Allergic cycle: relationships between asthma, allergic rhinitis, and atopic dermatitis.

Details of the symptomatic history of 118 asthmatic patients with allergic rhinitis (AR), 18 asthmatic patients with atopic dermatitis (AD), and 6 asthmatic patients with both AR and AD were investigated. All 142 patients had atopic (64 cases) or mixed-type asthma (78 cases). In 118 (83%) and 66 (46%) of the 142 patients, asthmatic attacks were mainly associated with autumn and the rainy season in Japan, respectively. In 84 (68%) of 124 patients with AR, AR-related symptoms were mainly associated with spring. In 68 patients (55%), AR appeared 1-33 years (mean, 10.5 years) before the initial appearance of asthma. In patients with asthma and AR, 102 (82%) of 124 cases had an inverse relationship between the peak times of symptoms consistent with asthma and AR. In 84 (82%) and 80 (78%) of 102 patients with an inverse relationship between the peak times of symptoms associated with asthma and AR, respectively, episodes of preceding AR and infectious rhinitis were not seen at each asthmatic attack. Of 24 asthmatic patients with AD, 12 (50%) had AD 1-23 years (mean, 14.3 years) after the initial appearance of asthma. In 18 (75%) of 24 patients, an inverse relationship between the peak times of symptoms consistent with asthma and AD was observed. These results have tempted us to consider an allergic cycle theory that asthma may be inactive when AR or AD is active; i.e., one active allergic reaction occurs at only one site among allergic sites of the body, including the bronchi, nasal mucosa, and skin.