Association between Dipeptidyl Peptidase-4 Inhibitors and Allergic Rhinitis in Asian Patients with Diabetes

Abstract

In this retrospective study, we attempted to evaluate the association between dipeptidyl peptidase-4 (DPP-4) inhibitors and allergic rhinitis in patients with diabetes. We analyzed the Longitudinal Health Insurance Database 2000 subdatabase. Our study population included patients with type 2 diabetes (ICD-9-CM 250) between 2009 and 2012, and the study groups were DPP-4 inhibitor users and nonusers. Propensity scores were estimated in a multivariable logistic regression model for the analysis of allergic rhinitis (ICD-9-CM 477.9). Each group consisted of 6204 patients. DPP-4 inhibitor users had a reduced risk of allergic rhinitis (aHR = 0.74, 95% confidence interval (CI) = 0.61–0.90) in all stratifications. Among women, DPP-4 inhibitor users had a lower risk of allergic rhinitis (aHR = 0.67, 95% CI = 0.50–0.90). Among patients aged older than 40 years, DPP-4 inhibitor users had a decreased risk of allergic rhinitis (those aged 40–59: aHR = 0.75, 95% CI = 0.56–0.99; those aged ≧60: aHR = 0.73, 95% CI = 0.54–0.97). Among patients with comorbidities, the risk of allergic rhinitis for DPP-4 inhibitor users was 0.73 (95% CI = 0.60–0.90). High-dose (cumulative defined daily dose ≧648mg) DPP-4 inhibitor users had a decreased risk of allergic rhinitis (aHR = 0.23, 95% CI = 0.15–0.35). Our study revealed that Asian patients with diabetes who used DPP-4 inhibitors had decreased risk of allergic rhinitis, especially for DPP-4 inhibitor treatment in patients who were women, were older than 40 years, had higher diabetes severity scores, were taking higher doses of DPP-4 inhibitors, and had diabetes with comorbidities.

DPP4 Inhibitor Sitagliptin Reduces Inflammatory Responses and Mast Cell Activation in Allergic Rhinitis

“…That study did not actually explore the effects of inhibiting DPP4 on AR. Furthermore, in a retrospective study, excluding a history of AR and DPP4 inhibitor treatment, Asian patients with diabetes treated with a DPP4 inhibitor within 3 years had a significantly lower risk of developing AR (diagnosed according to ICD-9 codes) [6]. Besides, DPP4 has been recognized as a susceptibility gene for AR [7].…”

“…Upregulation of DPP4 is associated with atopic dermatitis; however, its role in AR is rarely studied [5]. As shown in existing studies, the use of DPP4 inhibitors reduces the risk of AR in Asian diabetic patients, especially women treated with DPP4 inhibitors [6]. The expression level of DPP4 in peripheral blood of AR is increased.…”

Effects of dipeptidyl peptidase-4 inhibitor treatment doses on tuberculosis in patients with diabetes: a long-term nationwide population-based cohort study

“…Animal studies showed that diabetes increased the frequency of airway shedding of Mycobacterium tuberculosis even without cavitations and it might be related to a higher pulmonary bacterial load or an alteration in the airway microenvironment in diabetic patients (25). Many DPP4 transcripts were noted in the nasal epithelia of children who suffered from dust mite allergic rhinitis (13). It might be the possible link of DPP4i and TB.…”

“…In our previous series of DPP4i studies, DPP4i appeared to increase infections, such as herpes zoster, but did not increase inflammations, such as allergic rhinitis or chronic rhinosinusitis (12)(13)(14). Fewer studies have mentioned the association between TB and DPP4i in patients with diabetes.…”