A contemporary look at allergic conjunctivitis.
Dupuis Pascale,Prokopich C Lisa,Hynes Alexander,Kim Harold
Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology
Allergic eye disease is common, yet often overlooked in North America. In the U.S., up to 40% of the population is deemed to be affected and this number is growing. Symptoms and signs of ocular allergy can lead to decreased productivity and negatively impact quality of life (QoL). Various treatment options exist to achieve symptom control. For allergic conjunctivitis, ophthalmic agents include antihistamines, mast cell stabilizers, dual-activity agents, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids and some off-label treatments. Immunotherapy is recommended as a therapeutic option. This review provides a summary of the forms of ocular allergies, with a focus on symptoms and signs, impact on QoL, physical examination, diagnosis and therapeutic options of allergic conjunctivitis. Through multidisciplinary collaborations, a simplified algorithm for the treatment of allergic conjunctivitis is proposed for Canadian clinical practice.
Prevalence of Comorbidity between Dry Eye and Allergic Conjunctivitis: A Systematic Review and Meta-Analysis.
Journal of clinical medicine
This systematic review aimed to determine the comorbid dry eye (DE) and allergic conjunctivitis (AC) prevalence. We searched PubMed and EMBASE for articles published until 22 March 2022, combining the terms "(dry eye OR keratoconjunctivitis sicca) AND allergic conjunctivitis." Study-specific estimates (DE and AC incidence rates among patients with AC and DE, respectively) were combined using the one-group meta-analysis in a random-effects model. The initial search yielded 700 studies. Five articles reporting AC incidence among individuals with DE and six articles reporting DE incidence among individuals with AC were included in the qualitative synthesis. In these nine articles, the total sample size was 7254 patients. The DE incidence among individuals with AC was 0.9-97.5%; the AC incidence among individuals with DE was 6.2-38.0%. One-group meta-analysis using a random-effects model showed that 47.2% (95% confidence interval: 0.165-0.779; 320/1932 cases) of patients with AC had comorbid DE and 17.8% (95% confidence interval: 0.120-0.236; 793/4855 cases) of patients with DE had comorbid AC, as defined by each article. Complimentary screening and treatment for patients with DE and AC may improve long-term outcomes and prevent chronic ocular damage in highly susceptible populations.
Association of Allergic Conjunctivitis With Health-Related Quality of Life in Children and Their Parents.
IMPORTANCE:Allergic conjunctivitis (AC) is one of the most common allergic diseases and is especially problematic in children and adolescents. The course of AC is generally prolonged and often recurs. Understanding the health-related quality of life (QOL) of both children with AC and their parents would be useful. OBJECTIVE:To evaluate the association between AC and health-related QOL in children and their parents. DESIGN, SETTING, AND PARTICIPANTS:A prospective case-control study was conducted at Zhongshan Ophthalmic Center, a single tertiary referral center, from November 16, 2019, through January 20, 2020. Participants comprised 92 children aged 5 to 18 years with AC and their parents and 96 healthy, age-matched children who served as controls and their parents. The 92 children in the AC group were subdivided into cohorts with vernal keratoconjunctivitis (VKC) (23 [25.0%]) or atopic keratoconjunctivitis (AKC) (7 [7.6%]) and seasonal allergic conjunctivitis (SAC) (26 [28.3%]) or perennial allergic conjunctivitis (PAC) (36 [39.1%]). EXPOSURES:Allergic conjunctivitis. MAIN OUTCOMES AND MEASURES:Pediatric Quality of Life Inventory, version 4.0 (PedsQL), scores for children and their parents. Scores range from 0 to 100, with higher scores indicating better health-related QOL and fewer negative aspects. RESULTS:In the AC group, 77 of 92 (83.7%) participants were boys, and 67 (72.8%) of the parents were women. Of the individuals in the control group, 55 of 96 (57.3%) of the children were girls and 76 (79.2%) of the parents were women. Median total PedsQL scores were reduced in both children with AC (69.6 [interquartile range [IQR], 66.3-72.8 vs 96.7; IQR, 92.7-98.9; P < .001) and their parents (68.8; IQR, 63.9-71.4 vs 96.5; IQR, 95.1-97.9; P < .001). The reduction in health-related QOL was more severe in children with VKC/AKC than in those with SAC/PAC (difference, -3.3; 95% CI, -5.4 to -1.1; P = .004) and their parents (difference, -4.3; 95% CI, -7.1 to -2.1; P < .001). In the AC group, a higher corneal fluorescein staining score was associated with lower QOL in children (β, -1.16; 95% CI, -1.80 to -0.52; P = .001); higher corneal fluorescein staining scores (β, -1.12; 95% CI, -1.74 to -0.50; P = .001) and multiple clinical consultations (β, -3.96; 95% CI, -7.34 to -0.57; P = .02) were associated with lower QOL in parents. The parents' QOL scores were correlated with their children's QOL scores (correlation coefficient, r = 0.59; P < .001). CONCLUSIONS AND RELEVANCE:These findings suggest AC has a negative association with health-related QOL for children and their parents, especially in children with VKC/AKC or higher corneal fluorescein staining scores.
Effects of Antihistamine-Releasing Contact Lenses on Severe Allergic Conjunctivitis.
Ocular immunology and inflammation
Half of the patients who used CL daily did not wish to switch to spectacles even with ocular-allergic symptoms and findings. Therefore, continued CL use with suppressed ocular allergy can improve productivity and quality of life for CL users. This study described the clinical courses of CL users with ocular-allergic conjunctivitis who started ARCL trials on their eyes. Diagnoses of the seven understudied cases were AKC in 3, VKC in 2, SAC in 1, and CLPC in 1 case. All seven cases had myopia. Following the use of ARCL, six patients except for case 7 were satisfied, and objective findings were judged to be well-controlled. ARCL can be a useful tool for CL users with allergic conjunctivitis. However, ARCL should be introduced after allergic conjunctivitis is controlled or becomes asymptomatic. Furthermore, ARCL should be immediately discontinued if ocular-allergic symptoms flare after introducing ARCL.
Epidemiological aspects of allergic conjunctivitis.
Miyazaki Dai,Fukagawa Kazumi,Okamoto Shigeki,Fukushima Atsuki,Uchio Eiichi,Ebihara Nobuyuki,Shoji Jun,Namba Kenichi,Shimizu Yumiko
Allergology international : official journal of the Japanese Society of Allergology
The prevalence of ocular allergies has been increasing worldwide for the past several decades. The geographical distribution and hot spots of rhinoconjunctivitis have been documented in a global survey by the International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC indicated that Africa, Latin America, and Japan were notable for their high prevalence of rhinoconjunctivitis. The outcomes of follow-up studies of regional differences and the characteristics of allergic conjunctivitis are summarized in this review. Currently, comorbid diseases and socioeconomic and environmental factors, including climate and air pollution, are proposed to contribute to the regional differences in the prevalence of allergic conjunctivitis. Of them, rhinitis has been shown repeatedly to be significantly associated with allergic conjunctivitis. Their mechanistic aspects on association with the prevalence of systemic allergic diseases have been reviewed by examining the birth cohort or in vitro analyses. A vision threatening form of ocular allergy, vernal keratoconjunctivitis, is prevalent in the African countries and Japan. Of the proposed associated factors, air pollution was shown to contribute not only to aggravating the symptoms but also to the increase in the incidence of its severe forms. Its mechanistic aspects are discussed in this review in the context of comorbid diseases.
Diagnosing and managing allergic conjunctivitis in childhood: The allergist's perspective.
Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology
Allergic conjunctivitis in childhood often poses problems of diagnosis and management for the allergist. We present the salient points concerning the diagnosis and treatment of ocular allergy emerging from a large cohort survey conducted jointly in the departments of ophthalmology and paediatric allergy in a French teaching hospital. Seasonal acute conjunctivitis is a common disorder and not overly difficult to diagnose and treat when associated with rhinitis leading to allergic rhinoconjunctivitis. An ophthalmologist should be consulted when conjunctivitis occurs alone and if another form of conjunctivitis is suspected, such as perennial allergic conjunctivitis, vernal keratoconjunctivitis or atopic keratoconjunctivitis. When IgE-mediated hypersensitivity assessment does not establish aetiological diagnosis, a conjunctival allergen provocation test can be performed. The principal non-IgE-mediated allergy is chronic blepharoconjunctivitis. The main problem for differential diagnosis is the presence of signs suggestive of dry eye. Management includes non-pharmacological treatments, such as lacrimal substitutes, avoidance measures and protection of the ocular surface. Second-line treatment consists of eye drops, preferably single dose or without additives and with dual local action, mast cell stabilizer action and antihistaminic action. Third-line treatment is reserved for severe forms. Short-lasting local steroid therapy can control flare-ups of allergic keratoconjunctivitis, which should have specialized follow-up. Cyclosporine is a disease-modifying treatment, which is both effective and well tolerated.
[The prevalence of allergic conjunctivitis based on outpatients in Baotou area].
Lu L X,Bao J Y,Wang J Y,Liu S X,Chen J,Tian L,Shao Q Y,Wu B G,Jie Y
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]
To explore the prevalence and influencing factors of allergic conjunctivitis in Baotou area at different times. A cross-sectional study was conducted in January 2021, 111 patients with allergic conjunctivitis who were admitted to the Department of Ophthalmology, the Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology in 2020 were selected as the research subjects. The basic information, allergic conditions, living habits and other information of the patients were obtained by self-made questionnaire. The pollen concentration and allergy related indicators(allergic duration and frequency, eye itching score, eye burn score, eye foreign body sensation score, tears score and the total scores) of 2019 and 2020 were analyzed by paired sample -test. The pollen concentration of 2019 and 2020 were analyzed by Wilcoxon signed rank test. The allergy related indicators of different genders were analyzed by independent sample -test. The allergy related indicators of different ages were analyzed by one-way analysis of variance. The relationship between the length of wearing masks and the allergy related indicators were analyzed by Spearman correlation analysis. Among the 111 patients with allergic conjunctivitis, 54 were males and 57 were females, ranging in age from 8 to 69 years old, with a median age of 35 years old and an average age of (36.77±13.18) years old. The average pollen concentration in Baotou in 2019 was (125.35±222.64) grains/1 000 square millimeter, and the average pollen concentration in Baotou in 2020 was (107.38±137.29) grains/1 000 square millimeter. There was no significant difference in pollen concentration between the two years(-0.178, 0.859). The severity of allergic indicators in all patients in 2020 is significantly lower than in 2019( values were 4.701,3.587,2.582,3.661,4.444,2.784,2.555,3.886,respectively, with 0.05). The severity of allergic indicators in male patients is lower than that of female patients ( values were -1.558, -1.257, -3.41, -3.085, -2.335, -2.897, -2.652, -4.124, respectively). The prevalence of allergic conjunctivitis dose not vary significant with age ( values were 0.504, 0.095, 0.499, 0.265, 0.284, 0.655, 0.421, 0.976, respectively). In 2020, the average time that patients wear masks is (6.55±3.28) h/d, and there is a correlation with the difference in allergy duration (0.191, 0.045). The severity of allergic conjunctivitis in Baotou in 2020 was significantly improved compared with that in 2019, which may be related to masks wearing.
Brazilian guidelines for the monitoring and treatment of pediatric allergic conjunctivitis.
Arquivos brasileiros de oftalmologia
Allergic conjunctivitis is an increasingly frequent condition with a higher prevalence in children. It can be debilitating and is responsible for a great economic burden. These guidelines were developed on the basis of the medical literature (PubMed/Medline database) and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology, the Brazilian Council of Ophthalmology, the Brazilian Society of Pediatrics, and the Brazilian Association of Allergy and Immunology. Allergic conjunctivitis is considered to be controlled when the ocular symptoms are not uncomfortable or are present, at most, on 2 days a week; the visual analog scale score is below 5; and the degree of conjunctival hyperemia is graded 0 or 1 on the Efron scale. Allergic conjunctivitis should be classified as mild, moderate, severe, and vision-threatening for adequate treatment and monitoring of frequency. The present document is a guideline for diagnosing, treating, and monitoring pediatric allergic conjunctivitis considering the clinical and demographic aspects of allergic conditions in Brazil.
Neuropathic pain and itch: mechanisms in allergic conjunctivitis.
Current opinion in allergy and clinical immunology
PURPOSE OF REVIEW:Allergic conjunctivitis is highly prevalent and affects up to one third of the general population. The current understanding of the pathophysiology and therapeutic strategies center around the type 2 inflammatory pathway. However, there is an increasing body of evidence that suggests neurogenic mechanisms also play a role in allergic inflammation, with a substantial proportion of allergic conjunctivitis patients experiencing both ocular itch and pain. RECENT FINDINGS:Unmyelinated C fibres on the ocular surface transmit histaminergic itch and can be directly activated by mast cell mediators. The conjunctival mucosa also contains TRPV1+ (histamine-dependent) and TRPA1+ (histamine-independent) neurons that enhance ocular pain and itch in allergic conjunctivitis. Allergen-complexed IgE also binds directly to FcεRI expressed on peripheral neurons. Environmental aeroallergens can also directly stimulate neuronal nociceptors to release inflammatory substances. Allergic inflammation thus stimulates nerve terminals to release vasoactive and inflammatory neuropeptides, leading to a cyclical neuronal dysregulation that augments mast cell activity. These repetitive cycles lead to both peripheral and central sensitization and neuronal plasticity, resulting in decreased itch/pain thresholds and a heightened itch/pain response. SUMMARY:Neurogenic mechanisms including peripheral and central sensitization may drive chronic ocular itch and pain secondary to allergic inflammation. Research into these pathways may help to identify therapeutic targets in allergic conjunctivitis patients with refractory symptoms.
Epidemiological Aspects Of Allergic Conjunctivitis.
Journal of Ayub Medical College, Abbottabad : JAMC
BACKGROUND:Allergic conjunctivitis is a common ocular disease which not only affects vision but can also compromise the quality of life of patients to a greater extent. If it is not properly managed it can lead to decreased vision due to corneal complications. This study was conducted to evaluate the epidemiological aspects of allergic conjunctivitis. METHODS:This cross-sectional study was carried out in the Ophthalmology department of Federal General Hospital, from June 2018 to June 2020. We enrolled 236 patients of allergic conjunctivitis. Data collection form consisted of a structured questionnaire, records of ocular findings using slit lamp biomicroscope and skin prick test results. Data analysis was done using SPSS version 23.0. RESULTS:The mean age (±SD) of study population was 22.71±13.11 years, 60.2% were females. Most common type of conjunctivitis was vernal keratoconjunctivitis (VKC) 46.2%, followed by perennial (27.1%), seasonal (17.4%) and atopic (9.3%). There was significant association of type of conjunctivitis with the age, pvalue< 0.001. VKC was prevalent in patients of age <20 years. There was a significant association of gender with type of conjunctivitis, p-value =0.000. Perennial variety was more prevalent in females while VKC was common in males. Collateral atopy was present in 52.1% patients. Corneal involvement was seen in 17.8% patients. There was a significant association between corneal involvement and interference with daily visual activities, p-value 0.034. SPT was positive in 79.7% patients. CONCLUSIONS:Ocular allergies/ conjunctivitis was more prevalent in female population. VKC is the most common type of allergic conjunctivitis, prevalent in males of age <20 yrs. Allergic rhinitis was the most common co-morbidity followed by dermatitis.
Conjunctival Intraepithelial Lymphocytes, Lacrimal Cytokines and Ocular Commensal Microbiota: Analysis of the Three Main Players in Allergic Conjunctivitis.
Frontiers in immunology
Conjunctival intraepithelial lymphocytes, tear soluble molecules and commensal microbiota have important roles in the ocular mucosal immune response in healthy and diseased subjects. For the purpose of this study, the cellular and microbial populations of the conjunctiva and the lacrimal soluble molecules were analyzed to find the main biomarkers in allergic conjunctivitis. A total of 35 healthy subjects, 28 subjects with seasonal allergic conjunctivitis and 32 subjects with perennial allergic conjunctivitis were recruited to obtain peripheral blood, conjunctival brush cytology, tear fluid and microbiota samples. Flow cytometry for lymphocytes, multiplex bead assays for cytokines and high-throughput DNA sequencing for microbiome analysis were used. For perennial allergic conjunctivitis, an increased proportion of Th2 and NKT lymphocytes was found, while CD3+TCRγδ+ lymphocytes and double negative MAIT cells were decreased. In contrast, seasonal allergic conjunctivitis was distinguished by an increase in Th17 and Th22 cell proportions, while the Th1 cell proportion decreased. Among tear fluid, the vast majority of pro-inflammatory cytokines (especially Th2 and Th17 cytokines) in perennial allergies and MMP-9 together with IgA in seasonal allergies were increased. In contrast, TGF-β2 was decreased in both forms of conjunctivitis. Finally, fungal ( species) and bacterial ( and species) colonization were observed in the perennial allergic conjunctivitis group. These results provide the basis for the development of a disease profile for perennial allergic conjunctivitis and open the door to new therapeutic and diagnostic strategies.
Current Knowledge in Allergic Conjunctivitis.
Villegas Beatriz Vidal,Benitez-Del-Castillo Jose Manuel
Turkish journal of ophthalmology
Allergic conjunctivitis is a disease of increasing prevalence that affects both children and adults and causes significant deterioration of their quality of life and sometimes irreversible visual damage. There are various forms of the disease, some are allergen-induced such as seasonal and perennial allergic conjunctivitis, giant papillary conjunctivitis, and contact allergic blepharoconjunctivitis, whereas others are not always explained by allergen exposure, such as vernal keratoconjunctivitis and atopic keratoconjunctivitis. We review their clinical course, characteristics, and differential diagnosis, and highlight recent advances in their pathophysiology and treatment.
Relationship between allergic rhinitis and allergic conjunctivitis (allergic rhinoconjunctivitis) - review.
Romanian journal of ophthalmology
Allergic rhinitis and allergic conjunctivitis are so frequently associated that the need to coin a new name to describe the simultaneous manifestations generated the term allergic rhinoconjunctivitis. The significant impact of rhinoconjunctivitis on the quality of life and the wellbeing of the patients is the reason why the medical community shows a great interest to this disease. Another aspect is the financial burden that is not negligible. The anatomical connection between the organs involved facilitates the propagation of the disease. The allergic pathophysiological mechanisms implicated in allergic rhinitis and conjunctivitis also share common features. The diagnosis of rhinoconjunctivitis is based on the concordance between the symptoms, the clinical examination, and the diagnostic tests that should reveal the existence of an allergen specific IgE in vivo or in vitro. Whilst the nasal smear for eosinophils is considered a reliable diagnostic test for allergic rhinitis, the occurrence of eosinophils in the conjunctive is not a trustworthy indicator of allergy. The therapy of allergic rhinoconjunctivitis is based on patient education, pharmacotherapy, and allergen-specific immunotherapy. The local treatment for the allergic rhinitis is primarily based on topical corticosteroids that also manage the ocular symptoms. The first line of treatment of the ocular manifestations is represented by topical antihistamines and mast-cell stabilizers or double action drugs.