Pharmacologic Management of Allergic Disease and Sleep

Sleep disturbance affects up to 60% of children suffering from allergic diseases and is the leading cause of reduced quality of life in this population. Lack of sleep can have detrimental consequences on a child’s neurocognitive development and growth. The etiology of the disease is multifactorial with proposed inflammation mechanisms mediated by T lymphocytes, cytokines, reduced melatonin, and increased IgE. Due to circadian fluctuations of inflammatory mediators, patients often experience worsening symptoms during the night. The following chapter will review the role of antihistamines (oral and nasal), melatonin, clonidine, chloral hydrate, doxepin, montelukast, benzodiazepines, hypnotics (zaleplon, zolpidem, and eszopiclone), topical therapies, steroids (topical, inhaled, and intranasal), and immunomodulatory therapies (calcineurin inhibitors, antimetabolites, steroids, and dupilumab) in improving sleep for various allergic diseases. In addition to the efficacy and safety of these agents, pregnancy and lactation considerations will be reviewed.