并降低其对患者生命健康及公共卫生服务的危害。     

Seasonal Changes in Platelet Activity in Pollen-Induced Seasonal Allergic Rhinitis and Asthma

Background. Previously we reported that patients sensitized to pollen-allergens who had seasonal allergic rhinitis and seasonal asthma may show increased plasma levels of platelet activation markers during grass pollen season. Objective. To find out whether the pattern of platelet activity measured by plasma PF-4 level in the same group of patients changed off-season compared with the pollen season as well as in comparison with healthy control subjects. Methods. Off-pollen season, plasma PF-4 level was determined by enzyme-linked immunosorbent assay (ELISA) in 16 grass pollen allergic patients who had seasonal allergic rhinitis and seasonal asthmatic symptoms (none of them had any history of allergic diseases outside the season) and in 29 healthy nonatopic subjects. Results. Plasma PF-4 level in the patients off–pollen season was significantly lower as compared with the season and did not differ significantly as compared to the healthy subjects. Conclusions. This observation taken along with our previous results indicates that patients with seasonal allergic rhinitis and asthma symptoms may have an increased circulating platelet activation, yet this phenomenon disappears in the asymptomatic period of the disease. This might indicate that platelet activation within the systemic circulation is an important factor in the development of seasonal allergic airway inflammation.     

Ragweed in France and the Rhône-Alpes region (Lyon,Bourgoin, Grenoble,Roussillon

Ragweed in France is a rather recent pollen which causes strong allergies on the populations concerned. This pollen, mainly located in the area Rhone-Alpes, extend more and more on totality of France. Indeed, the pollinic data highlight the presence of ragweed on all the territory with very low, as for Brittany, to several hundreds grains in the area of Rhone-Alpes. So four towns of this area have followed closely the extend of this pollen during the year 2002 through five pollen-traps (2 for the town of Lyon). The trap of Lyon I (Gerland) made it possible to follow temporal the extend of ragweed from 1987 to 2002 and the increase of the number of grains as that of the number of days with a significant allergic risk. The study shows also the differences in quantity of pollens, the differences between the daily allergic risks of the five sites, as well as the differences, between the cities, of the number of days when the allergic risk is significant. It is necessary that pollen of ragweed can be followed closely because of its strong allergenic capacity, in the area of Rhone-Alpes, where the plant prevails mainly, but also on the totality of the own territory, this to supervise its evolution and the speed of proliferation of the plant.     

变态反应性疾病变应原的体内外诊断及分析

目的 应用变应原皮肤点刺试验(SPT)分析西安地区不同变态反应性疾病的主要变应原,同时应用UniCAP 100检泓血清特异性免疫球蛋白E(IgE),并对结果进一步评价.方法 我院变态反应门诊就诊的变态反应性疾病患者679例,选用19种常见的变应原进行SPT,比较不同疾病患者主要变应原阳性率的异同;其中116例患者同时抽取静脉血检测血清粉尘螨特异性IgE,并与SPT结果比较.结果 ①在所有变态反应性疾病患者中,粉尘螨、屋尘螨均是最主要的变应原,总的阳性率分别是49.78%和43.00%,其次依次为蒿属花粉、霉菌、悬铃木属花粉和树Ⅰ花粉等,总阳性率均在10%以上,上述变应原是西安地区变态反应性疾病的主要变应原;②羽毛、鸡蛋、牛奶、蒿属、虾和花生6种变应原的阳性率在4种变态反应性疾病组间比较差异有统计学意义(P<0.05),其余变应原的阳性率在各组间差异无统计学意义,哮喘及过敏性鼻炎组患者的主要变应原以吸入性变应原为主,而荨麻疹组及过敏性紫癜组患者的主要变应原除以上吸入变应原外,还包括鸡蛋、牛奶、虾和花生等食人性变应原;③以血清特异性IgE为标准,以"+++及以上"为SPT阳性标准时的诊断价值高于以"++及以上"为SPT阳性标准,且IgE定量与SPT风团直径呈对数关系(r=0.629,P<0.05).结论 粉尘螨、屋尘螨、蒿属花粉、霉菌、悬铃木属花粉和树Ⅰ花粉等变应原是西安地区变态反应性疾病的主要变应原;不同疾病的主要变应原稍有不同;IgE定量与SPT风团直径呈对数关系,两者检测结果可以互补.     

西安市气传花粉变应原20年变化特点研究

目的明确西安市20年来优势气传花粉的变化特点,为当地花粉症的防治及环保治理气传花粉污染提供依据。方法调查和研究20082010年西安市气传花粉种类、数量和随季节消长的规律,并与19901992年的研究结果进行比较。在西安市分别设置3处花粉取样点,采用Durham重量玻片法取样,并对所收集花粉的形态进行观察和鉴定;每日进行气象资料的观测和记录;进行野外植被调查,制作植物标本及标准花粉片;对门诊确诊的过敏性哮喘患者进行花粉变应原筛查。结果 3处花粉取样点3年来共收集花粉42138粒,其中市中心13309粒、东郊13914粒、西郊14915粒,可归为32科、41属、33种,每月都有花粉飘逸,并形成了3～5月和8～9月2个花粉飘逸高峰;植被调查发现西安市绿化植物以杨树、法桐、松树、柳树、柏树等树木为主,杂草以艾蒿、葎草、藜草、禾本科等草本植物为主;3年来共给501例过敏性哮喘患者进行花粉变应原筛查,抗原阳性率依次为艾蒿、法桐、藜草、葎草。结论 20年来,西安市的气传花粉种类及飘散时间无明显变化,而飘逸数量明显减少;城市绿化树木的数量及品种均比过去有所增加,特别是法桐,在近20年中,作为绿化树木被广泛种植,而郊区庄稼作物及杂草明显减少;艾蒿、葎草、藜草等花粉依然是主要变应原,而法桐过敏阳性率明显升高。     

Urban air pollution at the crossroads of the allergic pandemic

In these past decades an important increase in the prevalence of allergic respiratory diseases has been documented in most countries of the world with large differences being reported within different areas, particularly in industrialized countries. Persistent environmental exposure to particulate air pollution from motor vehicles has been suggested to be an important factor contributing to the observed increased prevalence of allergic diseases. Data from various investigators in different parts of the world have shown an important association between environmental levels of motor vehicle exhaust emissions and increased symptoms of asthma and rhinitis. In addition, recent human and animal laboratory-based studies have shown that particulate toxic pollutants, and especially diesel exhaust particles, can enhance allergic inflammation and induce the development of allergic immune responses. This article reviews the current state of knowledge on the role of diesel exhaust particles in the susceptibility to allergy. It scrutinizes the epidemiological evidence that supports the causative link between particulate air pollution from motor vehicles and the increasing prevalence in allergic conditions and the immunologic mechanisms by which diesel exhaust particles enhance the susceptibility to allergy.     

北京地区门诊患者常见吸入过敏原致敏谱

目的 了解北京地区过敏性疾病常见吸入过敏原致敏谱,探讨国产过敏原皮肤点刺试验(skin prick test,SPT)试剂的安全性.方法 选取2017年1月至2020年7月就诊于本科门诊可疑过敏性鼻炎、过敏性哮喘和过敏性鼻炎合并哮喘的患者,采用32种吸入过敏原试剂进行SPT,比较年龄和疾病变应原分布,观察评价国产SPT...     

Alpha2-macroglobulin and eosinophil cationic protein in the allergic airway mucosa in seasonal allergic rhinitis.

As previously demonstrated in seasonal allergic rhinitis, increased microvascular permeability and eosinophil activation are key features of allergic airway inflammation. In the present study, the hypothesis that exudation of alpha2-macroglobulin may cause the appearance of eosinophil cationic protein (ECP) in the airway lumen was explored. Nasal lavages were carried out using the nasal pool device before and during the pollen season both at baseline and after histamine challenge in 10 children with allergic rhinitis. Nasal lavage fluid levels of alpha2-macroglobulin and ECP were determined. All patients experienced nasal symptoms of allergic rhinitis during the pollen season (p<0.01-0.05). Baseline nasal lavage fluid levels of alpha2-macroglobulin and ECP were increased during the season (p<0.01-0.05) and were found to be well correlated (p<0.0001). Histamine produced concentration-dependent plasma exudation before and during the pollen season, but it was only during the pollen season that this caused an increase in the lavage fluid levels of ECP (p<0.05). These data suggest that exudation of plasma and increased tissue levels and output of eosinophil cationic protein characterize nasal mucosal inflammation in children with seasonal allergic rhinitis. The plasma exudation process in part may account for lumenal entry of eosinophil cationic protein molecules that have been released in mucosal tissue compartments. A combination of induced exudation and nasal lavage may improve the yield of important markers of inflammation in studies of nasal diseases.     

Exhaled and nasal NO levels in allergic rhinitis: relation to sensitization, pollen season and bronchial hyperresponsiveness.

Exhaled nitric oxide is a potential marker of lower airway inflammation. Allergic rhinitis is associated with asthma and bronchial hyperresponsiveness. To determine whether or not nasal and exhaled NO concentrations are increased in allergic rhinitis and to assess the relation between hyperresponsiveness and exhaled NO, 46 rhinitic and 12 control subjects, all nonasthmatic nonsmokers without upper respiratory tract infection, were randomly selected from a large-scale epidemiological survey in Central Norway. All were investigated with flow-volume spirometry, methacholine provocation test, allergy testing and measurement of nasal and exhaled NO concentration in the nonpollen season. Eighteen rhinitic subjects completed an identical follow-up investigation during the following pollen season. Exhaled NO was significantly elevated in allergic rhinitis in the nonpollen season, especially in perennially sensitized subjects, as compared with controls (p=0.01), and increased further in the pollen season (p=0.04), mainly due to a two-fold increase in those with seasonal sensitization. Nasal NO was not significantly different from controls in the nonpollen season and did not increase significantly in the pollen season. Exhaled NO was increased in hyperresponsive subjects, and decreased significantly after methacholine-induced bronchoconstriction, suggesting that NO production occurs in the peripheral airways. In allergic rhinitis, an increase in exhaled nitric oxide on allergen exposure, particularly in hyperresponsive subjects, may be suggestive of airway inflammation and an increased risk for developing asthma.     

Bronchial hyperreactivity and spirometric impairment in patients with seasonal allergic rhinitis

We previously demonstrated in a group of patients with perennial allergic rhinitis alone, impairment of spirometric parameters and high percentage of bronchial hyperreactivity (BHR). Thus, the present study aimed at evaluating a group of subjects suffering from seasonal allergic rhinitis alone to investigate the presence of spirometric impairment and BHR both during and outside the pollen season. METHODS: One-hundred rhinitics sensitized to pollen allergens only were evaluated during and outside the pollen season. Spirometry and methacholine bronchial challenge were performed. RESULTS: Four rhinitics showed impaired values of FEV1 without referred symptoms of asthma during the pollen season. FEF 25-75 values were impaired in 17 rhinitics during the pollen season and in 11 rhinitics outside the pollen season (P<0.05). Fifty-four patients showed positive methacholine bronchial challenge both during and outside the pollen season. PD20/FEV1 methacholine was lower during the pollen season than outside (P<0.05). In BHR positive patients, reduced values of FVC (P<0.05), FEV1 (P<0.05), and FEF 25-75 (P<0.01) were significantly demonstrated in comparison with BHR negative rhinitics. There was a relationship between BHR degree and FEF 25-75 values only during the pollen season (P<0.001). CONCLUSIONS: This study evidences that an impairment of spirometric parameters may be observed also in patients with seasonal allergic rhinitis alone during the pollen season. A high percentage of these patients had BHR. A close relationship between upper and lower airways is confirmed also in the model of pollen allergy. Thus, a careful evaluation of lower airways should be performed also in those patients with seasonal allergic rhinitis alone.     

����֢�����μ�Ԥ��

近年来花粉过敏的发病率逐年增高,已经成为世界各国所面临的重要的卫生问题之一。文章从花粉症的历史和流行病学、主要症状、诊断和鉴别诊断及治疗和预防等方面进行了较详细的介绍。     

Comparative study of the pollen protein contents in two major varieties of Cupressus arizonica planted in Tehran

During past few years, the Cupressus arizonica has been abundantly planted in Tehran, causing a significant increase of allergic diseases from the middle of winter to the beginning of spring. The aim of this study was the comparison of pollen protein content in two major varieties of C. arizonica planted in Tehran, including C. arizonica var. arizonica and C. arizonica var. glabra, in order to determine pollen's specificity of each variety and also to find out whether environmental conditions can influence pollen protein contents and its allergenic components. Pollen grains were directly collected from mature male cones of trees planted in different areas of the city. Pollen's proteins were extracted, and were analyzed by SDS PAGE. Total protein content of pollen extracts was measured by Bradford assay. Our investigations revealed noticeable differences in protein content of each variety. Bradford protein assay showed a higher total protein content in C. arizonica var. arizonica pollen extracts. A new major protein, with an approximate molecular weight of about 35 kDa was detected in both varieties. Immunoblotting using the serum of a cypress allergic subject showed that the protein with 35 kDa was also the major allergen of both varieties in pollen extracts. These results showed that there are some intraspecie specificities in Arizona cypress pollens. The major allergen of Cupresuss arizonica pollen, Cup a 1 (45 kDa), has been reported as the most representative protein in pollen extracts of Mediterranean countries, but in our autochthon extracts of both varieties, a protein band at 35 kDa was more representative. These observations seem to indicate that C. arizonica pollen protein content may be influenced by environmental conditions. Moreover, Immunoblot results provided a reliable indication on the allergenic activity of this new major protein band at 35 kDa. The confirmation of these aspects would facilitate the preparation of an effective extract, improving the diagnosis of the allergy to the Cupressus arizonica pollen.     

Schlafmedizinische Aspekte bei COPD,Asthma bronchiale und allergischer Rhinitis

Bronchial asthma, allergic rhinitis and chronic obstructive pulmonary disease (COPD) are chronic diseases affecting millions of people around the world. Sleep plays an important modulatory role for these diseases. Circadian variations of respiration and pulmonary function may cause hypoventilation in COPD patients and may worsen asthmatic symptoms during sleep. Sleep disordered breathing is highly prevalent in all of these diseases. Finally, asthma, COPD and allergic rhinitis can contribute to the development of insomnia via multiple mechanisms. This article focuses on the complex relationships between these diseases and sleep and reviews the implications for diagnosis and therapy.