Pathobiology of Second-Generation Antihistamines Related to Sleep in Urticaria Patients

SIMPLE SUMMARY: Sleep is a restorative state that is crucial for all human beings. Sleep is important for many biological processes in the body and has a huge impact on quality of life. According to previous studies, we know that patients with hives report sleep impairments. However, there are no data objectifying the sleep pattern. Guideline-based therapy for hives includes second-generation antihistamines of up to fourfold dosage. It is known that first-generation antihistamines lead to changes in sleep pattern and increased daytime sleepiness. However, the effect of second-generation antihistamines on sleep is not known. This pilot study was conducted to better understand the pathobiology of sleep in patients suffering from hives, who are medicated with high-dosed second-generation antihistamines. As healthy sleep in many dermatologic patients is still an unmet need, it is of utmost importance to raise awareness and eventually include sleep improvement in the therapy of urticaria patients. ABSTRACT: Background: Standard treatment options for urticaria are second-generation antihistamines; however, their effect on sleep is uncertain. This study measures the influence of different antihistamines on the biologic sleep pattern of urticaria patients and the relevance of sleep in urticaria patients. Methods: Ten patients with chronic spontaneous urticaria (CSU) and uncontrolled symptoms under a single dose of second-generation antihistamines were included. Two nights were monitored: the first night after 5 days on single dosage and the second night after 5 days on fourfold dosage. Patient-rated questionnaires were used and sleep was monitored using polygraphy. Results: The patients’ rated daytime sleepiness decreased (p = 0.0319), as did their insomnia severity (p = 0.0349). The urticaria control (UCT) improved (p = 0.0007), as did the quality of life (p < 0.0001). There was no significant change of nightly pruritus (p = 0.1173), but there was an improvement of daytime pruritus (p = 0.0120). A significant increase in rapid eye movement (REM) sleep was seen (p = 0.0002) (from a mean of 3.9% to 14.3%). The deep sleep state (N3) also improved (8.7% to 12.3%) (p = 0.1172). Conclusion: This study has demonstrated an improvement of the sleep pattern in CSU patients under up-dosed second-generation antihistamines, without increased daytime sleepiness, alongside an improvement of urticaria symptoms and quality of life.