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Atopy includes hay fever (allergic rhinitis), asthma, and eczema (atopic dermatitis/urticaria). It’s a type of allergy with certain hallmark features

  • Early onset.
  • High allergen-specific circulating IgE antibody is better associated with allergic asthma while skin prick response (wheal size) with allergic rhinitis.
  • Presumed genetic predisposition.

Summary

  • Asthma prevalence is higher in boys compared to girls but higher in women compared to men.
  • Menstrual cycle stage influences asthma symptoms. In particular, symptoms such as shortness of breath tend to be lowest with peak circulating progesterone levels.
  • Early menarche (first period) and HRT (Hormone Replacement Therapy) are associated with higher asthma.
  • No clear pattern with contraception.
  • A problem with many studies is they don’t explicitly assess IgE or skin prick responses nor do they always confirm early-onset. Rather they rely on self-reporting of symptoms so atopy assessment is loose to say the least.
  • Explicit mechanistic link between estrogen, progesterone and lung function is still missing in human studies but epidemiology suggests a plausible link. Link with eczema (atopic dermatitis/urticaria) is as yet even more feeble.


Asthma prevalence is higher in boys compared to girls but higher in women compared to men
These are well-substantiated age associations (1, 2, 3, 4, 5, 6, 7, 8, 9; figure below from 9 adapted from data in 10).


Epidemiology suggests that menstrual cycle stage influences asthma symptoms

  • Emergency room visits for bouts of acute asthma differ with menstrual cycle stage.
  • Asthma exacerbations were more frequent during the preovulatory menstrual phase (days 5 to 11).
  • While they were lowest with highest progesterone levels (based on an idealized menstrual cycle).
  • Includes two independent prospective studies on 288 women (12) and 792 women (13).


These studies have several advantages over previous studies

  • Prospective, i.e., minimized recall bias.
  • More women than in previous studies, also recruited at many more sites, i.e., minimized demographic bias (for e.g., reference 12 included 64 Emergency Departments in 22 US states and 2 Canadian provinces).
  • Consecutive enrollment, i.e., as and when women presented to emergency department with acute asthma.These results were different from earlier questionnaire-based retrospective studies where 30 to 40% women reported symptom worsening immediately or prior to menstruation.

Weaknesses of these studies

  • Self-reporting of asthma and menstrual histories.
  • Estradiol and progesterone levels weren’t measured.

So link between menstrual cycle stage and severity of asthma appears robust. However, the association is much more complicated rather than simply linear. Certain, not all, symptoms worsen at certain stages of the menstrual cycle. A questionnaire-based study on 3926 women (14) assessed various asthma symptoms vis-a-vis menstrual cycle stage.

  • They analyzed symptoms of shortness of breath, wheeze and cough among both healthy and asthmatic women.
  • ‘incidence of wheeze was lowest on days 14 to 16, coinciding with peak estrogen, LH [Luteinizing Hormone] and FSH [Follicle Stimulating Hormone].
  • OTOH, ‘shortness of breath incidence was strikingly low in the late luteal phase, the time when progesterone peaks‘.
  • Cough did not fit into any neat, predictable pattern.

 

  • While specialists haven’t yet explicitly connected the link, high progesterone levels (the luteal phase of the menstrual cycle) coincide with improved lung function measures such as lung volume and peak flow (15, 16, 17, 18, 19, 20). In other words, a plausible mechanistic link between female sex hormone level and lung function.

Early menarche (first period) is associated with higher asthma

  • Earlier menarche, higher the risk of allergic rhinitis (hay fever) (21), especially in childless women (22).
  • The flips side of the association also holds true as in later the menarche (>13 years of age), lower the risk of new-onset allergic rhinitis (hay fever) (32).
  • As for asthma, a meta-analysis (31) of 7 independent studies (24, 25, 26, 27, 28, 29, 30) observed a clear 37% increased risk of asthma in girls with early menarche.
  • The most detailed assessment among these studies identified poorer lung function, greater likelihood of wheeze, multiple asthma symptoms and higher asthma score in women who had menarche at <10 years of age (30).
  • The first ever twin cohort study also observed association between early menarche and increased asthma risk (32).
  • Since menarche’s a surrogate marker for puberty, it implies a role for increased female sex hormone levels in lung immune function dysregulations such as asthma and allergic rhinitis.

Postmenopausal HRT (Hormone Replacement Therapy) is associated with higher asthma (33, 34, 35).
Risk is highest for women using conjugated estrogen (36) and who are non-smoking (37) or for those who have low BMI (Body Mass Index) (38, 39). While higher risk in non-smokers is surprising, it implies estrogen supplementation modulates non-smoke damaged lung tissue considerably more than foreseen.

Bibliography

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  11. National Health Interview Survey Data 2012
  12. Zimmerman, Janice L., et al. “Relation between phase of menstrual cycle and emergency department visits for acute asthma.” American journal of respiratory and critical care medicine 162.2 (2000): 512-515. Page on atsjournals.org
  13. Brenner, B. E., et al. “Relation between phase of the menstrual cycle and asthma presentations in the emergency department.” Thorax 60.10 (2005): 806-809. Relation between phase of the menstrual cycle and asthma presentations in the emergency department
  14. Macsali, Ferenc, et al. “Menstrual cycle and respiratory symptoms in a general Nordic–Baltic population.” American journal of respiratory and critical care medicine 187.4 (2013): 366-373. Page on researchgate.net
  15. Chen, Hsiun-Ing, and VARU TANG. “Effects of the Menstrual Cycle on Respiratory Muscle Function1-3.” Am Rev Respir Dis 140 (1989): 1359-1362.
  16. Sarwar, R., B. Beltran Niclos, and O. M. Rutherford. “Changes in muscle strength, relaxation rate and fatiguability during the human menstrual cycle.” The Journal of physiology 493.1 (1996): 267-272. Changes in muscle strength, relaxation rate and fatiguability during the human menstrual cycle.
  17. Dabhoiwala, Shahin, et al. “Pulmonary functions in different phases of menstrual cycle and its relation with serum progesterone levels.” (2012). Page on mahidol.ac.th.
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  19. Ameen, Ameerah Jasim M., AL Mottesmbellah Abdelruhman Gaiz, and Monqith Abdulmohsin AL-janabi. “The Impact of Normal Physiological Fluctuation of Progesterone Hormone on Peak Expiratory Flow Rate in Premenopausal Women in A sample of Iraqi.” Journal of Biology, Agriculture and Healthcare 4.12 (2014): 92-94. Journal of Biology, Agriculture and Healthcare
  20. Mishra, Abhilasha, and R. B. Kamal. “Variation in pulmonary function tests parameters in different phases of menstrual cycle in healthy female medical students.” National Journal of Physiology, Pharmacy and Pharmacology 5.5 (2015). Page on scopemed.org).
  21. Hong, Chi‐Chen, et al. “Younger pubertal age is associated with allergy and other atopic conditions in girls.” Pediatric Allergy and Immunology 25.8 (2014): 773-780; Page on nih.gov
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  34. Tattersfield, A. E. “Is postmenopausal HRT a risk factor for adult-onset asthma?.” Thorax 65.4 (2010): 282-284. Is postmenopausal HRT a risk factor for adult-onset asthma?
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  36. Troisi, Rebecca J., et al. “Menopause, postmenopausal estrogen preparations, and the risk of adult-onset asthma. A prospective cohort study.” American journal of respiratory and critical care medicine 152.4 (1995): 1183-1188. Page on joannabriggs.org
  37. Romieu, Isabelle, et al. “Postmenopausal hormone therapy and asthma onset in the E3N cohort.” Thorax 65.4 (2010): 292-297. Postmenopausal hormone therapy and asthma onset in the E3N cohort
  38. Real, F. Gómez, et al. “Hormone replacement therapy, body mass index and asthma in perimenopausal women: a cross sectional survey.” Thorax 61.1 (2006): 34-40. a cross sectional survey
  39. Jarvis, D., and B. Leynaert. “The association of asthma, atopy and lung function with hormone replacement therapy and surgical cessation of menstruation in a population‐based sample of English women.” Allergy 63.1 (2008): 95-102. Page on wiley.com

https://www.quora.com/Whats-the-relationship-among-estrogen-progesterone-and-atopy/answer/Tirumalai-Kamala

 

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