The relationship between hormones and the pathogenesis of asthma, rhinitis, and eczema were outlined in practice guidelines published in the Journal of Allergy and Clinical Immunology: In Practice. The guidelines provide clinical considerations for the effects of sex hormones, insulin, thyroxine, and cortisol on these 3 disorders.
Sex hormones are known to affect the prevalence and severity of asthma. Specifically, ovarian hormones appear to worsen the effects of asthma, and androgens appear to confer anti-inflammatory effects. The guidelines also referenced observational studies that suggest that sex hormones may affect the incidence of rhinitis, although the mechanism of this association is unclear. Late-onset menarche appears to have a protective effect on the onset of allergic rhinitis, and estrogen exposure can induce significant nasal histopathological changes. Sex hormones also appear to regulate several skin processes relevant to eczema. Estrogen appears to enhance skin barrier formation and recovery, and progesterone and testosterone may have detrimental effects. Studies have found that sex hormones drive fluctuations in transepidermal water loss, which may contribute to eczema severity.
The guidelines also addressed the impact of insulin in the context of diabetes. Patients with diabetes mellitus type 2 (DM2) are known to have more severe asthma outcomes than healthy comparators, although this same association is not observed with type 1 (DM1). Similarly, while a relationship may exist between chronic rhinosinusitis and DM2, DM1 appears to have little influence on the risk for rhinitis. A study found an association between elevated fasting blood glucose levels and risk for allergic rhinitis in patients with DM2. However, research on the subject is limited, it was noted. For both DM1 and DM2, the association with eczema is not well understood. Some studies suggest a higher rate of DM2 in patients with atopic dermatitis, although other research contradicts this finding. Further, T helper type 1 (Th1) cells are known to mediate DM1 and may be implicated in certain subtypes of eczema. Additional research is necessary to clarify the association.
Thyroxine, the thyroid hormone, appears to have an association with asthma and rhinitis. Specifically, hypothyroidism, characterized by an underproduction of thyroxine, correlates with elevated rates of asthma and allergic rhinitis. In addition, although hypothyroidism does not cause eczema, data suggests it may exacerbate the symptoms. Cortisol release is mediated by environmental and hormonal stimuli. Multiple studies have indicated that psychological stress, which precipitates cortisol release, may exacerbate acne. Similar associations appear to exist with rhinitis and eczema.
Per these clinical guidelines, hormone fluctuations can impact the disorders of asthma, rhinitis, and eczema. “Recognizing these hormonal associations
and, when necessary, appropriately treating them will improve asthma, rhinitis and eczema outcomes as well as the underlying endocrinopathy,” study authors wrote. “An endocrinologist, where necessary, should be consulted.”
Weare-Regales N, Chiarella SE, Cardet JC, Prakash YS, Lockey RF. Hormonal effects on asthma, rhinitis, and eczema. J Allergy Clin Immunol Pract. Published online April 14, 2022. doi:10.1016/j.jaip.2022.04.002